Artificial Intelligence

Artificial Intelligence
Applications in Healthcare Delivery

Edited by
Sandeep Reddy
First published 2021
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Contents

Foreword ................................................................................................... vii

Editor .......................................................................................................... ix
Technical Reviewers ................................................................................. xi
Contributors ............................................................................................ xiii
1 Algorithmic Medicine ..................................................................1
SANDEEP REDDY

2 Use of Artificial Intelligence in the Screening and

Treatment of Chronic Diseases .................................................. 15
CHAITANYA MAMILLAPALLI, DANIEL J. FOX, RAMANATH
BHANDARI, RICARDO CORREA, VISHNU VARDHAN GARLA, AND
RAHUL KASHYAP

3 AI and Drug Discovery .............................................................. 55

ARASH KESHAVARZI ARSHADI AND MILAD SALEM

4 Mammographic Screening and Breast Cancer

Management – Part 1 ................................................................. 67
JAMES CONDON AND LYLE PALMER

5 Mammographic Screening and Breast Cancer

Management – Part 2 .................................................................97
MARK R. TRAILL

6 Deep Learning for Drawing Insights from Patient Data for

Diagnosis and Treatment ......................................................... 109
DINESH KUMAR AND DHARMENDRA SHARMA

7 A Simple and Replicable Framework for the Implementation

of Clinical Data Science ........................................................... 137
JUAN LUIS CRUZ, MARIANO PROVENCIO, AND
ERNESTINA MENASALVAS

v
vi ◾ Contents

8 Clinical Artificial Intelligence – Technology Application

or Change Management? .......................................................... 163
CHRISTOPHER PEARCE, ADAM MCLEOD, ANNA FRAGKOUDI,
AND NATALIE RINEHART

9 Impacting Perioperative Quality and Patient Safety

Using Artificial Intelligence..................................................... 183
PIYUSH MATHUR, JACEK B. CYWINSKI, AND FRANCIS A. PAPAY

10 Application of an Intelligent Stochastic Optimization

Nonlinear Model ...................................................................... 195
GONZALO HERNÁNDEZ AND FERNANDO A. CRESPO

11 Audit of Artificial Intelligence Algorithms and Its

Impact in Relieving Shortage of Specialist Doctors ................ 207
VIDUR MAHAJAN AND VASANTH VENUGOPAL

12 Knowledge Management in a Learning Health System ........... 223

ULI K. CHETTIPALLY

13 Transfer Learning to Enhance Amenorrhea Status

Prediction in Cancer and Fertility Data with Missing Values ... 233
XUETONG WU, HADI AKBARZADEH KHORSHIDI, UWE AICKELIN,
ZOBAIDA EDIB, AND MICHELLE PEATE

14 AMD Severity Prediction and Explainability Using Image

Registration and Deep Embedded Clustering.......................... 261
DWARIKANATH MAHAPATRA

15 Application of Artificial Intelligence in Thyroidology ............ 273

JOHNSON THOMAS

16 Use of Artificial Intelligence in Sepsis Detection and

Management............................................................................. 285
NEHA DEO AND RAHUL KASHYAP

17 Transforming Clinical Trials with Artificial Intelligence ........ 297

STEFANIE LIP, SHYAM VISWESWARAN, AND
SANDOSH PADMANABHAN

18 An Industry Review of Neuromorphic Chips .......................... 307

DEEPAK KUMAR GOPALAKRISHNAN, ADITYA RAVISHANKAR,
AND HAMID ABDI

19 Artificial Empathy – An Artificial Intelligence Challenge ....... 321

DHARMENDRA SHARMA AND BALAJI BIKSHANDI

Index .............................................................................................. 327

