Artificial intelligence is poised to become a transformational force in healthcare. How will providers and patients benefit from the impact of AI-driven tools?The healthcare industry is ripe for some major changes. From chronic diseases and cancer to radiology and risk assessment, there are nearly endless opportunities to leverage technology to deploy more precise, efficient, and impactful interventions at exactly the right moment in a patient’s care.
As payment structures evolve, patients demand more from their providers, and the volume of available data continues to increase at a staggering rate, artificial intelligence is poised to be the engine that drives improvements across the care continuum.
AI offers a number of advantages over traditional analytics and clinical decision-making techniques. Learning algorithms can become more precise and accurate as they interact with training data, allowing humans to gain unprecedented insights into diagnostics, care processes, treatment variability, and patient outcomes.
At the 2018 World Medical Innovation Forum (WMIF) on artificial intelligence presented by Partners Healthcare, a leading researchers and clinical faculty members showcased the twelve technologies and areas of the healthcare industry that are most likely to see a major impact from artificial intelligence within the next decade.
Every member of this “Disruptive Dozen” has the potential to produce a significant benefit to patients while possessing the potential for broad commercial success, said WMIF co-chairs Anne Kiblanksi, MD, Chief Academic Officer at Partners Healthcare and Gregg Meyer, MD, Chief Clinical Officer.
With the help of experts from across the Partners Healthcare system, including faculty from Harvard Medical School (HMS), moderators Keith Dreyer, DO, PhD, Chief Data Science Officer at Partners and Katherine Andriole, PhD, Director of Research Strategy and Operations at Massachusetts General Hospital (MGH), counted down the top 12 ways artificial intelligence will revolutionize the delivery and science of healthcare.
UNIFYING MIND AND MACHINE THROUGH BRAIN-COMPUTER INTERFACES
Using computers to communicate is not a new idea by any means, but creating direct interfaces between technology and the human mind without the need for keyboards, mice, and monitors is a cutting-edge area of research that has significant applications for some patients.
Neurological diseases and trauma to the nervous system can take away some patients’ abilities to speak, move, and interact meaningfully with people and their environments. Brain-computer interfaces (BCIs) backed by artificial intelligence could restore those fundamental experiences to those who feared them lost forever.
“If I’m in the neurology ICU on a Monday, and I see someone who has suddenly lost the ability to move or to speak, we want to restore that ability to communicate by Tuesday,” said Leigh Hochberg, MD, PhD, Director of the Center for Neurotechnology and Neurorecovery at MGH.
“By using a BCI and artificial intelligence, we can decode the neural activates associated with the intended movement of one’s hand, and we should be able to allow that person to communicate the same way as many people in this room have communicated at least five times over the course of the morning using a ubiquitous communication technology like a tablet computer or phone.”
Brain-computer interfaces could drastically improve quality of life for patients with ALS, strokes, or locked-in syndrome, as well as the 500,000 people worldwide who experience spinal cord injuries every year.
DEVELOPING THE NEXT GENERATION OF RADIOLOGY TOOLS
Radiological images obtained by MRI machines, CT scanners, and x-rays offer non-invasive visibility into the inner workings of the human body. But many diagnostic processes still rely on physical tissue samples obtained through biopsies, which carry risks including the potential for infection.
Artificial intelligence will enable the next generation of radiology tools that are accurate and detailed enough to replace the need for tissue samples in some cases, experts predict.
We want to bring together the diagnostic imaging team with the surgeon or interventional radiologist and the pathologist,” said Alexandra Golby, MD, Director of Image-Guided Neurosurgery at Brigham & Women’s Hospital (BWH). “That coming together of different teams and aligning goals is a big challenge.”
“If we want the imaging to give us information that we presently get from tissue samples, then we’re going to have to be able to achieve very close registration so that the ground truth for any given pixel is known.”
Succeeding in this quest may allow clinicians to develop a more accurate understanding of how tumors behave as a whole instead of basing treatment decisions on the properties of a small segment of the malignancy.
Providers may also be able to better define the aggressiveness of cancers and target treatments more appropriately.
Artificial intelligence is helping to enable “virtual biopsies” and advance the innovative field of radiomics, which focuses on harnessing image-based algorithms to characterize the phenotypes and genetic properties of tumors.
EXPANDING ACCESS TO CARE IN UNDERSERVED OR DEVELOPING REGIONS
Shortages of trained healthcare providers, including ultrasound technicians and radiologists can significantly limit access to life-saving care in developing nations around the world.
More radiologists work in the half-dozen hospitals lining the renowned Longwood Avenue in Boston than in all of West Africa, the session pointed out.
Artificial intelligence could help mitigate the impacts of this severe deficit of qualified clinical staff by taking over some of the diagnostic duties typically allocated to humans.
