Collaborating Authors

EHRs Connect Research and Practice: Where Predictive Modeling, Artificial Intelligence, and Clinical Decision Support Intersect Machine Learning

Objectives: Electronic health records (EHRs) are only a first step in capturing and utilizing health-related data - the challenge is turning that data into useful information. Furthermore, EHRs are increasingly likely to include data relating to patient outcomes, functionality such as clinical decision support, and genetic information as well, and, as such, can be seen as repositories of increasingly valuable information about patients' health conditions and responses to treatment over time. Methods: We describe a case study of 423 patients treated by Centerstone within Tennessee and Indiana in which we utilized electronic health record data to generate predictive algorithms of individual patient treatment response. Multiple models were constructed using predictor variables derived from clinical, financial and geographic data. Results: For the 423 patients, 101 deteriorated, 223 improved and in 99 there was no change in clinical condition. Based on modeling of various clinical indicators at baseline, the highest accuracy in predicting individual patient response ranged from 70-72% within the models tested. In terms of individual predictors, the Centerstone Assessment of Recovery Level - Adult (CARLA) baseline score was most significant in predicting outcome over time (odds ratio 4.1 + 2.27). Other variables with consistently significant impact on outcome included payer, diagnostic category, location and provision of case management services. Conclusions: This approach represents a promising avenue toward reducing the current gap between research and practice across healthcare, developing data-driven clinical decision support based on real-world populations, and serving as a component of embedded clinical artificial intelligences that "learn" over time.

AI found better than doctors at diagnosing, treating patients

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Applying the same technologies used for voice recognition and credit card fraud detection to medical treatments could cut healthcare costs and improve patient outcomes by almost 50%, according to new research. The research by Indiana University found that using patient data with machine-learning algorithms can drastically improve both the cost and quality of healthcare through simulation modeling. The computer models simulated numerous alternative treatment paths out into the future and continually planned and replanned treatment as new information became available. In other words, it can "think like a doctor," according to the university. This is not the first time artificial intelligence has been brought to bear on healthcare.

The Ethical Implications of Shared Medical Decision Making without Providing Adequate Computational Support to the Care Provider and to the Patient Artificial Intelligence

There is a clear need to involve patients in medical decisions. However, cognitive psychological research has highlighted the cognitive limitations of humans with respect to 1. Probabilistic assessment of the patient state and of potential outcomes of various decisions, 2. Elicitation of the patient utility function, and 3. Integration of the probabilistic knowledge and of patient preferences to determine the optimal strategy. Therefore, without adequate computational support, current shared decision models have severe ethical deficiencies. An informed consent model unfairly transfers the responsibility to a patient who does not have the necessary knowledge, nor the integration capability. A paternalistic model endows with exaggerated power a physician who might not be aware of the patient preferences, is prone to multiple cognitive biases, and whose computational integration capability is bounded. Recent progress in Artificial Intelligence suggests adding a third agent: a computer, in all deliberative medical decisions: Non emergency medical decisions in which more than one alternative exists, the patient preferences can be elicited, the therapeutic alternatives might be influenced by these preferences, medical knowledge exists regarding the likelihood of the decision outcomes, and there is sufficient decision time. Ethical physicians should exploit computational decision support technologies, neither making the decisions solely on their own, nor shirking their duty and shifting the responsibility to patients in the name of informed consent. The resulting three way (patient, care provider, computer) human machine model that we suggest emphasizes the patient preferences, the physician knowledge, and the computational integration of both aspects, does not diminish the physician role, but rather brings out the best in human and machine.

Reinforcement Learning in Healthcare: A Survey Artificial Intelligence

As a subfield of machine learning, \emph{reinforcement learning} (RL) aims at empowering one's capabilities in behavioural decision making by using interaction experience with the world and an evaluative feedback. Unlike traditional supervised learning methods that usually rely on one-shot, exhaustive and supervised reward signals, RL tackles with sequential decision making problems with sampled, evaluative and delayed feedback simultaneously. Such distinctive features make RL technique a suitable candidate for developing powerful solutions in a variety of healthcare domains, where diagnosing decisions or treatment regimes are usually characterized by a prolonged and sequential procedure. This survey will discuss the broad applications of RL techniques in healthcare domains, in order to provide the research community with systematic understanding of theoretical foundations, enabling methods and techniques, existing challenges, and new insights of this emerging paradigm. By first briefly examining theoretical foundations and key techniques in RL research from efficient and representational directions, we then provide an overview of RL applications in a variety of healthcare domains, ranging from dynamic treatment regimes in chronic diseases and critical care, automated medical diagnosis from both unstructured and structured clinical data, as well as many other control or scheduling domains that have infiltrated many aspects of a healthcare system. Finally, we summarize the challenges and open issues in current research, and point out some potential solutions and directions for future research.

Challenges for Reinforcement Learning in Healthcare Artificial Intelligence

Many healthcare decisions involve navigating through a multitude of treatment options in a sequential and iterative manner to find an optimal treatment pathway with the goal of an optimal patient outcome. Such optimization problems may be amenable to reinforcement learning. A reinforcement learning agent could be trained to provide treatment recommendations for physicians, acting as a decision support tool. However, a number of difficulties arise when using RL beyond benchmark environments, such as specifying the reward function, choosing an appropriate state representation and evaluating the learned policy.