Medical Care
Healthcare AI: Ensuring Successes & Avoiding Accidents
2024-12-03
Given the rapid spread of AI in U.S. healthcare, it's no surprise that unintended effects are emerging. While some may be pleasant, others pose risks. To navigate this landscape, healthcare organizations and AI developers must collaborate. Two researchers emphasize this in a recent JAMA opinion piece.

Strengthening Healthcare with AI Safety and Transparency

Conducting Real-World Clinical Evaluations

Before implementing AI-enabled systems into routine care, it's crucial to conduct or wait for real-world clinical evaluations published in high-quality medical journals. As new systems mature, healthcare organizations should conduct independent testing with local data to minimize patient safety risks. Iterative assessments should accompany this risk-based testing to ensure the systems benefit patients and clinicians while being financially sustainable and meeting ethical principles.

For example, imagine a hospital considering a new AI-powered diagnostic tool. By waiting for proper evaluations, they can ensure its accuracy and reliability before relying on it for patient care. This not only protects patients but also builds trust in the use of AI in healthcare.

Moreover, different medical specialties may have specific requirements for AI systems. By conducting local evaluations, organizations can tailor the use of AI to meet the unique needs of their patients and clinicians.

Involving AI Experts in Governance

Inviting AI experts into new or existing AI governance and safety committees is essential. These experts can include data scientists, informaticists, operational AI personnel, human-factors experts, and clinicians working with AI. Regular meetings of these committees allow for the review of new AI applications, consideration of safety and effectiveness evidence before implementation, and the creation of processes to monitor AI application performance.

For instance, a data scientist can provide insights into the data used by the AI system, ensuring its quality and relevance. An informaticist can help integrate the AI system into the healthcare workflow seamlessly. Human-factors experts can focus on how clinicians interact with the AI, minimizing potential errors.

By having a diverse group of experts involved, healthcare organizations can make more informed decisions about AI implementation and ensure its safe and effective use.

Maintaining an Inventory of AI Systems

Healthcare organizations should maintain and regularly review a transaction log of AI system use, similar to the audit log of the EHR. This log should include details such as the AI version in use, date/time of use, patient ID, responsible clinical user ID, input data, and AI recommendation or output. The AI committee should oversee ongoing testing to ensure the safe performance and use of these programs.

Let's take a hospital's radiology department as an example. By maintaining an inventory of their AI-enabled radiology systems, they can easily track which systems are in use, by whom, and for what patients. This allows for quick identification of any issues and enables proactive monitoring of system performance.

Regular reviews of the inventory help organizations stay updated on the status and usage of their AI systems, ensuring they are meeting the needs of the patients and clinicians.

Creating Training Programs for Clinicians

Initial training and subsequent clinician engagement with AI systems should include a formal consent-style process with signatures. This ensures that clinicians understand the risks and benefits before accessing the AI tools. Steps should also be taken to ensure patients understand when and where AI systems are used and the role of clinicians in reviewing the output.

For example, a training program for cardiologists using an AI-based heart disease diagnosis system might include detailed explanations of how the AI works, its limitations, and the importance of clinician review. Clinicians would sign a consent form indicating their understanding and agreement to use the system.

By providing clear instructions and engaging clinicians in the process, healthcare organizations can enhance the safe and effective use of AI in clinical practice.

Establishing a Reporting Process for Safety Issues

Developing a clear process for patients and clinicians to report AI-related safety issues is crucial. A rigorous, multidisciplinary process should be implemented to analyze these issues and mitigate risks. Healthcare organizations should also participate in national postmarketing surveillance systems to aggregate and analyze safety data.

Imagine a situation where a patient experiences an unexpected outcome after using an AI-enabled surgical system. With a clear reporting process, both the patient and the clinician can quickly report the issue. A multidisciplinary team can then investigate and take appropriate actions to prevent similar incidents in the future.

Participating in national surveillance systems allows for a broader analysis of safety data and the sharing of best practices among different healthcare organizations.

Providing Disabling Authority for AI Systems

Similar to preparing for EHR downtime, healthcare organizations must have policies and procedures in place to manage clinical and administrative processes when the AI is not available. Clear written instructions should enable authorized personnel to disable, stop, or turn off AI-enabled systems 24/7 in case of an urgent malfunction.

For instance, during a power outage or a system failure, having the ability to quickly disable the AI system ensures the safety of patients and allows for a smooth transition to manual processes. Regular assessments of how AI systems affect patient outcomes, clinician workflows, and system-wide quality are also essential.

If AI models fail to meet pre-implementation goals, revisions should be considered. If revisions are not feasible, the entire system may need to be decommissioned to protect patient safety and maintain the integrity of the healthcare system.

Health Vending Machines Installed in Omaha with Free Healthcare Items
2024-12-03
In Omaha, a remarkable initiative is taking shape with the installation of health vending machines. These machines are not your typical vending machines filled with junk food; instead, they offer a wide range of essential health products.

"Access to Health at Your Fingertips - Omaha's Health Vending Machines"

Locations and Installation

The Siena Francis House is one of the five locations where the Douglas County Health Department has installed these health vending machines. These machines can be found at various places across Omaha, including the Douglas County Health Department, American Dream bar, Nebraska Urban Indian Health Coalition, Charles B. Washington Library, and the Siena Francis House emergency shelter. Four of the machines are currently placed outdoors, while the one at Siena Francis House is awaiting an outside electricity hookup. They were installed last week with no marketing or promotion.

