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Patient engagement and adherence applications

Patient engagement and adherence has long been seen as the ‘last mile’ problem of healthcare – the final barrier between ineffective and good health outcomes. The more patients proactively participate in their own well-being and care, the better the outcomes – utilisation, financial outcomes and member experience. These factors are increasingly being addressed by big data and AI.

Providers and hospitals often use their clinical expertise to develop a plan of care that they know will improve a chronic or acute patient’s health. However, that often doesn’t matter if the patient fails to make the behavioural adjustment necessary, eg losing weight, scheduling a follow-up visit, filling prescriptions or complying with a treatment plan. Noncompliance – when a patient does not follow a course of treatment or take the prescribed drugs as recommended – is a major problem.

In a survey of more than 300 clinical leaders and healthcare executives, more than 70% of the respondents reported having less than 50% of their patients highly engaged and 42% of respondents said less than 25% of their patients were highly engaged.

If deeper involvement by patients results in better health outcomes, can AI-based capabilities be effective in personalising and contextualising care? There is growing emphasis on using machine learning and business rules engines to drive nuanced interventions along the care continuum. Messaging alerts and relevant, targeted content that provoke actions at moments that matter is a promising field in research.

Another growing focus in healthcare is on effectively designing the ‘choice architecture’ to nudge patient behaviour in a more anticipatory way based on real-world evidence. Through information provided by provider EHR systems, biosensors, watches, smartphones, conversational interfaces and other instrumentation, software can tailor recommendations by comparing patient data to other effective treatment pathways for similar cohorts. The recommendations can be provided to providers, patients, nurses, call-centre agents or care delivery coordinators.

Diagnosis and treatment applications

Diagnosis and treatment of disease has been a focus of AI since at least the 1970s, when MYCIN was developed at Stanford for diagnosing blood-borne bacterial infections. This and other early rule-based systems showed promise for accurately diagnosing and treating disease, but were not adopted for clinical practice. They were not substantially better than human diagnosticians, and they were poorly integrated with clinician workflows and medical record systems.

More recently, IBM’s Watson has received considerable attention in the media for its focus on precision medicine, particularly cancer diagnosis and treatment. Watson employs a combination of machine learning and NLP capabilities. However, early enthusiasm for this application of the technology has faded as customers realised the difficulty of teaching Watson how to address particular types of cancer and of integrating Watson into care processes and systems. Watson is not a single product but a set of ‘cognitive services’ provided through application programming interfaces (APIs), including speech and language, vision, and machine learning-based data-analysis programs. Most observers feel that the Watson APIs are technically capable, but taking on cancer treatment was an overly ambitious objective. Watson and other proprietary programs have also suffered from competition with free ‘open source’ programs provided by some vendors, such as Google’s TensorFlow.

Implementation issues with AI bedevil many healthcare organisations. Although rule-based systems incorporated within EHR systems are widely used, including at the NHS, they lack the precision of more algorithmic systems based on machine learning. These rule-based clinical decision support systems are difficult to maintain as medical knowledge changes and are often not able to handle the explosion of data and knowledge based on genomic, proteomic, metabolic and other ‘omic-based’ approaches to care.

This situation is beginning to change, but it is mostly present in research labs and in tech firms, rather than in clinical practice. Scarcely a week goes by without a research lab claiming that it has developed an approach to using AI or big data to diagnose and treat a disease with equal or greater accuracy than human clinicians. Many of these findings are based on radiological image analysis, though some involve other types of images such as retinal scanning or genomic-based precision medicine. Since these types of findings are based on statistically-based machine learning models, they are ushering in an era of evidence- and probability-based medicine, which is generally regarded as positive but brings with it many challenges in medical ethics and patient/clinician relationships.

Tech firms and startups are also working assiduously on the same issues. Google, for example, is collaborating with health delivery networks to build prediction models from big data to warn clinicians of high-risk conditions, such as sepsis and heart failure. Google, Enlitic and a variety of other startups are developing AI-derived image interpretation algorithms. Jvion offers a ‘clinical success machine’ that identifies the patients most at risk as well as those most likely to respond to treatment protocols. Each of these could provide decision support to clinicians seeking to find the best diagnosis and treatment for patients.

