ai与虚拟现实_AI医疗的神话与现实

ai与虚拟现实

Editor’s Note: AI has had a transformative effect on many industries, the healthcare industry included. In this insightful piece, Kerrie Holley, SVP and Technology Fellow at Optum, and Dr. Siupo Becker, VP of Health Care Strategies at UnitedHealthcare, explore some of the ways that AI and healthcare providers have been able to work together, while dispelling some popular myths about the role of AI in healthcare. We’d love to hear from you about what you think about this piece.

编者注：人工智能对包括医疗保健行业在内的许多行业产生了变革性的影响。 在这一有见地的文章中，Optum的高级副总裁兼技术研究员Kerrie Holley和UnitedHealthcare的卫生保健战略副总裁Siupo Becker博士探讨了AI和医疗保健提供者能够协同工作的一些方式，同时消除了一些流行的方法。关于AI在医疗保健中作用的神话。 我们很乐意听到您对您对此作品的看法。

AI医疗保健神话 (AI Healthcare Myths)

There is so much excitement involving AI in healthcare, but what exactly is AI in healthcare supposed to fix? People look to AI to predict future disease, prevent disease, enhance disease treatment, overcome obstacles to health care access, solve the burden of overworked and burnt out clinicians, and overall improve the health of people while decreasing the cost of healthcare. While some of this is achievable, AI is not a miracle panacea to all health and healthcare related problems.

在医疗保健领域涉及AI的事情是如此令人兴奋，但是医疗保健领域的AI应该解决什么呢？ 人们期望AI来预测未来的疾病，预防疾病，增强疾病治疗，克服获得医疗保健的障碍，解决过度劳累和精疲力竭的临床医生的负担，并总体上改善人们的健康状况，同时降低医疗保健成本。 尽管其中一些是可以实现的，但AI并不是解决所有与健康和医疗保健相关问题的灵丹妙药。

Roy Amara, a previous head of the Institute of the Future, coined Amara’s Law, which states, “We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.” One of the major myths regarding AI is that AI will replace physicians and other healthcare providers. AI relies upon the knowledge base provided by trained and experienced clinicians. AI cannot replace the “care” aspect of human interaction and its associated documented therapeutic effect. AI does not have the capability to determine the best solution when a holistic review of a patient would recommend an approach that relies on human creativity, judgment and insight. For example, take an otherwise healthy ninety year old patient who develops an imminently treatable cancer. Logic and current medicine would support aggressive treatment to destroy the cancer. The human aspect comes into play when this same patient lets their clinician know that they are widowed and alone, and although not depressed, feel they have lived a full life and decline treatment. AI and most physicians would argue for treatment. Patient autonomy and holistic review of an individual’s wishes and autonomy in their healthcare decisions takes priority here and would have been missed by an autonomous AI agency operating without human oversight.

未来研究所的前任负责人罗伊·阿马拉(Roy Amara)创造了《阿马拉法》，该法指出：“我们倾向于在短期内高估技术的效果，而在长期内低估效果。” 关于AI的主要神话之一是AI将取代医生和其他医疗保健提供者。 人工智能依赖于训练有素且经验丰富的临床医生提供的知识库。 人工智能无法取代人类互动的“护理”方面及其相关的书面治疗效果。 当对患者进行全面检查会建议一种依赖于人类创造力，判断力和洞察力的方法时，AI无法确定最佳解决方案。 例如，请一名原本很健康的九十岁患者患上即将可治疗的癌症。 逻辑学和当前医学将支持积极治疗以摧毁癌症。 当同一位患者让他们的临床医生知道他们是孤寡寡妇，尽管并不沮丧，却感到自己过着充实的生活并拒绝接受治疗时，人的方面就发挥了作用。 人工智能和大多数医生会主张治疗。 患者自主权以及对个人意愿和医疗保健决策自主权的全面审查在这里被优先考虑，而在没有人为监督的情况下，自治的AI机构会错过这一机会。

AI can apply counterintuitive strategies to health management, but the steps from raw data to decision are complex and need human perceptions and insights. The process is a progression, starting with clinical data, obtained from innumerable sources that is built and developed to become relevant information, which is then used and applied to populations and/or individuals. The transformation from raw data to insights to intelligence is a process that is guided by clinicians working with data scientists using AI. The clinical interpretation of data is dependent upon humans and their understanding of disease processes and its effect on the timeline of progression of disease that molds this early knowledge. Algorithms for disease management, identification of risk factors predicting the probability of development of disease, all this is based on human understanding and interpretation of the disease process and the human state. The use of AI and clinicians activities are intertwined and together the potential for improving health is remarkable.

