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Why Accuracy Isn’t Sufficient For AI In Healthcare

In an era where data reigns supreme and artificial intelligence (AI) plays a pivotal role in healthcare, the industry is experiencing a profound transformation. AI is no longer confined to the peripheries of healthcare; it's at the core of digital transformation initiatives, adding intelligence to every facet of healthcare operations and patient care.  

From enhancing customer experiences through chatbots and provider search tools to revolutionising clinical diagnoses and optimizing workflows, AI has infiltrated every nook and cranny of the healthcare landscape. 

Payers are using intelligent systems to improve member portals, clinical teams are harnessing AI for diagnostic purposes, and product managers are modernizing their workflows through AI integration. Whether it's automating claims adjudication, prioritising tasks, or optimizing care gap closure, AI is the catalyst for change. Even in the realm of MedTech and medical devices, AI algorithms are making their mark, enhancing diagnostic accuracy and patient care. 

Yet, amid this technological revolution, a pertinent challenge emerges for those invested in AI within healthcare – defining the success criteria for these initiatives. Relying solely on statistical accuracy as the yardstick for success might appear to be the most logical; however, it falls short in a field where outcomes are multifaceted.  

The need for a comprehensive framework for AI adoption

In healthcare, decisions often hinge on a delicate balance between patient safety, bias mitigation, and sustainable value. AI solutions aren't static; they continuously evolve and adapt based on new data and decisions. Therefore, success in AI healthcare initiatives requires an ongoing monitoring mindset rather than a one-and-done approach. 

Furthermore, the responsibility for shaping these success metrics can't solely rest with data science teams. Healthcare organizations must go beyond accuracy and develop an extensive framework suited to navigate the sector's unique complexities. 

Circumventing this challenge calls for the creation of a comprehensive framework that can offer an all-encompassing way to evaluate AI initiatives. By deeply analyzing several crucial parameters across workflows, the framework could eventually ensure that AI solutions meet the unique challenges of the healthcare sector. 

Seven considerations for better AI outcomes in healthcare 

  1. Business Outcomes: The first dimension evaluates whether an AI solution aligns with organizational goals, benefiting various stakeholders. For example, optimizing healthcare claim negotiation processes with machine learning not only improves efficiency but also reduces turnaround time, ultimately enhancing the bottom line. Success is measured through quantifiable improvements in key performance indicators. 

  1. Compliance: In healthcare, safety is paramount. AI solutions must adhere to compliance standards, such as HIPAA and other regulations, to ensure patient data remains secure. The novel framework can emphasize the responsible use of AI and machine learning in healthcare. 

  1. Initial Accuracy: While accuracy is essential, healthcare AI solutions must also consider the clinical and functional perspective. Precision, recall, and statistical accuracy metrics ensure that the initial results are reliable, creating a strong foundation for the AI solution. 

  1. Drift & Recovery: The framework must emphasize the ability of AI models to adjust to new information and data, ensuring they auto-recover to defined accuracy levels. This dynamic approach is crucial to account for shifting healthcare landscapes, such as changes in clinical notes or evolving ontologies. 

  1. Confidence & Boundary: Confidence is key in healthcare AI. The framework should urge organizations to define confidence levels and error tolerances, ensuring that predictions fall within well-defined boundaries. This is particularly important in scenarios where it's better to say, "I don't know" than make a risky prediction. 

  1. Performance: AI solutions should improve healthcare processes without compromising user experience or system performance. Measures like response rates and processing times ensure that the solution doesn't hinder operational efficiency. 

  1. Explainability & Experience: To gain user trust, AI solutions must be explainable and provide a satisfactory experience. Users should understand recommendations, and the solution should offer insights into its decision-making process.  

A New Language for AI Success

Successful AI implementation in healthcare requires a new language that transcends mere statistical accuracy. A unified framework for AI outcomes in healthcare can provide a common language which encourages collaboration among stakeholders with diverse capabilities, priorities, and goals. It can facilitate discussions around the importance of each dimension and the trade-offs necessary to achieve healthcare objectives. 

Healthcare organisations must engage in transparent discussions to define the goals and trade-offs across these seven dimensions. Failure to communicate effectively can lead to conflicts and misunderstandings when implementing AI solutions, potentially resulting in unrealistic expectations and disappointments. 

While not universally applicable, a framework of this nature can make the adoption of AI in healthcare more meaningful and results-oriented. By embracing such a multidimensional perspective, healthcare organisations can leverage AI's full potential to enhance patient care, streamline operations, and achieve better outcomes. 

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Sridhar Turaga

Guest Author SVP - Data and Analytics Practices, CitiusTech

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