Callaghan Innovation’s new report on artificial intelligence is absolutely right in identifying that the health sector needs to start embracing emerging digital technologies.
The discussion paper, titled ‘Thinking Ahead: Innovation Through Artificial Intelligence’, identifies the four sectors AI will have the biggest impact on. Health is one of them alongside energy, digital and agriculture.
The paper looks at high impact AI innovations that will drive the most change in each sector, calling out medical imaging diagnosis, predictive personalised medicine, autonomous surgical robots and hospital workflow optimisation for health.
New Zealand is facing the same challenges as many other health care systems. Harnessing digital and emerging technology is essential if we are to deliver better health outcomes for all New Zealanders.
Here at the Ministry of Health, we know technology is going to be a huge enabler of change for more accessible health care in the future. We have established a team whose core role is to understand the implications for the health system of new technologies.
Bigger scale innovations needed
It’s great to see some innovations happening locally in health technology but we need more application at the national level to achieve bigger scale. We are investigating the viability of a national electronic health record which would give consumers, health care providers, and policy and service planners' better access to health information. This is currently at the Indicative Business Case Stage.
The fact that the Callaghan Innovation report states there were 200 people on the waiting list to try Holter arrhythmia monitors at Middlemore Hospital demonstrates strong public interest in new health technologies. We are supporting innovations driven by medical practitioners themselves through the annual Clinician’s Challenge, in partnership with Health Informatics New Zealand. The Challenge aims to bring new ideas to solve existing problems and improve productivity, resulting in enhanced healthcare delivery.
The runners-up of the 2017 Clinician’s Challenge were Ask Ruru, an app for mental health professionals, and an electronic breath ketone sensor. The new idea category winner was an online immunisation schedule catch-up calculator. Winner of the active project/development winner was DermNet NZ which aims to partner with technology companies to train AI software to recognise the most common and dangerous skin diseases in images through pattern recognition. It could lead to quicker, easier and more accurate diagnosing of skin diseases. The tool would be available to healthcare providers free or at very low cost, in both remote and urban locations.
The NZ context is important
For New Zealand, it’s crucial that any AI in our health system uses algorithms developed using data relevant to our population to deliver the best outcomes for all New Zealanders.
There are some uses of algorithms already happening in the health system. For example, the use of algorithms is part of the Early Warning Score used with patients in hospital. It triggers an escalating clinical response so clinicians with the right skills can intervene and manage the patient's deterioration.
In any machine learning, there are a number of risks that need to be considered - including how bias is managed when a new algorithm is introduced. This becomes increasingly important when algorithms are developed by machines such as in AI systems.
We have increasing diversity and currently there are poorer health outcomes for Māori and Pacific. People are living longer, and the number of people here aged 65 plus is expected to double in 30 years. We know these challenges are widening the gap between particular groups.
We’re hoping that in future in innovators and developers will be directly connected with consumers and providers of health care and wellbeing services, giving greater market share to agile start-ups. It would be great to see developers work in an open source environment, where companies can co-operate more than they compete.
Interoperability is of critical importance when it comes to the adoption of more forms of technology in health care because we currently have some fragmented systems.
We work in partnership with New Zealand Health IT to engage the wider industry and stakeholders. Standards and architecture are currently developed by the Ministry of Health in collaboration with the sector. In future, all systems should use these approved standards and only systems that are fully interoperable should be active in the New Zealand market.
Giving consumers more control
Technology can help medical practitioners to deliver care remotely, so all New Zealanders including people who live remotely will receive the same level of care. Telehealth such as video consultations provides remote patients the option of remaining closer to home, making consultations more convenient and reducing travel. Currently, 17 out of the 20 District Health Boards currently have video conferencing capability. Usage varies across DHBs but we understand the most common uses are for tele-pediatrics and renal care. The Ministry of Health works collaboratively with the Telehealth Leadership Group that brings together experts to nationally promote the uptake of telehealth.
In primary care, almost half a million Kiwis are already using secure online patient portals that give them convenient and secure electronic access to their health information. These can be used to request repeat prescriptions, book appointments, see lab results and clinical notes, access immunisation and vaccination history.
In future, we want consumers to have more control of access to their health information. It would need be held securely, and audited to ensure privacy and confidentiality. Care could then be co-ordinated by a virtual team of health professionals who have secure access to our health records.
When people control their own health information, they feel supported to be in control of their own health. With increased health literacy, more routine health care needs could be self-managed through technology using a variety of wearable and telehealth devices. In this way, technology can help consumers to be healthier and feel confident that their health problems are detected and addressed early.
How AI will impact New Zealand
Source: Callaghan Innovation
The Callaghan Innovation report classifies the impact of artificial intelligence on health as ‘Extreme’, its highest rating, and calls for a change to models of care in our health system. We agree evolution of our health system - in a way that embraces technology - is important.
We are currently developing a Digital Health Strategy that recognises the complexity of the health sector and the impact of the rapidly changing digital landscape. It describes a person-centred digital health eco-system that will create the conditions to improve health outcomes and optimise health system performance.
Technology, including AI, has huge potential in health. With that comes the opportunity to transform the health of all New Zealanders. To make the most of these opportunities, the health sector needs to work collaboratively as one team to drive initiatives forward.
Ann-Marie Cavanagh is the chief technology and digital services officer for the Ministry of Health.
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