ai’s potential impact on concierge medicine physicians and ... · concierge medicine physicians...

AI’s potential impact on concierge medicine physicians and their patients

By Terry Bauer, CEO, Specialdocs Consultants

Concierge Medicine Forum– October 2019

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AI History Quiz

Background and foundation

What is AI?

How long has it been around?

What are the expectations for AI in medicine?

How will it impact your practice, your patients

and you and your career?

What’s next for AI, etc.?

Questions and Answers

Discussion Outline

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In 1942, in a short story by Isaac Asimov called “Runaround,” a character

enumerates three laws governing the behavior of robots. Which of these

wasn’t among them?

AI History Quiz

A robot may not injure a human being or, through inaction, allow a human being to

come to harm.

A robot must obey the orders given it by human beings except where such orders

would conflict with the First Law.

In time of war a robot can take human lives but only in accord with human rules of

warfare.

A robot must protect its own existence as long as such protection does not conflict

with the First and Second Laws.

1

A

B

C

D

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In 1942, in a short story by Isaac Asimov called “Runaround,” a character

enumerates three laws governing the behavior of robots. Which of these

wasn’t among them?

AI History Quiz

1

C

The robot rules in “Runaround” made no exceptions for times of war.

In time of war a robot can take human lives but only in accord with

human rules of warfare.

Answer:

5

By having a computer take the SATs

By putting a computer in text dialogue with humans. If the humans can’t tell they’re

conversing with a machine, that machine can fairly be said to think.

By asking the computer to read emotion in a series of human faces. If it can do so as

reliably as humans can, it is thinking.

By asking the computer to create something, such as a drawing or a piece of music, within

parameters set by a person.

AI History Quiz

In 1950 the English mathematician Alan Turing published a paper asking,

“Can machines think?” How did he propose to find out?2

A

B

C

D

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By putting a computer in text dialogue with humans. If the humans can’t tell

they’re conversing with a machine, that machine can fairly be said to think.

AI History Quiz

In 1950 the English mathematician Alan Turing published a paper asking,

“Can machines think?” How did he propose to find out?2

B

Answer:

The Loebner Prize is awarded annually for the most human-seeming computer program, but

nobody has yet won the $100,000 Grand Prize offered for computer behavior indistinguishable

from that of a human on a more difficult test involving an as-yet undefined audio/visual

component. No computer has come close enough even to require the details of this A/V

component to be worked out.

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Tax preparation

Medical care

Criminal law

Poker

AI History Quiz

In the early 1970s, Edward Shortliffe created perhaps the first expert AI system. It

was a rules-based program for decision making—in what realm?3

A

B

C

D

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Medical care

AI History Quiz

In the early 1970s, Edward Shortliffe created perhaps the first expert AI system. It

was a rules-based program for decision making—in what realm?3

B

Answer:

The program was called MYCIN and its aim was choosing the right antibiotic for patients with

infections.

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The Bell Labs complex in Holmdel, N.J.

IBM’s Thomas J. Watson Research Center in Yorktown Heights, N.Y.

The Stanford University Artificial Intelligence Laboratory

A basement AI lab at Carnegie Mellon University

AI History Quiz

In 1979, the first computer-controlled, autonomous vehicle navigated a room full

of chairs. Where?4

A

B

C

D

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The Stanford University Artificial Intelligence Laboratory

AI History Quiz

In 1979, the first computer-controlled, autonomous vehicle navigated a room full

of chairs. Where?4

C

AI specialist Hans Moravec writes in the book “Autonomous Robot Vehicles” that the slow but

reliable “Stanford Cart” made its way “through cluttered spaces, gaining its knowledge of the world

entirely from images broadcast by an on-board TV system,” and that it changed its path as it

perceived new obstacles.

Answer:

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Google Duplex

Google Secretary

Google Gobot

Google Hal

Last year, Google unveiled a new AI technology for enabling a computer to

make hair salon appointments and the like using natural conversation so

“real” that it is hard to tell it isn’t a person. What’s the technology called?

5

A

B

C

D

AI History Quiz

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Google Duplex

AI History Quiz

Last year, Google unveiled a new AI technology for enabling a computer to

make hair salon appointments and the like using natural conversation so

“real” that it is hard to tell it isn’t a person. What’s the technology called?

5

A

Answer:

Google Duplex can carry out certain conversations so effectively that the company decided it

should disclose at the start of each call that the caller isn’t an actual human.

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Background and Foundation


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The AI timeline1936 Turing paper (Alan Turing)1943 Artificial neural network (Warren McCollogh, Walter Pitts)1955 Term "artificial intelligence" coined (John McCarthy)1957 Predicted 10 years for AI to beat human at chess (Herbert Simon)1958 Perceptron (single-layer neural network) (Frank Rosenblatt)1959 Machine learning described (Arthur Samuel)1964 ELIZA, the first chatbot1964 We know more than we can tell (Michael Polany's paradox)1969 Question AI viability (Marvin Minsky)1986 Multilayer neural network (NN) (Geoffrey Hinton)1989 Convolutional NN (Yann LeCun)1991 Natural-language processing NN (Sepp Hochreiter, Jurgen Schmidhuber)1997 Deep Blue wins in chess (Garry Kasparov)2004 Self-driving vehicle, Mojave Desert (DARPA Challenge)2007 ImageNet launches2011 IBM vs. Jeopardy! champions2011 Speech recognition NN (Microsoft)2012 University of Toronto ImageNet classification and cat video recognition (Google Brain, Andrew Ng, Jeff Dean)2014 DeepFace facial recognition (Facebook)2015 DeepMind vs. Atari (David Silver, Demis Hassabis)2015 First AI risk conference (Max Tegmark)2016 AlphaGo vs. Go (Silver, Demis Hassabis)2017 AlphaGo Zero vs. Go (Silver, Demis Hassabis)2017 Libratus vs. poker (Noam Brown, Tuomas Sandholm)2017 AI Now Institute launched


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Selected metrics of healthcare in the US that have changed in the past 40+ years

Metric 1975 Now

Number of healthcare jobs 4 million > 16 million (#1 US economy)

Healthcare spending per person $550/yr. > $11,000/yr.