Foreword

Artificial intelligence (AI) provokes us to reimagine healthcare. The very sub-

strate of clinical practice is expertise, and the machinery that transforms that
knowledge into care is decision-making. For decades, we have imagined
ways of doing things better for our patients – better drugs, better surgeries,
better procedures and, always, better decisions.
Computational methods that capture clinical knowledge and automate
reasoning have been with us for decades. We are witnessing now a renais-
sance in the field of AI, driven in part by better methods for learning and
making decisions by machine. This rebirth is also driven by the steady
digitization of healthcare. The more we measure practice and make those
measures machine readable, the more readily can we embed AI into clinical
practice.
This embedding of AI into healthcare is the focus of this book. No matter
how accurate or efficient a machine process is, if it cannot be well embed-
ded into real-world applications, then it will not achieve what we expect
of it. The application of AI to real-world problems is sometimes considered
mere ‘engineering’ work, but the task of application is actually a scientific
challenge at least as complex as that of creating reasoning machines.
Implementation science is the discipline that seeks to understand how we
embed tools and practices into the complex network of people, processes
and tools that come together to create our human systems. Healthcare is
amongst the most complex of human industries, and we know that embed-
ding technology into healthcare is a complex process in of itself. What
works well in one place may not work so well elsewhere. What is important
in one place is not so in another.
The application of AI into healthcare then is not so much the creation
of a medicine driven by algorithms, but a medicine which is practised
as a partnership between human and machine, each bringing their

vii
viii ◾ Foreword

complementary strengths. That partnership is then embedded in a complex

network of relationships and constraints that profoundly shape how well
they perform.
The challenge before us is to deeply understand what makes AI work in
some healthcare settings and not others. We must understand which ele-
ments of application context shape the outcomes of application and how we
design the partnership that will be formed between human and machine –
each bringing unique strengths to the task of providing patient care. When
we are finished, we will have profoundly reshaped healthcare and for the
better.

Professor Enrico Coiera

Director, Centre for Health Informatics
Australian Institute of Health Innovation
Macquarie University
Editor

Associate Professor Sandeep Reddy is

an artificial intelligence (AI) in healthcare
researcher based at the Deakin School of
Medicine, Geelong, Australia, besides being
the founder/chairman of Medi-AI, a globally
focused AI company. He also functions as a
certified health informatician and is a Fellow of
the Australasian Institute of Digital Health and
a World Health Organisation-recognised digital
health expert.
He has a medical and healthcare management background and has com-
pleted machine learning/health informatics training from various sources. He
is currently engaged in research about the safety, quality and explainability
of the application of AI in healthcare delivery in addition to developing AI
models to treat and manage chronic diseases. Also, he has authored sev-
eral articles and books about the use of AI in medicine. Further, he has set
up local and international forums to promote the use of AI in healthcare
in addition to sitting on various international committees focusing on AI in
healthcare.

ix
Technical Reviewers

Primary Technical Reviewer

Dr Bhushan Garware works as a senior data sci-
entist at Persistent Systems. He heads Deep Vision
Group at Persistent Systems with special interest
in medical imaging. He holds a Ph.D. degree and
has three patents in his name. He has conducted
many workshops and tutorial sessions on machine
learning in several industries, academia and
research institutes. He has published his work on
applications of deep learning for CT, MRI, X-ray
and microscopic images in reputed international conferences. His current
areas of research interest are explainable AI and assistive intelligence.

Secondary Technical Reviewer

Ravi Kiran Bhaskar is a software professional
with over 20 years of experience, currently work-
ing as a Technical Architect at The Washington
Post. He has an M.S. in Electrical Engineering
from George Mason University, Fairfax, VA,
USA, and B.E. in Electronics Engineering from
Nagpur University, India. His career spanned
across multiple disciplines ranging from satellite
communications, mobile networking, security,
web development, web services, system admin-
istration, search engineering and supervised/

xi
xii ◾ Technical Reviewers

unsupervised learning. He specialises in natural language processing, search

technologies and algorithm development, and is passionate about disruptive
technologies in the fields of machine learning, artificial intelligence and
high-performance computing.
Contributors

