How AI will transform healthcare (and can it fix the US healthcare system?)
This thorough review focuses on the impact of AI, 5G, and edge computing on the healthcare sector in the 2020s as well as a look at quantum computing's potential impact on AI, healthcare, and financial services.
For those who are new to AI, Machine Learning, and Deep Learning, I recommend taking a look at the following article entitled "An Introduction to AI." I will refer to Machine Learning and Deep Learning as being subsets of AI. Furthermore, this article is non-exhaustive in relation to potential applications of AI to healthcare and Quantum Computing to various sectors of the economy.
The reason for the focus on AI in healthcare is in light of recent articles by a few senior medical practitioners in the US expressing concern about the role of AI in healthcare.
Some of the concerns expressed, such as the need for improved sharing of data by healthcare participants including hospitals and ensuring the highest quality in the preparation of data, are entirely valid and I take the view that the need for access to data and sharing of data by hospitals may need to become a matter of political and regulatory concern. In addition, careful evaluation of ground truth for data labelling, testing, and validation of models needs to be ensured across all AI companies offering services across healthcare.
However, I remain of the view that AI and in particular Deep Learning technology will have a major role to play in healthcare in the 2020s.
Furthermore, it is important to note that the current medical system is broken and the system is only getting worse. I expect that healthcare will be a major issue in the US Presidential elections in 2020 and also the anticipated election in the UK in the near future. For example, Robert Pearl observed that "Healthcare remains the nation’s top voting issue ahead of the 2020 elections... Surveys show voters remain frustrated with high drug prices, growing out-of-pocket expenses and skimpy health-insurance benefits."
On a personal level, I am very passionate about the potential for AI in healthcare across the next decade. The projects that I have been involved in within healthcare entailed working with a team of experts from the fields of highly qualified medical practitioners (PhD research level), postgraduates in computational biology, biochemistry, and physicists alongside Machine Learning experts. The team includes both men and women and different cultural backgrounds that allows for a higher-performing team.
Furthermore, I believe that such cross-domain expertise is essential in order to enable drug discovery and personalised medicine projects succeed. Domain experience is essential in order to propose technical solutions. However, we can often find that solutions to problems can often come from those outside a sector. For example, Jeff Bezos move from finance into retail, and the track record of Elon Must for disrupting different sectors. It is clear for those of us who have been users of the healthcare system that there is a real problem and that it needs addressing. Finding solutions for healthcare by bringing together diverse backgrounds with domain knowledge of the healthcare system alongside AI experts who can evaluate the problem with a different perspective may help solve different problems in the healthcare sector.
In the 2020s, we will see a convergence of emerging technologies with AI being at the heart of all of them. 5G with AI will usher in a new era of Robotics, Virtual Reality, Augmented Reality with Machine to Machine communication.
Healthcare is a sector that I believe will perhaps be the most affected by AI and the other emerging technologies that 5G will enable (AR, VR, IoT with device to device communication) over the next decade. Healthcare is a sector each and every one of us encounter in our lives. For many, the engagement with this sector it is at a point when things have gone wrong, and there is a need for a remedy.
It is also a sector that the tech majors will go after and make many acquisitions of startups over the course of the next 5 years. This will accelerate as 5G rolls out and AI disrupts the healthcare sector.
CBINSIGHTS noted in "Apple Is Going After The Healthcare Industry, Starting With Personal Health Data" that "Apple CEO Tim Cook has said, the healthcare market makes the smartphone market look small. In fact, with over $7 trillion in health spending per year, it’s already almost 10% of global GDP."
Setting the Scene: visuals can be worth a thousand words.
The 2020s will see remote surgery with 5G become a norm:
Robots trained with AI interacting with humans. Robot passes medical exams in China:
The problem facing healthcare
Healthcare systems around the world are facing a cost crisis. The healthcare sector is under pressure all over the world. We live longer and in much of the OECD and China too, we face a demographic pressure whereby the younger population (future tax payers and less likely to use healthcare) are decreasing in number relative to the older population (more likely to use the healthcare system). However, in parts of the emerging markets and developing world there remains a rapid population growth but scarce availability of resources for complex diseases and other medical matters. It takes time to train doctors and nurses and the equipment tends to be costly.
A good starting point is to consider the issues faced by two types of healthcare system, one being the US model based heavily upon private medical health insurance and the other being the state run UK National Health Service (NHS). The UK and US are two countries that I am familiar with and have encountered the healthcare system. There has also been speculation in the media that a future trade deal between the US and UK in a post Brexit world would entail the healthcare system. Hence it is interesting to start by looking at some of the challenges faced by both.
Healthcare spending in the USA amounts to 17.9% of the country's GDP. However, in spite of the fact that the USA spends the largest amount on healthcare out of any nation, life expectancy ranks 31st in the world — lower than in Costa Rica, Slovenia, Cyprus and Chile, while scoring one notch higher than Cuba.