人工智能可以将违反直觉的策略应用于健康管理，但是从原始数据到决策的步骤非常复杂，需要人类的理解和见识。 从临床数据开始，这个过程是一个过程，该过程是从无数资源中获得的，这些数据经过建立和发展成为相关信息，然后被使用并应用于人群和/或个人。 从原始数据到洞见再到情报的转变是一个由临床医师与使用AI的数据科学家合作的过程指导的过程。 数据的临床解释取决于人类及其对疾病过程的了解，以及对疾病发展时间线的影响，从而影响了这一早期知识。 疾病管理算法，识别预测疾病发展可能性的风险因素的算法，都是基于人类对疾病过程和人类状态的理解和解释。 人工智能和临床医生活动的使用相互交织在一起，并且改善健康的潜力非常显着。

AI has inherent benefit and broad application, but it is AI in collaboration with the human interface which allows AI tools to be so impactful. AI will not replace health care providers, but is a powerful tool to augment disease identification, and management along with the physician. Let’s explore some of the ways that AI and healthcare providers have been able to work together, while also dispelling the myths that AI can do it all on its own.

人工智能具有固有的优势和广泛的应用，但正是人工智能与人机界面相结合，使人工智能工具如此具有影响力。 AI不会取代医疗保健提供者，而是与医生一起增强疾病识别和管理能力的强大工具。 让我们探索AI和医疗保健提供者能够一起工作的一些方式，同时还消除了AI可以自己全部完成的神话。

AI将治愈疾病 (AI Will Cure Disease)

AI is not a replacement for a medicinal cure that may one day end diseases (e.g., coronary artery disease or cancer); however, advances in AI, the massive accumulation of data (i.e., Big Data), and data sharing in health care could lead to what does. Some people believe that if AI can be used to predict who is at risk for disease, then we can intervene and change behaviors or start treatment that would circumvent the disease from ever becoming present. Of course helping people avoid getting a disease is not the same as curing a disease. Defining what we mean by a cure can be confusing, and is never more evident than in certain diseases, such as Human Immunodeficiency Virus (HIV). Magic Johnson, NBA All star proclaimed he was cured from HIV, because doctors were unable to detect virus in his body after, and with ongoing treatment for HIV. Without the anti-retroviral medications, HIV would have increased in number and once again been found in his body. Was he ever truly cured? For certain diseases what defines a cure is not well defined. However, preventing a disease for an individual is better than trying to cure that disease.

AI并不能替代可能一天之内会导致疾病(例如冠状动脉疾病或癌症)的药物治疗； 但是，人工智能的进步，大量数据(即大数据)的积累以及医疗保健中的数据共享可能会导致这种情况。 有人认为，如果可以使用AI来预测谁有患疾病的风险，那么我们可以进行干预和改变行为，或者开始进行治疗，从而避免疾病的发作。 当然，帮助人们避免患病与治愈疾病并不相同。 定义我们所指的治愈方法可能会造成混淆，并且从未像人类免疫缺陷病毒(HIV)这样的某些疾病更加明显。 NBA魔术师约翰逊(Magic Johnson)全明星宣布他已从艾滋病毒中治愈，因为医生在接受艾滋病毒治疗后无法检测到他体内的病毒。 如果没有抗逆转录病毒药物，艾滋病毒的数量将会增加，并再次在他的体内被发现。 他曾经真正治愈过吗？ 对于某些疾病，定义治愈的方法尚不明确。 但是，为个人预防疾病胜于尝试治愈该疾病。

The norm today is that we do this also, often without AI, working to prevent disease. Routinely, healthcare companies take in data from Electronic Health Records (EHRs), health care claims, prescriptions, biometrics and numerous data sources to create proprietary models for the identification of “at risk” patients. Healthcare constituents need to use artificial intelligence to support decisions and make recommendations based on the assessment and findings of clinicians providing healthcare to all patients for prevention to be effective.

今天的规范是，我们通常在没有AI的情况下也这样做，以预防疾病。 通常，医疗保健公司会从电子健康记录(EHR)，医疗保健索赔，处方，生物识别数据和众多数据源中获取数据，以创建专有模型来识别“高危”患者。 医疗保健人员需要使用人工智能来支持决策，并根据对所有患者提供医疗保健的临床医生的评估和发现提出建议，以使预防有效。

The healthcare ecosystem comprises consumers in need of health care services, clinicians and providers who deliver health care services, the government who regulates, insurance and payers who pay for services and the various agencies who administer and coordinate services. In the ideal state each of these ecosystem constituents are in sync optimizing patient care. A simple example is medical coding where the medical jargon does not always sync with the coding terminology resulting in gaps in care appearing in identifying the true disease process of an individual patient. The current system is heavily dependent on coding of diagnoses by hospitals, providers, medical coders and billing agents. This coding process, CAC, discussed previously, will improve as we see greater AI adoption increasing the opportunity to prevent diseases.

医疗保健生态系统包括需要医疗保健服务的消费者，提供医疗保健服务的临床医生和提供者，监管服务的政府，保险公司和为服务付费的付款人以及管理和协调服务的各种机构。 在理想状态下，这些生态系统成分中的每一个都可以同步优化患者护理。 一个简单的例子是医学编码，其中医学术语并不总是与编码术语保持同步，从而导致在识别单个患者的真实疾病过程中出现护理方面的空白。 当前的系统严重依赖于医院，提供者，医疗编码人员和计费代理机构对诊断的编码。 前面已经讨论过，这种编码过程，即CAC，将得到改善，因为我们看到更多的AI采用增加了预防疾病的机会。

AI can provide clinicians with more and better tools, augment a clinician’s diagnostic capabilities by analyzing a holistic picture of the individual patient with broader data streams and technological understanding of the disease process and who is both at risk and will be most greatly impacted. AI has become a more accurate tool for identifying disease diagnosis in images and with the rise of intelligent spaces (e.g. hospitals, homes, clinicians’ work spaces) AI triggers a more viable source of diagnostic information. The volume of data streams makes this unmanageable for a human but highly possible for intelligent machines powered by AI. By identifying and stratifying individuals most at risk AI can intervene to alert physicians and healthcare companies to intervene and address modifiable risk factors to prevent disease.