Hamid Abdi Uli K. Chettipally

School of Engineering Society of Physician Entrepreneurs,
Deakin University San Francisco Bay Area chapter
Geelong, Australia InnovatorMD
San Francisco, California
Uwe Aickelin
School of Computing and James Condon
Information Technology University of Adelaide,
University of Melbourne Adelaide, Australia
Melbourne, Australia
Ricardo Correa
Arash Keshavarzi Arshadi Department of Endocrinology
Computational Biotechnology University of Arizona College of
University of Central Florida Medicine, Phoenix and Phoenix
Orlando, Florida VAMC
Tucson, Arizona
Ramanath Bhandari
Department of Opthalmology Fernando A. Crespo
Springfield Clinic DAiTA LAb, Facultad de Estudios
Springfield, Illinois Interdisciplinarios
Universidad Mayor
Balaji Bikshandi Santiago, Chile
Faculty of Science & Technology
University of Canberra Juan Luis Cruz
Canberra, Australia Hospital Universitario 12 de Octubre
Madrid, Spain

xiii
xiv ◾ Contributors

Jacek B. Cywinski Gonzalo Hernández

Anesthesiology Institute Centro Científico y Tecnológico
Cleveland Clinic de Valparaíso
Cleveland, Ohio Valparaíso, Chile

Neha Deo Rahul Kashyap

Mayo Clinic Alix School of Department of Anesthesiology/
Medicine Critical Care Medicine
Mayo Clinic Mayo Clinic
Rochester, Minnesota Rochester, Minnesota

Hadi Akbarzadeh Khorshidi

Zobaida Edib School of Computing and
School of Computing and Information Technology
Information Technology University of Melbourne
University of Melbourne Melbourne, Australia
Melbourne, Australia
Dinesh Kumar
Daniel J. Fox Faculty of Science & Technology
Department of Clinical Research University of Canberra
Springfield Clinic Canberra, Australia
Springfield, Illinois
Stefanie Lip
Anna Fragkoudi Institute of Cardiovascular and
Outcome Health Medical Sciences
Melbourne, Australia University of Glasgow
Glasgow, United Kingdom
Vishnu Vardhan Garla
Department of Endocrinology Vidur Mahajan
University of Mississippi Medical Mahajan Imaging
Center New Delhi, India
Jackson, Mississippi
Dwarikanath Mahapatra
Deepak Kumar Gopalakrishnan Inception Institute of Artificial
School of Engineering Intelligence
Deakin University Abu Dhabi, United Arab Emirates
Geelong, Australia
 Contributors ◾ xv

Chaitanya Mamillapalli Christopher Pearce

Department of Endocrinology Outcome Health
Springfield Clinic Melbourne, Australia
Springfield, Illinois
Michelle Peate
Piyush Mathur School of Computing and
Anesthesiology Institute Information Technology
Cleveland Clinic University of Melbourne
Cleveland, Ohio Melbourne, Australia

Adam McLeod
Mariano Provencio
Outcome Health
Melbourne, Australia Department of Oncology
Puerta de Hierro University
Hospital and
Ernestina Menasalvas
Universidad Autónoma de Madrid
Universidad Politécnica de
Madrid, Spain
Madrid
Madrid, Spain
Aditya Ravishankar
Sandosh Padmanabhan School of Engineering
Institute of Cardiovascular and Deakin University
Medical Sciences Geelong, Australia
University of Glasgow
Glasgow, United Kingdom Natalie Rinehart
Outcome Health
Lyle Palmer Melbourne, Australia
University of Adelaide and
Adelaide, Australia Case Western Reserve University
Cleveland, Ohio
Francis A. Papay
Cleveland Clinic Lerner College of Milad Salem
Medicine Computational Biotechnology
Case Western Reserve University University of Central Florida
Cleveland, Ohio Orlando, Florida
and
Dermatology and Plastic Surgery Dharmendra Sharma
Institute Faculty of Science & Technology
Cleveland Clinic University of Canberra
Cleveland, Ohio Canberra, Australia
xvi ◾ Contributors

