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Mayo AI CAI final.pptx
- 1. ©2022 Mayo Foundation for Medical Education and Research | WF988050-1 ©2022 Mayo Foundation for Medical Education and Research | WF988050-1 Image Copyright Shutterstock Department of Cardiovascular Medicine CURRENT APPLICATIONS AND FUTURE OF ARTIFICIAL INTELLIGENCE IN CARDIOLOGY ©2021 Mayo Foundation for Medical Education and Research | WF247956-1 Image Copyright Shutterstock HYATT REGENCY SAN FRANCISCO 5 Embarcadero Center San Francisco, CA 94111 JULY 14–16, 2022 LIVE IN-PERSON AND LIVESTREAMING
- 2. ©2022 Mayo Foundation for Medical Education and Research | WF988050-2 CONVERSATIONAL AI IN CARDIOLOGY REDESIGNING VOICE EXPERIENCE FOR PATIENTS AND PROVIDERS IN DIGITAL WORLD Jai Nahar, MD, MBA Associate Professor of Pediatrics George Washington University School of Medicine Attending, Division of Cardiology Children’s National Hospital, Washington DC Department of Cardiovascular Medicine ©2022 Mayo Foundation for Medical Education and Research | WF988050-2 Image Copyright Shutterstock ©2021 Mayo Foundation for Medical Education and Research | WF247956-2 Image Copyright Shutterstock
- 3. ©2022 Mayo Foundation for Medical Education and Research | WF988050-3 REFERENCES TO OFF-LABEL USAGE(S) OF PHARMACEUTICALS OR INSTRUMENTS • Nothing to disclose • I have no relevant financial relationships to disclose at this time. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIP(S) WITH INDUSTRY
- 4. ©2022 Mayo Foundation for Medical Education and Research | WF988050-4 ©2022 Mayo Foundation for Medical Education and Research | WF988050-4 LEARNING OBJECTIVES Review- 1. Introductory concepts of Conversational AI 2. Conversational AI touchpoints and uses in Health Care Delivery 3. Challenges in Adoption 4. Future Directions
- 5. ©2022 Mayo Foundation for Medical Education and Research | WF988050-5 ©2022 Mayo Foundation for Medical Education and Research | WF988050-5 VOICE AS NEW OS Clinician What was the LVEF on last echo and LVEF trend over last three years? LVEF was 50% on January 4, 2022 This is the LVEF trend. LVEF dropped down to 40% during hospitalization on January 12, 2021
- 6. ©2022 Mayo Foundation for Medical Education and Research | WF988050-6 ©2022 Mayo Foundation for Medical Education and Research | WF988050-6 VOICE AS NEW OS Patient When is my next cardiology clinic appointment? July 22, 2022, at 10 am. I can assist you with online check in process to save time.
- 7. ©2022 Mayo Foundation for Medical Education and Research | WF988050-7 HISTORY: HUMAN COMPUTER INTERACTION GUI WEB www Mobile VUI 1980s 1990s Voice: • Natural mode of communication • Convenient • Scalable • Rich Content • Metadata • Biomarkers Present 2000s
- 8. ©2022 Mayo Foundation for Medical Education and Research | WF988050-8 INTRODUCTORY CONCEPTS Conversational AI: Technology which allows Human - Computer interaction through the use of Natural conversation, utilizing voice user interface and Machine Intelligence Conversational AI Voice Technology NLP ML, Deep Learning Synergistic Convergence Conversation Human Computer Chang A. Analytics and Algorithms, Big Data, Cognitive Computing, and Deep Learning in Medicine and Health Care. AI Med Ebook; 2017
- 9. ©2022 Mayo Foundation for Medical Education and Research | WF988050-9 CONVERSATIONAL AI Natural Conversation using Machine intelligence 1 Perception/Sense 2 Understanding Comprehension 3 Action/Execution Speech/Voice Recognition Natural Language Understanding Natural Language Generation 4 Learn from past actions/experiences Machine Learning
- 10. ©2022 Mayo Foundation for Medical Education and Research | WF988050-10 CURRENT STATE CONVERSATIONAL AI ECOSYSTEM Smart Speakers Smart voice enabled devices Chatbots Virtual Assistants Ambient Clinical Intelligence Conversational AI Voice VUI NLP Ambient Sensors
- 11. ©2022 Mayo Foundation for Medical Education and Research | WF988050-11 PUTTING THEM TOGETHER Conversational AI Health Care delivery
- 12. ©2022 Mayo Foundation for Medical Education and Research | WF988050-12 CONVERSATIONAL AI IN HEALTH CARE DELIVERY •Use it to ease our professional life? •Augment care we provide? •Understand and overcome the challenges in adoption? •Foster its development as a community?
