ARTIFICIAL INTELLIGENCE IN HEALTHCARE

Shivangi Saxena, BCA (VI th Sem)

Email: shivangisaxena03111998@gmail.com

Trinity Institute of Professional Studies

Dwarka Sector 9, Institutional Area, Near Metro Pillar No.1160

Nearest Metro Station Dwarka Sector 10, New Delhi-110075

Phone: 011- 45636921/22/23

Website: www.tips.edu.in

Email: tips@tips.edu.in

ABSTRACT WHAT IS AI?

Artificial intelligence (AI) aims to mimic There is no universally agreed definition of

human cognitive functions. It is bringing a
paradigm shift to healthcare, powered by
increasing availability of healthcare data
and rapid progress of analytics techniques.
We survey the current status of AI
applications in healthcare and discuss its
future. AI can be applied to various types of
healthcare data (structured and
unstructured). Popular AI techniques
include machine learning methods for
structured data, such as the classical support
vector machine and neural network, and the
modern deep learning, as well as natural
language processing for unstructured data.
Major disease areas that use AI tools
include cancer, neurology and cardiology.
We then review in more details the AI
applications in stroke, in the three major
areas of early detection and diagnosis,
treatment, as well as outcome prediction
and prognosis evaluation.
AI. The term broadly refers to computing
technologies that resemble processes
associated with human intelligence, such as
reasoning, learning and adaptation, sensory
understanding, and interaction.1 Currently,
most applications of AI are narrow, in that
they are only able to carry out specific tasks
or solve pre-defined problems.
OVERVEIW OF THE MEDICAL
ARTIFICIAL INTELLIGENCE (AI)
RESEARCH
Recently AI techniques have sent vast
waves across healthcare, even fuelling an
active discussion of whether AI doctors will
eventually replace human physicians in the
future. We believe that human physicians
will not be replaced by machines in the
foreseeable future, but AI can definitely
assist physicians to make better clinical
decisions or even replace human judgement
in certain functional areas of healthcare (eg,
radiology). Guided by relevant clinical
questions, powerful AI techniques can
unlock clinically relevant information
hidden in the massive amount of data,
which in turn can assist clinical decision
making.
In this article, we survey the current status
of AI in healthcare, as well as discuss its
future. We first briefly review four relevant
aspects from medical investigators’
perspectives:
1. motivations of applying AI in
healthcare
2. data types that have be analysed by
AI systems
3. mechanisms that enable AI systems
to generate clinical meaningful
results
4. disease types that the AI
communities are currently tackling.
HEALTHCARE DATA
Before AI systems can be deployed in
healthcare applications, they need to be
‘trained’ through data that are generated
from clinical activities, such as screening,
diagnosis, treatment assignment and so on,
so that they can learn similar groups of
subjects, associations between subject
features and outcomes of interest. These
clinical data often exist in but not limited to
the form of demographics, medical notes,
electronic recordings from medical devices,
physical examinations and clinical
laboratory and images.
Specifically, in the diagnosis stage, a
substantial proportion of the AI literature
analyses data from diagnosis imaging,
genetic testing and electrodiagnosis (figure
1)

MOTIVATION

The advantages of AI have been

extensively discussed in the medical
literature. AI can use sophisticated
algorithms to ‘learn’ features from a large
volume of healthcare data, and then use the
obtained insights to assist clinical practice.
It can also be equipped with learning and
self-correcting abilities to improve its
accuracy based on feedback. An AI system
can assist physicians by providing up-to-
date medical information from journals,
textbooks and clinical practices to inform
proper patient care. In addition, an AI Figure 1
system can help to reduce diagnostic and The data types considered in the
therapeutic errors that are inevitable in the artificial intelligence artificial (AI)
human clinical practice Moreover, an AI literature. The comparison is obtained
system extracts useful information from a through searching the diagnosis
large patient population to assist making techniques in the AI literature on the
real-time inferences for health risk alert and PubMed database.
health outcome prediction. IMPACT ON HEALTHCARE

