RISING TO THE CHALLENGES OF

ARTIFICIAL INTELLIGENCE
IN HEALTHCARE
PRODUCED IN PARTNERSHIP WITH
INTRODUCTION
Artificial intelligence (AI) is poised to revolutionize the way
healthcare providers and patients interact with data. From
enhancing radiology, pathology, and clinical decision support
(CDS) to creating administrative efficiencies across the care
continuum, the applications for AI and machine learning are
virtually endless.
At the 2018 World Medical Innovation Forum presented by
Partners HealthCare, researchers and innovators shared
ideas for deep learning, machine learning, natural language
processing, and other AI algorithms that leverage the
enormous wealth of digital data available within the care
delivery and payment ecosystems.
HARNESSING THE POTENTIAL OF ARTIFICIAL INTELLIGENCE IN HEALTHCARE
AI is quickly moving into many aspects of clinical care,
but radiology and other imaging-rich disciplines, such as
pathology and ophthalmology, may be among its earliest
beneficiaries.
Computer vision is one of the most advanced aspects of AI,
and many algorithms are able to rival or surpass the human
ability to distinguish extremely fine details in clinical images.
“Machine learning has tremendous promise for diagnostics,
including in my field of radiology,” said Mark Michalski, MD,
Executive Director of the MGH & BWH Center for Clinical
Data Science.
“It is very good at processing images, and characterizing the
features in those images, to make radiologists more efficient
and help them make their reports more quantitative and
useful for the patients they serve.”
Imaging analytics to support radiology and pathology
featured prominently on Partners HealthCare’s “Disruptive
Dozen” list: a compilation of the twelve AI applications most
likely to produce positive impacts on healthcare within the
next handful of years.
“Seventy percent of all decisions in healthcare are based
on a pathology result,” said Jeffrey Golden, MD, Chair of the
Department of Pathology at Brigham & Women’s Hospital.
“Somewhere between 70 and 75 percent of all the data in
an EHR are from a pathology result. So the more accurate
we get, and the sooner we get to the right diagnosis, the
better we’re going to be. That’s what digital pathology and
AI has the opportunity to deliver.”
purestorage.com
But AI’s great promises are matched by equally great
challenges, cautioned every panel of academics, business
executives, infrastructure developers, and clinical leaders.
The majority of artificial intelligence applications require vast
volumes of data, which must be gathered, stored securely,
normalized, annotated, analyzed, and presented to end-
users in a meaningful, intuitive fashion.
In order to take advantage of what artificial intelligence has
to offer, healthcare organizations will need to overhaul their
technical foundations, clinical workflows, and strategic goals.
“We’re now getting to the point where we can do a better
job of assessing whether a cancer is going to progress
rapidly or slowly and how that might change how patients
will be treated based on an algorithm rather than clinical
staging or the histopathologic grade. That’s going to be a
huge advance,” he continued.
In conjunction with more accurate diagnostics, AI has the
potential to carve out a piece of the $500 billion spent on
wasted interventions for diseases, said Colin Hill, CEO of
GNS Healthcare, a life science company.
“There’s at least half a trillion dollars wasted when patients
aren’t getting the right drug, or they’re not in the right care
management program, or they didn’t get the right procedure
or medical device,” he said. “That’s a staggering cost, and
it’s a massive opportunity to change health outcomes
by getting down to the fundamentals of slowing disease
progression, reducing hospitalizations, and optimizing
therapeutic effectiveness.”
Precision healthcare will be the most important application
of AI, according to Hill. “If we can better match health
interventions to individual patients, we can improve
outcomes and lower the total cost of care. Part of that
requires the discovery and development of new drugs,” he
asserted.
“We need to understand what works for whom, what the
underlying mechanism is, how a biological system operates,
and how an intervention impacts that,” he continued.
“Machine learning is critical for that process, because it
helps us advance from grappling with the little pieces of
1
what we think we know and presents more insights than
humans can typically uncover.”
Using AI to get upstream of developing problems is a
common theme among researchers and developers.
Preventing adverse drug events, alerting providers to patient
deterioration, stratifying patients by risk for population health
management programming, supporting chronic disease
management, identifying metastasizing cancers, and
predicting kidney function decline are a few of the hundreds
of use cases for predictive AI.
