Department of Medicine and Surgery - Anesthesiology, Critical Care and Pain Medicine Division, University of Parma: Universita degli Studi di Parma, Parma, Italy.
Med Sci Monit. 2023 Mar 3;29:e939366. doi: 10.12659/MSM.939366.
Modern medicine, both in clinical practice and research, has become more and more based on data, which is changing equally in type and quality with the advent and development of healthcare digitalization. The first part of the present paper aims to present the steps through which data, and subsequently clinical and research practice, have evolved from paper-based to digital, proposing a possible future of this digitalization in terms of potential applications and integration of digital tools in medical practice. Noting that digitalization is no more a possible future, but a concrete reality, there is a strong need for a new definition of evidence-based medicine, which must take into account the progressive integration of artificial intelligence (AI) in all decision-making processes. So, leaving behind the traditional research concept of human intelligence versus AI, poorly adaptable to real-world clinical practice, a Human and AI hybrid model, seen as a deep integration of AI and human thinking, is proposed as a new healthcare governance system. The second part of our review is focused on some of the major challenges the digitalization process has to face, particularly privacy issues, system complexity and opacity, and ethical concerns related to legal aspects and healthcare disparities. Analyzing these open issues, we aim to present some of the future directions that in our opinion should be pursued to implement AI in clinical practice.
现代医学，无论是在临床实践还是研究中，都越来越依赖于数据，随着医疗数字化的出现和发展，数据在类型和质量上都发生了同样的变化。本文的第一部分旨在介绍数据以及随后的临床和研究实践从基于纸张到数字化的发展步骤，提出数字化在医疗实践中潜在应用和数字工具集成的可能未来。鉴于数字化不再是一种可能的未来，而是一种具体的现实，我们强烈需要重新定义循证医学，必须将人工智能（AI）在所有决策过程中的逐步集成考虑在内。因此，摒弃传统的人类智能与 AI 对抗的研究概念，该概念很难适应现实世界的临床实践，我们提出了一种混合模型，将人类和 AI 视为人工智能和人类思维的深度融合，作为一种新的医疗保健治理系统。我们综述的第二部分重点介绍了数字化进程必须面对的一些主要挑战，特别是隐私问题、系统复杂性和不透明性，以及与法律方面和医疗保健差距相关的伦理问题。分析这些悬而未决的问题，旨在提出一些我们认为应该在实施 AI 于临床实践中应该遵循的未来方向。
