@wernerleodolter shaping the subconscious mind of ... · the psychology of decision making (of...
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@WernerLeodolter
Shaping the Subconscious Mind of Healthcare Organizations Digital Biomarkers and future Clinical Decision-Making
Werner Leodolter
Prof. Dr., CBMed
The psychology of decision making(of humans and organization(al units))
• Analogy and Intuition (Hofstaedter: „The heart of thinking“, Gigerenzer)
• Thinking fast and slow (Kahneman) - System 1 und 2
• Instinctive linking of experience and perception/sensations and the formation of mental models for the future lead to• overestimate the likelihood of positive outcomes• emotional transfer of actual presence in the future• ignorance of non-events (Gilbert)
• The pitfalls of psychology are also valid for organisation(al units)• bias, priming, self-deception etc.
• Those pitfalls even accumulate in organizations with more personswith the same biases etc. (due to culture, structure, same information sources, following the leaders - „leadership“ etc.)
June 2016 © Werner Leodolter 2
The cognitive process –how do we take decisions?
• the single person
• in the organization
• in the process chain of mybusiness model
perceive
Recognize, evaluate
decide
act
© Werner Leodolter 3
The cognitive processhybrid – analog+digital
IoT, VR, AR, Drones, speechanalysis, affectivecomputing, chatbots, virtualassistents etc
© Werner Leodolter 4
perceive
Recognize, evaluate
decide
act
image and patternrecognition, Speech analysis, affectivecomputing, Decision support Systemschatbots, virtualassistents etc
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perceive
Recognize, evaluate
decide
act
The cognitive processhybrid – analog+digital
© Werner Leodolter
Methods:Rule based (Expert Systems e.g. with fuzzyLogic)Supervised andunsupervised machinelearning, etc.
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perceive
Recognize, evaluate
decide
act
The cognitive processhybrid – analog+digital
© Werner Leodolter
• In the organization
• In the businessprocess
automated
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perceive
Recognize, evaluate
decide
act
The cognitive processhybrid – analog+digital
automated
© Werner Leodolter
Wahr-nehm
en
Erkennen, Verstehen,
Nachdenken, Abwägen
Ent-scheid
en
HandelnDATA,
DATA,DATA
The basis:
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The cognitive processhybrid – analog+digital
© Werner Leodolter
The basicidea
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…network man and machine intelligently
…Hybrid Intelligence
Decisions and actionsof
organisation(al unit)semerge from
organizationallyconsciousas well as
organizationallyunconscious
processes
The subconscious mind of your organization –cascaded hybrid intelligences
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Shape thesubconscious mind
deliberately
Let emerge Hybrid Intelligencies
in a targeted way
Agencies other HC providers
Assistents, ChatbotsPatients
What does this mean in real life? –How to support value based care - examples
• Telemonitoring, „eMail-visits“ etc. are broadening the HC organization´sperception
• Exploiting the EHRs…….. – „Digital Biomarkers“ as part of the subconscious
– My patient – patients like mine
– Derive predictions from statistical models developed with supervised machinelearning
– give hints for clinical reasoning! – why this prediction?
– Beware of bias in the data!