Routine tasks (e.g., patient scheduling, supply chain
management, booking operating rooms) could also benefit
from automation, said Katherine Andriole, PhD, Director
of Research Strategy and Operations at the MGH & BWH
Center for Clinical Data Science (CCDS).
“An MRI scanner is a very expensive piece of equipment,
and letting it sit idle is like throwing money down the drain,”
she said.
“There are more occasions than we’d like where a
patient shows up to have an MRI, but it turns out they’re
contraindicated. Right now, the process for gathering
OVERCOMING AI CHALLENGES WITH INNOVATION AND COLLABORATION
The AI revolution is already well underway in other
industries, panelists at the three-day event pointed out
repeatedly. Mentions of autonomous vehicles popped up
in nearly every session, while references to how consumer
technology giants like Apple, Amazon, Uber, and Google
integrate AI into their smartphones, search functions, apps,
and other offerings were nearly as frequent.
Innovation in these sectors is moving at incredible speed
due to high demand and fierce competition to become
the lifestyle platform of choice for consumers craving
convenience and on-demand services.
“In the consumer space, if you pull out your smartphone and
search for an object inside your pictures, you can identify
thousands of different features,” said Keith Dreyer, DO,
PhD, Chief Data Science Officer and Corporate Director of
Enterprise Medical Imaging at Partners Healthcare.
“We don’t think of the fact that artificial intelligence is doing
that. We just see a smarter phone. When AI works, you
don’t call it AI anymore. But getting to the point of complete
ubiquity is going to take a long time in healthcare.”
purestorage.com
that information before the appointment is to call them.
Sometimes the patient doesn’t know, or gets something
wrong, and sometimes we don’t actually connect with them
at all—but we still keep that appointment booked.”
“Somewhere between 70 and 75 percent of
all the data in an EHR are from a pathology
result. So the more accurate we get, and
the sooner we get to the right diagnosis, the
better we’re going to be. That’s what digital
pathology and AI has the opportunity to
deliver.”
—Jeffrey Golden, MD
—Chair, Department of Pathology
—Brigham & Women’s Hospital
“Why can’t we use data to start identifying the patients likely
to have a contraindication before we put them through
that entire process? If we can use AI to predict a problem
before we waste resources and time on both sides of the
patient-provider relationship, we’re going to create better
experiences for everyone.”
Healthcare is uniquely positioned to take advantage of what
AI has to offer, and many members of the care continuum
are eager to see data-driven changes to the way they
are now delivering care. Early results have been highly
promising, but many of these successes have been confined
to small pilots and studies, said Dreyer.
“The question we’re facing now is how we can turn these
experiments and studies into widely-adopted reality in a field
as complex as healthcare. In addition to all the questions of
regulation and approval, there are infrastructure concerns,”
he said.
“Do you put it in the cloud? Do you put it on premises?
If it’s in the cloud, how do you transfer data in and out
of the hospitals? If it’s on your own servers, how do you
manage the storage needs when you’re working with tens
of thousands of images and all the other data needed to
support the training and validation of an algorithm?”
Different models need different amounts of data to function,
explained Michalski. But all models require health IT
infrastructure solutions that allow seamless access to large
volumes of data in order to produce trustworthy results.
2
“If you’re trying to classify features in a CT scan, for example,
you could need anywhere from 100 images to millions of
images,” he said. “That means you need a lot of storage and
a lot of processing power at your disposal. Our capabilities
are growing exponentially, but so are our needs. We’re
moving from 2D data to 3D data in some cases, and
everyone is using larger and more complex datasets. One of
the grand challenges is creating the infrastructure that can
support that work.”
Partners HealthCare has developed a combination of on
premise and cloud resources to train their AI models.
“We have over a petaflop of GPU-based computing power
on premise, and we’re growing the size of our cluster by
about twofold by the end of 2018 to meet the demand,” said
Michalski.
“There’s an entire ecosystem that’s missing right now.
There’s no infrastructure for AI platforms and the standards
still need a lot of work,” he said. “That kind of fragmentation
is going to be a real problem for hospitals or health systems
that are trying to purchase and implement clinical decision
support tools that aren’t native to their current systems.”
Once organizations gain access to the right data and
develop a scalable, secure, and flexible infrastructure to
store the information, they must still face the question of
training their algorithms to function accurately.
Annotation of data is a critical step in the AI process,
stressed both Dreyer and Michalski. Human experts must
label the images or other data sets and define which
elements are normal and which should be flagged.
