WCPT poster: Introduction to machine learning in healthcare

It’s a bit content-heavy and not as graphic-y as I’d like but c’est la vie.

I’m quite proud of what I think is a novel innovation in poster design; the addition of the tl;dr column before the findings. In other words, if you only have 30 seconds to look at the poster then that’s the bit you want to focus on. Related to this, I’ve also moved the Background, Methods and Conclusion sections to the bottom and made them smaller so as to emphasise the Findings, which are placed first.

Here is the tl;dr version. Or, my poster in 8 tweets:

  • Aim: The aim of the study was to identify the ways in which machine learning algorithms are being used across the health sector that may impact physiotherapy practice.
  • Image recognition: Millions of patient scans can be analysed in seconds, and diagnoses made by non-specialists via mobile phones, with lower rates of error than humans are capable of.
  • Video analysis: Constant video surveillance of patients will alert providers of those at risk of falling, as well as make early diagnoses of movement-related disorders.
  • Natural language processing: Unstructured, freeform clinical notes will be converted into structured data that can be analysed, leading to increased accuracy in data capture and diagnosis.
  • Robotics: Autonomous robots will assist with physical tasks like patient transportation and possibly even take over manual therapy tasks from clinicians.
  • Expert systems: Knowing things about conditions will become less important than knowing when to trust outputs from clinical decision support systems.
  • Prediction: Clinicians should learn how to integrate the predictions of machine learning algorithms with human values in order to make better clinical decisions in partnership with AI-based systems.
  • Conclusion: The challenge we face is to bring together computers and humans in ways that enhance human well-being, augment human ability and expand human capacity.
My full-size poster on machine learning in healthcare for the 2019 WCPT conference in Geneva.

Reference list (download this list as a Word document)

