Update on Artificial Intelligence and Healthcare

The sheer volume of available medical knowledge has long since outstripped even the most capable clinician's ability to review and properly analyze the all the data now being generated and collected about a patient's health. Today it requires the assistance of sophisticated computer systems to not only help them with the analysis of the data, but to also stay on top of breakthroughs in genomics, predictive analytics, clinical decision support, population health management, and the continuous changes in best practices. Read How Healthcare Can Prep for Artificial Intelligence.

Even the best, most attentive health care providers simply can’t stay on top of all the data and the growing body of ever-changing medical knowledge. Doctors just can't be there for a patient around the clock, to catch every bad habit or reinforce every positive behavior. However, Artificial intelligence (AI) has evolved to the point that it can now begin to significantly augment the healthcare provided by physicians, pharmacists, nurses, and health coaches – not to mention self care.

Today, over 90 Artificial Intelligence (AI) startup comanies are already active in developing new solutions in the areas of Imaging & Diagnostics, Drug Discovery, Remote Patient Monitoring, Hospital Management, Customer Service, Healthcare Analytics & Research, Patient Alerts & Reminders, Telemedicine, Public Health, and more. See Artificial Intelligence Startups in Healthcare by CB Insights.

Selected Quotes In a recent interview, AthenaHealth CEO Jonathan Bush noted the limitations of traditional doctors and said, “The human is wrong so freaking often, it’s a massacre.” “By 2025, AI systems could be involved in everything from population health management, to digital avatars capable of answering specific patient queries.” — Frost & Sullivan. Stephen Hawking has said the development of full Artificial Intelligence (AI) could spell the end of the human race – and Elon Musk agreed.

Current Examples of AI in Healthcare

Aside from the big players like IBM and Google, some of the other major startup companies focused on AI in healthcare include: Ayasdi, Babylon Health, Digital Reasoning, Gauss Surgical, H2O AI, iCarbonX, Lumiata, Pathway Genomics, Stratified Medical, Welltok and Zephyr Health – to name just a few.

The following are specific examples of major AI systems and project activities in healthcare that you might want to explore further:

• Google Deepmind Health project is being used to mine the data of electronic medical records (EMR) in order to provide better and faster health services. 
• Medical Sieve, an ambitious long-term exploratory project by IBM is being used to build a next generation “cognitive assistant” with analytical, reasoning capabilities and a wide range of clinical knowledge to assist in clinical decision making in radiology and cardiology. 
• IBM has also launched Watson for Oncology that is able to provide clinicians with better evidence-based treatment options.  
• Babylon Health has launched an app this year which offers medical AI consultation based on personal medical history and common medical knowledge. 
• Medical start-up SenseLy uses AI and machine learning to support patients with chronic conditions in-between doctor’s visits using Molly, the world's first virtual nurse.
• Deep Genomics aims at identifying patterns in huge data sets of genetic information and medical records, looking for mutations and linkages to disease. 
• Human Longevity offers patients complete genome sequencing coupled with full body scan and very detailed medical check-up to help spot cancer or vascular diseases in their very early stage.  
• Baidu has introduced an artificial intelligence-powered chatbot called Melody to connect with patients, field medical questions, and suggest diagnoses to doctors. It is a new feature of the Baidu Doctor app it launched last year. 
• Mount Sinai Health System has tapped CloudMedx to help pinpoint people at risk of congestive heart failure as part of its emerging program dubbed HealthPromise.  
• The Computerized Patient Record System (CPRS) developed and implemented by the Veterans Health Administration (VHA) contains a number of modules that use first generation AI capabilities, e.g. Clinical Alerts, Clinical Reminders. 
• Open AI is a non-profit AI research company that aims to collaboratively develop and promote carefully an open source AI platform and software to benefit humanity as a whole. 
• VA Collaborating with Flow Health to Bring AI and Precision Medicine to Veterans. Flow Health has formed a five-year partnership with the US Department of Veterans Affairs (VA) to build a medical knowledge graph with deep learning to inform medical decision-making and train artificial intelligence (AI) to personalize care plans.

