People, ideas, machines. @enricocoiera AUSTRALIAN INSTITUTE OF - - PowerPoint PPT Presentation

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People, ideas, machines. @enricocoiera AUSTRALIAN INSTITUTE OF - - PowerPoint PPT Presentation

Jun 18, 2023 226 likes •473 views

People, ideas, machines. @enricocoiera AUSTRALIAN INSTITUTE OF HEALTH INNOVATION 2014 (1) 2016 (4) 2017 (6) 2018 (23) AUSTRALIAN INSTITUTE OF HEALTH INNOVATION Healthcare AI has quickly become a high stakes game. The promise of great

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AUSTRALIAN INSTITUTE OF HEALTH INNOVATION

People, ideas, machines.

@enricocoiera

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2014 (1) 2017 (6) 2018 (23) 2016 (4)

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Healthcare AI has quickly become a high stakes game. The promise of great reward is encouraging the taking of great risk.

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We don’t need to wait for technical breakthroughs to make a difference to healthcare today

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Dozens of RCTs now show clinical benefits

Screening

  • Detect diabetic retinopathy NPJ Digit. Med. (2018). 90.7% specificity. Led to

FDA approval.

  • Screen head CT images for acute neurologic events Nat. Med.(2018). Time to

diagnosis reduced from minutes to seconds. Diagnosis

  • Diagnose fracture in wrist radiographs. Natl. Acad. Sci. USA (2018). Av.

clinician relative reduction in misinterpretation rate of 47.0%.

  • Diagnose major depressive disorders. Scientific reports (2017) Sensitivity

increased across all severity levels and reached 73% for severe depression Treatment

  • Monitor medication adherence in opioid replacement therapy (AiCure)
  • Deliver cognitive behaviour therapy to young adults (Woebot) JMIR Ment.

Health (2017) significantly reduced their symptoms of depression compared to self-help online.

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AI enables new “Digital Only” services

  • A ‘digital only’ primary care provider might:
  • Have as its front door an app which:

– triages your problem using an AI driven symptom checker – Makes a booking using a chatbot – Organises repeat scripts via an online pharmacy

  • Provides online tele-consultations for problems needing human

interaction

  • Has a bricks and mortar partner where it can refer you when

physical presence is required

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BGPaH patient journey (from 2019 Independent Evaluation by Ipsos MORI)

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Australian Institute of Health Innovation, Macquarie University

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Australian Institute of Health Innovation, Macquarie University

Typically BGPaH patients are healthier than those at other practices even after adjusting for age.

(from 2019 Independent Evaluation by Ipsos MORI)

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Australian Institute of Health Innovation, Macquarie University

BGPaH patients are historically higher users of NHS 111 and A&E than might be expected.

(from 2019 Independent Evaluation by Ipsos MORI)

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The inverse care law

"The availability of good medical care tends to vary inversely with the need for it in the population served. This ... operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”

(Julian Tudor Hart, 1971)

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We are not designing algorithms. We are designing human-machine systems.

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The last mile

First mile

Data capture Cleaning Labeling

Middle mile

Model building and testing e.g. ML/DL

Last mile

Real world implementation Routine use

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AI and Thyroid Cancer Diagnosis

  • The DCNN showed improved performance in identifying thyroid

cancer patients versus skilled radiologists:

– specificity was 86·1% (81·1–90·2) versus 59·4% (53·0–65·6; p<0·0001). – sensitivity 93·4% (95% CI 89·6–96·1) versus 96·9% (93·9–98·6; p=0·003)

  • But thyroid cancer is over-diagnosed and over-treated (15-fold

increase in thyroid cancer in South Korea largely due to

  • verdiagnosis).
  • Many lesions will never lead to harm.
  • So might improved diagnostic performance by this AI cause more

unnecessary treatment, patient risks, and economic cost?

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The Australian Alliance for Artificial Intelligence in Healthcare (AAAiH)

Australian Institute of Health Innovation, Macquarie University

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AI Alliance Goals

  • Support and accelerate the adoption of

AI enabled health services in Australia

  • Build a community of shared interest

and pooled resource

  • Undertake essential research needed

to demonstrate AI-enabled services are scalable, sustainable, and have positive impacts on clinical and economic outcomes :

  • Precision Healthcare Flagship
  • Consumer Health Flagship
  • Rapidly build the national workforce

needed for success

  • To ensure AI is safe and ethical,

develop needed national regulatory and governance frameworks

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“People, ideas, things. And in that order.”

John Boyd (1927-1997)

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Thank you @enricocoiera enrico.coiera@mq.edu.au