I discussed something related to this earlier this year (the algorithmic de-skilling of clinicians) and thought that this short presentation added something extra. It’s not just that AI and machine learning have the potential to create scenarios in which qualified clinical experts become de-skilled over time; they will also impact on our ability to teach and learn those skills in the first place.
We’re used to the idea of a novice working closely with a more experienced clinician, and learning from them through observation and questioning (how closely this maps onto reality is a different story). When the tasks usually performed by more experienced clinicians are outsourced to algorithms, who does the novice learn from?
Will clinical supervision consist of talking undergraduate students through the algorithmic decision-making process? Discussing how probabilistic outputs were determined from limited datasets? How to interpret confidence levels of clinical decision-support systems? When clinical decisions are made by AI-based systems in the real-world of clinical practice, what will we lose in the undergraduate clinical programme, and how do we plan on addressing it?
I’ve just had a chapter published in an edited collection entitled: Artificial Intelligence and Inclusive Education: Speculative Futures and Emerging Practices. The book is edited by Jeremy Knox, Yuchen Wang and Michael Gallagher and is available here.
Here’s the citation: Rowe M. (2019) Shaping Our Algorithms Before They Shape Us. In: Knox J., Wang Y., Gallagher M. (eds) Artificial Intelligence and Inclusive Education. Perspectives on Rethinking and Reforming Education. Springer, Singapore. https://doi.org/10.1007/978-981-13-8161-4_9.
And here’s my abstract:
A common refrain among teachers is that they cannot be replaced by intelligent machines because of the essential human element that lies at the centre of teaching and learning. While it is true that there are some aspects of the teacher-student relationship that may ultimately present insurmountable obstacles to the complete automation of teaching, there are important gaps in practice where artificial intelligence (AI) will inevitably find room to move. Machine learning is the branch of AI research that uses algorithms to find statistical correlations between variables that may or may not be known to the researchers. The implications of this are profound and are leading to significant progress being made in natural language processing, computer vision, navigation and planning. But machine learning is not all-powerful, and there are important technical limitations that will constrain the extent of its use and promotion in education, provided that teachers are aware of these limitations and are included in the process of shepherding the technology into practice. This has always been important but when a technology has the potential of AI we would do well to ensure that teachers are intentionally included in the design, development, implementation and evaluation of AI-based systems in education.
This is an interesting post making the point that medical language – especially when written in clinical notes – is not the same as other, more typical, human languages. This is important to recognise in the context of training natural language processing (NLP) models in the healthcare context because medical languages have different vocabularies, grammatical structure, and semantics. Trying to get an NLP system to “understand”* medical language is a fundamentally different problem to understanding other languages.
The lessons from this article are slightly technical (although not difficult to follow) and do a good job highlighting why NLP in health systems is seeing slower progress than the NLP running on your phone. You may think that, since Google Translate does quite well translating between English and Spanish, for example, it should also be able to translate between English and “Radiography”. This article explains why that problem is not only harder than “normal” translation, but also different.
* Note: I’m saying “understand” while recognising that current NLP systems understand nothing. They’re statistically modelling the likelihood that certain words follow certain other words and have no concept of what those words mean.
The results underscore another growing problem in AI, too: the sheer intensity of resources now required to produce paper-worthy results has made it increasingly challenging for people working in academia to continue contributing to research. “This trend toward training huge models on tons of data is not feasible for academics…because we don’t have the computational resources. So there’s an issue of equitable access between researchers in academia versus researchers in industry.”
The article focuses on the scale of the financial and environmental cost of training natural language processing (NLP) models, comparing the carbon emissions of various AI models to those of a car throughout its lifetime. To be honest, this isn’t something I’ve given much thought to but to see it visually really drives the point home.
As much as this is a cause for concern, I’m less worried about this in the long term for the following reason. As the author’s in the article stake, the code and models for AI and NLP are currently really inefficient; they don’t need to be neat and compute is relatively easy to come by (if you’re Google and Facebook). I think that the models will get more efficient, as is evident by the fact that new computer vision algorithms can get to the same outcomes with datasets that are orders of magnitude smaller than was previously possible.
For me though, the quote that I’ve pulled from the article to start this post is more compelling. If the costs of modeling NLP are so high, it seems likely that companies like Google, Facebook and Amazon will be the only ones who can do the high end research necessary to drive the field forward. Academics at universities have an incentive to create more efficient models, which they publish and which then allow companies to take advantage of those new models while at the same time, having access to much more computational resources.
From where I’m standing this makes it seem that private companies will always be at the forefront of AI development, which makes me less optimistic than if it were driven by academics. Maybe I’m just being naive (and probably also biased) but this seems less than ideal.
There are a number of overlapping reasons it is difficult to build large health data sets that are representative of our population. One is that the data is spread out across thousands of doctors’ offices and hospitals, many of which use different electronic health record systems. It’s hard to extract records from these systems, and that’s not an accident: The companies don’t want to make it easy for their customers to move their data to a competing provider.
The author goes on to talk about problems with HIPAA, which he suggests are the bigger obstacle to the large-scale data analysis that is necessary for machine learning. While I agree that HIPAA makes it difficult for companies to enable the sharing of health data while also complying with regulations, I don’t think it’s the main problem.
The requirements around HIPAA could change overnight through legislation. This will be challenging politically and legally but it’s not hard to see how it could happen. There are well-understood frameworks through which legal frameworks can be changed and even though it’s a difficult process, it’s not conceptually difficult to understand. But the ability to share data between EHRs will, I think, be a much bigger hurdle to overcome. There are incentives for the government to review the regulations around patient data in order to push AI in healthcare initiatives; I can’t think of many incentives for companies to make it easier to port patient data between platforms. Unless companies responsible for storing patient data make data portability and exchange a priority, I think it’s going to be very difficult to create large patient data sets.
DeepMind’s agents are not really collaborating, said Mark Riedl, a professor at Georgia Tech College of Computing who specializes in artificial intelligence. They are merely responding to what is happening in the game, rather than trading messages with one another, as human players do…Although the result looks like collaboration, the agents achieve it because, individually, they so completely understand what is happening in the game.
The problem with arguments like this is that 1) we end up playing semantic games about what words mean, 2) what we call the computer’s achievement isn’t relevant, and 3) just because the algorithmic solution doesn’t look the same as a human solution doesn’t make it less effective.
The concern around the first point is that, as algorithms become more adept at solving complex problems, we end up painting ourselves into smaller and smaller corners, hemmed in by how we defined the characteristics necessary to solve those problems. In this case, we can define collaboration in a way that means that algorithms aren’t really collaborating but tomorrow when they can collaborate according to today’s definition, we’ll see people wanting to change the definition again.
The second point relates to competence. Algorithms are designed to be competent at solving complex problems, not to solve them in ways that align with our definitions of what words mean. In other words, DeepMind doesn’t care how the algorithm solves the problem, only that it does. Think about developing a treatment for cancer…will we care that the algorithm didn’t work closely with all stakeholders, as human teams would have to, or will it only matter that we have an effective treatment? In the context of solving complex problems, we care about competence.
And finally, why would it matter that algorithmic solutions don’t look the same as human solutions? In this case, human game-players have to communicate in order to work together because it’s impossible for them to do the computation necessary to “completely understand what is happening in the game”. If we had the ability to do that computation, we’d also drop “communication” requirement because it would only slow us down and add nothing to our ability to solve the problem.
I recently received ethics clearance to begin an explorative study looking at how physiotherapists think about the introduction of machine learning into clinical practice. The study will use an international survey and a series of interviews to gather data on clinicians’ perspectives on questions like the following:
What aspects of clinical practice are vulnerable to automation?
How do we think about trust when it comes to AI-based clinical decision support?
What is the role of the clinician in guiding the development of AI in clinical practice?
I’m busy finalising the questionnaire and hope to have the survey up and running in a couple of weeks, with more focused interviews following. If these kinds of questions interest you and you’d like to have a say in answering them, keep an eye out for a call to respond.
Here is the study abstract (contact me if you’d like more detailed information):
Background: Artificial intelligence (AI) is a branch of computer science that aims to embed intelligent behaviour into software in order to achieve certain objectives. Increasingly, AI is being integrated into a variety of healthcare and clinical applications and there is significant research and funding being directed at improving the performance of these systems in clinical practice. Clinicians in the near future will find themselves working with information networks on a scale well beyond the capacity of human beings to grasp, thereby necessitating the use of intelligent machines to analyse and interpret the complex interactions of data, patients and clinical decision-making.
Aim: In order to ensure that we successfully integrate machine intelligence with the essential human characteristics of empathic, caring and creative clinical practice, we need to first understand how clinicians perceive the introduction of AI into professional practice.
Methods: This study will make use of an explorative design to gather qualitative data via an online survey and a series of interviews with physiotherapy clinicians from around the world. The survey questionnaire will be self-administered and piloted for validity and ambiguity, and the interview guide informed by the study aim. The population for both survey and interviews will consist of physiotherapy clinicians from around the world. This is an explorative study with a convenient sample, therefore no a priori sample size will be calculated.
It’s a nice coincidence that my article on machine learning for clinicians has been published at around the same time that my poster on a similar topic was presented at WCPT. I’m quite happy with this paper and think it offers a useful overview of the topic of machine learning that is specific to clinical practice and which will help clinicians understand what is at times a confusing topic. The mainstream media (and, to be honest, many academics) conflate a wide variety of terms when they talk about artificial intelligence, and this paper goes some way towards providing some background information for anyone interested in how this will affect clinical work. You can download the preprint here.
