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August Issue 2017

CENTER STAGE

Artificially Intelligent!

We live in a digital age where everything is readily available at the click of a mouse, but have we ever imagined a doctor who can predict a patient's illnesses in advance and prescribe preventive medication in the blink of an eye? Or think about a smartphone app asking someone about the stomach ache they had yesterday and if they would like to consult a doctor.
While all this may seem like a faraway dream, this vision of healthcare is not too far off. Thanks to recent advancements in artificial intelligence (AI) in healthcare

By: Neelam Jhangiani

Artificial Intelligence (AI) has already made progress in the healthcare industry and is poised to further redefine the role of the medical practitioner and empower patients like never before with matters concerning their health. With a potential to revolutionise healthcare, it can lead to an age of personalised, accessible and lower-cost medicine for all. This transformative potential comes from its ability to interrogate, parse and analyse vast amounts of data. AI is particularly useful in diagnosis and creating customised treatment plans and even helping doctors keep up to date with the latest research.
According to industry reports, the healthcare AI market is projected to grow from $667 million in 2016 to nearly $8 billion by 2022.
"AI is an exciting technology use case but due to sheer nature of this solution, every discussion on this borders cynicism and at the same time looked by many as a huge opportunity to embrace. There are several names to the same thing, whether people refer to it as predictive analytics, machine learning, cognitive computing, it is all about a system working through huge amount of data and algorithms to arrive at a pattern to predict the outcomes," says Veneeth Purushotaman, Chief Information Officer, Fortis Healthcare Limited.
Sharing their perspective on AI in healthcare scenario, Columbia Asia Hospital Group believes that artificial intelligence and cognitive computing are transforming the healthcare space like never before. "Over the past five years, we have been working with a number of healthcare technology partners such as Siemens, Philips, Medtronic, GE, Beckman Coulter, employing some form of artificial intelligence," says Santosh Rathi, Senior VP-Biomedical Services, Columbia Asia Hospitals.
For Wockhardt Hospitals, it all started when the first integrated real-time solution was used during medication order entry. It matches key patient specific conditions and the hospital formulary to take into account whenever a medicine is prescribed or altered. It acts as a smart alert or assistant then. "Consultants and doctors at Wockhardt have appreciated this invisible assistant and it has helped in improving the care we provide to our patients. Likewise, we have created a smart barcode-based system for medication administration for our nursing team, which besides having features like reminders for administration of medicines, also eliminates possible human error. More recently, from the start of this year, we have introduced some AI techniques for P&L and cost analysis purposes," says Sumit Singh, CIO, Wockhardt Hospitals.
AI technologies like Watson are assisting physicians to summarise patient records and synthesise the vast pool of medical data — from medical literature to clinical records and even genomics. "While Watson is a valuable tool for clinicians, it is not a replacement for clinicians," says Navinder S Sachar, Sales Leader - Oncology & Genomics, APAC, IBM Watson Health.
In India, IBM has partnered with Manipal Hospitals to provide diagnosis and treatment to cancer patients. Watson uses cognitive computing, which is under the umbrella of AI. "We have the unique distinction of being only the second hospital in the world to leverage its unmatched capabilities. We are the first hospital in India to use Watson for oncology and we are also the first hospital in the world to offer it online to patients. We have been using Watson for more than a year now," says Dr. Ajay Bakshi, Managing Director & CEO, Manipal Hospitals.
Artificial Learning Systems (Artelus), a deep learning healthcare company, has plans to bring primary screening to the forgotten billion and create awareness about the problems associated with lack of primary screening services. "In developing countries, especially the rural areas, lack infrastructure, facilities, and trained personnel necessary to provide even minimal levels of health services is missing," says Pradeep Walia, Co-founder & Director, Artelus, Bengaluru.
Similarly, the need for patients & doctors to look at the past clinical data was recognised by Sanjay Singh, Founder and CEO at QorQl while getting his mother treated for Systemic Sclerosis. The data did not exist digitally and was patchy but was enough to make a decision if one spent and looked at the whole data together. This is what pulled the founder to build a platform to collect longitudinal clinical health data. The Founder's exposure to dealing with large amount of data and the recent advances in Big Data Storage, machine learning (ML) & AI created a unique opportunity to build a company focused on health analytics around ML/AI.

