Public Health Research Center, Université de Montréal, Montreal, QC, Canada.
Department of Health Management, Evaluation and Policy, École de santé publique de l'Université de Montréal, Montreal, QC, Canada.
J Med Internet Res. 2020 Jul 7;22(7):e17707. doi: 10.2196/17707.
Artificial intelligence (AI) is seen as a strategic lever to improve access, quality, and efficiency of care and services and to build learning and value-based health systems. Many studies have examined the technical performance of AI within an experimental context. These studies provide limited insights into the issues that its use in a real-world context of care and services raises. To help decision makers address these issues in a systemic and holistic manner, this viewpoint paper relies on the health technology assessment core model to contrast the expectations of the health sector toward the use of AI with the risks that should be mitigated for its responsible deployment. The analysis adopts the perspective of payers (ie, health system organizations and agencies) because of their central role in regulating, financing, and reimbursing novel technologies. This paper suggests that AI-based systems should be seen as a health system transformation lever, rather than a discrete set of technological devices. Their use could bring significant changes and impacts at several levels: technological, clinical, human and cognitive (patient and clinician), professional and organizational, economic, legal, and ethical. The assessment of AI's value proposition should thus go beyond technical performance and cost logic by performing a holistic analysis of its value in a real-world context of care and services. To guide AI development, generate knowledge, and draw lessons that can be translated into action, the right political, regulatory, organizational, clinical, and technological conditions for innovation should be created as a first step.
人工智能（AI）被视为改善医疗保健服务可及性、质量和效率，以及构建学习型和基于价值的医疗体系的战略杠杆。许多研究已经在实验环境中考察了 AI 的技术性能。这些研究为了解其在实际医疗保健服务环境中的应用所引发的问题提供的见解有限。为了帮助决策者系统和全面地解决这些问题，本观点文章借鉴了卫生技术评估核心模型，将卫生部门对 AI 使用的期望与为负责任地部署 AI 应减轻的风险进行对比。该分析采用了支付方（即卫生系统组织和机构）的视角，因为他们在监管、融资和报销新技术方面发挥着核心作用。本文认为，基于 AI 的系统应该被视为医疗体系转型的杠杆，而不仅仅是一套离散的技术设备。它们的使用可能会在多个层面带来重大变化和影响：技术、临床、人力和认知（患者和临床医生）、专业和组织、经济、法律和伦理。因此，对 AI 的价值主张的评估不应仅仅局限于技术性能和成本逻辑，而应通过对其在实际医疗保健服务环境中的价值进行全面分析来实现。为了指导 AI 的发展、生成知识并汲取可以转化为行动的经验教训，应该首先创造正确的政治、监管、组织、临床和技术创新条件。