  1. Yang, C. C., & Veltri, P. (2015). Intelligent healthcare informatics in big data era. Artificial Intelligence in Medicine, 65(2), 75–77. https://doi.org/10.1016/j.artmed.2015.08.002
  2. Qayyum, A., Anwar, S. M., Awais, M., & Majid, M. (2017). Medical image retrieval using deep convolutional neural network. Neurocomputing, 266, 8–20. https://doi.org/10.1016/j.neucom.2017.05.025
  3. Li, Z., Zhang, X., Müller, H., & Zhang, S. (2018). Large-scale retrieval for medical image analytics: A comprehensive review. Medical Image Analysis, 43, 66–84. https://doi.org/10.1016/j.media.2017.09.007
  4. Esteva, A., Kuprel, B., Novoa, R. A., Ko, J., Swetter, S. M., Blau, H. M., & Thrun, S. (2017). Dermatologist-level classification of skin cancer with deep neural networks. Nature, 542(7639), 115–118. https://doi.org/10.1038/nature21056
  5. Pratt, H., Coenen, F., Broadbent, D. M., Harding, S. P., & Zheng, Y. (2016). Convolutional Neural Networks for Diabetic Retinopathy. Procedia Computer Science, 90, 200–205. https://doi.org/10.1016/j.procs.2016.07.014
  6. Ramzan, M., Shafique, A., Kashif, M., & Umer, M. (2017). Gait Identification using Neural Network. International Journal of Advanced Computer Science and Applications, 8(9). https://doi.org/10.14569/IJACSA.2017.080909
  7. Kidziński, Ł., Delp, S., & Schwartz, M. (2019). Automatic real-time gait event detection in children using deep neural networks. PLOS ONE, 14(1), e0211466. https://doi.org/10.1371/journal.pone.0211466
  8. Horst, F., Lapuschkin, S., Samek, W., Müller, K.-R., & Schöllhorn, W. I. (2019). Explaining the Unique Nature of Individual Gait Patterns with Deep Learning. Scientific Reports, 9(1), 2391. https://doi.org/10.1038/s41598-019-38748-8
  9. Cai, T., Giannopoulos, A. A., Yu, S., Kelil, T., Ripley, B., Kumamaru, K. K., … Mitsouras, D. (2016). Natural Language Processing Technologies in Radiology Research and Clinical Applications. RadioGraphics, 36(1), 176–191. https://doi.org/10.1148/rg.2016150080
  10. Jackson, R. G., Patel, R., Jayatilleke, N., Kolliakou, A., Ball, M., Gorrell, G., … Stewart, R. (2017). Natural language processing to extract symptoms of severe mental illness from clinical text: The Clinical Record Interactive Search Comprehensive Data Extraction (CRIS-CODE) project. BMJ Open, 7(1), e012012. https://doi.org/10.1136/bmjopen-2016-012012
  11. Kreimeyer, K., Foster, M., Pandey, A., Arya, N., Halford, G., Jones, S. F., … Botsis, T. (2017). Natural language processing systems for capturing and standardizing unstructured clinical information: A systematic review. Journal of Biomedical Informatics, 73, 14–29. https://doi.org/10.1016/j.jbi.2017.07.012
  12. Montenegro, J. L. Z., Da Costa, C. A., & Righi, R. da R. (2019). Survey of Conversational Agents in Health. Expert Systems with Applications. https://doi.org/10.1016/j.eswa.2019.03.054
  13. Carrell, D. S., Schoen, R. E., Leffler, D. A., Morris, M., Rose, S., Baer, A., … Mehrotra, A. (2017). Challenges in adapting existing clinical natural language processing systems to multiple, diverse health care settings. Journal of the American Medical Informatics Association, 24(5), 986–991. https://doi.org/10.1093/jamia/ocx039
  14. Oña, E. D., Cano-de la Cuerda, R., Sánchez-Herrera, P., Balaguer, C., & Jardón, A. (2018). A Review of Robotics in Neurorehabilitation: Towards an Automated Process for Upper Limb. Journal of Healthcare Engineering, 2018, 1–19. https://doi.org/10.1155/2018/9758939
  15. Krebs, H. I., & Volpe, B. T. (2015). Robotics: A Rehabilitation Modality. Current Physical Medicine and Rehabilitation Reports, 3(4), 243–247. https://doi.org/10.1007/s40141-015-0101-6
  16. Leng, M., Liu, P., Zhang, P., Hu, M., Zhou, H., Li, G., … Chen, L. (2019). Pet robot intervention for people with dementia: A systematic review and meta-analysis of randomized controlled trials. Psychiatry Research, 271, 516–525. https://doi.org/10.1016/j.psychres.2018.12.032
  17. Jennifer Piatt, P., Shinichi Nagata, M. S., Selma Šabanović, P., Wan-Ling Cheng, M. S., Casey Bennett, P., Hee Rin Lee, M. S., & David Hakken, P. (2017). Companionship with a robot? Therapists’ perspectives on socially assistive robots as therapeutic interventions in community mental health for older adults. American Journal of Recreation Therapy, 15(4), 29–39. https://doi.org/10.5055/ajrt.2016.0117
  18. Troccaz, J., Dagnino, G., & Yang, G.-Z. (2019). Frontiers of Medical Robotics: From Concept to Systems to Clinical Translation. Annual Review of Biomedical Engineering, 21(1). https://doi.org/10.1146/annurev-bioeng-060418-052502
  19. Riek, L. D. (2017). Healthcare Robotics. ArXiv:1704.03931 [Cs]. Retrieved from http://arxiv.org/abs/1704.03931
  20. Kappassov, Z., Corrales, J.-A., & Perdereau, V. (2015). Tactile sensing in dexterous robot hands — Review. Robotics and Autonomous Systems, 74, 195–220. https://doi.org/10.1016/j.robot.2015.07.015
  21. Choi, C., Schwarting, W., DelPreto, J., & Rus, D. (2018). Learning Object Grasping for Soft Robot Hands. IEEE Robotics and Automation Letters, 3(3), 2370–2377. https://doi.org/10.1109/LRA.2018.2810544
  22. Shortliffe, E., & Sepulveda, M. (2018). Clinical Decision Support in the Era of Artificial Intelligence. Journal of the American Medical Association.
  23. Attema, T., Mancini, E., Spini, G., Abspoel, M., de Gier, J., Fehr, S., … Sloot, P. M. A. (n.d.). A new approach to privacy-preserving clinical decision support systems. 15.
  24. Castaneda, C., Nalley, K., Mannion, C., Bhattacharyya, P., Blake, P., Pecora, A., … Suh, K. S. (2015). Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine. Journal of Clinical Bioinformatics, 5(1). https://doi.org/10.1186/s13336-015-0019-3
  25. Gianfrancesco, M. A., Tamang, S., Yazdany, J., & Schmajuk, G. (2018). Potential Biases in Machine Learning Algorithms Using Electronic Health Record Data. JAMA Internal Medicine, 178(11), 1544. https://doi.org/10.1001/jamainternmed.2018.3763
  26. Kliegr, T., Bahník, Š., & Fürnkranz, J. (2018). A review of possible effects of cognitive biases on interpretation of rule-based machine learning models. ArXiv:1804.02969 [Cs, Stat]. Retrieved from http://arxiv.org/abs/1804.02969
  27. Weng, S. F., Reps, J., Kai, J., Garibaldi, J. M., & Qureshi, N. (2017). Can machine-learning improve cardiovascular risk prediction using routine clinical data? PLOS ONE, 12(4), e0174944. https://doi.org/10.1371/journal.pone.0174944
  28. Suresh, H., Hunt, N., Johnson, A., Celi, L. A., Szolovits, P., & Ghassemi, M. (2017). Clinical Intervention Prediction and Understanding using Deep Networks. ArXiv:1705.08498 [Cs]. Retrieved from http://arxiv.org/abs/1705.08498
  29. Vayena, E., Blasimme, A., & Cohen, I. G. (2018). Machine learning in medicine: Addressing ethical challenges. PLOS Medicine, 15(11), e1002689. https://doi.org/10.1371/journal.pmed.1002689
  30. Verghese, A., Shah, N. H., & Harrington, R. A. (2018). What This Computer Needs Is a Physician: Humanism and Artificial Intelligence. JAMA, 319(1), 19. https://doi.org/10.1001/jama.2017.19198

