{"id":6777,"date":"2024-04-04T11:55:12","date_gmt":"2024-04-04T09:55:12","guid":{"rendered":"https:\/\/trentinosalutedigitale.com\/blog\/intelligenza-artificiale-e-dati-sanitari\/"},"modified":"2024-04-10T10:20:42","modified_gmt":"2024-04-10T08:20:42","slug":"intelligenza-artificiale-e-dati-sanitari","status":"publish","type":"post","link":"https:\/\/trentinosalutedigitale.com\/en\/blog\/intelligenza-artificiale-e-dati-sanitari\/","title":{"rendered":"Artificial intelligence and health data"},"content":{"rendered":"

World Health Day will be celebrated on Sunday, April 7. One of the issues debated in recent years is the importance of diagnosis: according to a 2016 University of Baltimore analysis, in the United States alone, medical errors cause more than 250 thousand deaths a year out of a total of about 2.6 million deaths<\/strong>.\u00a0<\/strong><\/p>\n

\"\"<\/b><\/p>\n

Fortunately, in the face of this real social emergency,\u00a0AI<\/strong>\u00a0has come to the aid of health care workers, that appears to be almost twice as accurate as doctors in making diagnoses. However, this brings with it a number of issues, mainly related to data\u00a0privacy<\/em>. Solutions are also moving toward the use of synthetic data, which offers an optimal combination for future healthcare and research. But from what perspective?<\/strong> We talked about this with the<\/strong> director of\u00a0<\/strong>Fondazione Bruno Kessler<\/strong><\/a>‘s\u00a0<\/strong>Center for Digital Health and Wellbeing<\/strong><\/a>, Stefano Forti.<\/strong><\/p>\n

The use of AI raises an important question that experts have been wondering about for some time: will the physician be replaced by these systems (e.g., Machine Learning or<\/em>\u00a0Virtual and\u00a0<\/strong>Augmented Reality<\/strong><\/em>) in the coming years?<\/strong><\/p>\n

“The answer has to be contextualized,” said\u00a0Stefano Forti<\/strong>, who is also a contact person for FBK on the Executive Committee of the “TrentinoSalute4.0<\/strong><\/a>” center for digital health development. “It depends on the type of tool and the intended use,” he added.<\/p>\n

Elaborate, please.<\/strong><\/p>\n

“Regarding the area of\u00a0diagnostic and prognostic models<\/strong>\u00a0trained on data, to date we cannot disregard the fact that\u00a0the final decision always rests with the physician<\/strong>. The main reason is that these tools ‘see’ only one part of the problem. Algorithms do a single\u00a0task<\/em>\u00a0well (e.g., say whether an x-ray image is positive or negative), but they cannot count on a range of other contextual data (such as the patient’s medical history), which only the health care provider possesses. Radiologists<\/strong>\u00a0were the first to support the development and deployment of AI and at the same time to fear being replaced by those algorithms.\u00a0 For the past few years, diagnostic algorithms that replicate the diagnostic accuracy of the best radiologists have been available. The useful way to use them is as decision support for the radiologist, who, at the time of diagnosis, can\u00a0take into account the “algorithm’s suggestion,”<\/strong> but puts it in context with respect to the patient’s history. As can be seen in recent years, radiologists have not lost jobs, far from it. There is a shortage of radiologists in the national health care system. So integrating AI into health care can not only improve outcomes, but it also promotes more efficient and patient-centered diagnosis and treatment, and, let me be clear,\u00a0by supporting human expertise and not replacing it<\/strong>.”<\/p>\n

Another important issue on national discussion tables is the relationship between AI and privacy. What are the risks and what are the opportunities?<\/strong><\/p>\n

“The AI Act,<\/em><\/strong>\u00a0a regulatory document from the European Union, is a very good reference point. The general directions now will have to be specifically applied based on the different areas.\u00a0 In the health sector there are many issues to be addressed. We know that algorithms\u00a0need data\u00a0to<\/strong>\u00a0be trained. But the\u00a0availability of data in healthcare is unfortunately still a problem<\/strong>\u00a0to be solved. The development of AI models cannot be separated from the\u00a0informed consent<\/strong>\u00a0that the patient must provide to allow the use of information about him or her. Any study whose purpose is to validate clinical efficacy and risk must include consultation with the\u00a0ethics committee of the health care institution<\/strong>\u00a0that makes its patient data available to researchers. That is why to date the focus on\u00a0privacy<\/em><\/strong>\u00a0<\/em>and consent from patients is rightly very high.”<\/p>\n

In this context, citizen consent is a key issue.<\/strong><\/p>\n

“Patients must be informed\u00a0for what purpose their data is being used<\/strong>. But actually there is nothing new: the same principle in health care already applies when undertaking the various clinical trials (for example, on the approval of new drugs).”<\/p>\n

There is also much discussion about the responsibility of physicians when supported by Artificial Intelligence.<\/strong><\/p>\n

“Beyond the need to\u00a0certify<\/strong>\u00a0these tools as medical devices, their use in clinical practice is still in its infancy.\u00a0 Bringing an AI diagnostic-predictive algorithm ‘into production’ in clinical practice implies a systems approach in which various\u00a0stakeholders must necessarily be involved,<\/em>\u00a0starting with clinicians and including the various institutional levels that deal with\u00a0socio-economic-organizational and privacy aspects<\/strong>.<\/p>\n