More engaged and discerning consumers

are exerting greater influence on health
systems and driving new business models.
This trend is opening the door for new
entrants from industries such as retail,
telecommunications, technology, and
wellness and fitness. At the same time, new
products, services and delivery systems are
helping to democratise and decentralise
healthcare.
An era of patient-centric health systems is
emerging. We are seeing a general shift
away from fragmented care to integrated
models: organisations, communities and
social care providers coordinating their
services, with patients as active partners in
their health across the continuum.
Informed consumers will demand
increasing accountability, integrity and
transparency from their health systems.
Meanwhile, the pressure is on governments
to provide sustainable care in the face of
anticipated significant increases in
healthcare costs. The private sector offers
partnership opportunities to satisfying
consumer demands. As financial
performance is tied to clinical outcomes,
patient engagement will also become
increasingly important. The private sector
has the resources and innovative
technologies to meet the outcomes that
informed consumers increasingly value.
These companies can invest in insights and
have the versatility to adapt to satisfy
consumer needs.
mHealth services are already replacing
visits to nurses and doctors. Wireless
technology will improve access to health
for people around the world. As the
technologies improve and patients discover
they hold the power of self-care on their
personal devices, they will expect to have
greater access to these services. Mobile
technologies will improve the quality of
care they receive while easing some of the
pressures on the health system.
Widening choices in a growing global
health market have opened the doors for
new players like telecommunications to
access the broad healthcare consumer base.
PATIENT AND CONSUMER-FACING
APPLICATIONS
Our analysis of mHealth reveals mobile is
positioned to have a huge impact on how
healthcare is delivered. It offers
opportunities to address one of the most
pressing global challenges: making
healthcare more accessible, faster, better
and cheaper.
Mobile is accelerating trends in
healthcare
Three major trends already happening in
healthcare lend themselves to the revolution
in mobile technology:
• Ageing population: Ageing populations
and chronic illness are driving regulatory
reform. Public sector healthcare is seeking
better access and quality, and it’s looking to
the private sector for innovation and
efficiency. mHealth improves access and
quality, and offers dramatic innovation and
cost reduction.
• Foundations already in place: The
foundations of industrialisation of
healthcare are already in place — electronic
medical records, remote monitoring and
communications. ‘Care anywhere’ is
 already emerging. The platform for
mHealth is set.
• Personalisation: Healthcare, like other
industries, is getting personal. mHealth can
offer personal toolkits for predictive,
participatory and preventative care.
CURRENT MARKET SITUATION
More demanding and discerning consumers
are opening doors for new entrants in
healthcare provision. Consumers are taking
advantage of unprecedented access to
information to become more diligent and
informed about their health. The growing
power of the patient as discerning consumer
is creating new global markets and
informing new models for care.
Patients are demanding more sophisticated,
convenient, transparent, affordable and
personalised service. As a result, an agile
private sector has gained a strong foothold
in the delivery and financing of healthcare.
In a recent PwC consumer survey, almost
half of respondents said they would
consider having procedures like wound
treatment, stitches or staples removed at a
retail clinic or pharmacy. One-third said
they would get an MRI at a retail venue.
The underlying message is that patients are
accepting greater accountability for their
health.
Patients are also welcoming the flexibility
that technology brings to their care.
Increasingly, they are willing to be
monitored wirelessly for their conditions,
and to consider receiving traditionally
hospital-based medical treatments, such as
chemotherapy, at home. Obtaining readings
from devices like electrocardiograms,
pacemakers or defibrillators, which
generally requires an in-person visit, can
now be done through a mobile phone and
wirelessly sent to a physician.
Patients are taking a greater interest in their
care and are more willing to self-manage.
They want to be more empowered when it
comes to their health. Leveraging available
health information, new technology, and
mobile health (mHealth), the empowered
consumer knows more, wants more and is
able to do more for themselves.
An era of patient-centric health systems is
emerging, with a shift away from
fragmented care to integrated models.
ETHICAL AND SOCIAL ISSUES
Many ethical and social issues raised by AI
overlap with those raised by data use;
automation; the reliance on technologies
more broadly; and issues that arise with the
use of assistive technologies and
‘telehealth’.
• RELIABILITY AND SAFETY
Reliability and safety are key issues where