IBM’s Watson gave unsafe recommendations for treating cancer

In 2012, doctors at Memorial Sloan Kettering Cancer Center partnered with IBM to train Watson to diagnose and treat patients. But according to IBM documents dated from last summer, the supercomputer has frequently given bad advice, like when it suggested a cancer patient with severe bleeding be given a drug that could cause the bleeding to worsen.

Source: IBM’s Watson gave unsafe recommendations for treating cancer

I don’t suggest that these findings aren’t problematic, or that isn’t essential for expert systems like Watson to improve in their diagnosis and prediction but I do feel that it’s a bit like blaming a medical student for not being perfect.  Yes, Watson is still learning and won’t always get it right and yes, it can improve. But is it reasonable to hold these systems to standards of performance that we would never expect of human doctors (see the data on the human causes of medical error that lead to patient deaths).

A.I. Versus M.D. What happens when diagnosis is automated?

The word “diagnosis,” he reminded me, comes from the Greek for “knowing apart.” Machine-learning algorithms will only become better at such knowing apart—at partitioning, at distinguishing moles from melanomas. But knowing, in all its dimensions, transcends those task-focussed algorithms. In the realm of medicine, perhaps the ultimate rewards come from knowing together.

Source: A.I. Versus M.D. What happens when diagnosis is automated?

This New Yorker article by Siddhartha Mukherjee explores the implications for practice and diagnostic reasoning in a time when software is increasingly implicated in clinical decision-making. While the article is more than a year old (a long time in AI and machine learning research), it still stands up as an excellent, insightful overview of the  state of AI-based systems in the domain of clinical care.  It’s a long read but well worth it.