It can be extremely time-consuming. And because it involves
fallible and opinionated human experts defining what the
algorithm will be looking for, it’s also an opportunity for
unconscious bias to creep in.
“There’s nothing in the data that inherently says this
particular structure is definitely a nodule and it’s right
here, or that the nodule turned out to be non-cancerous,”
said Dreyer. “Some of it may be contained in the free-text
reports, but that data doesn’t typically exist in a structured
way.”
“If you’re going to start to train algorithms, you need to go
through the data integrity, the annotations, the training sets,
and the validation sets—that’s a lot of data engineering work
and it forms a considerable part of the challenge of creating
algorithms.”
purestorage.com
Ensuring that AI in healthcare is unbiased will be one of the
industry’s most pressing concerns. Bias is a problem in all
analytical tasks. Data is often selected based on specific
criteria, and those criteria may exclude or oversample
certain features based on the curator’s unconscious
leanings towards an expected solution or hypothesis.
“If we start feeding data in, including genomic data which
obviously contains race and ethnicity information, there’s the
possibility that the algorithms could spit out a result saying,
‘people who look like this don’t respond to a particular type
of therapy,’” said Anthony Rosenzweig, MD, Chief of the
Cardiology Division at Massachusetts General Hospital.
“That could just reinforce some of the disparities in
healthcare related to socioeconomic status or other biases
in the system. The hope of AI is that we can overcome those
disparities and improve the distribution of quality care more
widely,” he continued.
“Do you put it in the cloud? Do you put it
on premises? If it’s in the cloud, how do you
transfer data in and out of the hospitals? If it’s
on your own servers, how do you manage the
storage needs when you’re working with tens
of thousands of images and all the other data
needed to support the training and validation
of an algorithm?”
—Keith Dreyer, DO, PhD
—Chief Data Science Officer
—Corporate Director of Enterprise Medical Imaging
—Partners HealthCare
Artificial intelligence researchers may be pursuing lofty
goals, but maintaining reasonable expectations about the
pace of progress and the limitations of what an algorithm
has to offer will also be essential for developers and end-
users, pointed out Anne Klibanksi, MD, Chief Academic
Officer at Partners HealthCare and Co-Chair of the 2018
World Medical Innovation Forum.
“What we have right now is probably a very unrealistic set of
expectations based on what these things can do,” she said.
“There is an assumption right now for many people that if
you’re going to be doing this type of work, it’s going to be
100 percent accurate—and it’s going to replace every other
type of decision-making. I’m not sure that’s realistic, or that it
is ever going to be realistic.”
3
When AI falls short of that lofty bar, it can immediately erode
trust—sometimes to the point of abandoning an initiative all
together, she continued.
Creating the right level of expectation, stamping out
unintentional bias, and fostering a sense of trust in
transparent and clinically validated artificial intelligence
tools will help to develop an ecosystem that successfully
integrates AI tools into reliable decision-making.
“In reality, the bar for AI is not very high, in one sense,” said
Calum MacRae, Vice Chair for Scientific Innovation and
MEETING THE INFRASTRUCTURE NEEDS OF AI DEVELOPMENT AND DEPLOYMENT
Algorithms will always be data-hungry, and most healthcare
organizations will find it extremely challenging to keep up
with their storage needs in-house if they decide to pursue
development or deployment of cutting-edge tools.
“I haven’t seen anyone say that we have the exact amount
of data that we need, and that we don’t need any more,”
purestorage.com
Chief Executive of One Brave Idea at Brigham and Women’s
Hospital. “Right now, there’s a 12 to 15 year implementation
cycle from the time something becomes a clinical guideline
to the time it is more or less uniformly adopted.”
“As we start to think about how we can improve on that state
of affairs, it’s easy to see how AI might impact clinical care in
a very real way and in a very short amount of time. We just
have to make sure we’re improving on what already exists.”
Source: Partners HealthCare
Dreyer said. “Everyone wants as much data as they can get
their hands on because more data means better accuracy.”
More data moving more freely into and out of new health
IT systems also means more privacy and security concerns,
added Michalski.
4
“There’s a very low threshold for failure when it comes
to securing that data and protecting the privacy of the
individuals involved,” he said. “We are doctors first, and
preserving that trust is typically the number one priority.”
“Partners has been a leading force in balancing safety and
security with the raw potential of marrying this technology to
large datasets. They’ve created governance structures that
have been creating case law around how you deal with the
demand or desire for data from both internal and external
parties.”