AI Market & Financial Investment

According to a recent 2016 report by Frost & Sullivan, use of AI is growing in healthcare, with the market poised to reach $6 billion by 2021, up from $600 million in 2014. Cognitive solutions such as IBM’s Watson system are capable of sifting through huge volumes of data and providing guidance and decision support to healthcare providers, thereby improving work flow and patient care.

IBM is serious about bringing Watson into the healthcare industry. To build Watson’s medical credibility, IBM has spent $4 billion dollars purchasing companies that had huge stores of medical data, from billing records to MRI images. Read IBM's Watson Recommends Same Treatment as Doctors in 99% of Cancer Cases.

Artificial Intelligence (AI) coupled with the Internet of Things (IoT) could be the answer to solve major healthcare challenges that the world is facing today. IoT can helping care to move from hospital to home in low acuity and post-operative scenarios, with wearable sensors being monitored and analyzed continuously in real time by AI systems. The number of connected IoT healthcare devices is estimated to be $2.5 trillion by 2025. For more detail, read IoT and AI: Potent combo redefining healthcare.

Key Issues

Artificial Intelligence (AI) technology already exists, and is being deployed in many other arenas, such as finance and business intelligence. But in health care, there’s a human and psychological barrier: can we trust AI with our health?

Some of the key issues that need to be addressed over the coming decade before Artificial Intelligence (AI) systems are widely deployed include:

• Ethics - This emerging issue is concerned with the moral behavior being programmed by humans into robots and other 'smart' AI systems, e.g. Roboethics.
• Privacy & Security – When AI systems are turned loose to monitor health information systems gathering data on all facets of your personal health, concerns about who has access to the data and who it is being shared with are just a few of the issues that must be adequately addressed upfront.
• Jobs - The Bank of England has predicted that intelligent machines might take over 80 million American and 15 million British jobs, respectively over the next 10 to 20 years. The healthcare industry will not be immune to this change.
• Legal Issues - One of the most important points of interest that needs to be hammered out first is the legality of these machines. When a doctor's gross negligence leads to a misdiagnoses and patient harm, the fault is placed squarely on the shoulders of the offending physician. What happens if an AI system were to misdiagnose a patient? Who's to blame?
• Open Source - Many new 'open source' tools are arriving that can now run on affordable hardware and allow individuals and small organizations to perform prodigious data crunching and predictive tasks. Read about H2O, OpenAI, and other machine learning and AI tools being used in healthcare at Open Health News.

Conclusions & Next Steps

When and how artificial intelligence (AI) systems will stand in for doctors, nurses, therapists, or specialists is yet to be determined. The use of AI systems is already fairly prolific in some other industries. But the consensus is that these systems aren’t yet sophisticated enough for use in healthcare. However, expect all major electronic health record (EHR) systems of the future to include an AI platform within their architectural structure.

At this stage, AI is perceived as one of a group of emerging technologies that will increasingly be used to augment human capabilities. However, within 10 years AI coupled with IoT, Blockchain technology, and 'Big Data' Analytics may actually be used to carry out many of the functions currently being performed by clinicians. Read Making Us Better At The Things We Do Best.

As we continue to move forward with further development and deployment of AI systems, the following are some of the next steps that need to be taken:

• Ethical rules and standards to be incorporated in AI systems used in the healthcare need to be extensively addressed.
• The health IT industry needs to take careful, incremental steps when developing and implementing AI systems in healthcare over the next decade to avoid causing any harm.
• Medical professionals need to become much more knowledgable about AI technology and systems and work closely with developers before we move forward much further.
• Patients need to get accustomed to interacting with AI systems, discovering the potential benefits to themselves – to trust these new systems.
• Companies developing AI healthcare solutions need to carefully communicate with the general public about the potential advantages and risks associated with the use of AI in medicine.
• Healthcare oversight institutions need to carefully measure the success, shortcomings, and effectiveness of AI systems before they are widely deployed over the coming decades.

The next few decades are going to be an exciting time in healthcare. You might want to take a few minutes to read Searching for Godot – Health 4.0 by 2040.