We are talking about digital and AI solutions that are not aimed at doctors, but directly involve patients. In what area are they most useful?<\/strong><\/p>\n

“The potential is great, especially in the area of\u00a0prevention<\/strong>.\u00a0 We are already seeing a lot\u00a0of development of appropriately designed ‘virtual’ assistants<\/strong>\u00a0(chatbots<\/em>) that can perform a variety of tasks in an\u00a0automated way.<\/strong> Particularly in\u00a0behavioral medicine<\/strong>, they are designed to provide patients with skills and competencies that enable them to better manage their health and take care of themselves. \u00a0\u00a0 This is what\u00a0is called patientempowerment<\/strong><\/em> .<\/strong>\u00a0Through these systems, health care providers could entrust virtual assistants with some\u00a0educational and psycho-educational tasks and<\/strong>\u00a0thus gain more time to devote to other more critical aspects of their patients’ care. The study of these digital behavioral interventions is part of\u00a0a growing area of science and innovation called ‘digital therapies.'”<\/strong><\/p>\n

Speaking of apps and digital therapies, is the Italian patient-user ready for this new challenge?<\/strong><\/p>\n

“Let’s look around: who doesn’t own a\u00a0smartphone<\/em> nowadays? Who doesn’t use apps to manage every aspect of their lives, from bank account management, to entertainment or, as in the case of the provincial\u00a0TreC+<\/strong> platform, for health? So the answer is yes<\/strong>, all the more so if within the design and development process of these\u00a0digital interventions<\/strong>, aspects of usability and user experience have been taken into account. Then there is a part of the population that owns a\u00a0smartphone<\/em>, but refuses to use any kind of app and only uses it to make phone calls. With those people, we need to activate awareness programs and courses on the importance of using these tools for health purposes. If the patient finds the app useful then they will use<\/strong> it. Also, if it is the doctor who proposes the use of new technologies to their patients, they will have more confidence and start using them.”<\/p>\n

And are physicians ready?<\/strong><\/p>\n

The most important aspect is\u00a0to make healthcare personnel understand the potential of AI and digital therapies,<\/strong>\u00a0highlighting the\u00a0benefits<\/strong>\u00a0they can derive for their work. This educational<\/strong>\u00a0component should be offered as early as within\u00a0medical and health professions degree<\/strong> programs, but it should also be part of the training of\u00a0<\/strong>\u00a0managers<\/strong><\/em> working in various capacities within health care organizations, starting with general managers and medical directors. The key theme is that these new technologies have a\u00a0strong impact at the organizational level<\/strong>\u00a0in that they cannot be just an ‘addition’ to current processes, but necessarily lead to the need to\u00a0rethink new models of health service delivery<\/strong>.”<\/p>\n

Citizens, therefore, become more and more\u00a0<\/strong>managers\u00a0<\/strong><\/em>of themselves and increasingly aware of the management of their own health. This is one of the missions of TreC+, a digital platform through which citizens can manage their data and network with the health care system. How does the platform develop and how will the role of the citizen user\/patient evolve? \u00a0<\/strong><\/p>\n

“We believe that the issue of\u00a0prevention<\/strong>\u00a0(primary, secondary or tertiary) is of paramount importance. To date, the health care system is very much in the doldrums with respect to these issues.\u00a0 Providers focus on treatment, and with dwindling resources, the opportunities to proactively put in place\u00a0prevention<\/strong> actions, especially in\u00a0mental wellness<\/strong>, which has a lot of hidden cases, are very few today.\u00a0 In Trentino<\/strong>, the platform “TreC +<\/strong><\/a>” (which stands for Cartella Clinica del Cittadino, Citizen’s Medical Records) has been active for several years, through which Autonomous Province of Trento residents can take advantage of a wide set of\u00a0online<\/em> health services. Users can access one’s Electronic Health File (Fascicolo Sanitario Elettronico<\/strong>\u00a0(FSE<\/strong>) to consult information and documents concerning one’s health, such as reports, drug prescriptions and specialist referrals. They can schedule exams and visits, and through auhtorization, also manage all functions for loved ones they provide care for, such as an elderly parent or minor children. In addition,\u00a0telemedicine<\/strong> services will be provided in the coming years through the TreC+ platform.”<\/p>\n

What have you been working on in recent months?<\/strong><\/p>\n

“We have been working on the “third layer” for the\u00a0TreC+<\/strong> platform, which concerns\u00a0virtual assistants<\/strong>\u00a0in the area of\u00a0mental wellness<\/strong>\u00a0and\u00a0promotion of healthy lifestyles<\/strong>. In particular, we are studying solutions that target “at-risk” individuals (e.g., overweight adults or children), with interventions that motivate and teach the patient how to become a more responsible and educated “manager<\/em>” of their health.”<\/p>\n

How many citizens are using the TreC+ platform today?<\/strong><\/p>\n

“More than 270 thousand users in the autonomous province of Trento, representing more than 50 percent of the Province population. In the cell phone and tablet app versions, we count more than 170 thousand users.”<\/p>\n

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