People, ideas, machines. @enricocoiera AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
“People, ideas, things. And in that order” John Boyd (1927-1997) AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
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 reward is encouraging the taking of great risk. AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
We don’t need to wait for technical breakthroughs to make a difference to healthcare today AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
Dozens of RCTs now show clinical benefits • 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 Screening diagnosis reduced from minutes to seconds. • 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 Diagnosis increased across all severity levels and reached 73% for severe depression • 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 Treatment self-help online. AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
We are not designing algorithms. We are designing human-machine systems. AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
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 overdiagnosis). • Many lesions will never lead to harm. • So might improved diagnostic performance by this AI cause more unnecessary treatment, patient risks, and economic cost? AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
The last mile Middle mile First mile Last mile Data capture Model building Real world Cleaning implementation and testing Labeling e.g. ML/DL Routine use AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
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 AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
BGPaH patient journey (from 2019 Independent Evaluation by Ipsos MORI) AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
Australian Institute of Health Innovation, AUSTRALIAN INSTITUTE Macquarie University OF HEALTH INNOVATION
Typically BGPaH patients are healthier than those at other practices even after adjusting for age. (from 2019 Independent Evaluation by Ipsos MORI) Australian Institute of Health Innovation, AUSTRALIAN INSTITUTE Macquarie University OF HEALTH INNOVATION
BGPaH patients are historically higher users of NHS 111 and A&E than might be expected. (from 2019 Independent Evaluation by Ipsos MORI) Australian Institute of Health Innovation, AUSTRALIAN INSTITUTE Macquarie University OF HEALTH INNOVATION
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) AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
The Australian Alliance for Artificial Intelligence in Healthcare (AAAiH) Australian Institute of Health Innovation, Macquarie University AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
A national partnership to transform the health system Established Commenced late 2017 Partners 61 formal partners to date Government 5 State Departments of Health Industry Google Health, Accenture, Amazon AWS, IBM Research, Oracle, Orion, Alcidion National CSIRO, ADHA, Healthdirect Australia, ACSQHC, AIHW, Standards Australia State CEC, ACI, SA-NT Datalink Academia Universities: Macquarie, Melbourne, Queensland, Bond, UNSW, Sydney, South Australia, Adelaide, Flinders. MCRI, Australian Genomics, AIML Professional CHF, RANZCR, HISA, ACHI, MSIA International Stanford, Oxford, Toronto, Michigan, Liverpool AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
• Support and accelerate the adoption of AI enabled health services in Australia • Build a community of shared interest AI Alliance Goals 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 AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
“People, ideas, machines. And in that order” AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
Thank you @enricocoiera enrico.coiera@mq.edu.au AUSTRALIAN INSTITUTE OF HEALTH INNOVATION
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