Sunday, March 17, 2013

Artificial Intelligence

Artificial intelligence (AI) is the intelligence of machines-robots and the branch of computer science that aims to create it. AI textbooks define the field as "the study and design of intelligent agents" where an intelligent agent is a system that perceives its environment and takes actions that maximize its chances of success.  Wikipedia defines it as "the science and engineering of making intelligent machines."

One of the greatest values of the Electronic Health Record is the seamless addition of AI to the user’s own brainpower. This is manifested in various ways.  Below is a list of potential AI elements, some already present to some degree, in various systems:
  1. Drug interactions 
  2. Drug Allergies 
  3. Recommended “state of the art” treatment plans when a sign, symptom, lab result, x-ray results, EKG data, evaluation of PMH, SH,FH, working diagnosis are noted by the computer. The computer does a risk factor analysis of the data and creates a differential diagnosis. 
  4. Warnings --
    1. Errors in dosage 
    2. Errors in medications 
    3. “Are you sure you want to discharge this patient” with this constellation of data points? 
    4. Wrong patient-in congruent data entry 
  5. Reminders -- 
    1. Lack of documentation completion 
    2. Lack of signatures 
    3. Attention to attestation of information 
    4. Core measures, PQRS, on-going studies  
  6. Active rather than passive resource tool 
    1. Who’s on call 
    2. Phone numbers 
    3. Timing of interactions of consultants/i.e Cardiology consult might be beneficial 
    4. Recommend evidence based resources or wed sites if more info is needed 
    5. Calculates various scores (Glasgow Coma Scales, PERC score, TIMI scores) that are clinically relevant
  7. Feedback --
    1. How much money did you spend to attain this end-point? 
    2. What was clinical outcome of admitted patients? 
    3. Report on rechecks and bounce-backs 
    4. Admission rates 
    5. Times-LOS, door to doctor, doctor to decision 
    6. Benchmarking your performance within your practice, local hospitals, and national data
The addition of AI should be embraced not avoided. Theoretically, it could make your difficult job less stressful and more efficient.

However, one should always keep in mind the meaning of the words “artificial” and “intelligence.”   These do not inherently include the terms “wisdom” or “judgement,” the standards a physician is always held to, medically and legally. Thus a physician has the obligation to accept or reject the advice of the machine. In either case, the physician is ultimately responsible. While we are not yet confronted with the independence of the computer, as depicted by Hal in Stanley Kubrick’s 2001 A Space Odyssey, one might best remember that it was astronaut Dave who disconnected Hal’s power supply to save his own life. We may, at times, need to do the same.