Selected Links American Association for Artificial Intelligence Artificial Intelligence News Artificial Intelligence Journal Journal of Artificial Intelligence (AI) Research OpenAI Project Partnership on AI to Benefit People and Society White House Report: Preparing for the Future of Artificial Intelligence YouTube Video: Machine Intelligence Makes Human Morals More Important Association for the Advancement of Artificial Intelligence

Local Clarendon County HS Football Team Scores and Schedules - November 4, 2016

As the season winds down, the following are the latest Scores and Win-Loss records for all the local Clarendon County high school football team games that were played as of November 4, 2016:

• Manning HS Monarchs (7-2) vs. Timberland.
  
• Summerton's Scotts Branch Eagles (5-5) beat Bethune Bowman 38-36.
• Clarendon Hall Saints (2-7) lost to Richard Winn Academy 34-6.
• Laurence Manning Academy (LMA) Swampcats (7-3) beat Pinewood Prep 35-28.
  
• East Clarendon HS Wolverines (1-8) lost to Lake View 34-0.

The following are links to the 2016 Football schedule, roster, and detailed stats for local high schools in Summerton and across Clarendon County, SC:

• Clarendon Hall Saints
• East Clarendon High School Wolverines
• Laurence Manning Academy Swampcats
• Manning High School Monarchs
• Scott's Branch High School Eagles

* Check out MAXPREPS, a CBSSports.com web site for football team standings, other sports teams at your school, and more detailed statistics.

Biking Around Summerton, Santee, and Lake Marion, S.C.

Like to go Biking? Try one of the many scenic rides around Summerton, Santee, and Lake Marion in South Carolina.

Biking, also known as bicycling or cycling, involves the use of bicycles for transport, recreation, or for sport. Today, there are more than 1 billion bicycles in use worldwide.

The more common types include utility bicycles, mountain bicycles, racing bicycles, touring bicycles, hybrid bicycles, cruising bicycles, and BMX Bikes. You can also find tandem bicycles, lowriders, folding models, and ergonomic recumbent bikes.

When you visit Summerton and nearby Lake Marion, you will find many nature trails and back roads to ride as you explore the wildlife and historical sites throughout the region. Some of these include:

• Killer Three Loop Trail
• Palmetto Trail
• Santee National Wildlife Refuge Trails
• Santee Shuffle Bicycling Route
• Santee State Park Biking Trails

According to CEO Arnold Kamler of Kent International, by the end of 2016 over 500,000 bikes should be rolling off their assembly line in Clarendon County, S.C., Kent’s bicycles will be the first U.S.-made bikes sold in Wal-Mart stores in more than 15 years. The company is also a major supplier to Toys R Us, Amazon, and Academy Sporting Goods.

Selected Information Sources

• League of American Bicyclists
• Palmetto Cycling Coalition
• South Carolina Department of Natural Resources (DNR)
• South Carolina Great Outdoors

Biking in Santee State Park, S.C.

* Be sure to visit the Summerton SC: Nature & Outdoor Recreation web site.

US Election 2016: It's Almost Over - Vote on November 8, 2016

It's now just a matter of a few days before America goes to the polls on November 8, 2016, to elect a new President. Make sure you Vote! If you don't vote, don't complain about the outcome.

Update on Complementary and Alternative Medicine (CAM) and Integrative Health Information Systems

Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not widely accepted within the realm of conventional medicine. Yet, consumers have increasingly turned to complementary and alternative medicine (CAM) in order to enhance their health and well-being. CAM includes acupuncture, chiropractic medicine, osteopathic medicine, homeotherapy, use of natural herbal remedies and other practices to augment conventional medical treatments. The marketplace reflects the growing acceptance of complementary medicine by many patients and a growing number of health care providers.

In this article, the author advocates developing and further integrating CAM software modules into today's electronic health record (EHR) and personal health record (PHR) systems. By gathering and integrating health care information associated with the application of CAM procedures into a patient's electronic medical record, more accurate measurement of outcomes can be generated. Best practices can then emerge showing which CAM practices are most effective - when used by themselves or coupled with conventional medical treatments for specific disorders.