Johnson Thomas Shyam Visweswaran

Department of Endocrinology Department of Biomedical
Mercy Informatics
Springfield, Missouri University of Pittsburgh
Pittsburgh, Pennsylvania
Mark R. Traill
Metro Health Xuetong Wu
University of Michigan School of Computing and
Wyoming, Michigan Information Technology
University of Melbourne
Vasanth Venugopal Melbourne, Australia
Mahajan Imaging
New Delhi, India
Chapter 1

Algorithmic Medicine
Sandeep Reddy
Deakin University

Contents
1.1 Introduction ................................................................................................1
1.2 AI in Medicine – A History........................................................................2
1.3 AI Types and Applications .........................................................................4
1.3.1 Computer Vision.............................................................................6
1.3.2 Natural Language Processing .........................................................7
1.3.3 Robotics ..........................................................................................8
1.4 Challenges and Solutions ......................................................................... 10
1.5 The Future ................................................................................................ 12
References ......................................................................................................... 12

1.1 Introduction
For long health services have faced several challenges, chief among them
being rising expenditure and workforce shortages without clear solutions
in sight (Topol, 2019). At the same time, there has been an unprecedented
generation of medical data ranging from sources such as electronic health
records, medical imaging and laboratory units (Sidey-Gibbons & Sidey-
Gibbons, 2019). Clinicians have for long relied on computers to analyse such
data as the analysis of such complex, and large datasets exceed their human
capacity. In this context, the emergence of artificial intelligence (AI) with
its ability to significantly enhance the data analysis process has presented
an opportunity for clinicians and healthcare administrators to gain better

1
2 ◾ Artificial Intelligence

insights (Reddy, 2018). An opportunity to optimise care delivery, reduce

healthcare delivery costs and support a stretched workforce.
Of the various AI approaches, the most pertinent to analysing data is
machine learning (ML), which comprises aspects of mathematics, statistics
and computational science (Sidey-Gibbons & Sidey-Gibbons, 2019). ML is the
core of changes occurring in medicine because of AI. Unlike non-AI meth-
ods and software, which rely mainly on traditional statistical approaches, ML
software utilises pattern detection and probabilistic approaches to predict
medical outcomes (Reddy, 2018). This utilisation of ML algorithms and other
AI approaches to deliver medical care is what can be termed as algorithmic
medicine. The ability to predict crucial medical outcomes through AI
algorithms can make healthcare more precise and efficient. Beyond medical
care, AI can also support healthcare administration, drug discovery, popu-
lation health screening and social assistance (Reddy, 2018), thus expand-
ing the scope of algorithmic medicine beyond the confines of clinical care,
i.e. direct clinician to patient care. This ability and promise have ignited
the interest of governments and other healthcare stakeholders to consider
incorporation of AI in healthcare administration and delivery seriously.
This chapter outlines what would be involved for this to occur and what the
impact will be.

1.2 AI in Medicine – A History

Before we define AI and describe its techniques, it will be pertinent to
review the history of AI in healthcare. The concept of intelligent machines
is not new and in fact can be traced to Ramon Llull’s theory of reason-
ing machine in the 14th century (Reddy, 2018). However, modern AI can
be tracked back to the past 70 years with the term originating from the
workshop organised by John McCarthy at Dartmouth College in 1956
(AAIH, 2019). In the following decade, the availability of faster and cheaper
computers allowed experimentation with AI models particularly in the areas
of problem-solving and interpretation of spoken language (Anyoha, 2017).
However, as work progressed in these areas, the lack of requisite compu-
tational power and the limitations of the then algorithmic models came to
fore. In the 1980s, there was a revival of interest in AI particularly so in
expert systems, which were modelled to mimic the decision-making pro-
cess of a human expert (Figure 1.1). However, again these types of models
fell short of expectations, and interest in AI in both academia and industry
Figure 1.1 History of AI and its use in medicine.
Algorithmic Medicine
◾
3
4 ◾ Artificial Intelligence