AI可以为临床医生提供更多更好的工具，通过分析具有更广泛数据流和对疾病过程的技术了解以及风险最高，受影响最大的个体患者的整体情况来增强临床医生的诊断能力。 人工智能已经成为用于识别图像中疾病诊断的更准确的工具，并且随着智能空间(例如医院，家庭，临床医生的工作空间)的兴起，人工智能触发了更可行的诊断信息源。 数据流的数量使人类无法控制，但对于由AI驱动的智能机器则非常有可能。 通过识别和分层最高风险个体，AI可以干预以提醒医生和医疗保健公司干预并解决可修改的风险因素以预防疾病。

AI algorithms, personalized medicine and predictive patient outcomes can be used to study different diseases and identify the best practice treatments and outcomes leading to potential increase in cure of a specific disease. AI can further analyze whether and why a specific population may not respond to certain treatments versus another.

人工智能算法，个性化医学和患者的预测结果可用于研究不同的疾病，并确定导致特定疾病治愈率可能提高的最佳实践疗法和结果。 AI可以进一步分析特定人群与其他人群相比是否以及为什么不响应某些特定疗法。

One area where AI has made significant impact already, is in identification of cancer in radiologic studies. University of Southern California Keck School of Medicine published a study in 2019 showing improved cancer detection using AI. Specifically, “a blinded retrospective study was performed with a panel of seven radiologists using a cancer-enriched data set from 122 patients that included 90 false-negative mammograms.” Findings showed that all radiologists experienced a significant improvement in their cancer detection rate. The mean rate of cancer detection by radiologists of 51% increased to a mean of 62% with use of AI, while false positives (detection of cancer when cancer is not actually present) remained essentially the same.¹ Early detection of disease states makes an enormous positive impact on treatment and cure in cancer outcomes not just with radiologists but similarly with dermatologists. Computer scientists at Stanford created an AI skin cancer detection algorithm using deep learning for detection of malignant melanoma (a form of skin cancer) and found that AI identified cancers as accurately as dermatologists. China has used AI in the analysis of brain tumors. Previously, neurosurgeons performed tumor segmentation (used in diagnosis of brain cancer) manually. With AI the results were accurate, reliable and created greater efficiency. Where early and accurate detection can lead to cure AI has a proven place in the diagnosis of cancers.

人工智能已经产生重大影响的一个领域是放射学研究中的癌症识别。 南加州大学凯克医学院在2019年发表了一项研究，显示使用AI可以改善癌症检测能力。 具体来说，“由七名放射科医生组成的小组进行了一项盲法回顾性研究，使用了来自122位患者的包括90例假阴性乳房X线照片的癌症丰富数据集。” 研究结果表明，所有放射科医生的癌症检出率均得到了显着提高。 放射科医生使用AI的平均癌症检出率从51％上升到62％的平均值，而假阳性(当实际上不存在癌症时检出癌症)则基本保持不变。¹疾病状态的尽早发现使得不仅对放射科医生，而且对皮肤科医生，都对癌症结果的治疗和治愈产生巨大的积极影响。 斯坦福大学的计算机科学家使用深度学习创建了一种AI皮肤癌检测算法，用于检测恶性黑色素瘤(一种皮肤癌)，并发现AI能够像皮肤科医生一样准确地识别出癌症。 中国已将AI用于脑肿瘤的分析。 以前，神经外科医生手动进行肿瘤分割(用于诊断脑癌)。 借助AI，结果准确，可靠，并提高了效率。 早期和准确的检测可以治愈艾滋病的地方已在诊断癌症中得到了证实。

Identifying and diagnosing cancer in its early stages coupled with proper care treatment increases the opportunity to cure patients of cancer. AI can significantly contribute to the diagnosis of patients based on signals or symptoms missed by human detection. Gathering data from large populations pools allows an understanding, and awareness of the most effective plans for treatment. This leads to better treatment for individual patients based on what has been proven as the most effective treatment plans for other patients who have had similar types of cancers. This is where AI and specifically deep learning algorithms using large data sets containing data of millions of patients diagnosed with cancer all over the world, plays a role. AI can provide evidence based recommendations to clinicians on the treatment plans with the greatest opportunity for positive outcomes.

