Blockchain Papers

Anna Maria Fink, Johanna Nattenmüller, Stephan Rau, Alexander Rau · 10 authors

OBJECTIVES: This study evaluated the effect of enhancing a GPT-4 model with retrieval-augmented generation on its ability to diagnose and classify traumatic injuries based on radiology reports. MATERIALS AND METHODS: In this prospective proof-of-concept study, we used retrieval-augmented generation as a zero-shot learning approach to provide expert knowledge from the RadioGraphics top ten reading list for trauma radiology to the GPT-4 model, creating the context-aware TraumaCB. Radiological report findings of 50 traumatic injuries were independently generated by two radiologists. The performance of the TraumaCB compared to the generic GPT-4 was evaluated by three board-certified radiologists, assessing the accuracy and trustworthiness of the chatbot responses in the 100 reports created. RESULTS: The TraumaCB achieved 100% correct diagnoses, 96% correct classification, and 87% correct grading, outperforming the generic GPT-4 with 93% correct diagnoses, 70% correct classification, and 48% correct grading. TraumaCB sources consistently achieved a median rating of 5.0 for explanation and trust. Challenges encountered mainly involved traumatic injuries lacking widely accepted classification systems. CONCLUSION: Augmenting a commercial GPT-4 model with retrieval-augmented generation improves its diagnostic and classification capabilities, positioning it as a valuable tool for efficiently assessing traumatic injuries across various anatomical regions in trauma radiology. KEY POINTS: Question Retrieval-augmented generation has the potential to enhance generic chatbots with task-specific knowledge of emergency radiology. Findings The TraumaCB excelled in accuracy, particularly in injury classification and grading, and provided explanations along with the sources used, increasing transparency and facilitating verification. Clinical relevance The TraumaCB provides accurate, fast, and transparent access to trauma radiology classifications, potentially increasing the efficiency of image interpretation in emergency departments and enabling customized reports based on local or individual preferences.

Nima S. Ghorashi, Murwarit Rahimi, Reza Sirous, Ramin Javan

INTRODUCTION: Although blockchain technology and smart contracts are garnering attention in various sectors, their applications and familiarity within the realm of radiology remain largely unexplored. Blockchain, a decentralized digital ledger technology, offers secure, transparent, and resilient data management by distributing the verification process across a network of independent entities. This decentralized technology presents a possible solution for a range of healthcare challenges, from secure data transfer to automated verification processes. To address such challenges in the context of medical imaging, blockchain could provide different approaches, including smart contracts, machine learning algorithms, and the secure dissemination of large files among key stakeholders such as patients, healthcare providers, and institutions. This manuscript aims to explore the current attitudes and perspectives of trainees and radiologists to the utilization of blockchain technology and smart contracts in clinical radiology. Additionally, the study provides an in-depth analysis of the potential applications for incorporating blockchain into radiology. METHODS: After obtaining The George Washington University Committee on Human Research Institutional Review Board (IRB) approval, we conducted a 10-question survey among radiologists and trainees at several institutions and private practices. Surveys were created via the Google Forms application and were emailed to potential participants. Participants were asked about their current academic level (medical student, resident/fellow, academic radiologist, private practice radiologist, others), their knowledge level about the field of imaging informatics and blockchain and smart contract technologies, their level of interest in learning more about blockchain and smart contracts, and their opinion about possible applications of blockchain and smart contract in the future of medical imaging. RESULTS: A total of 118 survey requests were distributed; 83 were returned, reflecting a 70.3% overall response rate. Of these, 19 were sent to private practices with a 15.8% response rate (3/19), and 99 to academic centers, yielding an 80.8% response rate (80/99). The survey respondents demonstrated a strong interest and need to further understand these technologies among radiologists and trainees. This study focuses on key components of this technology as it relates to healthcare and the practice of radiology, including data storage, patient care, secure communication, and automation, as well as strengths, weaknesses, opportunities, and threats (SWOT) analysis. DISCUSSION: To our knowledge, this is the first study to investigate and establish a baseline for the current perspectives on the application of blockchain technology and smart contracts in clinical radiology amongst trainees and radiologists across academic and private settings. Incorporating blockchain and smart contracts technologies into the field of radiology has the potential to achieve greater efficiency, security, and patient empowerment. However, the adoption of this technology comes with challenges, such as infrastructure, interoperability, scalability, and regulatory compliance. Collaboration between radiologists, hospital administration, policymakers, technology developers, and patient advocacy organizations will help guide and advance our understanding of the potential applications of blockchain and smart contracts in radiology and healthcare.

