Vishal Khetpal and Nishant Shah at FastCompany: “Last spring, physicians like us were confused. COVID-19 was just starting its deadly journey around the world, afflicting our patients with severe lung infections, strokes, skin rashes, debilitating fatigue, and numerous other acute and chronic symptoms. Armed with outdated clinical intuitions, we were left disoriented by a disease shrouded in ambiguity.
In the midst of the uncertainty, Epic, a private electronic health record giant and a key purveyor of American health data, accelerated the deployment of a clinical prediction tool called the Deterioration Index. Built with a type of artificial intelligence called machine learning and in use at some hospitals prior to the pandemic, the index is designed to help physicians decide when to move a patient into or out of intensive care, and is influenced by factors like breathing rate and blood potassium level. Epic had been tinkering with the index for years but expanded its use during the pandemic. At hundreds of hospitals, including those in which we both work, a Deterioration Index score is prominently displayed on the chart of every patient admitted to the hospital.
The Deterioration Index is poised to upend a key cultural practice in medicine: triage. Loosely speaking, triage is an act of determining how sick a patient is at any given moment to prioritize treatment and limited resources. In the past, physicians have performed this task by rapidly interpreting a patient’s vital signs, physical exam findings, test results, and other data points, using heuristics learned through years of on-the-job medical training.
Ostensibly, the core assumption of the Deterioration Index is that traditional triage can be augmented, or perhaps replaced entirely, by machine learning and big data. Indeed, a study of 392 COVID-19 patients admitted to Michigan Medicine that the index was moderately successful at discriminating between low-risk patients and those who were at high-risk of being transferred to an ICU, getting placed on a ventilator, or dying while admitted to the hospital. But last year’s hurried rollout of the Deterioration Index also sets a worrisome precedent, and it illustrates the potential for such decision-support tools to propagate biases in medicine and change the ways in which doctors think about their patients….(More)”.