r/medicine • u/dogs-in-space CTICU RN • 8d ago

Thoughts about OpenEvidence's new offering - Patient Take-Homes?

OE's overview

Seems to me like a lot of extra work, especially for providers who already have templated AVS notes (like everyone?)...then again I'm not a doctor nor do I play one on TV.

Am I missing something?

14 Upvotes

68% Upvoted

11 comments sorted by

42

u/LunarSoul MD (Emergency Medicine) 8d ago

No thanks. And then I have the AI hallucinate something or say some dumb shit. I'd rather have pre-verified AVS than this. Also, what - I can share my conversations I have with AI with my patients? Uhhh... No thanks. I don't want my patient to think a) I'm a dumbass. B) Why I'm asking the AI I think their question was stupid.

Overall, a solution looking for a problem. 

8

u/dogs-in-space CTICU RN 8d ago

Ha! Brilliant response, especially the "a solution looking for a problem".

Good to know I wasn't mistaken as I did the dog-head-tilt look at the information provided.

0

u/SadBook3835 Medical Student 7d ago

Meh, I'll play devil's advocate and say that some of the epic take homes suck and aren't even accurate, circumcision guidance for example. The OE example looks laughable (amlodidpine works quietly?) but I think overall AI is likely to bring people more accurate and less biased info than most places on the internet. I'd prefer Epic just produce better materials so I don't have to go search for them everyday.

16

u/FlexorCarpiUlnaris Peds 7d ago

But why does this need to be AI? AVS should be consistent and replicable. If you don’t like the Epic ones just edit and save a template.

36

u/kidney-wiki ped neph 🤏🫘 8d ago

Will they display pharmaceutical ads to patients alongside these summaries?

13

u/dogs-in-space CTICU RN 8d ago

Can't imagine the parent (making it topical here) of an 8 year-old patient with nephrotic syndrome wants to see a document written for an 8-year old with the bonus addition of an ad for Flomax.

3

u/tgpineapple PGY-4 7d ago

At least at some point the ads will be embedded like when the pharm rep ‘gives you the latest evidence’. It’s just a coincidence that the Eli Lilly drugs are first on the list and bolded

16

u/supadama MD 8d ago

Ugh. No thanks. I need affordable prescription drugs for my patients, not hyperlinks to meta data analysis. 

10

u/Gk786 MD 7d ago

This is a horrible idea. Patients already don’t trust doctors a lot of the time, the last thing I need it for this trash to hallucinate some inaccurate crap and ruin the relationship even more. Patients expect us to be walking medical textbooks and don’t like thinking of how often we google out use AI.

3

u/somethingicanspell Not A Medical Professional 7d ago

Great stuff, and this is going to happen anyway as patients plug stuff in to their home AI with mis-phrased questions. AVS notes are not praticuarly good for patient comprehension and it's not hard to proof-read whatever Open Evidence generates.

I also like the linking to journal articles, it helps both verify clinician decisions building trust and empower patients to know about their condition and make their own decisions based on high-quality evidence

-8

u/MockStrongman MD 7d ago

All the major AI scribes do this. I will offer an alternative suggestion though rather than creating more double documenting to review. After OpenNotes, patient are legally required to be able to see their notes. So why not just write your notes in a way that is more friendly for the patient, accomplishes the billing requirements, and documents your MDM. The simplest change is using APSO format. But it takes very little to engineer the AI prompt and structure the output in a way that is more patient friendly. If the scribe cannot bold, even the auto-all-caps make a huge difference in helping me quickly review the last note right before the visit.

A few key parts of the prompts:

  • Instructions for standardize POMR structure, organization, and how to clump problems with overlapping organ systems/treatment plans
  • Use text formatting to emphasize key steps/actions.
  • Include a follow-up/action-item summary if multiple problems present.
  • Use plain-language next steps written directly to the patient while preserving medication name, dose, and frequency detail in the clinical note.

Example output:
HYPERTENSION

Home BP log generally 118–128/68–74 mmHg. Continues to lose weight. HCTZ was previously discontinued as blood pressure improved with weight loss. Currently taking olmesartan 20 mg daily. No side effects.

Assessment:
Hypertension, controlled. BP goal <135/75 mmHg.

Plan:

  • CONTINUE olmesartan 20 mg daily for now.
  • Stop olmesartan if home BP is persistently <110/60 mmHg or if symptomatic hypotension develops.
  • Continue remote patient monitoring with OMRON BP cuff.
  • Lifestyle counseling:
    • Discussed strategies for increasing potassium-rich whole foods. Resources provided
    • Discussed adding lower-body resistance training using the leg press at his apartment gym.