AI's Impact on the Future of Healthcare

AI's Impact on the Future of Healthcare

• 1. AI and Healthcare THE MUDDY FUTURE Zak Kohane Department of Biomedical Informatics Harvard Medical School October 4th, 2023

• 2. Highlights • Why the excitement? • Reminder of a few of the potholes. • Interesting ways forward for infectious disease.

• 3. UDN1 3 Worsening dystonia (not walking, not speaking) L-Dopa Folinic Acid 5-hydroytryptophan GTP cyclohydrolase I deficiency Walking, talking!

• 4. Present

• 5. 5 DEPARTMENT OF Biomedical Informatics Trend in USLME over 2 years

• 6. 6 DEPARTMENT OF Biomedical Informatics Trial Path Trial

• 7. 7 DEPARTMENT OF Biomedical Informatics Trainee path Trainee

• 8. 8 DEPARTMENT OF Biomedical Informatics Trochbearer Dr. House Torchbearer

• 9. 9 DEPARTMENT OF Biomedical Informatics 9

• 10. 10 DEPARTMENT OF Biomedical Informatics When does Medicine succumb to AlphaZero? • Deterministic. • Fully observed. • The action space is discrete. • Access to a perfect simulator (the game itself), so the effects of any action are known exactly. • Each episode/game is relatively short. • Evaluation is clear, fast and allows a lot of trial-anderror experience. • Huge datasets of human play. • NOT physiology • NOT disease course • NOT drug response • NOT surgery • So…. What might succumb…? Which medical ‘game’ fits the criteria….? •

• 11. 11 DEPARTMENT OF Biomedical Informatics 25% of US Healthcare Costs 11 NBER Economics of Artificial Intelligence Conference, September 2022. Nikhil R. Sahni, George Stein, Rodney Zemmel, and David Cutler

• 12. 12 DEPARTMENT OF Biomedical Informatics Primary care shortage between 17,800 and 48,000 • AAMC report • Retirements getting worse with COVID and burnout.

• 13. 13 DEPARTMENT OF Biomedical Informatics Not just a US Problem

• 14. 14 DEPARTMENT OF Biomedical Informatics + 14 AI?

• 15. 15 DEPARTMENT OF Biomedical Informatics 15

• 16. 16 DEPARTMENT OF Biomedical Informatics

• 17. 17 DEPARTMENT OF Biomedical Informatics 4 weeks later: CovidClinical.net & medRxiv…Nature Digitial Medicine

• 18. 18 DEPARTMENT OF Biomedical Informatics • Early evidence of major pathologies • Countries more similar than sites within them Meanwhile…

• 19. 19 DEPARTMENT OF Biomedical Informatics

• 20. 20 DEPARTMENT OF Biomedical Informatics Fundamental antecedent questions to inform policy 20 Whose utilities are maximized? Whose medicine is authoritative? Dyad to Triad: Distinct New Party ? Who controls incorporation of patient data into model? Should consumers have access to medical advice directly? Who funds?

• 21. 21 DEPARTMENT OF Biomedical Informatics 21

• 22. 22 DEPARTMENT OF Biomedical Informatics 22

• 23. 23 DEPARTMENT OF Biomedical Informatics Implications • Sea-change in healthcare with AI º Faster than regulation º Faster than education • Acceleration of clinical and basic research • Data + computational resources are obvious king. • Globalization paths • Increases dangers of non-quant data exploration. • Urgency of exploration by educators and science leaders 23

• 24. 24 DEPARTMENT OF Biomedical Informatics NEJM AI