在早期阶段识别和诊断癌症，再加上适当的护理治疗，增加了治愈癌症患者的机会。 AI可以根据人类检测遗漏的信号或症状为患者的诊断做出重大贡献。 从大量人群中收集数据可以使人们对最有效的治疗计划有所了解和认识。 基于已被证明是对其他患有类似癌症类型的患者最有效的治疗方案，这可以为单个患者提供更好的治疗。 AI在这里发挥着作用，特别是使用包含大数据集的深度学习算法的大数据集，这些数据集包含全世界数百万诊断为癌症的患者的数据。 AI可以为临床医生在治疗计划上提供基于证据的建议，从而最大程度地带来积极结果。

Human error can be life or death for cancer patients, detecting it early makes all the difference. AI helps with early detection and diagnosis by augmenting current diagnostic tools for clinicians. An important part of detecting lung cancer is finding if there are small lesions on the lungs from Computed Tomography (CT) scans. There is some chance of human error and this is where Artificial Intelligence plays a role. Clinicians using AI increase the likelihood of early detection and diagnosis which is a matter of life and death for these patients. With the big data available in relation to cancer and its treatment, AI has the potential to assist in creating structure out of these databases and pulling relevant information to guide patient decision making and treatment in the near future.

人为错误可能是癌症患者的生死攸关，因此尽早发现所有错误。 人工智能通过为临床医生增加当前的诊断工具来帮助及早发现和诊断。 检测肺癌的重要部分是通过计算机断层扫描(CT)扫描发现肺部是否有小病变。 人为错误有可能发生，而这正是人工智能发挥作用的地方。 使用AI的临床医生会增加早期发现和诊断的可能性，这对于这些患者而言是生死攸关的问题。 凭借与癌症及其治疗有关的大数据，人工智能有潜力协助在这些数据库中创建结构并提取相关信息以指导患者在不久的将来进行决策和治疗。

Giving patients tools which help them, also helps their doctors. Tools which rapidly analyze large amounts of patient data to provide signals that may otherwise go undetected. Machine learning algorithms that can learn about a patient continuously should increasingly play a role in healthcare. The shift of largely using computers to using devices that patients wear for early detection of disease states is on the rise. In spite of the plethora of good news seemingly almost daily of new machine learning algorithms or new devices or AI products improving healthcare, AI alone will not fix the healthcare problems facing societies. There are many challenges needed to be solved to make our healthcare system work better and AI will help but let’s dispel the next myth about AI alone fixing the problems facing healthcare.

给患者提供帮助他们的工具，也帮助他们的医生。 快速分析大量患者数据以提供可能无法检测到的信号的工具。 可以不断了解患者的机器学习算法应该在医疗保健中越来越多地发挥作用。 越来越多的人开始大量使用计算机，而将患者穿戴的设备用于疾病早期检测。 尽管似乎每天都有大量新机器学习算法或新设备或AI产品改善医疗保健的好消息，但仅靠AI并不能解决社会面临的医疗保健问题。 要使我们的医疗保健系统更好地工作，需要解决许多挑战，人工智能将有所帮助，但让我们消除关于仅靠人工智能解决医疗保健所面临的问题的下一个神话。

人工智能将取代医生 (AI Will Replace Doctors)

AI will not replace doctors now or in the near future. There is a lot of discussion suggesting that AI will replace doctors. In 2012, entrepreneur and Sun Microsystems co-founder, Vinod Khosla, articulated computers will replace 80 percent of what doctors do. Vinod sees a future where machines will replace 80 percent of doctors in a healthcare future that will be driven by entrepreneurs, not medical professionals. He wrote an article with the provocative title, “Do We Need Doctors Or Algorithms?”²

AI不会在现在或不久的将来取代医生。 大量讨论表明，人工智能将取代医生。 在2012年，企业家和Sun Microsystems联合创始人Vinod Khosla指出，铰接式计算机将取代医生工作的80％。 Vinod认为，在医疗保健的未来中，机器将取代80％的医生，这将由企业家而非医疗专业人员推动。 他写了一篇具有挑衅性标题的文章，“我们需要医生还是算法？”²

We can look at AI as a doctor replacement thing or a clinician augmentation. AI can perform a double check and see patterns from millions of patients that one doctor cannot possibly see. One doctor can’t possibly see a million patients across their lifetime but AI can. The diagnostic work done by a doctor arguably focuses heavily on pattern recognition. So augmenting diagnoses with AI makes sense.

我们可以将AI视为医生替代品或临床医生扩充。 AI可以执行双重检查，并查看一位医生可能看不到的数百万患者的模式。 一位医生一生可能看不到一百万名患者，但AI可以。 医生的诊断工作可以说主要集中在模式识别上。 因此，使用AI增强诊断是有意义的。

Key arguments for AI replacing doctors include:

人工智能替代医生的关键论点包括：

• AI can get more accurate every day, every year, every decade at a rate and scale not possible for human doctors
  AI每天，每年，每十年都能以人类医生无法企及的速度和规模变得更加准确
• AI will be able to explain possibilities and results with confidence scores
  人工智能将能够用置信度得分解释可能性和结果
• AI can improve the knowledge set, raise the insight of a doctor (perhaps not trained in a specific specialty)
  人工智能可以改善知识体系，提高医生的见识(也许未经过特定专业的培训)
• AI may be the only way to provide access to best-in-class health care to millions of people who don’t have access to healthcare services or can’t afford healthcare services
  人工智能可能是向数百万无法获得医疗服务或负担不起医疗服务的人们提供一流医疗服务的唯一途径

