In this post we will cover new experimental and optional AI capabilities in Mere to enhance the search experience and to answer user questions about their medical records. This article will discuss how we integrate semantic search and Q&A using OpenAI's text-embedding-3-large and gpt-4-turbo models.

Why Semantic Search Matters​

A year ago, during a feedback session, an early Mere user reported a "broken" search bar. She had entered "diabetes" and "high blood sugar" into the Mere search bar but received no results. While Mere's search was functioning correctly, performing basic text queries, it failed to meet her expectations of recognizing the relationship between her search terms and related medical records like A1c and blood glucose levels. This incident highlighted the need for a more sophisticated, semantic search capability.

A quick update on my life: I'm now in my fourth year of medical school, in the midst of applying for residency.

I've still been working on Mere in the pockets of time I find in between rotations, studying for board exams, and residency interviews. Its incredible how much progress can be made by small and consistent updates over a long period of time. I'm excited to share the latest developments that have been brewing behind the scenes.

This post will dive deeper into how personal health records (PHRs) can adopt the Clinical Decision Support (CDS) hooks standard to enable third-party extensibility. We're primarily focusing on CDS hooks because it is a more accessible standard for PHRs and third-party developers to adapt. For a high level context of why we care about this, please read Part 1.

The point of this post is to lay the groundwork and discuss how the CDS hook standard may need to be updated to handle PHR use cases. The great thing about building off a current standard like CDS hooks is that CDS hooks built for one PHR could be used for any PHR. For a deeper dive on CDS Hooks, read the HL7 Clinical Decision Support (CDS) hooks documentation.

Personal health records (PHRs) such as Mere do a great job of syncing and showing you your medical records across different healthcare providers. Mere makes it easy to read and search for your medical records across multiple health systems. Want to compare your last red blood cell count to your previous lab results? Mere will generate a graph for you. Need help remembering which vaccines you've already gotten? Mere can group and summarize your entire vaccine history in one view.

PHRs such as Mere are excellent at storing and showing you your medical data. But there's a big difference between just showing you your data and actually providing insights into your data.

The next problem Mere wants to solve is this: how can Mere make your data actionable? How can Mere help you learn more about yourself and your conditions? Can Mere recommend actions you can take to improve your health? And can Mere do all this while maintaining its core tenants of privacy, local-first data, and user autonomy?

About a year ago, I was a second-year medical student preparing to start my third-year clinical rotations. It was a pretty exciting but terrifying time - I was also getting ready to take my first set of board exams. On top of long days of studying, I had to complete a lot of paperwork required by the school and the hospitals I would be rotating at. One of the biggest things I needed to get done before starting my rotations was ensuring I was up to date on my vaccinations and had my latest health records.

I quickly realized that getting all my old vaccine records was more difficult than I originally expected. Most of my previous vaccination records were with my old primary care physician (PCP) in my hometown, not with my current one. Luckily, my old PCP offered a patient portal I could use to see my old records. After a quick phone call to my old PCP's office to set up my online account, I could log in and see my old vaccine records. However, my current PCP used a completely different patient portal. So if I wanted to see my most recent blood work and my historical vaccine data at the same time, I needed to log in to two places at once.

A few months later, I moved to a new apartment closer to my new rotation site and had to again find another new PCP closer to me. Luckily, this new PCP I chose used the patient portal system that my original PCP did. However, despite using the same EMR, I was forced to create a new login for this portal as this new doctor was part of a different health system from my original PCP. I now had a total of three different logins to see my health data.

Throughout this process, I kept thinking: why was getting all my medical records in one place so tricky? There had to be an easier way.