waned. Commencing in the mid-2000s, the availability of suitable technical

hardware and emergence of neural networks, an advanced form of ML, cou-
pled with their demonstrable performance in image and speech recognition
once again brought AI back to the limelight. Since then, significant funding
and interest has led to further advances in algorithms, hardware, infrastruc-
ture, and research.
Paralleling the general history of AI, its use in medicine formally com-
menced with the DENDRAL project in the 1960s, which was an early expert
system with an objective to define organic compound structures by inves-
tigating their mass spectra (AAIH, 2019). The development of this system
required new theories and programming. This was followed by MYCIN
in the 1970s, which was aimed at identifying infections and recommend-
ing appropriate treatment. The learning from MYCIN was extrapolated to
develop the CADUSEUS system in the 1980s. This system was then hyped
as the most knowledgeable medical expert system in existence. In line with
the general history of expert system, the application of expert systems in
medicine fell short of expectations. The sophistication of neural networks
and availability of hardware to run these algorithms presented a new oppor-
tunity for the use of AI in medicine (Naylor, 2018; Reddy, 2018). Since then,
increasing evidence has been detailed of what AI models can do in terms of
medical imaging interpretation, support for clinical diagnosis, drug discovery
and clinical natural language processing.

1.3 AI Types and Applications

Before we discuss the different types of AI and its applications, it is
important to define what AI is? There are numerous definitions of AI in the
literature, but this one derived from computer science describes AI as “the
study of intelligent agents and systems, exhibiting the ability to accomplish
complex goals” (AAIH, 2019). However, this definition is oriented to an
academic perspective. From an application and industry perspective, AI can
be best described as “machines assuming intelligence”. Now that we have
defined AI, it is pertinent to mention here two levels of AI: General and
Narrow AI. General AI, also referred to as Artificial General Intelligence, is
when AI exhibits “a full range of cognitive abilities or general intelligence
actions by an intelligent agent or system” (AAIH, 2019), while Narrow AI,
also referred to as Weak AI, is where AI is specified to address a singular or
limited task.
 Algorithmic Medicine ◾ 5

Figure 1.2 AI types, learning approaches and applications.

The predominant approach of AI, currently, is ML (Figure 1.2). This

approach involves performing tasks without explicit instructions relying
mainly on patterns and relationships in the training data and environment
(AAIH, 2019). To develop ML models, you will need to define the necessary
features, i.e. dependent and independent or input and target variables, and
develop datasets including the features. Further to this, you split up the data-
set into training and test datasets to allow for internal validation. Following
this, the datasets are trained or tested with relevant ML algorithms. If the
training dataset contains the input data and the appropriate output/target
variable, then it is termed supervised learning (El Morr & Ali-Hassan, 2019).
However, if there is no known output and the algorithm is left to detect
hidden patterns or structures within the dataset, then this is unsupervised
learning. In recent years, a hybrid form where the training set has a mix of
labelled and unlabelled data and the expectation is that a function predict-
ing the target variable is arrived at, which is termed semi-supervised learning
(El Morr & Ali-Hassan, 2019).
ML algorithm development does not necessarily have to adopt the train-
ing approach described above. Reinforcement learning, a relatively newer
form of ML, involves a process of maximising reward function based on
the actions taken by the agent (AAIH, 2019). A trial-and-error approach is
adopted to eventually arrive at optimal decision-making by the agent. In
generative learning, the model development involves creating new examples
from the same distribution as the training set and in certain instances with a
particular label. The evolutionary algorithm model builds on this approach
where initially developed algorithms are tested for their fitness, similar to an
6 ◾ Artificial Intelligence

Figure 1.3 Representation of the neural network architecture (Creative Commons

License).

evolutionary process, until peak performing algorithms are identified and no

more progress in fitness of the group can be derived (AAIH, 2019).
While there are numerous ML algorithms in use, a couple of commonly
used algorithms in medicine are linear regression, logistic regression, deci-
sion trees, random forest and support vector machines (SVMs). An advanced
form of ML that excels at analysing complex patterns between variables in
datasets is deep learning (DL) (Topol, 2019). This approach is inspired by
the architecture and ability of human brains whereby learning and complex
analysis is achieved through interconnected neurons and their synapses.
This is computationally simulated through many layers of artificial neurons
between the input and output variables. These artificial neurons through a
hierarchical and interconnected process are programmed to detect complex
features and the model depending on complexity of data adds necessary
number of layers (auto-didactic quality) (Topol, 2019). Sandwiched between
the input and output layers are the hidden layers (see Figure 1.3), which
adds to the feature optimisation and model performance but also creates
opacity about the decision-making process of the model.
While there are myriad ways as to how neural networks and AI are in
use in healthcare, three applications where they are mostly used or have
most promise are profiled: computer vision, natural language processing and
robotics.

