The opportunities for real societal impact (and phoney baloney) in the AI applications to health care. What improves? Who might get paid?

1. DEPARTMENT OF
Biomedical Informatics
Artificial Intelligence in
Medicine
Isaac ”Zak” Kohane, MD, PhD
Part Deux

2. DEPARTMENT OF
Biomedical Informatics
Artificial Intelligence in Medical Diagnosis
PETER SZOLOVITS, Ph.D.; RAMESH S. PATIL, Ph.D.; and
WILLIAM B. SCHWARTZ, M.D.; ANNALS OF INTERNAL
MEDICINE Vol.108; No.1, pages 80-87. January 1988.
Medicine is an information
and knowledge processing
discipline

3. DEPARTMENT OF
Biomedical Informatics
Let’s dispose of this
question:

4. DEPARTMENT OF
Biomedical Informatics
Deal Distribution

5. DEPARTMENT OF
Biomedical Informatics
With a large
problem
comes a
large
opportunity

6. DEPARTMENT OF
Biomedical Informatics
Diverse portfolio
in AIM reflect
broad definition

7. DEPARTMENT OF
Biomedical Informatics
Who is not
featured
here?

8. DEPARTMENT OF
Biomedical Informatics

9. DEPARTMENT OF
Biomedical Informatics
THE BREAKTHROUGH (2012)
• Pivotal event occurred
in an image
recognition contest
which brought
together 3 critical
ingredients for the
first time:
• Massive amounts of
labeled images
• Training with GPUs
• Methodological
innovations that
enabled training
deeper networks
while minimizing
overfitting

10. DEPARTMENT OF
Biomedical Informatics
Availability
of massive
datasets with
high-quality
labels
Where are
these in
medicine,
genomics etc?

11. DEPARTMENT OF
Biomedical Informatics
Shift in computing No. 1 system from June 2002 to June 2004

12. DEPARTMENT OF
Biomedical Informatics
Working in full immersive worlds

13. DEPARTMENT OF
Biomedical Informatics
The major contribution of doctors was…

14. DEPARTMENT OF
Biomedical Informatics
Expert-level + (? Value of incr. imaging tech).

15. DEPARTMENT OF
Biomedical Informatics
Don’t forget the
Superhuman human
fallacy!

16. DEPARTMENT OF
Biomedical Informatics
Buggy whip is making a space next to it for
pure medical image critiquing
• Not pure critique role may be
enhanced:
• retinal images (might increase
surgical time)
• Mammography and other
screening
• Competition and co-opting for
off-shored image reads
• Pathology
• Dermatology
• Radiology
• Dysmorphology

17. DEPARTMENT OF
Biomedical Informatics
Changing public health, actuarial science,
precision medicine

18. DEPARTMENT OF
Biomedical Informatics
But they
can’t beat
us at
common
sense +
alternative
facts?

19. DEPARTMENT OF
Biomedical Informatics

20. DEPARTMENT OF
Biomedical Informatics
• Who completes the loop?
• Who is trusted?
• Who integrates with rest of care?
• Who oversees
• Process automation?
• Who does expert catch?

21. DEPARTMENT OF
Biomedical Informatics
About surgery…
Once you have shown robot
effectors in the surgical field…

22. DEPARTMENT OF
Biomedical Informatics

23. DEPARTMENT OF
Biomedical Informatics
Which path?
Electronic
Health
Record
Data
(labs, meds, images…)
Summary & Decisions
(Rx, Dx, Prognosis…)

24. DEPARTMENT OF
Biomedical Informatics
Which path?
Electronic
Health
Record
Data
(labs, meds, images…)
Summary & Decisions
(Rx, Dx, Prognosis…)

25. DEPARTMENT OF
Biomedical Informatics
Which path?
Electronic
Health
Record
Data
(labs, meds, images…)
Summary & Decisions
(Rx, Dx, Prognosis…)

26. DEPARTMENT OF
Biomedical Informatics
Which path?
Electronic
Health
Record
Data
(labs, meds, images…)
Summary & Decisions
(Rx, Dx, Prognosis…)
Who are likely
winners in for this
path?

27. DEPARTMENT OF
Biomedical Informatics
Which path?
Electronic
Health
Record
Data
(labs, meds, images…)
Summary & Decisions
(Rx, Dx, Prognosis…)
Imaging companies?
AI companies?
ED MD? Oncologist?
What are the levers?

28. DEPARTMENT OF
Biomedical Informatics
A common diagnosis becomes undiagnosed
• 3 years and 10 months old with bloody stool.
• Underwent endoscopy in November 2005 at 4 years old which showed a pancolitis.
• He was started on sulfasalazine; maintained on fish oil and sulfasalazine until age 13 ½ at which
point he flared. That was in July 2015.
• He’s been in a flare since. Unsuccessful wean from prednisone, vancomycin effect transient
• Started on 6MP in March 2016 with no effect over 3 months despite therapeutic levels.
• Started on infliximab 5mg/kg 7/6/2016 with no effect.
• Aug 20th tried a course of Rifaximin with initial, temporally related, transient improvement.
• Has tried multiple forms of PR meds with no effect, including cortisone enemas, cortifoam,
canasa suppos. .
• In September 2016, stool turned bloody and frequency was hourly, hospitalized for tacrolimus
• which improved symptoms but did not produce a remission.
• Vedolizumab was added in October with no appreciable effect.

29. DEPARTMENT OF
Biomedical Informatics
Boundary between diseased and
healthy patients
Can we identify an existing drug that
will move these patients towards the
healthy region?
IBD Expression Profiles:
Whole Blood

30. DEPARTMENT OF
Biomedical Informatics
Tissue: Blood
Drug: Azathioprine

31. DEPARTMENT OF
Biomedical Informatics
Best ranked compound for our patient
• Indirubin
• Chemical compound
most often produced
as a byproduct of
bacterial metabolism
• Constituent of indigo
naturalis (also known
as qing dai),

32. DEPARTMENT OF
Biomedical Informatics
Big $$$$ questions for next 5 years
• Will AI be primary tool in billing information warfare ?
• Game over for medical imaging?
• How does work and $$$ get redistributed
• Deliver better outcomes?
• Who: Penetrate or bypass existing healthcare process automation?
• AHC vs Google/Apple/Facebook vs
• Will the point of maximum, $$$ leverage be outside or inside the providers’
offices/hospital
• Does the high-touch, shamanistic part of medicine get re-valued,
de-valued or replaced?

33. DEPARTMENT OF
Biomedical Informatics
Thank you
Special Thanks to
Andrew Beam, PhD
Nathan Palmer, PhD
Kun-Hsing Yu, MD, PhD
Bryce Allen, PhD
Ken Mandl, MD, MPH
Bill Geary