- 13. ©2022 Mayo Foundation for Medical Education and Research | WF988050-13 CREATING VALUE WITH VOICE Quadruple Aim Improved Clinician Experience Improved Patient Experience Lower Costs Better Outcomes
- 14. ©2022 Mayo Foundation for Medical Education and Research | WF988050-14 Conversational AI Outpatient Clinic/Virtual Visits Home Health Customer Service/ Call Center Inpatient Hospital Care 1. Patient Education, inpatient care navigation 2. Discharge preparation 3. Clinical Decision Support Easing the Hospital Journey 1. EHR documentation, navigation 2. Ambient clinical Intelligence 3. Clinical Decision Support 4. Foreign language interpretation Decreasing Physician Burnout: POC Tasks Home Health Optimization 1. Appointment Navigation 2. Patient Education 3. Patient Engagement 4. Medication management 5. Behavior Modification 6. Virtual Digital Assistant Operational Ease 1. Scheduling appointment 2. Information 3. Assistance Voice and Conversational AI Touchpoints Applications in Health Care delivery Jai Kumar Nahar, Francisco Lopez-Jimenez, Utilizing Conversational Artificial Intelligence, Voice, and Phonocardiography Analytics in Heart Failure Care, Heart Failure Clinics, Volume 18, Issue 2, 2022, Pages 311-323, ISSN 1551-7136, ISBN 9780323920193 https://doi.org/10.1016/j.hfc.2021.11.006
- 15. ©2022 Mayo Foundation for Medical Education and Research | WF988050-15 ©2022 Mayo Foundation for Medical Education and Research | WF988050-15 ENHANCING PROVIDER EXPERIENCE Voice assistant enabled EHR • Information retrieval • EHR navigation • Information entry • Task Completion • Workflow Optimization • Provider centric design
- 16. ©2022 Mayo Foundation for Medical Education and Research | WF988050-16 Comprehensive Voice enabled AI solution • Decreases Physician administrative burden • Decreases Physician burnout • More attention to the patient • Increases patient satisfaction, better outcome ACI: AMBIENT CLINICAL INTELLIGENCE ACI Ambient Sensing Technology User Initiated Virtual Assistant Automated Documentation service
- 17. ©2022 Mayo Foundation for Medical Education and Research | WF988050-17 ©2022 Mayo Foundation for Medical Education and Research | WF988050-17 ENHANCING PATIENT EXPERIENCE Home Outpatient care Inpatient • Chatbots (Voice bots) • Voice Assistants • Voice enabled Digital devices/hubs • Voice enabled Connected care
- 18. ©2022 Mayo Foundation for Medical Education and Research | WF988050-18 DIGITAL EXPERIENCE AS A SERVICE (EAAS) VOICE INTEGRATION Digital Front Door Dynamic Platform Omni channel access Evolving suite of Innovative Digital tools Digital User Experience UX(D) Engagement Adherence Brand loyalty Meet needs & Expectations
- 19. ©2022 Mayo Foundation for Medical Education and Research | WF988050-19 VOICE ENABLED CHATBOTS (VOICE BOTS) https://www.mayoclinic.org/symptoms
- 20. ©2022 Mayo Foundation for Medical Education and Research | WF988050-20 VOICE ENABLED VIRTUAL HEALTH ASSISTANT: CREATING VALUE Assistance/ Automation Enhanced Digital Experience Adherence, Engagement Value & Impact • Automation of customer service tasks • Intelligence (IVA) • Embodied virtual agents • Customized • Empathetic • Proactive • Brand Loyalty Value Pyramid 1 2 3
- 21. ©2022 Mayo Foundation for Medical Education and Research | WF988050-21 Assistance Digital Front Door Chronic Care Management & Wellness • Screen, Triage • Inform • Assist with care navigation • Connect with providers • Educate • Digital Connection • Remote Monitoring • Risk stratification • Prediction (Voice biomarkers) • Engagement • Adherence • Digital Therapeutics • Behavior modification • Promotion of wellness Functional Spectrum of Voice Enabled Virtual Health Assistants in Health care delivery Jai Kumar Nahar, Francisco Lopez-Jimenez, Utilizing Conversational Artificial Intelligence, Voice, and Phonocardiography Analytics in Heart Failure Care, Heart Failure Clinics, Volume 18, Issue 2, 2022, Pages 311-323, ISSN 1551-7136, ISBN 9780323920193 https://doi.org/10.1016/j.hfc.2021.11.006
