Searching for Sepsis—Fast and Slow

Unlocking Insights to Empower Clinicians

Doctors are human beings, and some patients leave an impression that lasts a lifetime. Early in his career, Jeff Hersh, Ph.D., M.D., Chief Medical Officer of GE Healthcare, cared for an elderly gentleman who reminded him of his own grandfather. Hersh was covering the ICU when a woman brought in her 76-year-old husband in the middle of the night. In addition to being confused, the man displayed multiple physical signs of distress: respiratory rate 26, oxygen saturation only 86%, temperature 103.1 degrees and systolic blood pressure only 86 mmHg. His chest x-ray showed a pneumonia, his white count was very elevated, as was his serum lactate. He showed all the characteristics of someone in septic shock. Throughout the course of his treatment that night and the next day, this elderly man was intubated, given intravenous fluids as well as broad-spectrum antibiotics, and put on medication to support his blood pressure. As his condition changed, so did his treatments, with his mechanical ventilation, fluids and pressure support medications all adjusted. But everything felt reactive, as if the medical team couldn’t get ahead of the situation. The man died later that evening. “That patient stays with me in part because he represents the importance of improving,” said Dr. Hersh. “Mortality for sepsis can be up to 50 percent in some cases; we need to do more than chase the condition.” [caption id="attachment_13082" align="alignleft" width="292"] Jeff Hersh, Ph.D., M.D., Chief Medical Officer of GE Healthcare[/caption] And sepsis shows no signs of slowing. In fact, this infection that causes a life-threatening response throughout the body, strikes 1.6 million Americans each year and kills more people than breast cancer, prostate cancer, and AIDS combined. Timely detection is critical but challenging. Early symptoms of sepsis can mirror those of common, less severe conditions. The highest-risk patients often have other underlying conditions which further cloud the diagnostic picture. And there is no confirmatory gold-standard test. Part of the answer may lie in technology that helps clinicians optimize the two ways humans arrive at decisions—intuitively (fast) and analytically (slow). Popularized in the best-seller Thinking, Fast and Slow by Daniel Kahneman, this dual-track paradigm is behind a new approach—interactive augmented intelligence—that may provide a unique tool for earlier detection and diagnosis of sepsis. “We need to help clinicians practice medicine to the limits of their expertise,” says Dr. Hersh. Having been board certified in Internal Medicine, Pediatrics and Emergency Medicine and with more than 30 years of clinical experience, Dr. Hersh knows first-hand what doctors and nurses face today: An influx of critically ill patients, too few staffing resources, and a growing avalanche of medical data that defies rapid assimilation. In other words, less and less time to “figure out what’s going on.” A software tool built on interactive augmented intelligence (IAI) could help clinicians “sift and winnow” all the information available on a potentially septic patient. This includes continuous biometric data from laboratory, imaging, and patient monitoring systems, the latest care guidelines, and the patient’s medical history. “It’s not uncommon to see patients whose medical records are 500 pages long,” says Dr. Hersh. “Clinicians simply do not have time to read the whole medical chart—but a computer could do it in seconds and alert you to relevant data that is critical to the diagnosis.” The interactive nature of the IAI software is key. “The system shouldn’t be a black box. Clinicians need to be able to literally consult with the system in real-time via common language software to collaborate on the diagnosis and care plan,” he says. Using machine learning capabilities, the system could continually refine its analytical acumen based on clinical feedback. The goal is high-quality insights—combining the clinician’s judgement and intuition and the computer’s data analytics—to guide treatment for individual patients at risk for sepsis-related decline. “It’s all about precision health,” says Dr. Hersh. “This approach empowers us to provide the right care for the right patient at the right time.” GE Healthcare and Roche Diagnostics recently entered into a partnership to develop precision health tools to support clinicians’ decision-making, particularly in the areas of oncology and acute care, including sepsis. “The important thing to understand about augmented intelligence software,” says Dr. Hersh, “is that it’s meant to complement, not replace, human intelligence. The idea to is to free up clinicians to focus their time on clinical care and directly assessing and interacting with the patient.” “There is no clinician on earth who wants a machine to tell them what to do,” he says. “There’s also no clinician on earth who doesn’t want to do the best thing for their patient and who doesn’t fear missing something. We want a tool to support and free clinicians, not replace them.”