Artificial intelligence in health: how must healthcare professions adapt?

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Fellow - Healthcare

Institut Montaigne, in collaboration with Ethik-IA - a French initiative feeding the debate on AI’s regulations and jurisdictions - has published a note analyzing the main impact of Artificial Intelligence (AI) on healthcare jobs in France. This note is intended to warn the French government on the need to anticipate AI’s impacts on jobs in the healthcare sector. Indeed, AI has the potential to deeply transform the French healthcare system as it could improve patient services, diagnostic, therapy and quality of care, while cutting costs.

What is the purpose of anticipating the effects of AI on health employment?

The healthcare sector has been defined as a priority sector for AI deployment by the French government. Indeed, in the Villani report of March 2018 Giving meaning to artificial intelligence (Donner un sens à l’intelligence artificielle), health is one of the 4 sectors identified as a priority along with transport, defence and environment. Health is therefore a very promising area for AI-related technologies. As such, the French government has announced the launch of the Health Data Hub, a national initiative that directly answers the double issue of data’s exploitation and protection. This hub would be a unique platform opening the access to health data for startups, medtechs, researchers, companies etc. Its main goal consists in providing conditions to improve AI innovations. Indeed, allowing AI systems to process data collection will make healthcare systems much more productive and efficient.

AI in the medical sector will considerably change the way in which patients will be treated tomorrow, it is necessary to anticipate the transformation of jobs.

Because the disruption induced today by AI in the medical sector will considerably change the way in which patients will be treated tomorrow (diagnosis, treatments, clinical tests, patient follow-up, etc.), it is necessary to anticipate the transformation of jobs, and thus studies as well as continuous training. For all professionals working in hospitals, it will help to define, the required skills.

What are the main impacts of AI in the healthcare sector ?

The impacts of AI on health employment and human resources in France have been poorly analyzed. They are difficult to assess and vary by sector: many studies focus on the impact of AI on employment in general, with very different conclusions, but none focus on the healthcare sector. A sectoral approach is necessary to get closer to the reality of jobs and properly analyse the impacts. Thus, in the healthcare sector, the main impacts are observed on the organization of hospitals as a whole, but also on the medical professions, not to mention the back office functions (e.g. medical secretary, technicians, handler).

In medical research institutes, AI will increase the physician's capabilities. Indeed, some leading institutions in care and research are already developing very advanced AI projects. This is the case of the University Hospital Institute in Strasbourg, which aims to integrate AI techniques into surgical operations. Thanks to computer-assisted solutions, the Visible Patient: virtual and augmented reality project enables the creation of a 3D and personalized model of the patient before the operation. This technology simplifies the surgical procedure because the surgeon can plan his operation in advance. This 3D information is then stored to create a large database, which is very useful for the development of AI technologies in surgery and personalized medicine.

In hospitals with medical shortage, AI will compensate for the absence of doctors. Indeed, some establishments outside innovation and competitiveness clusters will use AI to combat the spread of medically underserved areas and the closing of some hospitals. In 2018, France had more than 11 000 municipalities classified as territories marked by a medical shortage. AI technologies, like chatbots, remote X-ray or electrocardiograms analysis, and more broadly digital innovations such as telemedicine, could thus replace doctors where they would lacking. Indeed, assistance chatbot can be used to interview the patient remotely and analyse a possible relapse, particularly in the monitoring of psychiatric illnesses.

In the healthcare sector, the main impacts are observed on the organization of hospitals as a whole, but also on the medical professions, not to mention the back office functions.

In certain medical specialties, AI is already changing the way patients are cared for in the hospital. In radiology, a french startup is developing an algorithm which improves mammography screening to detect breast cancer. In cardiology, a french company has developed an extremely powerful algorithm, able to analyse electrocardiograms and improve diagnostics. In ophthalmology, the IDx-DR software developed in the United States identifies signs of diabetic retinopathy with an accuracy rate of 90 %. Needless to say that in France, with an average waiting period for an ophthalmologist appointment of 80 days, this kind of technology would definitely impact the landscape of ophthalmology. In clinical research, a french company builds mathematical models and algorithms that can interpret biomedical images, genomics and clinical data, to discover biomarkers and mechanisms associated with diseases and treatment outcomes. It will improve diagnosis and personalization of care.

The medical professions are not the only ones affected by AI. The care support functions are also concerned. A very likely hypothesis would be that AI solutions, already mature and present in other sectors (management of payroll, customer files, logistics, IT support), would be deployed to the support functions of the healthcare sector. For example, computer maintenance, inventory and flow management, delivery, etc. are gradually being carried out by robots or AI software in other sectors, such as mass distribution. At Nantes University hospital, intelligent software has the potential to save time for technical and administrative teams, in particular by optimizing the coding of hospital activity in order to anticipate patient flows. At Lyon, the University hospital has signed a partnership with Microsoft around AI. They aim to develop a vocal recognition system used during consultations, to assist medical secretaries with writing reports. The AI technology would also recognize keywords and be able to carry out a medical diagnosis.

How should we anticipate these disruptions?

Because AI will profoundly change medical practices and the back office function, an evolution and transformation of healthcare professions is now necessary. Indeed, it takes at least ten years to train a doctor, so we must ensure that the knowledge transmitted today will not be obsolete tomorrow. Thus, a methodology must be developed to assess the impacts on employment. The note published by Institut Montaigne and Ethik IA proposes a methodology that is divided into six steps, to determine the level of substitution by AI of each activity for a given job and then to define the rate of substitution for the job. For instance, for a medical secretary, it is possible to identify various tasks such as physical and telephone reception of patients and families, management and medico-administrative coordination, identification of patients' and families' needs and expectations, note taking, typing and document formatting, data entry related to medical activity, maintenance of patient records, etc. All these tasks must be reviewed to identify the level of substitution and then to determine whether the job would be completely or partially replaced by IA.

Healthcare institutions, for instance, must anticipate the changes through the adoption of a prospective approach to the transformation of jobs.

This report also promotes digital Corporate Social Responsibility (CSR) as a relevant ethical framework for AI in the field of healthcare. Digital CSR can be defined as a corporate commitment, assessing societal effects induced by digital transformation. It corresponds to an ethical and responsible approach to AI. The implementation of CSR could have many benefits on the French healthcare system. It may be associated with different concrete actions that can be carried out for several actors. Healthcare institutions, for instance, must anticipate the changes through the adoption of a prospective approach to the transformation of jobs.

They also have to develop evaluation methodologies of employees' skills. Employee awareness of digital issues, especially AI technologies, is particularly important. They should be trained to use existing and future technologies, in particular when their functions can be replaced by AI.

Better awareness of these issues will strengthen cooperation between these actors and thus enable hospitals to integrate new technological solutions into their healthcare provision, in order to improve patient care.