Definitions Complementary and Alternative Medicine (CAM) includes a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs that are often not embraced by conventional, mainstream medicine. CAM therapies are called Complementary when they are used in addition to conventional medical treatments. They are termed as Alternative when they are used instead of conventional treatment. Integrative Medicine, as defined by National Center for Complementary & Integrative Health (NCCIH), combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.

Major Complementary & Alternative Medicine (CAM) Categories

The National Center for Complementary & Integrative Health (NCCIH) classifies most complementary and alternative medical products and activities into one of three subgroups—Natural Products, Mind & Body Practices, and Other CAM Therapies.

Natural Products

This subgroup includes a variety of products, such as herbs, vitamins and minerals, and probiotics. They are widely marketed, readily available to consumers, and often sold as dietary supplements.

Mind & Body Practices

Mind and body practices include a large and diverse group of procedures or techniques administered or taught by a trained practitioner or teacher. The 2012 NHIS showed that yoga, chiropractic manipulation, osteopathy, meditation, and massage therapy are among the most popular mind and body practices used by adults. Other mind and body practices include acupuncture, relaxation techniques, tai chi, healing touch, hypnotherapy, and other movement therapies

Other CAM Therapies

In addition to the two broad areas discussed above, there are some some approaches that do not fit neatly into either of those groups. These other practices include traditional healers, Ayurvedic medicine, traditional Chinese medicine, homeopathy, and naturopathy.

Statistics on CAM Therapy Usage

The following are the 10 most commonly used Complementary & Alternative Medicine (CAM) therapies in the US according to a 2008 report published by NCCAM. The report shows that use of CAM has continued to increase to over 38% of American adults now receiving these treatments.

• Herbalism & Natural Products (17.7%)
• Deep Breathing (12.7%)
• Meditation (9.4%)
• Chiropractic & Osteopathic (8.6%)
• Massage (8.3%)
• Yoga (6.1%)
• Diet-based therapy (3.6%)
• Progressive relaxation (2.9%)
• Guided Imagery (2.2%)
• Homeopathic Treatment (1.8%)

Major CAM Organizations

The National Center for Complementary & Integrative Health (NCCIH) is the Federal Government's lead agency for scientific research on CAM. The NCCIH is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.

The NIH Office of Cancer Complementary and Alternative Medicine (OCCAM) was established back in October 1998 to coordinate and further enhance the activities of the National Cancer Institute (NCI) in the arena of complementary and alternative medicine (CAM).

You might also want to consider visiting the web sites of the American Botanical Council, American Chiropractic Association, American Osteopathic Association, American Association of Acupuncture & Oriental Medicine, National Center for Homeotherapy (NCH), or the National Association of Nutrition Professionals (NANP)

Native-American Indian Healing

There has been a steady surge of interest in the therapies of traditional cultures during recent years and patients' use of alternative medicine, mind-body healing therapies, and behavioral medicine treatments for chronic medical illness. Increasingly, traditional Native American healing practices are being requested by Native Americans and Non-Native peoples alike. Some hospitals have included traditional Native American healers as part of their staff. For example, Harvard University and Brigham & Women's Hospital have established the OSHER Center for Integrative Medicine.

Some of the spiritual approaches which patients may request, especially in the American Southwest, are Native American Healing (NAH) practices that are used to complement conventional medical treatment. Some Native-American patients even voice a preference for exclusive use of NAH.

The Market

In a 2005 report on Complementary and Alternative Medicine (CAM) in the U.S., the Board on Health Promotion & Disease Prevention states that the total visits to CAM providers exceed total visits to all primary-care physicians. In a 2009 report, NCCIH reported that out-of-pocket costs for CAM by adults in the U.S. exceeded $33 billion. A more recent Grand View Research 2014 Report reconfirmed that the global market for alternative medicine and therapies still remains well over $30 billion in size.

In particular, it should be noted that North America is one of the largest complementary and alternative medicine markets in the world. According to a national survey, in a given year more than 35.0% of all Americans incorporate some kind of alternative therapy into their healthcare routine. For example, more than 3 million people in the U.S. use acupuncture and around 2% of the Americans use homeopathy for the prevention or treatment of chronic diseases.