E.E. Funk, Jeff Riddell, Felix Ankel, Daniel Cabrera

Health professions educators face multiple challenges, among them the need to adapt educational methods to new technologies. In the last decades, multiple new digital platforms have appeared in the learning arena, including massive open online courses and social-media-based education. The major critique of these novel methods is the lack of the ability to ascertain the origin, validity, and accountability of the knowledge that is created, shared, and acquired. Recently, a novel technology based on secured data storage and transmission, called blockchain, has emerged as a way to generate networks where validity, trust, and accountability can be created. Conceptually, blockchain is an open, public, distributed, and secure digital registry where information transactions are secured and have a clear origin, explicit pathways, and concrete value. Health professions education based on blockchain will potentially allow improved tracking of content and the individuals who create it, quantify educational impact on multiple generations of learners, and build a relative value of educational interventions. Furthermore, institutions adopting blockchain technology would be able to provide certification and credentialing of health care professionals with no intermediaries. There is potential for blockchain to significantly change the future of health professions education and radically transform how patients, professionals, educators, and learners interact around safe, valid, and accountable information.

Gulrukh Zaidi

No abstract is available for this record.

Shari J. Welch, Todd B. Taylor, Dickson Cheung

Dr. Welch: is a fellow with Intermountain Institute for Health Care Delivery Research, an emergency physician with Utah Emergency Physicians, and a member of the board of the Emergency Department Benchmarking Alliance. Dr. Taylor is a physician executive for Microsoft Corporation's Health Solutions Group and the principle promoter of the national Emergency Department of the Future project. Dr. Cheung is a Malcolm Baldrige National Quality Award Examiner, former faculty of the Johns Hopkins Center for Innovation in Quality Patient Care and the Quality and Safety Research Group, and a member of ACEP's Quality and Performance Committee.Should board certified emergency physicians be required to earn certain “merit badge” credentials for hospital privileges? Should such certifications be required for activities like EMS base station medical control or specialty center designation? Hospitals, state EMS authorities, and specialty center designation bodies are increasingly turning to “merit badges” (see table) as proxies for competency in various specialty areas within emergency medicine. Does this make any sense? And where will this end? Will emergency physicians ultimately be required to hold certificates or earn CME hours in geriatric medicine, psychiatry, ethics, and ingrown toenail removal? An Internet search for “merit badge medicine” results in web sites for the Boy Scouts. Has it come to this? Should we wear merit badge sashes during our shifts? It's time to insert a bit of common sense into this madness. In the early days of the specialty, there were few training programs, and the first certifying examination in emergency medicine did not occur until 1980. As a result, most early emergency physicians gained on-the-job experience, and those who became board certified did so through the practice pathway. Since that time, training programs have expanded dramatically, and the only recognized path to board certification is now through emergency medicine residency training and the American Board of Medical Specialties' certifying bodies. Ironically, despite 30 years of formal emergency medicine board certification, “merit badge” requirements have re-emerged as a phenomenon. Are these efforts unwarranted, unnecessary, or even counterproductive? And what is driving this trend? The American College of Emergency Medicine and the American Academy of Emergency Medicine are clear on the use of “merit badges,” and these positions can be used as support exemption from merit badge requirements: The AAEM membership card notes that a fellow is board certified in emergency medicine and therefore has advanced resuscitation expertise in pediatric, trauma and cardiac care. The 1999 ACEP policy, “Use of Short Courses in Emergency Medicine as Criteria for Privileging or Employment,” strongly discourages the use of certificates in subareas of emergency medicine as requirements for privileges or