Arguments for not replacing doctors include:

不替代医生的论据包括：

• Doctors are better at decision making
  医生擅长决策
• Doctors have empathy which may be critical to clinical care
  医生的同理心可能对临床护理至关重要
• Doctors have a human connection which may directly influence how a patient feels and facilitate a patient adhering to a treatment plan
  医生具有人与人之间的联系，可以直接影响患者的感觉并促进患者遵守治疗计划
• American Medical Association (AMA) Journal of Ethics states “a patients’ desire for emotional connection, reassurance, and a healing touch from their caregivers is well documented”
  美国医学会(AMA)伦理学杂志指出：“患者对情感联系，放心和照顾者的抚慰的渴望得到了充分的证明”
• Doctors may observe or see critical signals because of human senses
  医生可能会由于人的感知而观察或看到关键信号
• AI cannot converse with patients like a human doctor
  人工智能无法像人类医生那样与患者交谈
• Subsconscious factors that may influence a doctor’s ability to treat, if not explicitly identified for AI, will be missed
  如果未明确确定AI可能影响医生治疗能力的潜意识因素将被忽略

There are many tasks that AI can do better than a doctor but rarely if at all will AI replace entire business processes, operations, occupation or profession. The most likely scenario is doctors in the foreseeable future will transition to a doctor who wields AI, understanding how to use AI tools for delivering more efficient and better clinical care. AI today provides a lot of point solutions and its opportunity to improve diagnostics is significant. Treatment pathways and even many diagnostics today require decision making something AI is not good at.

AI可以完成许多工作，胜过医生，但很少能取代AI取代整个业务流程，运营，职业或专业。 最可能的情况是，在可预见的将来，医生将过渡到使用AI的医生，他们了解如何使用AI工具来提供更有效，更好的临床护理。 当今的AI提供了许多点解决方案，其改善诊断的机会非常重要。 如今，治疗途径甚至许多诊断方法都需要做出决策，而人工智能则无法胜任。

A practical problem exists in that AI must live in our current brownfield world where several barriers must be overcome for AI replacing doctors. Today we have a proliferation of systems that do not integrate well with each other. For example, a patient who is cared for at a hospital, urgent care center or provider office may have his/her data spread across several different systems with varying degrees of integration and today a doctor’s ability to navigate the healthcare system is critical to patient care.

一个现实问题是，人工智能必须生活在我们当前的棕地世界中，在这个世界中，克服人工智能替代医生的障碍。 如今，我们出现了彼此之间无法很好集成的系统。 例如，在医院，紧急护理中心或提供者诊所中被护理的患者可能会将他/她的数据分散到具有不同集成度的多个不同系统中，而如今，医生浏览医疗保健系统的能力对于患者护理至关重要。

The reality is there is not going to be a computer, machine or AI that solves health care, just like there isn’t one solution to all banking, retail, or manufacturing. The path to digitization differs based on clinical speciality and most likely will occur one process at a time within domain or speciality. AI systems are here and on the horizon for assessing mental health, diagnosing disease states, identifying abnormalities and more.

现实是，没有一种计算机，机器或AI能够解决医疗保健问题，就像没有一种解决方案可解决所有银行业，零售业或制造业一样。 数字化的路径因临床专业而异，并且很可能一次在领域或专业范围内一次发生。 人工智能系统应运而生，用于评估心理健康，诊断疾病状态，识别异常等。

人工智能将减少医疗费用 (AI Will Decrease Healthcare Costs)

US health expenditure projections for 2018–2027 from CMS [cms.gov] show that the projected average growth rate on health care spend is 5.5% with expectations of meeting 6 trillion in spend by 2027. Looking at these numbers, it’s clear that healthcare spending will outstrip economic growth. All components of healthcare are projected to increase at exceedingly high annual rates over the next decade. For example, inpatient hospital care, which is the largest component of national health expenditures, is expected to grow at an annual average rate of 5.6%, which is above its recent five year average growth rate of 5%. AI alone won’t fix these problems but it can help with cost containment and cost reduction.

CMS [cms.gov]对美国2018-2027年医疗卫生支出的预测显示，医疗卫生支出的预计平均增长率为5.5％，预计到2027年将达到6万亿美元。从这些数字来看，很明显，医疗保健支出将超过经济增长。 预计在未来十年中，医疗保健的所有组成部分将以极高的年增长率增长。 例如，住院医疗是国家卫生支出的最大组成部分，预计将以5.6％的年平均增长率增长，高于最近五年的5％平均增长率。 单靠AI并不能解决这些问题，但可以帮助控制成本和降低成本。

The myth about AI and healthcare costs is thinking that AI will reinvent or overturn the existing healthcare or medical models in practice today. Or that AI will transform or revolutionize the healthcare industry triggering enormous savings. The reality is that AI as a general purpose technology will be transformative. Tremendous evidence abounds showing that the big technology companies and startups will transform how healthcare is done. AI will be the tool of trade making many of these transformations possible. You might see this as splitting hairs but the point is that the problems facing healthcare lie with resistance to change, historical inefficiencies and inertia, lack of cooperation for the greater good by companies designed to compete with each other and the lack of a game changing technology. Now we have the game changing technology, AI.