These machines offer a diverse range of items such as STI test kids, COVID test kits, condoms, lubricant, pregnancy tests, tampons, pads, wound care kits, emergency contraceptive, and fentanyl test strips. It's truly a one-stop solution for many health needs.

Access and Convenience

One of the most significant aspects of these health vending machines is their accessibility. People can return items like STI test kits directly to the vending machine, and the health department will collect them the next day. There is no need to provide a name, and the machine tracks demographic data such as zip code, age, race, ethnicity, and gender.

This provides a convenient way for people to access essential health products without the hassle of going through traditional channels. It's just one more avenue where the health department is meeting people where they are.

Impact and Usage

In just the first six days since the installation, about 120 items have reached the hands of those who need them. This shows the immediate demand and the positive impact these machines are having.

Chris Bauer, the chief development officer with Siena Francis House, is proud of the fact that these tools are available. He hopes that it will inspire people to think about their health and take steps to change. Leah Casanave, leading the charge on this project with the health department, believes that this is a significant step towards making health accessible for everyone.

The vending machines are funded through grants and private donations, ensuring that no taxpayer dollars are used. The money they have is expected to last for five years, and after that, the health department will seek further funding to keep this initiative going.

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Author Talks: Unraveling the Origins and Impact of 'Tribe'
2024-11-19
In this edition of Author Talks, McKinsey Global Publishing’s Christine Y. Chen engages in a captivating conversation with Michael Morris, the Chavkin-Chang Professor of Leadership at Columbia University Business School. Morris delves into his new book, "Tribal: How the Cultural Instincts That Divide Us Can Help Bring Us Together" (Thesis/Penguin Random House, October 2024). Through his extensive research and keen observations as a behavioral scientist, Morris unravels the origins of the word "tribe" and dispels the negative connotations often associated with it. He presents a framework that views culture as a positive, malleable entity, capable of being intentionally redefined to unite and inspire people and communities, rather than divide and discourage them. An edited version of the conversation follows, and you can also watch the full video at the end of this page.

Understanding the Misconceptions About "Tribe"

The word "tribe" is an ancient Latin term that originally described ethnic groups forming early nations. It later found its way into other languages through the Bible and was used to refer to various communities. During colonialism, it took on pejorative connotations of stasis and primitivism. However, tribe remains the best word to capture the feeling of being part of a community united by shared ideas, aesthetics, or customs. It has proliferated in ordinary and business discourse due to its significance in describing such communities. Morris emphasizes that we cannot ban the word as it has a long and bright future.There is a dangerous way of thinking that uses the concept of tribalism to explain escalating conflicts without providing practical solutions. Behavioral scientists and evolutionary theorists do not recognize this approach. Morris aims to counter this "toxic tribalism" by researching the basic social instincts that shape human behavior and how they create loyalties and biases.

Why Write a Book About Tribalism?

Morris, a behavioral scientist with decades of experience studying individual and organizational behavior, developed a framework for thinking about culture and its relevance to managers. He wanted to debunk the myth that culture is unchangeable and fixed. By providing people with the tools to understand and change culture deliberately, they can better manage and shape their environments.

Tribalism in Sports: The Guus Hiddink Story

Guus Hiddink is a Dutch soccer coach who demonstrated the adaptability of people and cultures. He brought out the talent in underperforming teams by creating new soccer styles. In South Korea, he transformed a faltering team by holding open tryouts and bringing in the world's best teams for exhibition games. The team's success was improbable, and it inspired other organizations to model their cultures after his. This shows how one person's belief in the adaptability of cultures can lead to significant changes.

Tribal Instincts and Signals

We all have multiple cultural identities that are triggered by situational cues. Understanding these triggers is crucial. The peer instinct allows us to imitate peers and work together efficiently. For example, a child from an underperforming school improves their test scores when placed in a higher-performing school due to conformity pressure.The hero instinct emerged about half a million years ago and involves sacrificing for the group. It enables cooperation and the growth of human groups. Symbols of the tribe play a significant role in triggering the hero instinct, as we emulate cultural heroes.The ancestor instinct represents our capacity to learn from the past. It allows us to build on the wisdom of previous generations and accumulate culture. Ceremonies trigger the continuity of evolution and create a traditionalist mindset, but they can also turn off critical thinking.

Leaders Leveraging Tribal Instincts for Cultural Change

Leaders can use different layers of culture to bring about change. Peer codes are sensitive to prevalence signals, and corporations can inspire change by showing people that others like them are doing certain things. Kodak, for example, created a culture of smiling for the camera by giving away inexpensive cameras and developing photo contests.Satya Nadella, the CEO of Microsoft, changed the company's culture from a knowing culture to a learning culture by going on a "listening tour" and understanding customer needs. He recognized structural impediments and put new measures in place.Finally, leaders can use the ancestor instinct through "invented traditions." Thanksgiving is a prime example where Abraham Lincoln created a new holiday to unite the country during a divided time. These examples show how leaders can understand and use the levers of tribal instincts to create cultural change.
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