Exploring Artificial Intelligence

What is artificial intelligence?

Created by the state legislature in 2019, the Vermont Artificial Intelligence Task Force issued its final report in January. The state became one of the first to weigh in on the potential benefits and risks of a technology that is many things to many different sectors. The report cites a definition of artificial intelligence (AI) that comes from an expert group set up by the European Commission:

“Artificial intelligence systems are systems (usually software) capable of perceiving an environment through data acquisition and then processing and interpreting the derived information to take action(s) or imitate intelligent behavior given a specified goal,” the definition reads. “AI systems can also learn/adapt their behavior by analyzing how the environment is affected by prior actions.”

The Vermont task force recognized that AI is already impacting major sectors of the state’s economy, including agriculture and natural resources, transportation and manufacturing, law enforcement, government and services and health care.

“In health care, artificial intelligence applications already examine patient X-ray and skin images to advise health professionals on whether particular areas warrant closer examination for the presence of cancer,” the panel’s report said.

AI applications are also used to process large volumes of patient data to optimize the diagnosis and care of patients and to better map the efficacy of medical therapies, the report noted.

While recognizing the importance of AI to medicine and other sectors, as well as its potential impacts on labor, civil liberties and other areas, the task force ultimately decided not to recommend new state regulations of AI at this time, but to recommend a permanent AI commission to study and monitor its development.

“We didn’t have enough information … and our conclusion is that we needed a longer term committee, something that could also delve more deeply into different areas that might look at regulation,” said Eugene Santos Jr., a professor of engineering at Dartmouth College in neighboring New Hampshire, who was appointed by the Vermont House of Representatives to serve on the task force.

States like Alabama, New York and Washington have all established AI task forces or commissions that are in various stages of their discussions. Santos believes they can learn much from Vermont’s experience.

“What we went through, I think the majority of the other states and organizations will also have to go through the same thing in just getting the landscape,” he said.

What is Artificial Intelligence in Health Care?

Edmund Jackson knows a bit about what AI means in the context of health care. He’s the chief data officer at HCA Healthcare, the Nashville-based for-profit operator of 185 hospitals and 119 freestanding surgery centers in the U.S. and the United Kingdom. HCA Healthcare is partnering with and advising CSG’s Healthy States National Task Force this year.

“As I usually encounter it, (AI is) a marketing strategy masquerading as a technology,” he said. “That’s a little facetious. Ultimately, my definition of AI is that it’s the next impossible thing that a computer is about to do. It’s a very, very old term. It comes to us from the 60s when the first perceptron algorithms were created, and really, it’s kind of a grab-all term or bucket term for things that are slightly beyond what normal computers are doing at any given time.”

“We have a lot of machine learning that goes on in health care,” he said. “There are a lot of rules and clinical decision support, but in terms of computers speaking or acting or seeing at the level of a human, I don’t really think it exists. […] There’s a lot in the press and the literature about computers making diagnoses. We don’t have that. For us at HCA Healthcare, the very clear thing is the provider makes the diagnosis. The provider is the locus of action and decision making. Computers can provide support in that in terms of using algorithms to fuse data together to better inform or to bring things together in a timely fashion.”

This year’s coronavirus outbreak has provided a significant proving ground for AI in many respects. Machine learning algorithms have been deployed to track the outbreak and to forecast how it would spread. Predictive analytics have been used to predict which COVID-19 patients would experience the most severe symptoms. Deep learning algorithms have been put to work finding new information about the structure of proteins associated with COVID-19 and speeding up drug research. Health care facilities and others have also deployed algorithms to manage the scheduling and logistical challenges presented by the epidemic and to deploy personnel and resources where they have been most needed.

Creating the Algorithms That Drive Artificial Intelligence

It's in the design of algorithms—the processes or sets of rules that tell a computer how to calculate and solve problems—that some of the biggest challenges for artificial intelligence come into play. For one thing, many of the health care algorithms used today are being designed by tech companies that aren’t actually in the business of providing health care, Jackson said. Another concern is that algorithms—and the data they process—can often take on the biases of the humans deploying them.