• Visualize process quality and outcome in realtime feedback loops - Make that part of your organization´s perception and self-regulation – its Subconscious
• Design a payment and care delivery environment that supports good clinical processes – watch the effectiveness of incentives closely – value-based care
CONFIDENTIAL - Property of CBmed
Digital Biomarkers for Precision Medicine (DBM4PM)
Clinical data
Industry Partners+
Scientific Partners
CONFIDENTIAL - Property of CBmed
as part of a comprehensive Biomarker Research initiative
1.7 Health technology assessment
Area 3: Metabolism
&Inflammatio
n
Area 1: Data
&Technologies
Area 2: Cancer
1.5 Metabolomics1.1 Clinical information system1.2 Semantic data management
1.4 Next generation sequencing
2.2 Tracking the trace2.4 Minimal residual disease and CAR T-cells
3.1 Diabesity
3.2 Cardiovascular disease3.3 Biosensors
3.4 Bone metabolism
3.5 Fertility 3.12 Electrochemical biomarkerdetection
3.6 Liver function
3.9 Microbiome-gut-brain
3.10 Sepsis
3.11 Fungal infections
2.7 ADX models
2.5 Eukaryotic initiation factors
2.8 Core Lab for Target Identify-cation and Probe Development
1.9 Clinical MALDI Applications1.8 Digital Pathology
1.6 Immunology 1.3 Knowledge discovery & data mining
2.51 Fusion Technology
Digital Biomarkers supporting clinical reasoningin diagnosis and decisions for therapy (CDS)…… • Principle: My patient – patients like my patient
• Use Cases
– Prediction of Delir to take action in order to prevent delir (and the associated suffering and costs)
– Prediction if ICU will be necessary for patient leads to better utilization of expensive ICU beds
– Readmission forecast for patients - analysing comparable EPRs – challenging staff to prevent readmission
– Early detection of sepsis (from parameter patterns) thus preventing ICU-admissions or reducing ICU-length ofstay
– Decision support for therapies – precision medicine (NGS – Genome, Proteom, Biomarker, Biobank, etc.)
– Homecare monitoring: proposals to prevent forecasted adverse events for chronically ill patients at home
– Help to convince patients to change their behaviour („these are EPR´s of real persons behind“)
– Prevent medication–related adverse events (esp. with polypharmacy)
– Clinical pathways, etc.
Use case: Will the patient suffer from delir?
Diether Kramer, Werner Leodolter
Reference
Prediction NO Y
NO 1145 163
Y 200 394
Accuracy : 0.8091
95% CI : (0.7908, 0.8266)
Sensitivity : 0.7074
Specificity : 0.8513
'Positive' Class : Y
Random Forest
1 - Specificity
Se
nsitiv
ity
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
Area under the curve: 0.9095
Predicting Health – Predicting Delir
Train and Improve Clinical Reasoning• Among the strategies proposed to improve clinical reasoning, education and
training are instruction and practice on • generating and refining a differential diagnosis,
• Imagine: a doctor with decision proposals for diagnostic, therapy etc. • He will mostly click „yes“
• Will he be a good doctor after 10 years doing that?
• Provide decision making simulator trainings - like airline pilots!
• Simulation of clinical decisions including decision proposals that make no sense – Trainees have to detect them when evaluating all decision proposals
© Werner Leodolter18.04.2018 17
„Hybrid Intelligencies“ shaping OrganisationsThe more you automate decisions – the more you have to consider the
subconscious mind of the organization
We shape our tools and then our tools
shape us.Marshall McLuhan: Understanding new media
Illustration ausDIE ZEIT13.2.2014
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Shape the Subconscious Mind ofyour organization
It is easy to use this metaphor………
…………just think of yourself
Leverage your patient´s data and use „Digital Biomarkers“ – …….like CBMed and KAGes
CDS: build decision simulators and train your staffperiodically
Enable your organization for value-based care
https://youtu.be/wB9hRIm75ow
contact:[email protected]
Redneragentur Speaker´sagency: Topspeaker
german book:Springer-Verlag
Since July 2017:
http://www.springer.com/in/book/9783319536170
…..further reading, links and video
http://cbmed.org
www.kages.at
Improving Diagnosis in HealthcareErin P. Balogh, Bryan T. Miller, and John R. Ball, Editors; Committee on Diagnostic Error in Health Care; Board on Health Care Services;Institute of Medicine; The National Academies of Sciences,Engineering, and Medicine
http://ebooks.iospress.nl/volumearticle/46457
Development and Validation of a Multivariable Prediction Model for the Occurrenceof Delirium in Hospitalized Gerontopsychiatry and Internal Medicine PatientsDiether Kramer, Sai Veeranki, Dieter Hayn, Franz Quehenberger, Werner Leodolter, Christian Jagsch, Günter Schreier
Thank you!
Werner Leodolter
Prof. Dr., CBMed
@ Speaker twitter handle