AI and Clinical Practice—Improving Health Care Quality and Equity
Oct 11, 2023
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Dr. Kedar S. Mate discusses AI's role in healthcare quality and equity. Topics include challenges in implementing evidence-based care, the evolution of the Institute for Healthcare Improvement, integrating equity and AI in healthcare systems, biases and risks of digital algorithms, and addressing bias in AI training data for equitable healthcare outcomes.
AI in healthcare can improve access and reduce bias, but requires transparency and equity considerations.
Incorporating AI into clinical decision-making can enhance health systems, but human judgment remains crucial.
Deep dives
The Role of Health Intelligence and Artificial Intelligence in Optimizing Clinical Care
Health intelligence has the potential to alleviate challenges in optimizing clinical care, but it must be stewarded appropriately. Artificial intelligence (AI) offers promise for medicine, but also introduces new challenges. It can increase access to care, reduce variability, and improve clinical practice. However, it requires careful implementation to address equity considerations and prevent bias. AI can benefit underserved communities and improve timeliness of care through image reading and data analysis. AI's ability to move knowledge rather than people can enhance health system performance. While AI has limitations and risks, such as complacency and potential bias, transparency and collaboration are vital in developing AI tools that support clinical reasoning and shared decision-making.
The Evolution of the Triple Aim to the Quintuple Aim with the Focus on Equity
The Institute for Healthcare Improvement (IHI) has expanded the triple aim, which focuses on improving the experience of care, health of populations, and cost efficiencies, to the quintuple aim by adding a focus on workforce joy and well-being. Furthermore, IHI advocates for incorporating equity into the healthcare system to achieve sustainable and durable improvements. Aligning AI with equity considerations from its inception prevents potential disparities. The AI tools have the potential to scale, increase access, and reduce variability. However, there is a need to ensure transparency, address bias, and make conscious choices about training data to avoid perpetuating inequities. Incorporating AI as an adjunct to clinical decision-making can transform health systems, but human clinical judgment remains essential.
AI's Potential Impact on Quality, Safety, and Equity in Clinical Care
AI has the potential to impact various dimensions of quality, including safety, timeliness, efficiency, effectiveness, equity, and patient-centeredness in clinical care. It can support diagnosing challenging conditions, improving handoffs and communication, reducing adverse drug events, and predicting sepsis earlier. However, the jury is still out on the overall impact of AI on patient safety. Risks associated with AI include complacency, incorrect AI conclusions, and the possibility of introducing bias, particularly with regard to equity considerations. Ensuring transparency, accountability, and ongoing evaluation of AI algorithms are crucial in order to harness the benefits of AI while mitigating its potential risks.
In this Q&A, JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, interviews Kedar S. Mate, MD, an internal medicine physician, President and Chief Executive Officer at the Institute for Healthcare Improvement, and faculty at Weill Cornell Medical College, to discuss AI’s role in health care quality and approaches to improving health equity. Related Content:
