A former Biden administration official, and DeKalb County health adviser, said Wednesday that artificial intelligence in medical spaces should be subjected to bias audits.
“When I hear ‘AI-based medicine,’ I think the evidence might not be sound,” Dr. Sandra Elizabeth Ford said Wednesday at the Health Connect South conference in Atlanta that drew about 1,100 participants, including doctors, researchers and students, to network and share ideas on a wide range of pressing public health issues. Ford said the assumptions on which many AI models are based could be flawed, and this can impact care for patients in the U.S. from minority backgrounds.
Though she thinks AI tools in medical settings could reduce paperwork for hospital employees and ultimately be useful, she told an audience at the annual health care conference at the Georgia Aquarium in downtown Atlanta that not all patients will know how to interact with AI platforms in medical settings.
She also flagged the potential bias of programmers and AI trainers as an area of concern.
“We need to make sure that the people who are programming AI respect diversity. We need to make sure that AI trainers are as diverse as the population they are serving,” she said.
AI medical biases also crosses over into gender, Ford noted. Women comprise 28.2% of the STEM workforce, according to the World Economic Forum, compared to 47.3% in non-STEM sectors. While 73% of business leaders believe having more women leadership is important for mitigating gender bias in AI, only 33% currently have a woman in charge of decision-making for AI strategy, according to IBM.
A federal rule issued in July aims to protect consumers from discrimination when artificial intelligence tools are used in health care, but it could be reversed by future administrations, KFF said. Dr. Rowland Illing, chief medical officer and director for Global Healthcare & Nonprofits Amazon Web Services, said at the conference the industry should strive to “plug gaps” around privacy and diversity concerns to head off further regulation.
But the U.S. needs to overcome a history of building biases into new health systems, cardiologist Dr. Jayne Morgan told The Atlanta Journal-Constitution.
“AI can end up being a tool of othering,” Morgan said. She added AI would be useful in a medical setting if “it were neutral and factual and clean, and the biases we have now in the medical system weren’t built into it.”
Dr. Anne Dunlop, a gynecologist and professor at Emory University, said AI holds the potential to free up doctors’ resources to focus on other aspects of the care experience. But as of now, she is only using it as a means of capturing notes.
She echoed Ford’s concerns, saying doctors can pick up body language or speech patterns that might elude AI systems.
“We as clinicians pick up how a patient is feeling when we are in the room,” she said. “People express pain with different words and expressions. AI, to be helpful in addressing complex medical issues, will need to reflect this diversity.”
Health care worker shortage continues
The CEOs of three major Georgia health systems were unanimous at the conference panel that the shortage of health care workers remains a huge problem. To address it, they’ve each invested in educational institutions to train more, hoping they’ll stay in Georgia and come to work at their companies.
“We always have a deficit of nurses and other clinicians,” said Scott Steiner, CEO of Phoebe Putney Health System of southwest Georgia.
“We turn down patients each and every day,” said Neil Pruitt, CEO of the skilled nursing and senior living company Pruitt Health. “Not because we don’t have open beds. But because we don’t have the staff available.”
Credit: arvin.temkar@ajc.com
Credit: arvin.temkar@ajc.com
As a result Steiner, Pruitt and Candice Saunders, CEO of Wellstar Health System, have each overseen major investments in colleges and technical schools. Phoebe Putney’s investment in a local nursing program reached $45 million.
One issue worsening the shortage, Saunders said, is the disturbing trend of violence against health care workers — it began during the pandemic and has increased.
“It’s a major threat to the workforce, and it’s something that we’re focused on every day,” Saunders said. Wellstar learned from a comprehensive assessment of the safety threat that “Yes, the ERs are high risk in our care settings, but so are doctor’s offices, so are urgent care, so are home care settings.”
As a result, Wellstar has begun implementing security measures, which patients and visitors will see. Those include armed guards in Wellstar locations, visitors no longer being able to enter freely and wander, and installing panic buttons. For workers who see patients remotely, Wellstar is investigating solutions like remote monitoring and even predictive AI.
“It’s been a huge investment,” Saunders said. “But then if there is an event, then we have a very, very rapid response, like we do for a heart attack in the hospital.”
“But I can’t emphasize enough how this is affecting the health and well-being of our health care workers today,” she said, “and is something that all of us need to be aware of.”
Public health partnerships needed
At another panel discussion focusing on public health partnerships, health leaders said hospitals and health systems need to give more than lip service to their efforts to partner with public health organizations to improve health care.
“I want public health to be recognized” on par with for-profit health care, said Dr. Kathleen Toomey, commissioner of the Georgia Department of Public Health. She said public health is often overlooked in health care because, “It’s not where the money is at.”
“We have the worst PR about ourselves,” she said. “We have to show our value to the health system.”
Toomey pointed to how public health gained more attention during 9/11 and the coronavirus pandemic when a wide range of partnerships were formed that included hospitals and the businesses community. But she didn’t believe public health emergencies should be the only impetus to strengthen those partnerships.
“We can’t wait for a public health emergency,” reiterated Chelsea Cipriano, managing director of the Common Health Coalition. Last year, four major health care organizations, including the American Medical Association and the American Hospital Association, formed the coalition, which focuses on using lessons learned during the pandemic to strengthen partnerships between health care and public health systems.
“We should have agreements in place and not just for emergencies.”
One such partnership, More in Common Alliance, links Morehouse School of Medicine and CommonSpirit Health, which provides health care to underserved communities. The goal of the partnership, formed in 2020, is to increase medical education opportunities for more people of color in the hopes of better diversifying the medical workforce and improving patient care.
The alliance believes patients fare better when treated by clinicians of similar backgrounds. The partnership is also trying to address a shortage of clinicians from diverse backgrounds and the need for more equitable health care.
In 2020, Morehouse School of Medicine teamed up with CommonSpirit Health in a 10-year, $100 million partnership to provide new training opportunities for Morehouse School of Medicine students in Chattanooga, Lexington and Seattle along with postgraduate residencies and fellowships in California in Bakersfield, Los Angeles, Santa Cruz and Ventura County.
About the Authors
