Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit?

[randocity@mstdn.social]

@M3L155A @meltedcheese @emilymbender For clarification, when I say that insurers aren’t deriving benefits from AI directly, I mean specifically the AI that’s being used in doctors offices, learning from patient recordings.

It is very possible, however, that insurance companies are using AI in their own internal systems, but those AI systems are entirely separate from AI used in doctor’s office patient systems.

[randocity@mstdn.social]

@Mikal @jrdepriest @emilymbender The only place where a doctor might get caught at doing it is if they produce a recording in a court of law as part of a legal case. The problem is, patient recordings would be considered part of HIPAA compliance and may be inadmissible if proper procedures are not followed.

There are definitely procedures to follow when introducing HIPAA data into a court case, such as giving the patient a chance to object.

[slotos@toot.community]

@emilymbender Funnily enough, transcribing can preserve privacy without issues. Whisper.cpp runs decently well on phones, and can be run on servers that process patient records under the same security constraints. Could easily be run locally even.

Problem is, that’s extremely hard to prove in the current „just slap a gear on it and call it steampunk” climate. I would definitely not trust a random provider.

And if they do „summarization”, forget privacy.

[2bfair@infosec.exchange]

@emilymbender Agreed. For any points that were valid, none of them necessitate the use of LLMs. Never mind without consent. Disgusting.

[commonst@social.vivaldi.net]

@randocity @emilymbender I am in zcanada. No HIPAa, but we do tend to go where the US goes on a lot of things.

[p__x@mastodon.social]

@emilymbender "he fullest version would be too long, so we're not actually doing informed consent?"

No, that is not what is being said there. Unlike a blog post, I am restricted in space. I explicitly said that is is a valid concern. A basic research consent form is 8+ pages of legalese and I'm afraid that the future solution will be to add it as a checkbox for 30 pages of text at check-in that nobody reads and doesn't actually inform better. And again, my point #1.

[p__x@mastodon.social]

@2Bfair @emilymbender

1) Consent is always obtained (and documented). The ideal way/length/detail to do it is up for debate. A 30 page EULA (if this is outsourced to the legal department) will not provide better informed consent, however. The Sutter lawsuit might propel better regulation and policies.

2) Nothing necessitates the use of LLMs. It doesn't mean that it can't be helpful in certain use cases, which I spent my time to point out hoping for a convo and not selective dismissal.

[adelinej@piaille.fr]

@emilymbender Had a similar experience to
@netopwibby one with a cardiologist, I am in Canada. But at the last appointment she didn’t seem to use it? Will try to think to ask her about the use of it next time if I don’t forget.

[audrinabell@mstdn.social]

@emilymbender
I have-- and refused!

[3janeta@beige.party]

@emilymbender no but in the agreement they ask us to sign periodically it said that they might use AI. So I said I wasn’t signing if they were going to. They asked the doc and she said no I don’t use AI transcription at all and I didn’t know that was in there!

[robotistry@fediscience.org]

@BoydStephenSmithJr @anne_twain @emilymbender You do have an excuse. You are requesting care.

When I need care, and I am faced with an additional executive function burden, there are three drivers that will push me to accept:
1. They are in a position to refuse me something I need, so I have incentive to accommodate them.
2. I lack the energy to cope with the consequences of refusing. (The "too invested" problem - it takes a lot of energy to interact with medical systems, and when I'm sick, I have less energy to spare.)
3. My ability to cope with decisions is reduced when I need care - the sicker I am, the more I focus on just making it through the next step of the process to obtaining care, and the less externalities matter.

The problem isn't you not doing better. The problem is a system set up to make it as hard as possible for you to decline.

And the solution isn't you doing better when you're interacting with the system. The solution is sustained pressure by healthy people when they aren't trying to use the system.

[elricofmelnibone@mastodon.social]

@emilymbender
One of my first jobs was providing tech support to doctors in a hospital setting. They were some of the most tech-illiterate folks I've ever encountered. They have no concept of operational security.

No doctor has ever asked me for permission to store any information about me in whatever systems they're using. For all I know they store it in plain text on an insecure S3 bucket.

[theodoraward@mastodon.social]

@emilymbender thankfully my therapist was like "yeah dude don't worry about it it's weird" but i still get an email alongside every 'upcoming appointment' email reminding me to sign the permission form

[starluna@mastodon.social]

@WhiteCatTamer @EverydayMoggie @emilymbender In California, if you refuse, they are legally obligated not to record. California is a two-party consent state. You cannot record anyone's voice for any reason without their consent.

[tsvenson@mastodon.online]

@emilymbender

Yes, and of course said no.

But then I discovered they used AI transcribing when adding notes to my journal, after the meetings, as it was full of obvious errors. So needed to lecture them again about my right it is not used on my medical record.

What makes this even worse is that they all know how bad it works, as it is frequently reported in media about complaints from the medical community about horrific errors, as well as inefficiency this overhyped piece of crap creates.

[lastrobot@writing.exchange]

@emilymbender Agree. GPs are low availability now, saying no to this means being viewed as difficult, maybe ejected from patient roster. So you can't really say no.
Also in two visits where reports were prepped from specialists, there were errors from AI transcription mishearing that I think a human would not have made (age cited quite differently in different paragraphs, a operation claimed as had which was spoken as DID NOT have, etc) Correction required my time, effort, Dr disfavor 🫤

[emilymbender@dair-community.social]

@P__X You are not restricted in space -- you wrote a whole thread.

My point is: if patients do not know what they are consenting to, it is not consent. If it is not possible in the context of the visit to convey the detail, then we shouldn't do the thing.

I encourage you to read the rest of the replies to my post, including the quotes, to see the lack of consent and how that is landing.

[fiddlesix@zeroes.ca]

@emilymbender

1. At my last vet visit, there was a small typed notice across the exam room from the person/animal seating area that said AI is now being used by the practice for all visits, and to assume that if staff are in the room, recording is happening.

2. At my last primary provider visit, I asked the medical assistant if AI was being used, and if she could opt me out. She agreed.
When the PA came into the exam room, her first words were that I needed to prioritize my questions/issues, as she would only be able to deal with two, since she would have to manually chart the whole visit.
(I had come hoping for a prescription refill and two referrals for specialist care.)

[mrmoore@mstdn.social]

@rbmath @emilymbender I have noticed this too, at my local vet. They have signs at the front desk and in all the rooms about it and letting people know they can opt out. One of the problems is how people tend to react when you say you want to opt out.

[bomkatt@ohai.social]

@emilymbender @BoydStephenSmithJr i actively refuse to go to a local provider chain because of the Terms of their EHR software. It basically kept the right to do what it wanted with data.

I always think of how few people would care enough to do that level of reading as well as have the education to catch the nuance and resources to choose another practice.

That is not to shame anyone! It is asking a lot of an individual to do that