The users of AI are banking on the huge potential that AI offers to the sector and the patients & providers see this as an opportunity to revolutionise healthcare and improve the quality of life

Exploring the potential

The potential power of the usage of AI in healthcare is enormous and undeniable. Columbia Asia uses AI to help doctors take clinical decisions in radiology, cardiology, laboratories, surgeries, post-surgery ICU care, to name a few. Image recognition and speech recognition technologies are being used as well. "The major benefit of utilising AI is to avoid manual errors as this is machine-generated algorithm-based level of care and diagnosis, aiding in making accurate clinical decisions and therefore treatment plans, all this with no additional cost to the patient," says Ms. Rathi.
Healthcare and hospital sector in India provide a variety of choices to patients. Besides preference or awareness of a facility or a doctor, many patients still make a choice based on expected clinical quality or outcome and cost. AI has already touched the quality of care of players using this tech.
An example of this is at Wockhardt. "We use AI for cost analysis to get better insights into hidden costs, the benefit of which is ultimately passed on to patients in one form or another. AI also frees up the internal staff with automation such that they can further add value in their area of expertise," Mr. Singh says.
The opportunities offered by AI in healthcare sector are limitless and go a long way in enhancing patient safety, satisfaction and immensely improve patient care. "Some of the uses around improving outcomes by focusing on appropriate interventions are reduced readmissions, based on the data available about the patients, the predictive analytics and machine learning. Together, it gives a daily guidance as to which patient is most likely to be readmitted and therefore we can focus to reduce the risk, the hospital length of stay (LOS) and predicting propensity to pay," says Mr.Purushotaman.

We use Watson for oncology across 16 facilities, where more than 20,000 patients are treated each year


Dr. Ajay Bakshi,
Managing Director & CEO,
Manipal Hospitals


While the users of AI in healthcare are banking on the huge potential that AI offers to the sector and the patients, the providers see this as an opportunity to revolutionise healthcare and improve the quality of life of patients. Oncologists in India and across the globe are struggling to keep up with the large volume of research, medical records and clinical trials. Further, doctors face an increasing battle to stay up to date about best practices in treatment and care management. Watson scales vital knowledge and provides insights and information to help oncologists as they consider treatment options for their patients. It leverages cutting-edge research done by Memorial Sloan Kettering Cancer Center, one among the world's most renowned cancer care hospitals, along with Manipal Hospitals' experience. "With nearly 60,000 research papers published annually, doctors today face an increasing battle to stay current with best practices and care management. Watson comes up with the latest published literature, clinical trial data and global guidelines, which helps our clinicians to stay current in their practice," says Dr. Bakshi.
Using the natural language, clinicians using Watson for Oncology will be able to have information to allow them to explore treatment options, and gather evidence specific to a patients' individual health needs. "Watson for oncology is offered at no extra cost to our patients, thus it does not add any extra cost to the customer in an already expensive healthcare system," adds Dr. Bakshi.


AI and cognitive computing should be used by experienced clinicians to further enhance their skills


Veneeth Purushotaman,
Chief Information Officer,
Fortis Healthcare Limited

What's the focus

QorQl is a company that is more focused in collecting data at this stage of their journey. The company is of the belief that for any AI system to be effective, there are two critical things – data & algorithms and when given a choice between the two, data is always bigger than latter. "There are several other companies who when solving a vertical problem in diagnostics, disease detections, etc., essentially build a set of algorithms and train them with data sets. We, however, believe that without data it is hard to build, train and improve the algorithms," says Mr. Singh of QorQl.
On the other hand, as a 20-month young company working in the deep learning space, Artelus is making products that would complement the knowledge and assist the clinician in making faster and accurate diagnosis. Healthcare domain in India has been enthusiastic in adopting their technology as it is increasing the capacity of healthcare providers enabling them to offer higher quality care without over-burdening the system.
"We have been able to create a social awareness around the impact of AI in healthcare by addressing the primary screening market. We have achieved a low-cost affordable business model to sustain our business and diversify our products in various critical fields of diagnosis where early detection is the key to prevention. Treatment costs are lower when a disease is identified in the early stages, hence reducing the healthcare cost for individuals and economy. Global screening for diseases that can be tackled with early detection is now possible with the help of our AI product that would complement the knowledge, and assist the clinician in making faster and accurate diagnosis," informs Mr. Walia.


Over the past five years, we have been working with a number of health tech partners, employing some form of AI


Santosh Rathi,
Senior VP-Biomedical Services,
Columbia Asia Hospitals

Major areas of growth

AI is the future of healthcare as the massive physician patient gap will take over 300 years to fill and may very well never gets filled, feel experts. A common view is that specialists, being fewer in number, should focus on treatment rather than examination. With the current computing power and technological advance, AI solutions are a big way to bridge the inequities in healthcare.
"AI will certainly play a very strong role in diagnosis, disease detection & management. It will help individuals take care of their body in real time and significantly alter the life-spans of humans beyond 100+ years. The most impactful will be very early detection of a disease before it spreads and becomes dangerous," says Sanjay Singh.
Various smart technologies are in the making and intelligent machines have helped in areas like first diagnosis including radiology & imaging, operating rooms, post-operative care monitoring, care in wards, etc. "Hospitals make use of specific technologies depending on their patient pool such as Watson that is changing the healthcare with its AI technology assisting doctors in oncology treatment," points out Mr. Sachar.