A 2013 article in the Smithsonian reinforces the point that alternative treatments and therapies are gaining popularity in the U.S., where around 50% of people say they have used them. That does not include those therapies or treatments covered by insurance. Hospitals, managed care plans, and conventional practitioners are now incorporating CAM therapies into their practices. In addition, medical schools, nursing schools, and schools of pharmacy now teach their students about CAM. Clearly, the CAM industry is big business.

Finally, despite the billions of dollars spent on these remedies each year, only a third of them have ever been scientifically tested. As USA Today reports, many American consumers cite distrust of big pharmaceutical companies as one of the main reasons they often lean toward using traditional therapies.

Electronic Health Records (EHR) and CAM Systems

The Healthcare Information and Management Systems Society (HIMSS) defines the Electronic Health Record (EHR) as a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. See http://www.himss.org/ASP/topics_ehr.asp

According to the American Health Information Management Association (AHIMA), the Personal Health Record (PHR) is an electronic, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in their PHR, which comes from both health care providers and the individual patients themselves. For more detail, see http://library.ahima.org/xpedio/groups/public/documents/ahima/pub_bok1_027351.html

Most modern EHR and PHR systems to date have been developed to meet the requirements of conventional Western medical practitioners. As work groups continue to formulate the standards and functional requirements for certified EHR and PHR systems of the future, one of the areas that ought to be addressed is the added domain of complementary and alternative medicine (CAM).

Examples of CAM Computer Systems & Software

The following are links to a few of the hundreds of examples of commercial-off-the-shelf and 'open source' CAM software products that are currently available:

• AcuGraph Acupuncture Software
• BioPulse Software
• Client Tracker 'Practice Management' System
• Capterra List of Chiropractic Software

• Homeopathy Software
• Herbal Medicine Software
• iTunes Alternative Medicine Apps
• Natural Healing Software
• Yoga, Meditation & Self-Realization Software

In other words, take the time to search the Internet and you'll find a growing range of Complementary and Alternative Medicine (CAM) and Integrative Health software solutions.

Key Findings & Conclusions

To gain more acceptance, there is a need to utilize the power of advanced computational systems to introduce more rigor in capturing and analyzing data related to complementary and alternative medicine practices. By gathering and integrating health care information associated with the application of CAM procedures into a patient's electronic health record (EHR), more accurate measurement of outcomes can be generated. Best practices can them emerge showing which complementary medical practices are most effective when coupled with conventional medical treatments for specific disorders.

At present, there appear to be a number of companies marketing CAM software modules. There are also a number of open source CAM solutions now available. However, none of the companies appear to have taken any major steps forward to integrate these products and data with PHR or EHR systems. There also seems to be little coordinated activity related to standardizing data elements within the major CAM domains.

Recommended Next Steps

There are a number of recommendations and next steps for health care organizations should consider taking with regards to development of CAM software modules to be integrated within their EHR systems:

• Conduct more detailed research into CAM health information systems
• Identify and prioritize CAM software modules to be developed and/or integrated within EHR and PHR systems, e.g. acupuncture, chiropractic, etc.
• Initiate a collaborative, open source initiatives to develop key CAM software modules
• Initiate efforts to identify and standardize data elements for each CAM domain
• Develop a prototype and begin pilot tests of high priority CAM modules
• Develop and release production versions of CAM software modules
• Integrate CAM software modules with PHR and/or EHR systems
• Put in place mechanisms needed to refine and further enhance CAM modules
• Encourage efforts to analyze, evaluate, and report on the outcomes of complementary and alternative medicine therapies using data collected by CAM modules in EHR and PHR systems

Selected References & Web Sites National Center for Complementary & Integrative Health (NCCIH) NCCIH 2016 Strategic Plan: Exploring the Science of Complementary & Integrative Health NCCIH 2008 Report - Use of Complementary & Alternative Medicine in the US American Chiropractic Association American Osteopathic Association American Association of Acupuncture & Oriental Medicine Evidence Based Complementary & Alternative Medicine Journal Journal of Alternative & Complementary Medicine Medline Plus: Complementary and Integrative Health National Center for Homeotherapy (NCH) National Association of Nutrition Professionals (NANP) NIH - Office of Cancer Complementary and Alternative Medicine (OCCAM)