“Honestly, it’s something that keeps me up at night,” Jackson said. “Algorithms generally are trained from the data. They encapsulate, reflect and hardwire history. So, if a thing occurs in a certain way historically, the algorithm will capture that and ensure that it occurs again with low variation in the future. If the historical behavior is biased, that will appear in the algorithm, and for sure, that’s a real problem. The other one is it can be really insidious as to how racial or gender or other biases can actually transmit through data.”

Jackson pointed to the example of an algorithm his team worked to design that inadvertently incorporated zip codes of individuals, which can be highly correlated with race.

Some are also concerned that the proliferation of algorithms in clinical decision support tools used by health care providers could contribute to inequities and other problems that already exist in the system.

Illinois state Rep. Tom Demmer is director of Innovation & Strategy at Katherine Shaw Bethea Hospital in Dixon and a member of the What’s Next? Leveraging Innovation subcommittee of the CSG Healthy States National Task Force.

“Do you see that there will be a situation in which there is kind of a different algorithm based on which (electronic health record) you use […] and we might have 100 different algorithms that are in play, maybe giving different guidance to providers?” he asked during the subcommittee’s session at the 2019 CSG National Conference in December. “Understanding, too, how even with a small tweak in an algorithm, we might see very different utilization trends, I worry about an algorithm that maybe 10 years ago would have contributed even more toward opioid over-prescription. […] What can we do to make sure that algorithms aren’t contributing to some of those trends that are already causing some problems in medicine? […] Do you think we’ll be in a world where you get a different flavor of algorithm depending on which provider you see?”

Jackson said that’s the world we’re already living in.

“I think that we will see a growing number of AIs out there, and it will affect the care experience that you experience in any particular venue,” he said. “The truth of the matter is that’s already the case depending on the physicians and the nurses and the other caregivers in any given care setting. If you have the superstar doctor in a particular hospital, your care experience will be different there today (than) elsewhere, and we know and accept that as a society already today.”

Regulation & Oversight of Artificial Intelligence

The primary regulator of AI and algorithm tools for health care at the federal level is the Food and Drug Administration, the agency traditionally charged with regulating interstate commerce in medical devices where action is taken automatically (for example, pacemakers or ventilators). Jackson worries that the proliferation of such tools has created a bit of a “Wild West” environment and that the industry could be ripe for additional oversight and regulation, but he argues it would need to be done in a thoughtful way.

“I get very nervous with some of the applications I see out there on the app stores that purport to do things, which haven’t been through the normal best practice clinical validation,” he said. “There’s a lot of that that makes me nervous. At the same time, I would also not welcome or find comfortable an extremely onerous process. If anything that was algorithmic were to have to go through a full regulatory review, that would slow down the pace of American innovation excessively.”

Jackson said he does see a role for state governments to help shape the development of AI in medicine, as states like Vermont lead the way.

“I think one of the real beauties of America is the federal system and the state system where we can get so much innovation and thinking done and experimentation by having states do things according to their own local characteristics,” said Jackson, who is British. “I think that’s one of the tremendous strengths of America. […] I think the tension is what’s the right level of regulation, and I would propose that the way forward on all of this is to promote interoperability and promote openness on these types of capabilities, so that what’s going on is occurring in the open in a shared fashion, and it’s to the benefit of the population generally.”

How AI is Changing Your Daily Life

1. It Improves Health Care

From the more complex robot-assisted surgery—robots actually in the operating room helping with the operation—to the easier-to-understand impacts of artificial intelligence on discovering new drugs to address new illnesses, new technology and innovation greatly impacts the healthcare industry. AI utilizes data sets to improve diagnostics and assists with assessments of X-rays and other scans. AI helps save lives and money in the health care industry.

2. It Makes Life More Convenient

For anyone who has ever called out to Amazon’s Alexa or logged on to a weather app to check the week’s forecast, artificial intelligence is making the simplest tasks even easier. Apple’s Siri can make a phone call or write a text message for us. Phone menus are more accessible to all callers. Servion Global Solutions estimates that by 2025, as many as 95% of all customer interactions will involve artificial intelligence.

3. It Delegates Menial Tasks

AI personal assistants can help business owners handle emails and set up calendars. Automated services schedule social media posts. Gmail’s AI settings filter out 99.9% of spam mail. The absence of human emotion in artificial intelligence allows it to be clinical and efficient in generating the right photos, hashtags and presets.