There are also several firms that focus specifically on diagnosis and treatment recommendations for certain cancers based on their genetic profiles. Since many cancers have a genetic basis, human clinicians have found it increasingly complex to understand all genetic variants of cancer and their response to new drugs and protocols. Firms like Foundation Medicine and Flatiron Health, both now owned by Roche, specialise in this approach.

Both providers and payers for care are also using ‘population health’ machine learning models to predict populations at risk of particular diseases or accidents or to predict hospital readmission. These models can be effective at prediction, although they sometimes lack all the relevant data that might add predictive capability, such as patient socio-economic status.

But whether rules-based or algorithmic in nature, AI-based diagnosis and treatment recommendations are sometimes challenging to embed in clinical workflows and EHR systems. Such integration issues have probably been a greater barrier to broad implementation of AI than any inability to provide accurate and effective recommendations; and many AI-based capabilities for diagnosis and treatment from tech firms are standalone in nature or address only a single aspect of care. Some EHR vendors have begun to embed limited AI functions (beyond rule-based clinical decision support) into their offerings, but these are in the early stages. Providers will either have to undertake substantial integration projects themselves or wait until EHR vendors add more AI capabilities.

Robotic process automation

This technology performs structured digital tasks for administrative purposes, ie those involving information systems, as if they were a human user following a script or rules. Compared to other forms of AI they are inexpensive, easy to program and transparent in their actions. Robotic process automation (RPA) doesn’t really involve robots – only computer programs on servers. It relies on a combination of workflow, business rules and ‘presentation layer’ integration with information systems to act like a semi-intelligent user of the systems. In healthcare, they are used for repetitive tasks like prior authorisation, updating patient records or billing. When combined with other technologies like image recognition, they can be used to extract data from, for example, faxed images in order to input it into transactional systems.

We’ve described these technologies as individual ones, but increasingly they are being combined and integrated; robots are getting AI-based ‘brains’, image recognition is being integrated with RPA. Perhaps in the future these technologies will be so intermingled that composite solutions will be more likely or feasible.

Physical robots

Physical robots are well known by this point, given that more than 200,000 industrial robots are installed each year around the world. They perform pre-defined tasks like lifting, repositioning, welding or assembling objects in places like factories and warehouses, and delivering supplies in hospitals. More recently, robots have become more collaborative with humans and are more easily trained by moving them through a desired task. They are also becoming more intelligent, as other AI capabilities are being embedded in their ‘brains’ (really their operating systems). Over time, it seems likely that the same improvements in intelligence that we’ve seen in other areas of AI would be incorporated into physical robots.

Surgical robots, initially approved in the USA in 2000, provide ‘superpowers’ to surgeons, improving their ability to see, create precise and minimally invasive incisions, stitch wounds and so forth. Important decisions are still made by human surgeons, however. Common surgical procedures using robotic surgery include gynaecologic surgery, prostate surgery and head and neck surgery

Rule-based expert systems

Expert systems based on collections of ‘if-then’ rules were the dominant technology for AI in the 1980s and were widely used commercially in that and later periods. In healthcare, they were widely employed for ‘clinical decision support’ purposes over the last couple of decades and are still in wide use today. Many electronic health record (EHR) providers furnish a set of rules with their systems today.

Expert systems require human experts and knowledge engineers to construct a series of rules in a particular knowledge domain. They work well up to a point and are easy to understand. However, when the number of rules is large (usually over several thousand) and the rules begin to conflict with each other, they tend to break down. Moreover, if the knowledge domain changes, changing the rules can be difficult and time-consuming. They are slowly being replaced in healthcare by more approaches based on data and machine learning algorithms.

Natural language processing

Making sense of human language has been a goal of AI researchers since the 1950s. This field, NLP, includes applications such as speech recognition, text analysis, translation and other goals related to language. There are two basic approaches to it: statistical and semantic NLP. Statistical NLP is based on machine learning (deep learning neural networks in particular) and has contributed to a recent increase in accuracy of recognition. It requires a large ‘corpus’ or body of language from which to learn.

