This is different, in that this service requires that a third party pay attention to the content of your discussion in order to work. That's significantly more intrusive.

Maybe its just the doc offices i've been to, but i think this would actually just increase the patient churn in a hospital. There's no way a doc is going to increase their patient time by the 40% saved if the hospital can toss them in front of another patient.

> in any case, HIPAA will protect you

It protects you insofar as it disincentives honest actors from doing sketchy things with your data. It's punishment for orgs, not protection for patients, like how laws against murder punishes the murderer rather than protecting the victim.

The best thing a patient can do to protect their privacy is to be actively avoid of medical practitioners that, for example, use tools like this which send your private medical consultation transcripts to God-knows-where.

First question - you say that you don't store anything (no audio, no transcript, no note), but your legal agreement says that in order to use this service, the doctor asserts to you that they have gotten consent from the patient for you to reuse all data processed through the service for research and development, and to improve the performance, models, and algorithms of this or any other solution you come up with in the future. Why the difference and how do you square A with B?

"Due to the substantial financial, material and human investments made by NABLA within the framework of the Contract for the development and updating of the Solution, NABLA wish to be allowed to reuse the data processed within the framework of the Contract.

The CLIENT, when applicable in the name and on behalf of the DATA CONTROLLER, warrants that the Data Subjects have been informed of their rights and have given their consent for the use of their data within the framework of the Contract when required by applicable laws or the Regulation and authorizes the DATA PROCESSOR to reuse the Data processed within the framework of the Contract, as long as the latter undertakes to comply with the Regulation for all of this Data, for the uses listed below:

- research and development of the Solution,

- improving the performance, models and algorithms developed and trained by NABLA in the context of the Solution or any other solution published by NABLA,"

Second question - you say that you don't store anything (no audio, no transcript, no note) and that it is all erased at the end of each consultation. But do you store any artifacts derived from the audio, transcript, or notes of a consultation, like data processed directly or indirectly from the audio, transcripts, or notes of a consultation that is fed in to an AI model, ML model, or other dataset that you persist after the consultation?

Secure and HIPAA-eligible

    Audio, transcripts, and notes are not stored by Nabla
    HIPAA-eligible and GDPR compliant
    SOC 2 and ISO 27001 certifications in progress

This data processing is done on Nabla's servers, which are powered by the HIPAA and GDPR compliant Google Cloud Platform (GCP), and on HIPAA-eligible LLM servers.

The blog posts also mention French trained ML.

> Cedille is a new open source French language model created by Coteries. It is trained to understand and write French and is also the largest model of its kind for French. Cedille is trained using large databases of publicly available content on the internet filtered for toxic content.

Expanding into the US, yes - they would need to deal with HIPAA, but until they do they likely don't need to.

https://www.scribeamerica.com/what-is-a-medical-scribe/

> A Medical Scribe is a revolutionary concept in modern medicine. Traditionally, a physician's job has been focusing solely on direct patient contact and care. However, the advent of the Electronic Health Record (EHR) created an overload of documentation and clerical responsibilities that slows physicians down and pulls them away from actual patient care. To relieve the documentation overload, physicians across the country are turning to Medical Scribe services.

> A Medical Scribe is essentially a personal assistant to the physician; performing documentation in the EHR, gathering information for the patient's visit, and partnering with the physician to deliver the pinnacle of efficient patient care.

https://www.hhs.gov/hipaa/for-professionals/covered-entities...

> If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information.

"If you handle, store or transmit protected health information (PHI) to or from a covered entity then you need to be HIPAA compliant."

Source: https://github.com/truevault/hipaa-compliance-developers-gui...

When a covered entity (a HIPAA-required provider) does business with a private non-covered entity _and_ that transaction involves HIPAA controlled information, they must enter into a Business Associate Agreement (BAA). This effectively forces the private entity to maintain the same HIPAA standard as the provider.

A private company is absolutely free to build non-HIPAA compliant software, but they completely unlikely to get any healthcare providers to actually use it.

I used to type, now I dictate.

Quality of note is provider dependent though. If an LLM can improve quality of notes across the board through simple summary that’s interesting. But the input matters - is the provider actually asking the right questions? Did they look at past relevant history and other notes and put it in their current note?

The LLM should be in a HIPAA compliant environment and have access to the EMR. Then it provides a tidy summary for that. Second it should have relevant questions for the provider to ask during the interview but also a real time/dynamic component which generates relevant follow up questions dependent on patient responses.

Lastly it should put together the old and the new and generate a new note which can then be edited by the provider. Editing notes is much easier than generation of a new high quality note.

You're not thinking like a hospital administrator. Sounds like these doctors can handle 40% more patients to me!

Everyone hates notes. However, there are already a bunch of dictation services that help write notes more efficiently. They absolutely work well enough.

Adoption and funding is the primary blocker. When my wife works at facilities that have M-Modal, she's 80%+ faster. However, she works at many, who despite knowing the benefits, simply don't care to spend the time, money, or resources on implementing scribe/dictation services.

Pharmacists in other countries do a lot of the basic shit doctors in the USA do, with less overhead, for cheaper and with a much faster turnaround. Antibiotics, blood pressure/cholesterol meds, antidepressants and other rubber stamp drugs absolutely do not need to be strongly controlled.

It's pretty close to the same thing. Programmers are paid for knowing how to program, not for memorizing APIs, system calls, etc. Being able to look up details is essential because it lightens the cognitive load, allowing deeper thought to be put into the real meat of the problem. No programmer can realistically memorize every technical detail they'll need to know.

It's the same with doctors. They're paid because they know the process of diagnosing illnesses, not for memorizing Gray's Anatomy and every pharmacopoeia. Being able to look stuff up is essential for the same reason it is for programmers.

Not to mention that medicine changes, and you want your doctor to have the latest information about whatever it is that ails you.

I shouldn't have to pay for your time so you can educate yourself on the thing you purported to know before I hired you. Especially when the hourly rates are in the hundreds of dollars.

So there is some balance there. And doctors are using software that spits them out shit in real-time and then they send you on your way with some printed info you can readily find on the web.

I just had a knee issue and the doctor thought it may be a torn meniscus. Didn't have me do any range of motion movements. We just chatted and he said I think it is this. Take an xray. Bye.

I go get an xray and results come back the next day over the app. All he says in the app - "xray is normal".

So I'm thinking what the hell. That's where you leave it? So what. Should we do an MRI? What's next. You gave me an anti-inflammatory and your guess was apparently wrong. What a shitty engineer this person would be.

Tech can help in some cases. I like getting lab results back in the app. I like that I can follow up with chat later.

But I fear it's making doctors less effective. And the best ones will be the ones that maintain their traditional craft and nuance even with all the fancy new tools and tech that save them time.

Just like everyone is a React developer these days. Tech and advances can make many people sloppy. And dumber. It can push away great talent due to mandates of the tech or process. And attract new talent that is worse.