1.3.1 Computer Vision

Computer Vision (CV) is where computers assist in image and video rec-
ognition and interpretation (Howarth & Jaokar, 2019). Increasingly DL has
 Algorithmic Medicine ◾ 7

Figure 1.4 Architecture of a CNN (Creative Commons License).

become central to the operation of CV. This is due to DL’s many layers
useful for identifying and modelling the different aspects of an image. In
particular, convolutional neural networks (CNNs), a form of DL, involve a
series of convolutions and max-pooling layers (see Figure 1.4) as its under-
lying architecture has been found to be very useful in image classification
(AAIH, 2019; Erickson, 2019). CNNs are credited for reviving interest in
neural networks in recent years. The way the CNNs work is by commenc-
ing with low-level features in the image and progress to higher-level features
that represent the more complex components of the image. For example,
the first layers will identify points, lines and edges, and the latter layers will
combine these to identify the target class. An early example of CNN was
AlexNet, an image classification model (AAIH, 2019). More recent versions
are CNNs with specialised layers including ResNet, ResNeXt and region-
based CNN (Erickson, 2019).
CNNs are increasingly being applied in medical image interpretation
(Erickson, 2019): for example, to classify chest X-rays that have malignant
nodules and those that haven’t. Here, a set of labelled or annotated chest
X-rays are used to train the neural networks to compute features that are
reliable indicators of malignancy or lack. CNNs can be used for segmenta-
tion too where the class of interest is delineated from the remaining area of
non-interest. However, CNNs are not restricted to analysing chest X-rays and
have also been used to interpret CT, MRI, fundoscopy, histopathology and
other images (Erickson, 2019; Reddy, 2018; Reddy, Fox, & Purohit, 2019).

1.3.2 Natural Language Processing

Natural language processing (NLP) is a process of computationally represent-
ing, transforming and utilising different forms of human language, i.e. text
8 ◾ Artificial Intelligence

or speech (Wu et al., 2020). Unlike other data, computing human language
is not straightforward as there is a lot of imprecision in human language
(Chen, 2020). Also, the unit component of language is not necessarily con-
ducive to computation. To address this natural language must be initially
reencoded into a logical construct before it can be administered for informa-
tion extraction or translation. For many years, NLP reliant on traditional ML
approaches like SVM and logistic regression, which were trained on very
high dimensional and sparse features, yielded shallow models (Friedman,
Rindflesch, & Corn, 2013). However, the advent of DL and its use in NLP has
resulted in better performing models. This is because DL enables multi-level
automatic feature representational learning.
An important reason for the success of DL in NLP is because of distrib-
uted representation, which describes the similar data features athwart mul-
tiple scalable and interdependent layers (Young, Hazarika, Poria, & Cambria,
2018). Examples of distributed representation include word embeddings,
word2vec and character embeddings. These examples follow the distribu-
tional hypothesis, where it is assumed that words with similar meanings
tend to occur in a similar context. Thus, the models aim to capture the char-
acteristics of the neighbours of a word to predict meaning. DL has also been
useful in Automatic Speech Recognition (ASR), sometimes referred to as
speech-to-text (Chen, 2020). Recurrent neural networks have been demon-
strated to work well for ASR by lending the algorithm tolerance to complex
language conditions such as accents, speed and background noise.
Clinical use of NLP has extended to the vector representation of clini-
cal documents such as clinical guidelines, extracting clinical concepts from
electronic medical records or discharge summaries through named entity
recognition, mapping clinical ideas and diagnoses with codified guidelines,
and developing human-to-machine instructions (Rangasamy, Nadenichek,
Rayasam, & Sozdatelev, 2018). NLP can also be potentially used for non-
clinical healthcare purposes such as efficient billing and accurate prior
authorisation approval through the extraction of information from unstruc-
tured physician notes or electronic health records. Further uses of NLP
include transcription and chatbot services (Reddy, Fox, et al., 2019).