employment. (http://bit.ly/ShortCourse.) Nevertheless, the growing list of merit badges required for hospital credentialing and privileging has become cumbersome. Resources for continuing medical education for physicians can be a zero-sum game. The time and cost for merit badge achievement will inevitably result in other, perhaps more important, educational areas being ignored. Most states and specialty societies require CME for maintenance of licensure and membership. On average, this requirement is 20 to 50 credit hours a year, and can often require up to two weeks away from work (worth $10,000 to $20,000) and $5000 to $8,000 for tuition and travel expenses. While making a financial argument against merit badges can be risky (i.e., “doctors make lots of money”), it can be done successfully. Arizona ACEP avoided state-mandated merit badges by pointing out the total annual cost for particular requirements. An effort to require PALS by all ED staff (including nurses) was defeated when it was suggested it should be funded as a state-mandated program at an annual cost of more than $8 million. This idea quietly went away. As a relatively young specialty, emergency medicine may suffer from a lack of understanding by the community, hospital administrators, and regulators on the breadth of expertise and training of board certified emergency physicians. Even among emergency physicians, considerable confusion exists over the Emergency Medicine Continuous Certification program requirements. These requirements, built on residency training and certification, are perhaps the best argument against merit badges. With the significant investment in initial training and the ongoing and increasing Maintenance of Certification requirements, merit badges are simply unnecessary. There is no evidence that any of these individual credentials correlate with improved clinical care. In contrast, one study demonstrated a quality correlation between board certification and quality measures. (Arch Intern Med 2010;170[16]:1442.) In addition, the “credentials equal quality” mental model is founded on a false premise, that putting more knowledge in the head of the practitioner will improve care. In the Agency for Healthcare Research and Quality whitepaper, “Mistake Proofing the Design of Health Care Processes” (www.ahrq.gov), the authors note that one of the biggest failed mental models in health care has been to assume that if we could put more into the practitioner's memory, we could avoid mistakes and provide better care. The premise is faulty because the human memory is fallible. The passage of time erases these efforts from memory if not used regularly. An example is pediatric resuscitation credentialing where pediatric critical care occurs only once every 30,000 to 40,000 ED visits. So the average PALS certified practitioner in a community hospital will go years or even decades before using the information, which is unlikely to be retrievable when actually needed. No other specialty requires physicians to jump through as many hoops to put on a white coat and practice medicine. Five arguments can be used against merit badge requirements for board certified emergency physicians: ACEP and AAEM have strong policy statements against merit badge requirements. Maintaining these credentials is growing more burdensome, expensive, and crowding out more important CME activities. The new ABMS Maintenance of Certification requirements supersede the need for merit badges. There is no proven quality correlation with merit badge requirements. The mental model of “knowledge in the head” is a false premise. Comments about this article? Write to EMN at[email protected]. Click and Connect!Access the links in this article by reading it onwww.EM-News.com. Typical Merit Badges Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) Advanced Trauma Life Support (ATLS) Advanced Pediatric Life Support (APLS) Pediatric Advanced Life Support (PALS) Advanced Airway Courses Procedural Sedation Courses Ultrasound Training and Credentialing Hazardous Materials Training (HAZMAT) The Joint Commission's Ongoing Practice Performance Evaluation (OPPE) 16 hours a year of trauma CME (for physicians practicing in American College of Surgeon Certified Trauma Centers) Various state-specific requirements (pain management, geriatric medicine, end-of-life care, infectious disease, risk management, sexual assault, domestic violence, cultural competence, appropriate prescribing, medical jurisprudence, ethics in medicine) CME Requirements Read a state-by-state listing of CME requirements at http://bit.ly/CMErequirements.