Liyanage Harshana, Liaw Siaw-Teng, Jonnagaddala Jitendra, Schreiber Richard, Kuziemsky Craig, Terry Amanda L, de Lusignan Simon
Department of Clinical & Experimental Medicine, University of Surrey, Guildford, Surrey, UK.
School of Public Health & Community Medicine, UNSW Medicine Australia, Ingham Institute of Applied Medical Research, NSW, Australia.
Yearb Med Inform. 2019 Aug;28(1):41-46. doi: 10.1055/s-0039-1677901. Epub 2019 Apr 25.
Artificial intelligence (AI) is heralded as an approach that might augment or substitute for the limited processing power of the human brain of primary health care (PHC) professionals. However, there are concerns that AI-mediated decisions may be hard to validate and challenge, or may result in rogue decisions.
To form consensus about perceptions, issues, and challenges of AI in primary care.
A three-round Delphi study was conducted. Round 1 explored experts' viewpoints on AI in PHC (n=20). Round 2 rated the appropriateness of statements arising from round one (n=12). The third round was an online panel discussion of findings (n=8) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups.
PHC and informatics experts reported AI has potential to improve managerial and clinical decisions and processes, and this would be facilitated by common data standards. The respondents did not agree that AI applications should learn and adapt to clinician preferences or behaviour and they did not agree on the extent of AI potential for harm to patients. It was more difficult to assess the impact of AI-based applications on continuity and coordination of care.
While the use of AI in medicine should enhance healthcare delivery, we need to ensure meticulous design and evaluation of AI applications. The primary care informatics community needs to be proactive and to guide the ethical and rigorous development of AI applications so that they will be safe and effective.
人工智能（AI）被视为一种可能增强或替代初级卫生保健（PHC）专业人员有限脑力的方法。然而，有人担心人工智能介导的决策可能难以验证和质疑，或者可能导致错误决策。
就初级保健中人工智能的认知、问题和挑战形成共识。
进行了三轮德尔菲研究。第一轮探讨了专家对初级卫生保健中人工智能的观点（n = 20）。第二轮对第一轮产生的陈述的适当性进行评分（n = 12）。第三轮是与国际医学信息学协会和欧洲医学信息学联合会初级卫生保健信息学工作组的成员进行的关于研究结果的在线小组讨论（n = 8）。
初级卫生保健和信息学专家报告称，人工智能有潜力改善管理和临床决策及流程，通用数据标准将对此起到促进作用。受访者不同意人工智能应用应该学习并适应临床医生的偏好或行为，他们也未就人工智能对患者造成伤害的潜在程度达成一致。评估基于人工智能的应用对医疗连续性和协调性的影响更加困难。
虽然在医学中使用人工智能应能改善医疗服务，但我们需要确保对人工智能应用进行精心设计和评估。初级保健信息学领域需要积极主动，指导人工智能应用进行符合伦理且严谨的开发，以便它们安全有效。