AI is used to control equipment, deliver
treatment, or make decisions in healthcare.
AI could make errors and, if an error is
difficult to detect or
has knock-on effects, this could have
serious implications. For example, in a
2015 clinical trial, an AI app was used to
predict which patients were likely to
develop complications following
pneumonia, and therefore should be
hospitalised. This app erroneously
instructed doctors to send home patients
with asthma due to its inability to take
contextual information into account. The
performance of symptom checker apps
using AI, has been questioned. For
example, it has been found that
recommendations from apps might be
overly cautious, potentially increasing
demand for unnecessary tests and
treatments.
• TRANSPARENCY AND
ACCOUNTABILITY
It can be difficult or impossible to
determine the underlying logic that
generates the outputs
produced by AI. Some AI is proprietary and
deliberately kept secret, but some are
simply too complex for a human to
understand. Machine learning technologies
can be particularly opaque because of the
way they continuously tweak their own
parameters and rules as they learn. This
creates problems for validating the outputs
of AI systems, and identifying errors or
biases in the data. The new EU General
Data Protection Regulation (GDPR) states
that data subjects have the right not to be
subject to a decision based solely on
automated processing that produces legal or
similarly significant effects. It further states
that information provided to individuals
when data about them are used should
include “the existence of automated
decision-making, (...) meaningful
information about the logic involved, as
well as the significance and the envisaged
consequences of such processing for the
data subject”. However, the scope and
content of these restrictions - for example,
whether and how AI can be intelligible -
and how they will apply in the UK, remain
uncertain and contested. Related questions
include who is accountable for decisions
made by AI and how anyone harmed by the
use of AI can seek redress.
• DATA BIAS, FAIRNESS, AND
EQUITY
Although AI applications have the potential
to reduce human bias and error, they can
also
reflect and reinforce biases in the data used
to train them. Concerns have been raised
about
the potential of AI to lead to discrimination
in ways that may be hidden or which may
not align with legally protected
characteristics, such as gender, ethnicity,
disability, and age. The House of Lords
Select Committee on AI has cautioned that
datasets used to train AI systems are often
poorly representative of the wider
population and, as a result, could make
unfair decisions that reflect wider
prejudices in society. The Committee also
found that biases can be embedded in the
algorithms themselves, reflecting the
beliefs and prejudices of AI developers.
Several commentators have called for
increased diversity among developers to
help address this issue. The benefits of AI
in healthcare might not be evenly
distributed. AI might work less well where
data are scarce or more difficult to collect
or render digitally. This could affect people
with rare medical conditions, or others who
are underrepresented in clinical trials and
research data, such as Black, Asian, and
minority ethnic populations.
LIMITS OF AI
AI depends on digital data, so
inconsistencies in the availability and
quality of data restrict the
potential of AI. Also, significant computing
power is required for the analysis of large
and complex data sets. While many are
enthusiastic about the possible uses of AI in
the NHS, others point to the practical
challenges, such as the fact that medical
records are not consistently digitised across
the NHS, and the lack of interoperability
and standardisation in NHS IT systems,
digital record keeping, and data labelling.
There are questions about the extent to
which patients and doctors are comfortable
with digital sharing of personal health
data.40 Humans have attributes that AI
systems might not be able to authentically
possess, such as compassion. Clinical
practice often involves complex judgments
and abilities that AI currently is unable to
replicate, such as contextual knowledge and
the ability to read social cues. There is also
debate about whether some human
knowledge is tacit and cannot be taught.
Claims that AI will be able to display
autonomy have been questioned on grounds
that this is a property essential to being
human and by definition cannot be held by
a machine.
CHALLENGES FOR GOVERNANCE
AI has applications in fields that are subject
to regulation, such as data protection,
research,
and healthcare. However, AI is developing
in a fast-moving and entrepreneurial
manner that
might challenge these established
frameworks. A key question is whether AI
should be regulated as a distinct area, or
whether different areas of regulation should
be reviewed with the possible impact of AI
in mind. Further challenges include the
need to ensure
that the way AI is developed and used is
transparent, accountable, and compatible
with
public interest, and balanced with the desire
to drive UK innovation. Many have raised
the need for researchers, healthcare
professionals, and policy-makers to be
equipped with the relevant skills and