The technology at the heart of the most innovative progress in health care artificial intelligence (AI) is in a sub-domain called machine learning (ML), which describes the use of software algorithms to identify patterns in very large data sets. ML has driven much of the progress of health care AI over the past five years, demonstrating impressive results in clinical decision support, patient monitoring and coaching, surgical assistance, patient care, and systems management. Clinicians in the near future will find themselves working with information networks on a scale well beyond the capacity of human beings to grasp, thereby necessitating the use of intelligent machines to analyze and interpret the complex interactions between data, patients, and clinical decision-makers. However, as this technology becomes more powerful it also becomes less transparent, and algorithmic decisions are therefore increasingly opaque. This is problematic because computers will increasingly be asked for answers to clinical questions that have no single right answer, are open-ended, subjective, and value-laden. As ML continues to make important contributions in a variety of clinical domains, clinicians will need to have a deeper understanding of the design, implementation, and evaluation of ML to ensure that current health care is not overly influenced by the agenda of technology entrepreneurs and venture capitalists. The aim of this article is to provide a non-technical introduction to the concept of ML in the context of health care, the challenges that arise, and the resulting implications for clinicians.
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.
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The developmental track of AI is a problem, and every one of us has a stake. You, me, my dad, my next-door neighbor, the guy at the Starbucks that I’m walking past right now. So what should everyday people do? Be more aware of who’s using your data and how. Take a few minutes to read work written by smart people and spend a couple minutes to figure out what it is we’re really talking about. Before you sign your life away and start sharing photos of your children, do that in an informed manner. If you’re okay with what it implies and what it could mean later on, fine, but at least have that knowledge first.
I agree that we all have a stake in the outcomes of the introduction of AI-based systems, which means that we all have a responsibility in helping to shape it. While most of us can’t be involved in writing code for these systems, we can all be more intentional about what data we provide to companies working on artificial intelligence and how they use that data (on a related note, have you ever wondered just how much data is being collected by Google, for example?). Here are some of the choices I’ve made about the software that I use most frequently:
Mobile operating system: I run LineageOS on my phone and tablet, which is based on Android but is modified so that the data on the phone stays on the phone i.e. is not reported back to Google.
Desktop/laptop operating system: I’ve used various Ubuntu Linux distributions since 2004, not only because Linux really is a better OS (faster, cheaper, more secure, etc.) but because open-source software is more trustworthy.
Browser: I switched from Chrome to Firefox with the release of Quantum, which saw Firefox catch up in performance metrics. With privacy as the default design consideration, it was an easy move to make. You should just switch to Firefox.
Email: I’ve looked around – a lot – and can’t find an email provider to replace Gmail. I use various front-ends to manage my email on different devices but that doesn’t get me away from the fact that Google still processes all of my emails on the back-end. I could pay for my email service provider – and there do seem to be good options – but then I’d be paying for email.
Search engine: I moved from Google Search to DuckDuckGo about a year ago and can’t say that I miss Google Search all that much. Every now and again I do find that I have to go to Google, especially for images.
Photo storage: Again, I’ve looked around for alternatives but the combination of the free service, convenience (automatic upload of photos taken on my phone), unlimited storage (for lower res copies) and the image recognition features built into Google Photos make this very difficult to move away from.
To do list: I’ve used Todoist and Any.do on and off for years but eventually moved to Todo.txt because I wanted to have more control over the things that I use on a daily basis. I like the fact that my work is stored in a text file and will be backwards compatible forever.
Note taking: I use a combination of Simplenote and Qownnotes for my notes. Simplenote is the equivalent of sticky notes (short-term notes that I make on my phone and delete after acting on them), and Qownnotes is for long-form note-taking and writing that stores notes as text files. Again, I want to control my data and these apps give me that control along with all of the features that I care about.
Maps: Google Maps is without equal and is so far ahead of anyone else that it’s very difficult to move away from. However, I’ve also used Here We Go on and off and it’s not bad for simple directions.
From the list above you can see that I pay attention to how my data is stored, shared and used, and that privacy is important to me. I’m not unsophisticated in my use of technology and I still can’t get away from Google for email, photos, and maps, arguably the most important data gathering services that the company provides. Maybe there’s something that I’m missing out but companies like Google, Facebook, Amazon and Microsoft are so entangled in everything that we care about, I really don’t see a way to avoid using their products. The suggestion that users should be more careful about what data they share, and who they share it with, is a useful thought experiment but the practical reality is that it would very difficult indeed to avoid these companies altogether.