From the start of this year, we have introduced some AI techniques for P&L and cost analysis purposes


Sumit Singh,
CIO,
Wockhardt Hospitals

Challenges encountered

The biggest challenge with AI is the difficulty around the extent of data points available and for the period for which it is accurately available. Further, when dealing with human beings as a species, any number of scenarios and data models need not guarantee an accurate prediction. Since one is dealing with life of an individual, one cannot entirely base the decision on what a machine or program tells. It is therefore pertinent to interpret the predictions and information correctly to arrive at the right procedure, interventions and this is a skill that a good clinician has. "AI and cognitive computing should therefore be used by experienced clinicians to further enhance their skills, to improve the patient experience and to provide the patient a higher degree of satisfaction and safety," feels Mr.Purushotaman.
Industry experts believe that AI is still an evolving space and it is yet to hit the mass market or penetrate our consciousness. "We are not yet accustomed to it. Can you imagine our first experience when we would personally get into a driverless car? Likewise, in a healthcare setting, where advanced surgery is carried out on a patient remotely, some degree of skepticism is natural. This cultural obstacle is the biggest challenge," says Sumit Singh.
He further adds that to select the right solution for a specific industry vertical is not an easy task given there are no clear winners in the space currently. A lot of homework is needed to be done by a healthcare company's IT team along with the functions with whom they plan to take their journey forward. Internally, a lot of maturity in data sciences and management of data are required. "Finally, it is a going to require a few iterations and we have to be prepared for it."

While Watson is a valuable tool for clinicians, it is not a replacement for clinicians


Navinder S Sachar,
Sales Leader - Oncology & Genomics,
APAC,
IBM Watson Health

Another challenge faced with AI is patient confidentiality, which is a major concern for healthcare providers. "We have been using AI technology as a smart device to aid in better diagnosis and treatment, thereby helping doctors offer better care to patients. However, this tool can also be an aid to assist the technology partners in standardising the protocols and in research activities, which means patient data needs to be shared and hence Columbia Asia has not forayed into the extended aspect of AI," says Ms. Rathi.
Acceptance and adoption by clinicians is also a challenge as senior doctors are sceptical of using machine technology for patient care. "Since AI was traditionally used in the e-commerce industry, healthcare has not been using it too much. This is because it is an industry that is dealing with patient's lives, clinicians and healthcare administrators are careful before making a decision to use it. Hospitals generally use AI for less critical things and we are the first to use it in a critical clinical setting. This keeps us at the forefront of adopting technology to enhance patient experience. Patients are also not used to seeing AI in healthcare and many of them have certain apprehensions. Over more time, it will become commonplace to see it adopted in the hospitals," opines Dr. Bakshi.


We have been able to create a social awareness around the impact of AI in healthcare by addressing the primary screening market


Pradeep Walia,
Co-founder & Director,
Artelus

The cost factor

Innovative business models funded/supported by insurance, pharma will help take the advantages of the new systems to the masses, believe experts in the industry. "The prices of systems and products tend to fall significantly when the economies of scale come in. Google has demonstrated how to build great products using cloud-source data with revenues coming from alternate sources of crowd-funding the R&D needed to build technology. This is specifically very true in the field of AI," says Sanjay Singh. As a low cost high impact business model, Artelus believes that with the help of AI technology, they can bring down the cost to less than 70% of current screening cost, which will be affordable to small and medium hospitals and primary health centers as well. As Mr. Walia says, "Our effort is to bring them care at an affordable price and democratise healthcare to the entire world and make the world a happier and healthier place."
Hospitals do agree that healthcare costs are a concern for one and all for a country like ours with wide income levels and affordability. "AI, even with adding the cost to get it initiated, will help such a large population and organisations in the space. It is a no-brainer investment. Like any other investment, it certainly requires some thought and planning, but this cost is amortised in the whole patient base, essentially making it imperceptible at the bill level as the benefits pay back on the investment handsomely and fairly quickly," suggests Sumit Singh.


AI will significantly alter the life-spans of humans beyond 100+ years


Sanjay Singh,
Founder & CEO,
QorQl

The way forward

In the coming years, AI is poised to disrupt healthcare to the maximum as compared to all other sectors in India. The Indian healthcare industry stands to gain immensely from AI. The potential gains and opportunities from AI are exciting, and new progress is seen every day. Eventually, the harmonious collaboration of man and machine will bring about a meaningful and long-lasting change in Indian healthcare leading to enhanced and precise treatment of medical cases, be it in urban or rural areas.