Allowing disparate organizations to share data and enabling
developers to reuse labeled training datasets for multiple
applications is an important part of being a member of the
artificial intelligence research community.
However, as data diffuses through the ecosystem, the
privacy and security risks rise.
“As time goes on, there is a higher and higher likelihood of
that data becoming identifiable again, or there being some
sort of breach,” said Michalski. “Because we know that more
access equals more risk, healthcare organizations have to
think very carefully about the way data is shared.”
Whether developing their own tools or purchasing platforms
or services, healthcare organizations will need to reevaluate
their partnerships with legacy technology providers to
achieve the level of scale required to succeed, said Joshua
Gluck, VP of Global Healthcare Technology Strategy at Pure
Storage.
“It’s important to find a strategic partner that can really
support these discoveries and do it in an innovative way,”
Gluck said. “Having an infrastructure and a data platform to
build upon and scale to the magnitude of data points and
disparate datasets that they need to combine to generate
those insights is vastly important.”
Providers need to carefully consider whether new
infrastructure is required to support long-term goals, such as
deploying AI tools in multiple domains or creating research
and development programs that demand huge volumes of
data and painstaking attention to privacy and security.
“Some of the traditional players in that market space are
taking the technology they’ve developed over the past
several years and trying to get that to scale out,” observed
Gluck.
“You can do that for a short amount of time, but just the
amount of data and the amount of systems that have to
be integrated to support some of these workflows and
purestorage.com
pipelines, especially in the genomics space…if you don’t
rethink the way these structures work, they just won’t scale.”
Organizations that commit to modernizing and strengthening
their health IT infrastructure are likely to be among a
select group of entities walking along the path to success,
said Samuel Aronson, Executive Director of IT at Partners
Personalized Medicine.
“There are two different futures in front of us,” he said. “In
one future, we take these tools that are incredibly powerful,
and we develop them based on traditional business models.
That leads us to new infrastructure that does represent a
substantial jump forward.”
“But once that happens, I believe we will just wind up at a
different plateau based on new proprietary systems that
will replace the old proprietary systems. Innovation will slow
down again.”
“There’s an entire ecosystem that’s missing
right now. There’s no infrastructure for AI
platforms and the standards still need a lot
of work. That kind of fragmentation is going
to be a real problem for hospitals or health
systems that are trying to purchase and
implement clinical decision support tools that
aren’t native to their current systems.”
—Mark Michalski, MD
—Executive Director
—MGH & BWH Center for Clinical Data Science
“The other future depends on everyone putting in the
significant amount of effort required to fund and deploy
open business models.”
Those models may be more complex, and Aronson
acknowledged that they may be risker for businesses to
engage in.
“However, I do believe they will also be much more
profitable,” he said. “If we can figure that out, then we wind
up with a scenario where we will all be able to innovate on
top of each other’s work,” he envisioned.
“We’ll be able to use as much open data as possible, and
we’ll start to be able to think about a truly continuously
learning healthcare system.”
5
CONCLUSION

Healthcare organizations that hope to take advantage of
the many benefits of artificial intelligence will need to work
collaboratively to solve some significant challenges over the
coming years.
Ensuring that AI tools are safe, effective, efficient, and free
of unconscious bias will be an ongoing process requiring
input and investment from every stakeholder involved in
delivering, receiving, or paying for high-quality patient care.
Leveraging AI to create administrative and clinical
efficiencies requires organizations to set reasonable
expectations and clear goals, but keep an open mind about
the future impact of these exciting, innovative strategies.
“We don’t want to overhype AI by saying it’s going to take
over everyone’s job, because it won’t. But we also don’t
want to under-hype it, or say it’s too hard or too futuristic,
because we don’t want people to stop trying,” said Dreyer.
“It’s really more about spreading a sense of reality and
making sure that everyone is patient but still committed to
working to make AI a force for good in healthcare.”

PUBLISHED BY ABOUT PURE STORAGE

Pure Storage offers healthcare providers and researchers an advantage—a radically

simple data platform. All-flash arrays and blades deliver high performance and 99.9999%
availability for machine learning, artificial intelligence, enterprise imaging and more. Pure’s
© 2018 Xtelligent Media, LLC Evergreen Storage® technology refresh program and non-disruptive upgrades mean no
more migrations.