Time allotted for office visits60 min. new,

30 min. return

12 min. new,

7 min. return

% of GDP healthcare < 8 18

Hospital daily room charge (avg.) ~ $100 $4,600

Miscellaneous None of theseRelative value units, EHRs,

PBMs, “health systems”


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The disconnected doctor and patient

Source: Adapted from “The Pharos,” The Pharos of Alpha Omega Alpha Honor Medical Society, Summer Edition, 78 (2015).


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Patient perceptions about their physician

Source: Adapted from B. Singletary et. Al., “Patient Perceptions About Their Physician in 2 Words: The Good, The Bad, and The Ugly,” JAMA Surg (2017): 152(12), 1169-1170.


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“Computing science will probably exert its

major effects by augmenting and, in some

cases, largely replacing the intellectual

functions of the physician.”

– William B. Schwartz, MD, in 1970


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“Imagine if a doctor can get all the

information she needs about a patient in two

minutes and then spend the next 13 minutes

of a 15-minute office visit talking with the

patient instead of spending 13 minutes

looking for information and two minutes

talking with the patient.”


– Lynda Chin, MD, former chair of MD Anderson Cancer Center

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What is AI and its implications?


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Artificial intelligence (AI) is the ability of a

computer program or a machine to think and

learn. It is also a field of study which tries to

make computers "smart".

... As machines become increasingly capable,

mental facilities once thought to

require intelligence are removed from

the definition.

What is Artificial Intelligence?


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“AI is probably the most important thing

humanity has ever worked on. AI is more

profound than electricity or fire.”


– Sundar Pichai, CEO, Google

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Miscellaneous tasks that AI has been reported to achieve in recent years

• Beat CAPTCHA• Create new musical instruments• Determine art history• Solve Rubik's cube• Manage stock portfolios• Write Wikipedia articles• Lip read• Design websites• Tailor clothes• Write songs• Find energy materials• Brain "shazam" (fMRI music)• Write text• Original paintings• Define accents• Write poetry• Do the census

• Distinguish fake vs. real art• Autonomous stores• Sort LEGO pieces• Make fake videos, photos• Predict purchase one week before person buys it• Convert text to art• Artificial comedy• Create slow mode video by imputing frames• Draw• Check NDAs• Pick ripe fruit• Count and identify wild animals• Put together IKEA furniture• Create movie trailers• Sense human posture through walls• Debate• Predict earthquake aftershocks• Text to speech w/ accent• Recommend fashion


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“I often tell my students not to be misled by the

name “artificial intelligence” – there’s nothing

artificial about it. AI is made by humans, intended

to behave by humans, and, ultimately, to impact

human lives and human society.”


- Fei-Fei Li, Co-Director of Stanford University’s Human-Centered

AI Institute

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The outlandish expectations for AI in healthcare, a partial list

• Outperform doctors at all tasks

• Diagnose the undiagnosable

• Treat the untreatable

• See the unseeable on scans, slides

• Predict the unpredictable

• Classify the unclassifiable

• Eliminate workflow inefficiencies

• Eliminate hospital admissions and readmissions

• Eliminate the surfeit of unnecessary jobs

• 100% medication adherence

• Zero patient harm

• Cure cancer


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“AIs are nowhere near as smart as

a rat.”


– Yann LeCun VP, Chief AI Scientist at Facebook

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24 reasons why everyone needs to own their own health and medical data

1. It’s your body.

2. You paid for it.

3. It is worth more than any other type of data.

4. It’s being widely sold, stolen, and hacked. And most people don’t know it.

5. It’s full of mistakes that keep getting copied and pasted and can’t be edited.

6. You are/will be generating more of it, but it’s homeless.

7. Medical privacy is precious.

8. The only way it can be made secure is to be decentralized.

9. It is legally owned by doctors and hospitals.

10. Hospitals won’t or can’t share the data (“information blocking”).

11. More than 65% of doctors prefer not to share office notes with their patients.

12. Patients are far more apt to share their data than their doctor is.

13. Patients may want to share it for medical research, but can’t get it.

14. Patients have seen many providers throughout their lives but no health system/insurer

has all their data.


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24 reasons why everyone needs to own their health and medical data

15. Essentially no one (in the United States) has all their medical data from birth throughout

their life.

16. The electronic health record was designed to maximize billing, not to help health.

17. Patients are more engaged and have better outcomes when they have their data.

18. Doctors who have been given full access to their patients’ data make this their routine.

19. It requires comprehensive, continuous, seamless updating.

20. Access to or “control” of data is not adequate for patients.

21. ~10% of medical scans are unnecessarily duplicated due to inaccessibility.

22. Patients can handle the truth.

23. Patients need to own their data; it should be a civil right.

24. It could save their lives.


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Summary and Q & A

AI’s potential to impact concierge medicine physicians and their patients

[email protected]

www.specialdocs.com

Concierge Medicine Forum– October 2019

Thank you.

For more information, please contact Terry Bauer

ai’s potential impact on concierge medicine physicians and ... · concierge medicine physicians...

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