关于AI和医疗保健成本的神话认为，AI将重塑或推翻当今实践中的现有医疗保健或医疗模型。 否则，人工智能将改变或革新医疗行业，从而节省大量资金。 现实情况是，作为通用技术的AI将具有变革性。 大量证据表明，大型科技公司和初创公司将改变医疗保健的方式。 人工智能将成为贸易工具，使许多此类转变成为可能。 您可能会认为这是四分五裂的问题，但问题是，医疗保健面临的问题在于变革的阻力，历史上的低效率和惯性，旨在竞争的公司缺乏为实现更大利益的合作以及缺乏改变游戏规则的技术。 现在我们有了改变游戏规则的技术AI。

Given this background, how and where will AI have an impact? One major area of spend is management of chronic disease. When people with a chronic condition are not adherent to treatment plans, then complications related to the underlying disease occur which can result in expensive hospitalizations and/or need to institute high cost specialty pharmacy therapies. For example, Diabetic Retinopathy (or DR — an eye disease of diabetes) is responsible for causing 24,000 Americans to go blind, annually, as reported by the Centers for Disease Control (CDC). This is a preventable problem and routine exams with early diagnosis and treatment can prevent blindness in up to 95% of diabetics. And yet, greater than 50% of diabetics don’t get their eyes examined, or are too late for effective treatment. Diabetes related disease and blindness is estimated to total more than $500 million per year.³

在这种背景下，人工智能将如何以及在何处产生影响？ 支出的主要领域之一是慢性病的管理。 当患有慢性病的人不遵守治疗计划时，就会发生与潜在疾病相关的并发症，这可能导致昂贵的住院治疗和/或需要建立高成本的专业药房疗法。 例如，根据疾病控制中心(CDC)的报告，糖尿病性视网膜病变(或称糖尿病-一种糖尿病眼病)每年导致24,000名美国人失明。 这是一个可预防的问题，对早期诊断和治疗进行例行检查可以预防多达95％的糖尿病患者失明。 然而，超过50％的糖尿病患者没有接受检查，或者为时已晚，无法有效治疗。 与糖尿病相关的疾病和失明估计每年总计超过5亿美元。³

AI can address cost spending in chronic disease through increasing efficacy and ease of obtaining eye exams in diabetics. AI using machine learning and deep learning have been adopted by various groups to develop automated DR detection algorithms, some of which are commercially available. Although binocular slit-lamp ophthalmoscopy remains the standard against which other DR screening approaches are compared, AI applications with fundus photography are more cost-effective and do not require an ophthalmologist consultation. The scarcity of specialists, ophthalmologists, necessitates the use of non physicians who can do the DR screening using AI algorithms (deep learning) embedded in various tools like a mobile device. Such solutions are already used in developing nations with a scarcity of ophthalmologists, that is, a highly trained doctor is not required for disease detection where AI can be trained to do the same.

AI可以通过提高功效和简化糖尿病患者的眼科检查来解决慢性病的成本支出。 各个组织已经采用了使用机器学习和深度学习的AI来开发自动化的DR检测算法，其中一些可以通过商业途径获得。 尽管双眼裂隙灯检眼镜仍然是与其他DR筛查方法进行比较的标准，但通过眼底摄影进行AI的应用更具成本效益，并且不需要眼科医生的咨询。 专家，眼科医生的稀缺性使非医生的需求成为可能，他们可以使用嵌入在各种工具(如移动设备)中的AI算法(深度学习)来进行DR筛查。 这样的解决方案已经在眼科医生稀少的发展中国家中使用，也就是说，疾病检测不需要训练有素的医生，因为可以训练AI来做同样的事情。

Cost savings using AI and fundus photography have been reported at 16–17% (due to fewer unnecessary referrals). A cost effectiveness study from China showed that though the screening cost per patient increased by 35%, the cost per quality-adjusted life year was reduced by 45%.⁴ Taking this a step further, to help diabetics with existing eye related disease, AT&T partnered with Aira combining smart glasses with AI algorithms to improve the patient’s quality of life and increase medication adherence by medication recognition technology. The technologies for medication adherence are varied such as intelligent pill bottle tracking when patients open their bottle using sensors in the cap or sensors in the bottle showing weight decline. Or mobile apps or smart speakers which alert patients to take their medications and these applications can also be armed with machine learning to teach the patients habits, and instead of sending annoying alerts learns the optimal time of day or scenario to send a reminder.