1.3.3 Robotics
Robots are machines that can carry out complex action and can be
programmed by computers (Ben-Ari & Mondada, 2017). Not all robots
are programmed by computers and are purely mechanical in nature.
 Algorithmic Medicine ◾ 9

However, for this chapter, we will review those robots that are programmable
by a robot. Robots can be of two categories: fixed and mobile, depending
on the environment they operate. Fixed robots like industrial robots oper-
ate in a well-defined environment, while mobile robots move and perform
activities in poorly defined and uncertain environments. Algorithms work in
robots through embedded computers that run on pseudocode utilising a mix
of natural language, mathematics and programming structures.
In healthcare, robots are used in various ways, including in surgery,
hospitals and aged care (Pee, Pan, & Cui, 2019; Reddy, 2018). One such
application that has become popular in recent years is robotic-assisted
surgery (Svoboda, 2019). In this format, surgeons control multiple robotic
arms through a hand-operated console (Figure 1.5). This application enables
surgeons’ greater vision and dexterity to operate in hard-to-reach areas.
Yet, this is not AI robotics which is about robots operating in an auto-
mated or semi-automated fashion. In this regard, trials are being held to
allow for independent operation of surgical procedures (Svoboda, 2019).
More straightforward or repetitive tasks like suturing and valve repair
lend themselves to surgical automation, while complex surgical tasks may
take many more years to be automated. Elsewhere, robotic assistants have
been used either to support the elderly as social companions or to guide
them with medications, appointments and in unfamiliar environments. As
AI-enabled robots attain more autonomous functionality through intelli-
gent algorithms, their use in various areas of healthcare is only to increase
(Reddy, 2018; Reddy, Fox, et al., 2019).

Figure 1.5 Robotic-assisted surgery (Creative Commons License).

10 ◾ Artificial Intelligence

As AI algorithms and models evolve, there will be broader applicability

of them in healthcare to drive efficiency and improved patient outcomes.
Demonstrable evidence in the areas of CV, NLP, AI robotics and predic-
tor models will enable adoption and broader use of AI within healthcare
broadly and specifically within clinical care models.

1.4 Challenges and Solutions

While AI has enabled unprecedented sophistication and performance in
medicine that very few technologies can match, it has also presented sig-
nificant challenges in its implementation (Reddy, Allan, Coghlan, & Cooper,
2019). While medical data are abundant, they all are not necessarily struc-
tured or standardised to train AI models (Wang, Casalino, & Khullar, 2018).
While the human brain is capable of inferring patterns from heterogeneous
and noisy data, AI models are less so. Utilisation of incorrect and non-
representative data can have several implications in the context of healthcare
delivery, including the introduction or affirmation of biases and exacerbation
of health disparities. Also, in a clinical setting, reliance on a model trained
on inaccurate data can have medico-legal repercussions (Reddy, Allan,
et al., 2019). Another issue that has emerged specifically with the use of DL
models is the opacity of decision-making that is intrinsic to these models.
When trained on large datasets, DL models use their many layers to simulate
complicated regularities in the data. However, the layered non-linear feature
learning makes it impractical to interpret the learning process (Hinton, 2018).
The inability to clearly explain the DL model’s conclusion basis presents an
obstacle to its use in clinical medicine. For example, if a DL model were to
make a clinical recommendation or diagnosis without a clear rationale, it
will find little acceptance amongst clinicians. Further to this, the training of
ML models involves several parameters (rules) (Beam, Manrai, & Ghassemi,
2019). Because of the use of randomness in training many ML models,
there are different possibility parameters arrived at each time the model is
retrained, thus limiting reproducibility of the models. Finally, the mathemati-
cal accuracy of AI models means nothing if there is no impact on patient
outcomes. Currently, very few studies have presented evidence of the down-
stream benefit of AI models in medicine.
While these are relatively significant challenges for the adoption and
applicability of AI in medicine, they are not without solutions. Most medical
DL models are relatively small and focused on medical image interpretation,
 Algorithmic Medicine ◾ 11