- 22. ©2022 Mayo Foundation for Medical Education and Research | WF988050-22 INNOVATION IN HEART FAILURE CARE DELIVERY: VOICE ENABLED CONNECTED CARE MODEL Digital Hub Comprehension • Intent recognition • Context Understanding • Learning Health Care Institution • Applications • Providers AI Engine On-Device, Edge, Cloud, AI • Devices • Sensors Execution/Personal Assistance • Natural Interaction (Voice) • Proactive • Personalized & actionable insights • Behavior Modification • Positive reinforcement Perception/Integration • Voice/Language • Biological Digital Signals (Digital, Voice biomarkers) • Physician • Nurse • Medical Assistant • Care Manager • Social Worker Patient Voice Voice enabled Intelligent Virtual Assistant Real Time Analytic Processing Actionable Insights Jai Kumar Nahar, Francisco Lopez-Jimenez, Utilizing Conversational Artificial Intelligence, Voice, and Phonocardiography Analytics in Heart Failure Care, Heart Failure Clinics, Volume 18, Issue 2, 2022, Pages 311-323, ISSN 1551-7136, ISBN 9780323920193. https://doi.org/10.1016/j.hfc.2021.11.006
- 23. ©2022 Mayo Foundation for Medical Education and Research | WF988050-23 CHALLENGES IN CONVERSATIONAL AI ADOPTION ? Privacy Security Accuracy Reliability Trust Ethics Design and smooth workflow integration
- 24. ©2022 Mayo Foundation for Medical Education and Research | WF988050-24 FUTURE DIRECTIONS Smart Voice enabled Clinician friendly workflows (CAI) Advanced HCI: Voice integrated Proactive Humanoid Virtual Assistants Hybrid Technology: CAI+ AR; CAI+Robotics Integrated Voice biomarkers: Multimodal AI
- 25. ©2022 Mayo Foundation for Medical Education and Research | WF988050-25 CONCLUSION: KEY TAKEAWAYS CAI: Intelligent User Interface Human Centered Design, Smooth Workflow integration Data Privacy, Security, is integral to successful implementation Voice Technology: New Digital Health Utility
- 26. ©2022 Mayo Foundation for Medical Education and Research | WF988050-26 QUESTIONS & ANSWERS Thanks for your time
Editor's Notes
- Let us look back at the history: How did we reach here? Over past 3-4 decades our interaction with computers has progressed through the GUI, www revolution, mobile revolution including TUI and now Voice revolution, VUI and conversational AI. The Era of VUI has great promise as Voice is Natural mode of communication Convenient Scalable Rich Content Metadata 1989: World Wide Web invention Jan 2007: First I phone released, beginning of smart phone era 2011 –present: Era of Conversational AI ( Siri) -- home Pod (2018) Google now--- Google assitant The Era of VUI has great promise
- Foundation of conversational AI is NLP, hence lets us start with it. Conversational AI: Human Machine interaction through the use of conversation, utilizing voice user interface and Machine Intelligence. This is made possible by synergistic convergence of Voice technology, and Artificial Intelligence technology (Natural Language processing, Machine and Deep Learning). It includes smart voice enabled devices, chat bots and virtual assistants Two common applications of Conversational AI are virtual assistants and chatbots, these are also known as virtual or conversational agents. A virtual assistant (e.g. Apple’s Siri, Google Assistant, and Amazon Alexa) is an AI-inspired software agent that is capable of performing certain tasks or services via text or voice. A chat bot is a conversational AI application that is capable of providing information to the user. Virtual voice assistant helps the user in performing simple daily tasks
- We as intelligent human beings perform 4 important tasks, perceive the environment around us through our sensory organs, understand what we sense and act/execute accordingly and also learn from our past actions and experiences. For intelligent machines to indulge in natural conversation, 4 human like capabilities are needed. Machine Perception of speech/voice takes thru speech/voice recognition Machine Comprehension occurs thru NLP Machine Execution occurs via NLG Learning from prior actions or results, which occurs thru ML
- There are many ways in we encounter conversational AI in our daily lives. These are in form of smart speakers, Smart displays next evolution of smart speakers and include Voice + touch screen Display : Amazon Echo show, Google home hub, Facebook portal
- Conversational AI (CAI) in health care delivery brings few considerations: How can we use use it to ease our daily life? Augment care we provide, leveraging its optimum use? How can we Foster its development as a community? Understand and overcome the challenges in its adoption?
