The Algorithm
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It's a long read, but you can get the gist from just the first few paragraphs:
The Pain Was Unbearable. So Why Did Doctors Turn Her Away?
For years, Kathryn had been managing her condition (endometriosis) in part by taking oral opioids like Percocet when she needed them for pain. But endometriosis is progressive: Having once been rushed into emergency surgery to remove a life-threatening growth on her ovary, Kathryn now feared something just as dangerous was happening, given how badly she hurt.
In the hospital, doctors performed an ultrasound to rule out some worst-case scenarios, then admitted Kathryn for observation to monitor whether her ovary was starting to develop another cyst. In the meantime, they said, they would provide her with intravenous opioid medication until the crisis passed.
On her fourth day in the hospital, however, something changed. A staffer brusquely informed Kathryn that she would no longer be receiving any kind of opioid. “I don’t think you are aware of how high some scores are in your chart,” the woman said. “Considering the prescriptions you’re on, it’s quite obvious that you need help that is not pain-related.”
Back at home, about two weeks later, Kathryn received a letter from her gynecologist’s office stating that her doctor was “terminating” their relationship. Once again, she was mystified. But this message at least offered some explanation: It said she was being cut off because of “a report from the NarxCare database.”
NarxCare—the system that inspired Kathryn’s gynecologist to part ways with her—is Appriss’ flagship product for doctors, pharmacies, and hospitals: an “analytics tool and care management platform” that purports to instantly and automatically identify a patient’s risk of misusing opioids.
On the most basic level, when a doctor queries NarxCare about someone like Kathryn, the software mines state registries for red flags indicating that she has engaged in “drug shopping” behavior: It notes the number of pharmacies a patient has visited, the distances she’s traveled to receive health care, and the combinations of prescriptions she receives.
Beyond that, things get a little mysterious. NarxCare also offers states access to a complex machine-learning product that automatically assigns each patient a unique, comprehensive Overdose Risk Score. Only Appriss knows exactly how this score is derived, but according to the company’s promotional material, its predictive model not only draws from state drug registry data, but “may include medical claims data, electronic health records, EMS data, and criminal justice data.” At least eight states, including Texas, Florida, Ohio, and Michigan—where Kathryn lives—have signed up to incorporate this algorithm into their monitoring programs.
For all the seeming complexity of these inputs, what doctors see on their screen when they call up a patient’s NarxCare report is very simple: a bunch of data visualizations that describe the person’s prescription history, topped by a handful of three-digit scores that neatly purport to sum up the patient’s risk.
At the time of her hospitalization, Kathryn owned two flat-coated retrievers, Bear and Moose. Both were the kind of dog she preferred to adopt: older rescues with significant medical problems that other prospective owners might avoid. Moose had epilepsy and had required surgery on both his hind legs. He had also been abused as a puppy and had severe anxiety. Bear, too, suffered from anxiety.
The two canines had been prescribed opioids, benzodiazepines, and even barbiturates by their veterinarians. Prescriptions for animals are put under their owner's name. So to NarxCare, it apparently looked like Kathryn was seeing many doctors for different drugs, some at extremely high dosages. (Dogs can require large amounts of benzodiazepines due to metabolic factors.) Appriss says that it is “very rare” for pets’ prescriptions to drive up a patient’s NarxCare scores.
And, how's that working out?
While the total amount of opioids prescribed fell by 60 percent between 2011 and 2020, the already record-level overdose death rate at least doubled during the same period. Simply cutting the medical supply didn't help; instead, it fueled more dangerous drug use, driving many Americans to substances like illegally manufactured fentanyl.
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I think your headline is misleading.
In this case, the real problem is not the algorithm but this:
a NarxCare score is not meant to supplant a doctor’s diagnosis. But physicians ignore these numbers at their peril.
This is like treating a patient for lung cancer based only on the fact that he's a smoker.
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@klaus said in The Algorithm:
I think your headline is misleading.
The headline is from the article, not me.
The title of the thread is about the algorithm in the article.
What's misleading?
In this case, the real problem is not the algorithm but this:
a NarxCare score is not meant to supplant a doctor’s diagnosis. But physicians ignore these numbers at their peril.
Yes. I know of at least two docs whose practice has been investigated for ignoring similar guidelines.
Obey these numbers or get investigated.
