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Specific contracting instruments are needed to ensure that data sharing involves both necessary protection as well as, where relevant, fair material returns to healthcare organizations and the patients they serve. Initiatives to give patients access to their healthcare data, including new proposals from the Center for Medicare and Medicaid Services 22 are welcome, and in fact it has long been argued that patients themselves should be the owners and guardians of their health data and subsequently consent to their data being used to develop AI solutions.
Another, more revolutionary path would be for governments to mandate that all healthcare organizations store their clinical data in commercially available clouds. In either scenario, existing initiatives such as the Observational Medical Outcomes Partnership OMOP 25 and Fast Healthcare Interoperability Resources FHIR standard 26 that create a common data schema for storage and transfer of healthcare data as well as AI enabled technology innovations to accelerate the migration of existing data 27 will accelerate progress and ensure that legacy data are included.
There are several complex problems still to be solved including how to enable informed consent for data sharing, and how to protect confidentiality yet maintain data fidelity. However, the prevalent scenario for data infrastructure development will depend more on the socio-economic context of the health system in question rather than on technology. A notable by-product of a move of clinical as well as research data to the cloud would be the erosion of market power of EMR providers. The status quo with proprietary data formats and local hosting of EMR databases favors incumbents who have strong financial incentives to maintain the status quo.
Creation of health data infrastructure opens the door for innovation and competition within the private sector to fulfill the public aim of interoperable health data. The potential of AI is well described, however in reality health systems are faced with a choice: to significantly downgrade the enthusiasm regarding the potential of AI in everyday clinical practice, or to resolve issues of data ownership and trust and invest in the data infrastructure to realize it. Now that the growth of cloud computing in the broader economy has bridged the computing gap, the opportunity exists to both transform population health and realize the potential of AI, if governments are willing to foster a productive resolution to issues of ownership of healthcare data through a process that necessarily transcends election cycles and overcomes or co-opts the vested interests that maintain the status quo—a tall order.
Without this however, opportunities for AI in healthcare will remain just that—opportunities. OpenLearn, The Open University. How London got its Victorian sewers. Rajkomar, A. Machine learning in medicine. Panch, T.
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Artificial intelligence, machine learning and health systems. Health 8 , Yan, S. A systematic review of the clinical application of data-driven population segmentation analysis. BMC Med. Pronovost, P. Paying the Piper: investing in infrastructure for patient safety. Jt Comm.
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Patient Saf. Keane, P. With an eye to AI and autonomous diagnosis. NPJ Digit Med 1 , 40 Shaban-Nejad, A. Health intelligence: how artificial intelligence transforms population and personalized health.
NPJ Digit Med. Fogel, A. Artificial intelligence powers digital medicine. Gijsberts, C. Hermansson, J. Systematic review of validity assessments of Framingham risk scoreresults in health economic modelling of lipid-modifying therapies in Europe.
Pharmacoeconomics 36 , — Fry, E. Death by a thousand clicks: where electronic health records went wrong. Collins, G. Reporting of artificial intelligence prediction models. Lancet , — Johnson, A. Department of Veterans Affairs.
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VA Informatics and Computing Infrastructure. Park, T. Mandl, K. BMJ , — Artificial intelligence: opportunities and risks for public health.
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Lancet Digit Health 1 , e13—e14 Ornstein, C. Revell, T. European Parliament, Council of the European Union. California Legislative Information. AB Privacy: personal information: businesses. Passions run high, and peoples' opinions vary wildly. It's frequently difficult to find agreement on anything. There is, however, one universal truth I've found about the everyday practice of medicine, and what constitutes great medical care for any individual in any healthcare system. Having worked in the United Kingdom, Australia, up and down the east coast here in America -- and even had experience with medicine in a third world country, India, when relatives have been unwell -- the same rule always applies.
This is the following: Good communication is at the core of all good medical care, no matter where you are.
The doctor-patient interaction. However advanced we become scientifically and technologically, humans will always be humans. We are emotional beings that crave one-on-one personal connection. That sacred doctor-patient interaction, centered around trust, is to be valued and promoted. Doctors frequently need to be good communicators above being highly skilled clinicians. The ability to communicate well with patients and have a deep understanding of human nature, is paramount for any competent physician.
We've all seen everyday examples of physicians who could quote you any scientific paper from the last decade, yet have no idea how to talk to patients and their families. At the opposite end of the spectrum, is a physician who is terrible clinically not that it's ever something to aspire to , yet is highly personable -- and their patients love them!
While lots of traits that lead people to be good communicators may be innate, there are also many skills that can totally be taught and improved upon through deliberate practice. Organizational and administrative communication. The reality of modern day healthcare is that organizations need to work with all their staff and be as collaborative and open as possible.
As soon as mistrust and suspicion has taken hold between administrations and their frontline staff, it's a very difficult situation to come back from without a major overhaul.