Healthcare expenditure per capita vs life expectancy
An article by Forbes Insights, Can AI Cure What Ails Health Insurance? reported that in 2017 $3.5 trillion of payments were made between insurers and others within the US Healthcare system, up from $74.5 billion in 1970.
Jeff Lagasse in "Why healthcare wastes $750 billion every year: Few organizations analyze data to stop it" noted that "Employers perceive healthcare waste to be a problem, with 57 percent saying that up to 25 percent of treatments their employees and dependents receive are wasteful. Yet most employers, 59 percent, don't collect or analyze data to track waste, and those that do rely on their vendors."
One may argue that the point above illustrated the need for hospitals and those who work within healthcare to become more data orientated rather than
The NHS in the UK is also under enormous strain as demonstrated in the charts shown below.
The following chart illustrates that the UK too has an increasing ageing population.
The UK faces increasing cost for care of an elderly population.
The graphics above demonstrate that both the USA and UK with two very different types of healthcare systems face serious challenges in relation to healthcare.
It should also be noted that training doctors takes time and is costly. The costs for medical school continue to surmount with the median four-year expense reaching upwards of $278,000 yet learning methods have not significantly changed with this price increase nor have they capitalized on new technologies.
Moreover, doctors take years to train and are costly. In the table below, Nomad Health compare the national average annual salary by specialty and the estimated locum tenens salary a doctor could make, with Doximity 2018 Physician Compensation Report:
Source Image above Nomad Health.
A comparison of average salaries for doctors is provided by Siôn Phillpott using OECD data in "Top 10 Countries with the Highest Salaries for Doctors" which sets out that the average salary for doctors in the US is not the highest in the world (ranking 3rd, with the average lower than the 2018 data from the Doximity report) with Luxembourg ranking first and Switzerland second. Nomad Health updated their report in 2019 and reported that "The mean salary of a doctor in the United States is $313,000/year according to a Medscape Report, up from $299,000/year in 2018 (+4.6%)."
It takes time to train doctors and nurses and the UK is forecast to face a shortage of trained staff. For example Nick Triggle in an article published in the BBC "NHS no chance of training enough staff' observed in relation to the NHS in England that "A report by three leading think tanks predicts that in the next five years nurse shortages will double and GP gaps nearly treble, without radical action."
In the emerging markets and developing world where population growth is rapid demand is growing for health services and yet these are the very regions where affording such costly resources is most difficult. An example of the brain drain of trained doctors from non OECD countries to the OECD is provided by The Conversation "Brain drain is a major challenge facing the Nigerian health system, leading to a dramatic reduction in the number of doctors in the country. According to the Organisation for Economic Co-operation and Development (OECD), Nigeria is one of the three leading African sources of foreign-born physicians."
It is important to note that the problems with healthcare are not only related to the USA and UK but truly global. For example Germany has a problem. with an ageing population and nursing crisis, whilst Ukraine and Russia illustrate the challenges facing healthcare in Eastern Europe. There are challenges across the continent of Africa including Kenya whose economy has undergone a period of sustained growth. Challenges with the healthcare sector also exist across Latin America and the Caribbean with Brazil highlighted as an example that the problem affects emerging markets just as much as OECD countries.
Furthermore, KPMG warned of challenges facing the healthcare sector in Australia with the pace of technological change. It has also been reported that the healthcare infrastructure faces challenges in New Zealand.
France which has long been regarded as a leader in healthcare services is also facing challenges as shown in the video below.
Moreover, China faces challenges in the healthcare sector with an ageing population with EqualOcean.com observing that "...the second half of the 21st century will be a hard landing for China’s economy with around 150 million people older than 80 years old."
A further problem relates to the way in which medicine is prescribed and delivered to patients. The practice is to recommend a standard dosage for example 2 tablets of paracetamol or aspirin irrespective of bodyweight or any other biological factors relating to that individual. Medicines may have beneficial or harmful side effects for that individual patient and also there are potential issues of interactions between medicines that the individual is taking that the prescribing doctor may not be aware of (in the event that the patient has misunderstood or takes some other medication later without being warned).
A shift away from the one size fits all approach of medicine today to the world of the future where precision medicine prevails will require a fundamental shift in the the mindset of the senior medical practitioners and those who are responsible for running hospitals to focus on data and in the future working with intelligent wearables and IoT sensors as we move into the world of 5G and edge computing.
The Solutions with AI
There is substantial potential to transform the healthcare sector with AI and help address many of the critical problems that the sector is facing in relation to both costs and improved outcomes for the patient.
The AI in healthcare market is expected to grow from USD 2.1 billion in 2018 to USD 36.1 billion by 2025, at a CAGR of 50.2% during the forecast period with Deep Learning expected to hold the largest size of the AI healthcare market.
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