COVER STORY them may just be garbage,” says Wil-liams-Jones. “But if you generate that and then you bring in the human being to look at it, it becomes a very powerful tool to help identify linkages and low incidents or markers that you would never otherwise find.” Tech not without issues When it comes to limitations of AI in healthcare, Ko stresses it’s still very much a numbers game at this point, and the systems need more calibrated data in order to fine-tune their accu-racy. “We need a lot more labelled data to train the machine,” he says, “But med-ical imaging, because of confidentiality issues and privacy, we don’t have enough labelled data, which means we can’t train the machine appropriately.” Another major concern, Wil-liams-Jones says, is ensuring there is no bias built into any software used in the health care setting. “If you’ve got poor quality data going in and you’re not aware that the data is poor quality, the results that come out of it are poor quality, and you don’t realize that,” he says. For example, imaging from a sports clinic will skew in a way that negatively impacts chiropractors and RMTs working in a rehabilitation role in a retirement home setting, and vice versa. Being aware of biases built into software programs is the first step in ensuring they’re removed, says Wil-liams-Jones. While job losses in the transcription field have already happened, techno-logical advances could knock even more providers out of jobs. In areas such as diagnostics, fewer radiologists can confirm more diagnoses if they’re simply double-checking a software’s results. If we want to move towards a knowl-edge economy, Williams-Jones says we need to skill-up the entire population, otherwise these tools contribute to social inequality and injustice. “We want to ensure that these inno-vations in AI, in big data, and learning systems don’t lead to reinforcing social inequalities where people are unedu-cated and unemployable because the robots are taking all the jobs.” he says. “Knowing that it’s a possibility, we can 14 Canadian Chiropractor December 2019 With these very advanced, very personal technologies comes fears that information could be hacked or misused. plan for it but that means we have to do things like invest in our primary and secondary schools.” It’s not all bad news though. Ko’s research has shown that radiologists at all levels of expertise are more accurate in their diagnoses after reviewing AI results. And, he says, these time-savings will allow for further medical advance-ments. With these very advanced, very per-sonal technologies come fears that in-formation could be hacked or misused. Smith notes some people fear losing out on a job or being denied health benefits or life insurance due to the results of their genetic testing. Ko adds that cyber security and the infrastruc-ture that goes along with it must be implemented properly in order to en-sure patient data is kept confidential, while still allowing for the growing of databases and machine learning. Williams-Jones notes that while people often have this deep-seated fear of killer robots and surveillance soci-eties, while those fears aren’t entirely unfounded, they are also not as ex-treme as many believe. Still, public discourse and input is important to ensuring responsible systems are put in place. As we continue moving towards an online health system, Williams-Jones says it’s important to ask some key questions. Who has access to the data; what about privacy rights? Is this data being sold? Is the data being housed on commercial platforms? Are those com-mercial platforms secure? If the com-pany that owns the commercial plat-form gets sold, is that data now the property of the new company? What about the person who contributed that data and do they need to be notified? Who is responsible in the event of a misdiagnosis? Responsible data management needs to be a cornerstone of these programs, which is why Williams-Jones finds it promising to see policies and proce-dures being developed by all stakehold-ers as advancements are made. “There’s the Montreal Declaration on Responsible Innovation in AI, there are European declarations — and all of this is being driven not by ethicists, but by the scientists and the engineers saying ‘we need to think about this.’ They are actively talking about ethics, and responsibility, and integrity, and that’s leading to very vibrant discus-sions.” The future for HCPs Williams-Jones says that professionals in rehabilitation – physios, MTs, and chiros – need to be active players in the uptake of these technologies. “They have an obligation to pay at-tention to this and to ask the right questions. ‘Is this a technology that I actually need to do my job better, or is it just the new toy of the day with lots of bells and whistles?’ That’s a real professional ethics issue. “The professional has an obligation to invest the time needed to learn about these technologies and to work with the developers and help shape the technol-ogy, because they’re ultimately the expert on how to help patients deal with a range of health conditions.” While all of these technologies are advancing at lightning speed, it’s im-portant to remember that it takes several years for a software to be de-veloped, tested, and implemented – not to mention receiving government approval. We’re still a ways off from handing over the controls to a com-puter for our health care decisions. Ultimately, machines will never re-place hands-on practitioners, but their roles will certainly shift as a result of these advances. www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor December 2019: Page 14
