BE PART OF THE REVOLUTION TRANSFORMING HEALTHCARE WITH AI - - PowerPoint PPT Presentation

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BE PART OF THE REVOLUTION TRANSFORMING HEALTHCARE WITH AI - - PowerPoint PPT Presentation

BE PART OF THE REVOLUTION TRANSFORMING HEALTHCARE WITH AI CALIFORNIA THE RITZ-CARLTON, LAGUNA NIGUEL 1114 DECEMBER 2019 1000 ATTENDEES 80 SPEAKERS 10 WORKSHOPS www.aimed.events/northamerica-2019/ 2 SOCIAL EVENTS #AIMed19 1 AIMed19


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Insert Logo, text, URLs, etc here 1000 ATTENDEES 80 SPEAKERS 10 WORKSHOPS 2 SOCIAL EVENTS 1 AIMed19

www.aimed.events/northamerica-2019/ #AIMed19

BE PART OF THE REVOLUTION

TRANSFORMING HEALTHCARE WITH AI

CALIFORNIA — THE RITZ-CARLTON, LAGUNA NIGUEL 11–14 DECEMBER 2019

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Edward H. Shortliffe, MD, PhD; Professor (Adjunct, Retired) Columbia University Arizona State University Weill Cornell Medical College Senior Executive Consultant, IBM Watson Health AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019 www.aimed.events/northamerica-2019

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tedshortliffe @tshortliffe

Look Looking g Ah Ahea ead with Both Ca Caution and Eager r An Anticipa pation

  • n
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JAMA 2018;320(21):2199-2200 CDSS = Clinical Decision-Support System

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Varying Models of Decision Support: Medical-Device Data Interpretation

Decision-specific clinical data (e.g., from measurement device) Software produces interpretive report e.g.

  • Electrocardiogram
  • Electroencephologram
  • Radiologic images

Well accepted: May be reviewed first by expert; clinician decides how to use result Deliver to clinician Clinician verifies interpretation and incorporates it into decision making process

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AI & Machine Learning for Data Analytics

  • JAMA. 2017;318(22):2211-2223
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Varying Models of Decision Support: Event Monitoring and Alerts

Repository for clinical information

  • n a patient (e.g.,

EHR) Interface to clinician for chart review and

  • rder entry

Event monitoring software Knowledge base of what to watch for (e.g. rules) If: patient is receiving digoxin and serum potassium is low Then: warn physician that patient may require potassium replacement Decision support:

  • Warnings
  • Alerts
  • Guidance
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Two Major Consulting Questions for Medical AI to Address What does my patient have? (a question about what is true right now) What should I do for my patient? (a question about action-oriented decision making)

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Varying Models of Decision Support: Direct Consultation with Clinical User

Clinical advisory tool (typically for diagnosis or treatment) Repository for clinical information

  • n a patient (e.g.,

EHR) Analytical methods (e.g. rules, scoring function, statistical) Interface to clinician that integrates decision support with chart review and order entry Issues:

  • Transparency/explanation
  • Time requirements
  • Usability and complexity
  • Relevance and insight
  • Respect for user
  • Scientific foundation

“Greek Oracle” model Preferred model

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

Cr Criter eria for

  • r CD

CDSS Accept cceptance nce and nd In Integ egra ration

  • n into
  • Wo

Workf kflow

  • Black boxes are unacceptable:
  • A Clinical Decision-Support System (CDSS) requires

transparency so that users can understand the basis for any advice or recommendations that are offered.

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

Cr Criter eria for

  • r CD

CDSS Accept cceptance nce and nd In Integ egra ration

  • n into
  • Work
  • rkflow
  • w
  • Time is a scarce resource:
  • A CDSS should be efficient in terms of time requirements

and must blend into the workflow of the busy clinical environment.

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

Cr Criter eria for

  • r CD

CDSS Accept cceptance nce and nd In Integ egra ration

  • n into
  • Work
  • rkflow
  • w
  • Complexity and lack of usability thwart use:
  • A CDSS should be intuitive and simple to learn and use

so that major training is not required and it is easy to

  • btain advice or analytic results.
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Users vote with their feet….

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

Cr Criter eria for

  • r CD

CDSS Accept cceptance nce and nd In Integ egra ration

  • n into
  • Work
  • rkflow
  • w
  • Relevance and insight are essential:
  • A CDSS should reflect an understanding of the pertinent

domain and the kinds of questions with which clinicians are likely to want assistance.

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Rapid pulse, sweating, shallow breathing. According to the computer, you’ve got gallstones.

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

Cr Criter eria for

  • r CD

CDSS Accept cceptance nce and nd In Integ egra ration

  • n into
  • Work
  • rkflow
  • w
  • Delivery of knowledge and information must be

respectful

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

Cr Criter eria for

  • r CD

CDSS Accept cceptance nce and nd In Integ egra ration

  • n into
  • Work
  • rkflow
  • w
  • Delivery of knowledge and information must be

respectful:

  • A CDSS should offer advice in a way that recognizes the

expertise of the user, making it clear that it is designed to inform and assist but not to replace a clinician.

X

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

Cr Criter eria for

  • r CD

CDSS Accept cceptance nce and nd In Integ egra ration

  • n into
  • Work
  • rkflow
  • w
  • Scientific foundation must be strong:
  • A CDSS should have rigorous, peer-reviewed scientific

evidence establishing its safety, validity, reproducibility, usability, and reliability.

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

De Decisi sion Ma Making is s Not the Only Topic fo for E Eval valuati ations ns

  • Time requirements and impact on workflow
  • Usability and acceptability
  • Impact of system use on clinician’s subsequent

decisions

  • Ultimate impact on patient outcomes
  • Cost-effectiveness of the introduction and use of the

technology

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

So Some Im Implic licatio tions

  • Commercialization of clinical decision support systems

requires a time-consuming staged evaluation plan that demonstrates more than quality of advice

  • Early adopters naturally become partners in evaluation

studies, since many questions cannot be answered in the laboratory and must be assessed in actual clinical use environments

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www.aimed.events/northamerica-2019/

AIMed NORTH AMERICA, CALIFORNIA 11–14 DECEMBER 2019

Th The F Futu ture

  • Decision support evaluation partnerships similar to

those that have long existed in pharmaceutical industry

  • Interactive medical AI systems and their

promulgation will be highly dependent on success in standards setting, interoperability, and rigorous evaluations

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Th Thank k You

ted@shortliffe.net