In healthcare, the dominant applications of NLP involve the creation, understanding and classification of clinical documentation and published research. NLP systems can analyse unstructured clinical notes on patients, prepare reports (eg on radiology examinations), transcribe patient interactions and conduct conversational AI.

Machine learning – neural networks and deep learning

Machine learning is a statistical technique for fitting models to data and to ‘learn’ by training models with data. Machine learning is one of the most common forms of AI; in a 2018 Deloitte survey of 1,100 US managers whose organisations were already pursuing AI, 63% of companies surveyed were employing machine learning in their businesses. It is a broad technique at the core of many approaches to AI and there are many versions of it.

In healthcare, the most common application of traditional machine learning is precision medicine – predicting what treatment protocols are likely to succeed on a patient based on various patient attributes and the treatment context. The great majority of machine learning and precision medicine applications require a training dataset for which the outcome variable (eg onset of disease) is known; this is called supervised learning.

A more complex form of machine learning is the neural network – a technology that has been available since the 1960s has been well established in healthcare research for several decades and has been used for categorisation applications like determining whether a patient will acquire a particular disease. It views problems in terms of inputs, outputs and weights of variables or ‘features’ that associate inputs with outputs. It has been likened to the way that neurons process signals, but the analogy to the brain’s function is relatively weak.

The most complex forms of machine learning involve deep learning, or neural network models with many levels of features or variables that predict outcomes. There may be thousands of hidden features in such models, which are uncovered by the faster processing of today’s graphics processing units and cloud architectures. A common application of deep learning in healthcare is recognition of potentially cancerous lesions in radiology images. Deep learning is increasingly being applied to radiomics, or the detection of clinically relevant features in imaging data beyond what can be perceived by the human eye. Both radiomics and deep learning are most commonly found in oncology-oriented image analysis. Their combination appears to promise greater accuracy in diagnosis than the previous generation of automated tools for image analysis, known as computer-aided detection or CAD.

Deep learning is also increasingly used for speech recognition and, as such, is a form of natural language processing (NLP), described below. Unlike earlier forms of statistical analysis, each feature in a deep learning model typically has little meaning to a human observer. As a result, the explanation of the model’s outcomes may be very difficult or impossible to interpret.

Types of AI of relevance to healthcare

Artificial intelligence is not one technology, but rather a collection of them. Most of these technologies have immediate relevance to the healthcare field, but the specific processes and tasks they support vary widely. Some particular AI technologies of high importance to healthcare are given below:

• Machine learning – neural networks and deep learning
• Rule-based expert systems
• Physical robots
• Robotic process automation

• Natural language processing

What is AI in Healthcare?

Artificial intelligence (AI) and related technologies are increasingly prevalent in business and society, and are beginning to be applied to healthcare. These technologies have the potential to transform many aspects of patient care, as well as administrative processes within provider, payer and pharmaceutical organisations.

There are already a number of research studies suggesting that AI can perform as well as or better than humans at key healthcare tasks, such as diagnosing disease. Today, algorithms are already outperforming radiologists at spotting malignant tumours, and guiding researchers in how to construct cohorts for costly clinical trials. However, for a variety of reasons, we believe that it will be many years before AI replaces humans for broad medical process domains. In this article, we describe both the potential that AI offers to automate aspects of care and some of the barriers to rapid implementation of AI in healthcare.

 

ARTIFICIAL INTELLIGENCE IN HEALTHCARE

I am Mehak, student at Charles Sturt University. I am currently pursuing my Master’s in Information and Technology and my specialisation is Business Analysis. I am really passionate about reading articles related to the growing technologies. My field of interest is Artificial Intelligence. 

Artificial Intelligence (AI) is an emerging technology and its usage is growing rapidly in each filed. AI is making a rapid growth in narrowing the gaps in healthcare. An important field of research involves designing machines, which can think and make decisions in different situations normally requiring human’s intelligence. There is a need to innovate technologies, which can diagnose better than humans. Deploying AI at general screenings could help in detecting life threatening diseases at early stages and subsequently develop new and better treatments. This is where AI can have a huge impact by allowing us to use our limited time in the most meaningful way.