The R Th Role o of C Cogniti tive ve Sc Science i in Dev - - PowerPoint PPT Presentation

Vimla L. Patel, PhD, DSc, FRSC Senior Research Scientist and Director Center for Cognitive Studies in Medicine and Public Health New York Academy of Medicine, New York City Professor (Adjunct of Biomedical Informatics Columbia University, New York, NY Arizona State University, Phoenix, AZ AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019 www.aimed.events/northamerica-2019 @VimlaLPatel www.lohia-patel.net

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A Case of Potassium Chloride Overdose

Potassium chloride (KCl) ordered as IV injection and as IV fluid additive using a CPOE system

• 85-year-old patient, admitted to the medical ICU with

septic shock and respiratory failure

• Patient received 316 mEq KCl over 42 hrs in setting of

acute and chronic kidney failure

• High dose delivered due to errors and misperceptions by

several care providers

• Compounded errors propagated through the system over

three days

Horsky, J., Kuperman, G.J., & Patel, V.L. (2005). Comprehensive analysis of a medication dosing error related to CPOE: A case report. Journal of the American Medical Informatics Association; 12: 377-382.

JAMIA 2005 12:377-82

Understanding What is Underneath

A A A A A A A A A A A A Mon 2/2/04 9:39 AM Sat 1/31/04 3:34 PM IV Fluids, Crystalloi d Enter D5W w/ 80meq KCl/L Active 12 Sat 1/31/04 3:34 PM Sat 1/31/04 3:34 PM IV Fluids, Crystalloi d NULL D/C D5W w/ 80meq KCl/L DC 11 Sat 1/31/04 3:34 PM Sat 1/31/04 2:42 PM IV Fluids, Crystalloi d Enter additives D5W w/ 80meq KCl/L Active 10 Sat 1/31/04 2:26 PM Sat 1/31/04 2:26 PM IV Fluids, Crystalloi d NULL D/C D5W w/ 100 meq KCl/L DC 9 Sat 1/31/04 2:26 PM Sat 1/31/04 2:26 PM IV Fluids, Crystalloi d NULL D/C D5W DC 8 Sat 1/31/04 1:37 PM Sat 1/31/04 1:37 PM IVP B NUL 20 mEq KCl 20 mEq Inj - Central potassium Chloride/wate r DC 7 Sat 1/31/04 2:26 PM Sat 1/31/04 1:36 PM IV Fluids, Crystalloi d Enter additives D5W w/ 100 meq KCl/L Active 6 Sat 1/31/04 2:26 PM Sat 1/31/04 1:35 PM IV Fluids, Crystalloi d Enter additives D5W Active 5 Sat 1/31/04 1:35 PM Sat 1/31/04 1:35 PM IV Fluids, Crystalloi d NULL D/C D5W w/ 40meq KCl/L DC 4 Sat 1/31/04 1:35 PM Sat 1/31/04 1:31 PM IV Fluids, Crystalloi d for one liter D5W w/ 40meq KCl/L Active 3 Sat 1/31/04 1:30 PM Sat 1/31/04 1:30 PM IV Fluids, Crystalloi d NULL D/C D5W DC 2 Sat 1/31/04 5:00 PM Sat 1/31/04 1:30 PM IV q1h 10 mEq Potassium Chloride Inj potassium Chloride Active 1

Saturday, Jan 31, 2004

1:30 pm 2:26 pm 3:34 pm

R e s i d e n t O r d e r N u m b e r S t a t u s G e n e r i c N a m e B r a n d N a m e D

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Swiss Cheese Model of Patient Safety Errors

Patient needs medication.

R1 R2 R3 Pharmacy/ Nurse

Patient receives medication overdose

There are many opportunities for error detection & correction: AI tool for automatic real time detection?

Intelligent Support for Augmenting Human Error Detection and Correction

BMJ Quality and Safety. 24, 468–474.

Cognitive Science and AI

Cognitive science or the science of cognition, includes numerous subfields of psychology, philosophy, linguistics, cognitive anthropology, neuroscience and computer science. Various field within cognitive science, influence AI research, where one branch of AI system developers try to mimic cognitive processes (not machine learning): Augmenting human intelligence

Patel, V.L., & Kaufman, D.R. (2013). Cognitive Science and Biomedical

• Informatics. In E. H. Shortliffe & J. J. Cimino (Eds.), Biomedical Informatics:

Computer Applications in Health Care and Biomedicine (4 ed., pp. 133-185). New York, NY: Springer-Verlag.

§ The overdosing case study exemplifies a larger problem: Decision support systems, as intelligent as they may be, seldom align with the mental processes underlying clinical decisions. § We cannot underestimate the important role of human mind § We cannot view AI as passive tools, they influence our thinking, as much as we shape their behavior

Patel, V.L., Kushniruk, A.W., Yang, S., & Yale, J.F. (2000) Impact of a computerized patient record system on medical data collection,

• rganization, and reasoning. Journal of the American Medical Informatics

Association; 7(6): 569-585

Message 1: Role of Human Cognition

• There are hidden variables that can never be taken into account

even if you have billions of data points. All risks cannot be computed

• To function in a complex and uncertain world, clinicians need:
• To have at their disposal a simple yet effective toolset for

decision-making

• To develop the ability to ignore information that is not critical or

important

• To know when to trust their own judgment rather than relying

completely on complex models

Patel, V.L., Kaufman, D.R., & Kannampallil, T.G. (2019). Diagnostic Reasoning and Expertise in Healthcare. In: The Oxford Handbook of Expertise: Research & Application.

Message 2: Understand the Real Clinical World

Future looks towards Cognitive AI

• Deep learning AI systems crunch data
• Symbolic AI, deals with human-like reasoning
• The unique hybrid combination of the two plus the

explainability (transparency) of symbolic AI is the next step towards the future of AI and decision making

Message 3: Future Role of Cognition and AI

Thank you

vpatel@nyam.org http://www.lodhia-patel.net/