据报道，使用AI和眼底照相可以节省16-17％的费用(由于不必要的转诊减少)。 来自中国的一项成本效益研究表明，尽管每位患者的筛查成本增加了35％，但每质量调整生命年的成本却降低了45％。⁴进一步采取措施，以帮助患有现有眼病的糖尿病患者AT＆T与Aira合作，将智能眼镜与AI算法相结合，通过药物识别技术改善患者的生活质量并提高药物依从性。 药物依从性的技术多种多样，例如当患者使用瓶盖中的传感器或瓶中显示重量下降的传感器打开药瓶时，就可以进行智能药丸瓶跟踪。 或提醒患者服用药物的移动应用程序或智能扬声器，这些应用程序还可以配备机器学习功能，以教患者习惯，而不是发送烦人的警报，而是学习一天中最佳时间或场景以发送提醒。

All of these varied strategies using AI in chronic condition management lead to ongoing waterfall health effects and cost savings. In this case, the Diabetic is now screened through ease and efficacy of AI for Diabetic eye related disease, if they are found to have significant disease then the AT&T and Aira “pill bottle reader project” can facilitate medication adherence and issues such as falls related to poor vision, fractures/other musculoskeletal trauma, hospital admissions for poor blood sugar control, infections related to poor blood sugar control, etc can all be avoided at significant cost savings and quality of life improvement for patients.

在慢性病管理中使用AI的所有这些不同策略都会导致瀑布对健康的持续影响并节省成本。 在这种情况下，现在可以通过AI缓解糖尿病眼相关疾病的便捷性和有效性来筛查糖尿病患者，如果发现他们患有重大疾病，则AT＆T和Aira的“药瓶读取器项目”可以促进药物依从性以及与跌倒相关的问题可以避免视力差，骨折/其他肌肉骨骼创伤，因血糖控制不佳而入院，与血糖控制不佳相关的感染等，所有这些都可以避免，从而可节省大量成本，并改善患者的生活质量。

AI can assist in standardizing and identification of best practice management of chronic disease. It has always been known in the medical community that there is a wide variation in practices, and economists have pointed out that treatment variability results in wasteful health care spending. As an example of how treatment management can impact health care spend, let’s examine low back pain. Over 80% of Americans experience low back pain at some point in their lives. Of those people with low back pain 1.2% account for about 30% of expenditures. When treatment guidelines were adhered to, costs were less. The pattern for increasing costs to both the overall healthcare system and patients is reflected in Figure 1–4 illustrating the impact on costs when consumers, that is, patients fail to adhere to treatment guidelines.

AI可以帮助标准化和确定慢性病的最佳实践管理。 在医学界一直以来都知道实践存在很大差异，经济学家指出，治疗方法的差异会导致医疗保健支出的浪费。 作为治疗管理如何影响医疗保健支出的一个例子，让我们研究一下腰痛。 超过80％的美国人在生活中的某个时候经历了腰痛。 在那些腰痛的人中，有1.2％的人占支出的30％。 遵循治疗指南，成本会降低。 图1-4反映了整体医疗保健系统和患者费用增加的模式，说明了消费者(即患者不遵守治疗指南)对费用的影响。

AI can reduce treatment variability by applying AI to the myriad of siloed data sources to identify optimal care pathways leading to updating of current guidelines and improvement in cost expenditure.

AI可以通过将AI应用于众多孤立的数据源来确定最佳的护理途径，从而导致最新指南的更新和成本支出的减少，从而减少治疗的差异。

Hospitalization and administrative costs are also a major driver for US health care. “More than $1 trillion is wasted each year on costly administration and avoidable hospital readmissions,” per Orion Health CEO Ian McCrae.⁵ Orion Health used AI to predict patient costs and readmission risks, while analyzing clinical and financial outliers to improve the treatment and practice management at the point of care. AI is being applied to the large data pools coming in through numerous inputs including socio-economic data, behavioral data, biometric data, demographics, geographic location, etc, all in an effort to more accurately predict who would benefit from more aggressive treatment management with the goal of avoiding hospitalizations.

住院和行政费用也是美国医疗保健的主要驱动力。 Orion Health首席执行官Ian McCrae表示：“每年在昂贵的管理和可避免的医院再住院上浪费了超过1万亿美元。” Orion Health使用AI来预测患者的费用和再住院风险，同时分析临床和财务异常值以改善治疗和实践护理时的管理。 通过大量输入将AI应用于大型数据池，包括社会经济数据，行为数据，生物特征数据，人口统计数据，地理位置等，所有这些都是为了更准确地预测谁将从更积极的治疗管理中受益避免住院的目标。

Another area of high health care spend is medication research and discovery. Historically, new medications and vaccines took a long time to develop, and demonstrating safety and efficacy was a tedious time-consuming process. Now AI could facilitate this process by increasing the speed of the process in expediting the analysis and research components.

高卫生保健支出的另一个领域是药物研究和发现。 从历史上看，新药物和疫苗的研发花费了很长时间，而证明安全性和有效性是一个繁琐且耗时的过程。 现在，AI可以通过加快分析和研究组件的速度来促进该过程。

Accenture performed a study in 2017 showing a potential savings of $150 billion in annual health care cost savings by 2026 with the application of AI to health care in the areas of: robot-assisted surgery ($40 B), virtual nursing assistants ($20 B), administrative workflow assistance ($18 B), fraud detection ($17 B), dosage error reduction ($16 B), connected machines ($14 B), clinical trial participant identifier ($13 B), preliminary diagnosis ($5 B), automated image diagnosis ($3 B), and cybersecurity ($2 B).10 These statistics show the potential, value and transformative effect in adopting AI to reduce costs. But these are potential future costs reduction and the real rub lies in translating these costs to reduced patient costs.