For example, AI imaging tools can screen chest x-rays for signs of tuberculosis, often achieving a level of accuracy comparable to humans. This capability could be deployed through an app available to providers in low-resource areas, reducing the need for a trained diagnostic radiologist on site.
“The potential for this tech to increase access to healthcare is tremendous,” said Jayashree Kalpathy-Cramer, PhD, Assistant in Neuroscience at MGH and Associate Professor of Radiology at HMS.
However, algorithm developers must be careful to account for the fact that disparate ethnic groups or residents of different regions may have unique physiologies and environmental factors that will influence the presentation of disease.
“The course of a disease and population affected by the disease may look very different in India than in the US, for example,” she said.
“As we’re developing these algorithms, it’s very important to make sure that the data represents a diversity of disease presentations and populations – we can’t just develop an algorithm based on a single population and expect it to work as well on others.”
REDUCING THE BURDENS OF ELECTRONIC HEALTH RECORD USE
EHRs have played an instrumental role in the healthcare industry’s journey towards digitalization, but the switch has brought myriad problems associated with cognitive overload, endless documentation, and user burnout.
EHR developers are now using artificial intelligence to create more intuitive interfaces and automate some of the routine processes that consume so much of a user’s time.
Users spend the majority of their time on three tasks: clinical documentation, order entry, and sorting through the in-basket, said Adam Landman, MD, Vice President and CIO at Brigham Health.
Voice recognition and dictation are helping to improve the clinical documentation process, but natural language processing (NLP) tools might not be going far enough.
“I think we may need to be even bolder and consider changes like video recording a clinical encounter, almost like police wear body cams,” said Landman. “And then you can use AI and machine learning to index those videos for future information retrieval.
“And just like in the home, where we’re using Siri and Alexa, the future will bring virtual assistants to the bedside for clinicians to use with embedded intelligence for order entry.”
Artificial intelligence may also help to process routine requests from the inbox, like medication refills and result notifications. It may also help to prioritize tasks that truly require the clinician’s attention, Landman added, making it easier for users to work through their to-do lists.
CONTAINING THE RISKS OF ANTIBIOTIC RESISTANCE
Antibiotic resistance is a growing threat to populations around the world as overuse of these critical drugs fosters the evolution of superbugs that no longer respond to treatments. Multi-drug resistant organisms can wreak havoc in the hospital setting, and claim thousands of lives every year.
C. difficile alone accounts for approximately $5 billion in annual costs for the US healthcare system and claims more than 30,000 lives.
Electronic health record data can help to identify infection patterns and highlight patients at risk before they begin to show symptoms. Leveraging machine learning and AI tools to drive these analytics can enhance their accuracy and create faster, more accurate alerts for healthcare providers.
“AI tools can live up to the expectation for infection control and antibiotic resistance,” Erica Shenoy, MD, PhD, Associate Chief of the Infection Control Unit at MGH.
“If they don’t, then that’s really a failure on all of our parts. For the hospitals sitting on mountains of EHR data and not using them to the fullest potential, to industry that’s not creating smarter, faster clinical trial design, and for EHRs that are creating these data not to use them…that would be a failure.”
CREATING MORE PRECISE ANALYTICS FOR PATHOLOGY IMAGES
Pathologists provide one of the most significant sources of diagnostic data for providers across the spectrum of care delivery, says Jeffrey Golden, MD, Chair of the Department of Pathology at BWH and a professor of pathology at HMS.
“Seventy percent of all decisions in healthcare are based on a pathology result,” he said. “Somewhere between 70 and 75 percent of all the data in an EHR are from a pathology result. So the more accurate we get, and the sooner we get to the right diagnosis, the better we’re going to be. That’s what digital pathology and AI has the opportunity to deliver.”
Analytics that can drill down to the pixel level on extremely large digital images can allow providers to identify nuances that may escape the human eye.
“We’re now getting to the point where we can do a better job of assessing whether a cancer is going to progress rapidly or slowly and how that might change how patients will be treated based on an algorithm rather than clinical staging or the histopathologic grade,” said Golden. “That’s going to be a huge advance.”
Artificial intelligence can also improve productivity by identifying features of interest in slides before a human clinician reviews the data, he added.
“AI can screen through slides and direct us to the right thing to look at so we can assess what’s important and what’s not. That increases the efficiency of the use of the pathologist and increases the value of the time they spend for each case.”
BRINGING INTELLIGENCE TO MEDICAL DEVICES AND MACHINES
Smart devices are taking over the consumer environment, offering everything from real-time video from the inside of a refrigerator to cars that can detect when the driver is distracted.
In the medical environment, smart devices are critical for monitoring patients in the ICU and elsewhere. Using artificial intelligence to enhance the ability to identify deterioration, suggest that sepsis is taking hold, or sense the development of complications can significantly improve outcomes and may reduce costs related to hospital-acquired condition penalties.