Artificial Intelligence in Medicine

ARTIFICIAL INTELLIGENCE IN MEDICINE

DESCRIPTION:

Artificial intelligence in medicine is a new research area that combines sophisticated representational and computing techniques with the insights of expert physicians to produce tools for improving health care.

Artificial Intelligence is the study of ideas which enable computers to do the things that make people seem intelligent ... The central goals of Artificial Intelligence are to make computers more useful and to understand the principles which make intelligence possible.

Medicine is a field in which technology is much needed. Our increasing expectations of the highest quality health care and the rapid growth of ever more detailed medical knowledge leave the physician without adequate time to devote to each case and struggling to keep up with the newest developments in his field. Due to lack of time, most medical decisions must be based on rapid judgments of the case relying on the physician's unaided memory. Only in rare situations can a literature search or other extended investigation be undertaken to assure the doctor (and the patient) that the latest knowledge is brought to bear on any particular case.

We view computers as an intellectual, deductive instrument, which can be integrated into the structure of the medical care system. The idea that these machines can replace the many traditional activities of the physician is probably. Advocators for artificial intelligence research envisions that physicians and the computer will engage in frequent dialogue, the computer continuously taking note of history, physical findings, laboratory data, and the like, alerting the physician to the most probable diagnoses and suggesting the appropriate, safest course of action

Expert or knowledge-based systems are the commonest type of AIM system in routine clinical use. They contain medical knowledge, usually about a very specifically defined task, and are able to reason with data from individual patients to come up with reasoned conclusions. Although there are many variations, the knowledge within an expert system is typically represented in the form of a set of rules.

Medicine has formed a rich test-bed for machine learning experiments in the past, allowing scientists to develop complex and powerful learning systems. While there has been much practical use of expert systems in routine clinical settings, at present machine learning systems still seem to be used in a more experimental way. There are, however, many situations in which they can make a significant contribution.


PROS

Machine learning systems can be used to develop the knowledge bases used by expert systems. Given a set of clinical cases that act as examples, a machine learning system can produce a systematic description of those clinical features that uniquely characterise the clinical conditions. This knowledge can be expressed in the form of simple rules, or often as a decision tree.

The decisions and recommendations of a program can be explained to its users and evaluators in terms which are familiar to the experts.

We can measure the extent to which our goal is achieved by a direct comparison of the program's behavior to that of the experts.

The ability to develop expert computer programs for clinical use, making possible the inexpensive dissemination of the best medical expertise to geographical regions where that expertise is lacking, and making consultation help available to non-specialists who are not within easy reach of expert human consultants.

To ability to formalize medical expertise, to enable physicians to understand better what they know and td give them a systematic structure for teaching their expertise to medical students.

The ability to test Artificial Intelligence theories in a "real world" situations.

The resulting developments in the AI sub-field of machine learning have resulted in a set of techniques which have the potential to alter the way in which knowledge is created.

AI looks at raw data and then attempt to hypothesize relationships within the data, and newer learning systems are able to produce quite complex characterizations of those relationships. In other words they attempt to discover humanly understandable concepts.

AI allows the ability to discover new drugs. The learning system is given examples of one or more drugs that weakly exhibit a particular activity, and based upon a description of the chemical structure of those compounds, the learning system suggests which of the chemical attributes are necessary for that pharmacological activity. Based upon the new characterization of chemical structure produced by the learning system, drug designers can try to design a new compound that has those characteristics.

CONS

Some systems require the existence of an electronic medical record system to supply their data, and most institutions and practices do not yet have all their working data available electronically.

Others suffer from poor human interface design and so do not get used even if they are of benefit.

Much of the reluctance to use systems simply arose because expert systems did not fit naturally into the process of care, and as a result using them required additional effort from already busy individuals.

Computer illiteracy of healthcare workers is also a problem with artificial intelligent systems. If a system is perceived as beneficial to those using it, then it will be used. If not, it will probably be rejected.

APPLICATIONS

There are many different types of clinical task to which expert systems can be applied.

Generating alerts and reminders. In so-called real-time situations, an expert system attached to a monitor can warn of changes in a patient's condition. In less acute circumstances, it might scan laboratory test results or drug orders and send reminders or warnings through an e-mail system.

Diagnostic assistance. When a patient's case is complex, rare or the person making the diagnosis is simply inexperienced, an expert system can help come up with likely diagnoses based on patient data.

Therapy critiquing and planning. Systems can either look for inconsistencies, errors and omissions in an existing treatment plan, or can be used to formulate a treatment based upon a patient's specific condition and accepted treatment guidelines.

Agents for information retrieval. Software 'agents' can be sent to search for and retrieve information, for example on the Internet, that is considered relevant to a particular problem. The agent contains knowledge about its user's preferences and needs, and may also need to have medical knowledge to be able to assess the importance and utility of what it finds.

Image recognition and interpretation. Many medical images can now be automatically interpreted, from plane X-rays through to more complex images like angiograms, CT and MRI scans. This is of value in mass-screenings, for example, when the system can flag potentially abnormal images for detailed human attention.

EXPERT LABORATORIES INFORMATION SYSTEMS

The PUFF system for automatic interpretation of pulmonary function tests has been sold in its commercial form to hundreds of sites world-wide. PUFF can diagnose the presence and severity of lung disease and produce reports for the patient's file. PUFF went into production at Pacific Presbyterian Medical Centre in San Francisco in 1977, making it one of the very earliest medical expert systems in use. Many thousands of cases later, it is still in routine use.

GermWatcher is an expert system that monitors microbiology culture data from a hospital's laboratory system, identifies those cultures which represent nosocomial infections and reports them to the US National Centers for Disease Control and Prevention (CDC). GermWatcher checks for hospital-acquired (nosocomial) infections, which represent a significant cause of prolonged inpatient days and additional hospital charges (Kahn et al.,1993). Microbiology culture data from the hospital's laboratory system are monitored by GermWatcher, using a rule-base containing a combination of national criteria and local hospital infection control policy.

PEIRS (Pathology Expert Interpretative Reporting System) appends interpretative comments to pathology reports. The knowledge aqusition strategy is the Ripple Down Rules method, which has allowed a pathologist to build over 2300 rules without knowledge engineering or programming support. During it period of operation, PEIRS interpreted about 80-100 reports a day with a diagnostic accuracy of about 95%. It accounted for about which 20% of all the reports generated by the hospital's Chemical Pathology Department. PEIRS reported on thyroid function tests, arterial blood gases, urine and plasma catecholamines, hCG (human chorionic gonadotrophin) and AFP (alpha fetoprotein), glucose tolerance tests, cortisol, gastrin, cholinesterase phenotypes and parathyroid hormone related peptide (PTH-RP).

Web Resources:

http://groups.csail.mit.edu/medg/ftp/psz/AIM82/ch1.html
http://www.openclinical.org/aiinmedicine.html
http://www.openclinical.org/aisp_germwatcher.html
http://www.openclinical.org/aisp_peirs.html
http://www.openclinical.org/aisp_puff.html

Related Terminology:

Electronic patient record
PEIRS
GermWatcher
PUFF
Machine learning

Citations/References:
NA

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