埃森哲于2017年进行的一项研究表明，到2026年，通过将AI应用于医疗领域，人工智能在医疗领域的应用可能节省1500亿美元，这些领域包括：机器人辅助手术($ 40 B)，虚拟护理助手($ 20 B) ，行政工作流程协助($ 18 B)，欺诈检测($ 17 B)，减少剂量错误($ 16 B)，连接的机器($ 14 B)，临床试验参与者标识符($ 13 B)，初步诊断($ 5 B)，自动图像诊断($ 3 B)和网络安全($ 2 B).10这些统计数据显示了采用AI降低成本的潜力，价值和变革性影响。 但这可能会降低未来的成本，真正的麻烦在于将这些成本转换为降低的患者成本。

Translational challenges continue to exist and include issues such as costs of implementing this technology, and cultural acceptance of AI in healthcare. All of which continue to act as barriers to AI use in helping to control healthcare spend. Investments in AI can take away from short term financial goals. Legacy systems usually exist as silos and the time and expense of creating interoperability can be cost or time prohibitive. Providers themselves may be unaware of the benefits of AI and its applications to their practices in improving the lives of their patients. Safely and respectfully controlling the confidentiality of patient information through these systems and use of AI is another potential barrier. That said, the future of AI in healthcare in both controlling health care costs and improving the health of our population is clear. AI has opened a world of potential opportunities through various means to work with clinicians and health care systems to better the lives and health of our population. The future is full of potential for AI use in healthcare, but limitless, it is not.

转换挑战仍然存在，包括诸如实施该技术的成本以及医疗保健领域对AI的文化接受度等问题。 所有这些继续阻碍AI在帮助控制医疗保健支出方面的使用。 在AI上的投资可以脱离短期财务目标。 遗留系统通常以孤岛形式存在，创建互操作性的时间和费用可能是成本或时间限制。 提供者本身可能并没有意识到AI及其在改善患者生活中的实践应用的好处。 通过这些系统和使用AI安全且尊重地控制患者信息的机密性是另一个潜在的障碍。 也就是说，人工智能在控制医疗保健成本和改善我国人口健康方面的未来是显而易见的。 人工智能通过各种方式与临床医生和医疗保健系统合作，打开了一个潜在机会的世界，以改善我国人民的生活和健康。 人工智能在医疗保健中的应用充满了未来的潜力，但无限的并非如此。

¹ https://link.springer.com/journal/10278/32/4

¹https ://link.springer.com/journal/10278/32/4

² https://techcrunch.com/2012/01/10/doctors-or-algorithms/

²https ://techcrunch.com/2012/01/10/doctors-or-algorithms/

³ https://www.cdc.gov/visionhealth/pdf/factsheet.pdf

³https ://www.cdc.gov/visionhealth/pdf/factsheet.pdf

⁴ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258577/

⁴https : //www.ncbi.nlm.nih.gov/pmc/articles/PMC6258577/

⁵ https://www.thejournalofprecisionmedicine.com/orion-health-unveils-new-predictive-intelligence-using-machine-learning-help-save-billions-healthcare-costs/

⁵https : //www.thejournalofprecisionmedicine.com/orion-health-unveils-new-predictive-intelligence-using-machine-learning-help-save-billions-healthcare-costs/

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Kerrie Holley is focused on advancing UnitedHealth Group (UHG) in the adoption of emerging technologies — including machine learning, graph databases, deep learning, natural language processing, IoT, virtual reality, genomics, blockchain, and virtual assistants — with a heavy focus on Artificial Intelligence. Kerrie leads an engineering team committed to applying and incubating emerging technologies to make the health care system work better and help people live healthier lives. Dr. Siupo Becker joined Optum/UnitedHealthcare in 2016, focusing on population health management and data analysis focusing on application to improving health care and quality outcomes. She has since been named as Vice President of Health Care Strategies within UnitedHealthcare and drives nationwide health care initiatives that impact the quality and control of health care costs.

Kerrie Holley致力于通过采用新兴技术(包括机器学习，图形数据库，深度学习，自然语言处理，物联网，虚拟现实，基因组学，区块链和虚拟助手)来推动UnitedHealth Group(UHG)的发展。人工智能。 Kerrie领导的工程团队致力于应用和孵化新兴技术，以使医疗保健系统更好地工作，并帮助人们过上更健康的生活。 Siupo Becker博士于2016年加入Optum / UnitedHealthcare，专注于人口健康管理和数据分析，专注于改善医疗保健和质量结果的应用。 从那以后，她被任命为UnitedHealthcare卫生保健战略副总裁，并推动影响医疗保健质量和成本控制的全国性卫生保健计划。

翻译自: https://medium.com/oreillymedia/myths-and-realities-of-ai-healthcare-51b11fbef5d6

ai与虚拟现实