which has fewer issues in terms of structure and reproducibility (Beam et al.,
2019). Increasingly, medical researchers are utilising shared or open-source
datasets to train their models and providing open access to the code used
for the training. These measures allow for transparency and reproducibility
of AI models. Also, academic and transdisciplinary collaborations present an
opportunity to test and embed AI models in routine clinical care (Sendak,
Gao, Nichols, Lin, & Balu, 2019). To address bias or safety and quality issues
that may arise from the use of AI models, a governance model that incor-
porates fairness, transparency, trustworthiness and accountability has been
proposed (Figure 1.6) (Reddy, Allan, et al., 2019).
Fairness requires representation from the community at which the AI
medical application is aimed at in determining how the software developer
uses data (Reddy, Allan, et al., 2019). The representation could be at a data
governance panel that reviews datasets used for training such AI medical
applications. While it is not feasible for all software developers to consti-
tute such panels, they could potentially draw advice from a government-
instituted committee. Information from the group can contribute to less
discriminatory or less biased AI models being developed. Transparency
stresses the explainability of medical AI models. Where possible, algorithms
that lend themselves to explainability are to be utilised, and when DL types
of algorithms are necessary, functional understanding of the model con-
veyed through interpretable frameworks. Also, in clinical practice, informed
consent is obtained from patients before use of AI medical applications in
the treatment and management of their medical conditions. These initiatives

Figure 1.6 Components of an AI in healthcare governance framework. (Adapted

from Reddy, Allan et al. (2019).)
12 ◾ Artificial Intelligence

are also required to ensuring trustworthiness of AI medical applications in

addition to educating clinicians and the general community about AI and
its use and limitations. Through this education and subsequent understand-
ing, AI stands a better chance of being accepted by the medical and patient
populations. Finally, accountability is about ensuring the safety and qual-
ity of AI medical application through appropriate regulatory and clinical
governance processes. This requires input and involvement from a range of
governmental and non-governmental bodies. Further to this, legal frame-
works and guidance need to be constituted as to who becomes responsible
if there were AI-related medical errors or mishaps. In essence, accountability
is extending beyond the AI medical application to cover a range of players
(Reddy, Allan, et al., 2019). This is necessary to ensure the appropriate and
safe use of AI in medicine.

1.5 The Future

As costs of running healthcare, the volume of medical data, the time
required to train and deploy work-ready medical workforce and complex-
ity of medical delivery increase, it is inevitable for stakeholders to explore
an increased role for AI. The rate and extent at which AI gets adopted in
routine clinical care delivery are not guaranteed. However, based on current
evidence, one can speculate where AI can contribute to and benefit clinical
care. AI can replace some of the mundane or repetitive tasks that clinicians
engage with leaving them more time to engage with patients in a meaning-
ful manner. Also, areas which require analysis of complex or voluminous
data may benefit from AI’s ability to infer patterns from the data contribut-
ing to an augmented medicine model. Further, the progression of research
and trials in AI robotic systems can eventuate in the automation of certain
aspects of surgery, aged care and hospital logistics (Pee et al., 2019; Svoboda,
2019). All these developments herald an era of algorithmic medicine.

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Audit of Artificial Intelligence Algorithms and Its Impact in Relieving Shortage of

Specialist Doctors
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Use of Artificial Intelligence in Sepsis Detection and Management

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Transforming Clinical Trials with Artificial Intelligence

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An Industry Review of Neuromorphic Chips

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Artificial Empathy An Artificial Intelligence Challenge

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