- Voice technology can be used to achieve: Improve clinician experience/decrease physician burnout Improved patient experience and engagement Ultimately leading to better outcomes
- Ambient clinical intelligence (ACI) — a comprehensive, AI-powered, voice-enabled solution — uses ambient sensing technology to securely listen to clinician-patient encounter conversations while offering workflow and knowledge automation to complement the EHR. It has three components: Ambient sensing technology: Clinicians engage in conversation with their patient while a wall-mounted purpose built healthcare device uses a multi-microphone array and integrated machine vision to capture and track audio. 2. User-initiated virtual assistants: Simply say “Hey Dragon” to get information in and out of the EHR. Use natural language to reduce the time it takes to document care, navigate patient charts, and follow up on documentation details. 3. Automated Documentation Services: During an encounter, every spoken word is diarized with speech recognition and automatically translated into a draft clinical note using discrete data that’s delivered to the clinician for authentication directly through the EHR. https://www.nuance.com/healthcare/ambient-clinical-intelligence.html
- Voice technology can be used to enhance patient experience at various points in their health care journey.
- This slide illustrates the Functional Spectrum of Voice Enabled Virtual Health Assistant. There are 3 important functional groups. First is assistance with information, care navigation and education. Second is use as digital interface between pt and provider thus helping for home based remote monitoring which is evolving as an important component of virtual care. Third is Chronic care management and promotion of wellness specially important for high risk patients such as CHF, HTN, diabetes
- Let us look at second value proposition of voice: in improving patient experience. This slide shows 3
- This slide illustrates an innovative care delivery model which I have labelled as Voice Integrated Connected Intelligence This is a good example of man-machine intelligence synergy and leverages technology such as remote monitoring devices, voice, virtual assistants, AI to connect patient to the care providers, augmenting care delivery at home. This has 3 important interconnected components. First is remotely monitored patient, and voice enabled virtual assistant, second is the AI engine and third is the multidisciplinary care delivery team. Patient’s voice commands and digital remote monitoring signals are transmitted via the virtual voice assistant (gateway) to the AI engine and as needed to Care delivery team. The AI Engine enables RTAP of this input and in conjunction with care provider team, provides personalized and actionable health promoting insights, delivered back to the patient via voice enabled virtual assistant.
- Let us look at the challenges in Conversational AI adoption. These include: Maintenance of Privacy and security of confidential Health Information, Accuracy and reliability of information provided by the CAI Building of trust by the end user. Ethical use of exchanged health information And last but not the least optimum design and smooth work flow integration for the end user.
- Looking ahead in future, consideration should be given to humanizing the VA by making their response proactive, incorporating context specific empathy for the end user, cognitive capabilities and On-device AI, so they can be great companion and asset for the end user. In future consideration should be given to 1. Designing Smart Voice enabled Clinician friendly workflows 2. Development of Advanced HCI solutions: Voice integrated Proactive Humanoid Virtual Assistants with integrated Cognition & Empathy. 4. Hybrid technology: integration of CAI+AR to form intelligent reality , CAI +Robotics can be used to design children Friendly applications 5. Voice integrated RPM 6. Integrated Voice biomarkers in multimodal AI solutions
- In conclusion CAI can be used as Intelligent user interface for patients and providers in augmenting care delivery Good UX enabled by Human Centered design, Smooth workflow integration, Data privacy and security are integral to successful implementation. Voice technology is emerging as the new digital health utility Field of Voice Biomarkers is an emerging frontier and can be used as adjunct to other digital biomarkers, for risk prediction in early warning systems