knowledge to evaluate and make the best
use of AI.
THE FUTURE OF AI
In the future, it is likely that AI systems will
become more advanced and attain the
ability to
carry out a wider range of tasks without
human control or input. If this comes about,
some have suggested that AI systems will
need to learn to ‘be ethical’ and to make
ethical decisions. This is the subject of
much philosophical debate, raising
questions about whether and how ethical
values or principles can ever be coded or
learnt by a machine; who, if anyone, should
decide on these values; and whether duties
that apply to humans can or should apply to
machines, or whether new ethical principles
might be needed.
CONCLUSION
We reviewed the motivation of using AI in
healthcare, presented the various healthcare
data that AI has analysed and surveyed the
major disease types that AI has been
deployed. We then discussed in details the
two major categories of AI devices:
ML and NLP. For ML, we focused on the
two most popular classical techniques:
SVM and neural network, as well as the
modern deep learning technique. We then
surveyed the three major categories of AI
applications in stroke care.
A successful AI system must possess the
ML component for handling structured data
(images, EP data, genetic data) and the
NLP component for mining unstructured
texts. The sophisticated algorithms then
need to be trained through healthcare data
before the system can assist physicians with
disease diagnosis and treatment
suggestions.
The IBM Watson system is a pioneer in this
field. The system includes both ML and
NLP modules, and has made promising
progress in oncology. For example, in a
cancer research, 99% of the treatment
recommendations from Watson are
coherent with the physician decisions.
Furthermore, Watson collaborated with
Quest Diagnostics to offer the AI Genetic
Diagnostic Analysis. In addition, the
system started to make impact on actual
clinical practices. For example, through
analysing genetic data, Watson successfully
identified the rare secondary leukaemia
caused by myelodysplastic syndromes in
Japan.
Stroke is a chronic disease with acute
events. Stroke management is a rather
complicated process with a series of clinical
decision points. Traditionally clinical
research solely focused on a single or very
limited clinical questions, while ignoring
the continuous nature of stroke
management. Taking the advantage of large
amount of data with rich information, AI is
expected to help with studying much more
complicated yet much closer to real-life
clinical questions, which then leads to
better decision making in stroke
management. Recently, researchers have
started endeavours along this direction and
obtained promising initial results.
Although the AI technologies are attracting
substantial attentions in medical research,
the real-life implementation is still facing
obstacles. The first hurdle comes from the
regulations. Current regulations lack of
standards to assess the safety and
efficacy of AI systems. To overcome the
difficulty, the US FDA made the first
attempt to provide guidance for assessing
AI systems. The first guidance classifies AI
systems to be the ‘general wellness
products’, which are loosely regulated as
long as the devices intend for only general
wellness and present low risk to users. The
second guidance justifies the use of real-
world evidence to access the performance
of AI systems. Lastly, the guidance clarifies
the rules for the adaptive design in clinical
trials, which would be widely used in
assessing the operating characteristics of AI
systems. Not long after the disclosure of
these guidances, Arterys’ medical imaging
platform became the first FDA-approved
deep learning clinical platform that can help
cardiologists to diagnose cardiac diseases.
The second hurdle is data exchange. In
order to work well, AI systems need to be
trained (continuously) by data from clinical
studies. However, once an AI system gets
deployed after initial training with
historical data, continuation of the data
supply becomes a crucial issue for further
development and improvement of the
system. Current healthcare environment
does not provide incentives for sharing data
on the system. Nevertheless, a healthcare
revolution is under way to stimulate data
sharing in the USA. The reform starts with
changing the health service payment
scheme. Many payers, mostly insurance
companies, have shifted from rewarding the
physicians by shifting the treatment volume
to the treatment outcome. Furthermore, the
payers also reimburse for a medication or a
treatment procedure by its efficiency.
Under this new environment, all the parties
in the healthcare system, the physicians, the
pharmaceutical companies and the patients,
have greater incentives to compile and
exchange information. Similar approaches
are being explored in China.
REFERENCES
1. IBM Research (5 January 2017)
IBM 5 in 5: with AI, our words will
be a window into our mental health.
2. STAT (5 September 2017) IBM
pitched its Watson supercomputer
as a revolution in cancer care. It’s
nowhere close.
3. British Academy and Royal Society
(2017) Data management and use:
governance in the 21st century.
4. See www.nuffieldbioethics.org
5. https://svn.bmj.com/content/2/4/230