Monday, September 25, 2017

Artificial Intelligence in the Healthcare Arena: Implications for Emergency Medicine

This is really interesting. Elon Musk has another company called OpenAI, an artificial intelligence company. OpenAI built a neural network that was designed to teach *itself* how to play a very difficult video game and then the AI played against the best players in the world on stage in front of millions of people. 

What’s really interesting is that the AI used strategies that the humans had never considered and could not even initially understand. 

The implication for the ER is really interesting. Optimizing ED workflow is really a “game” in the same sense - you have two teams (providers/nurses/techs vs patients), with limited resources and functions, and each side has specific goals (for patients it is to get out quickly and have their healthcare issue resolved, for hospitals/doctors it is to keep the patient alive and get them out as quickly as possible by using the fewest resources). 

Imagine if somebody created a video game that mimicked the people, forces, goals, and parameters of the emergency room, and then created an AI bot to play it, in order to figure out the best strategy to "win." That strategy could then be studied and learned from by humans.

For those who are naive to the challenges of Emergency Medicine, here are some of the huge problems in our specialty:

1. How should one staff?

How many doctors and APPs (Advanced Practice Providers, i.e., physician assistants) should you staff and at which hours? It depends on the volume and acuity of patients coming in, but you can't predict that accurately enough, so your best guess is usually based on averages seen in previous months and years.

However, if you staff for the average, you'll be understaffed 50% of the time (putting people's lives at risk), and overstaffed 50% of the time (wasting money).

2. Should you have more doctors, or more APPs, and in what ratio?

APPs are less expensive than doctors, but need oversight and have a reputation for ordering too many tests (although there are plenty of doctors who are guilty of that as well).

3. Should you pick up the next new patient, or discharge one of the patients who is ready to go?

This is a fascinating question that requires knowing a few other variables to solve properly (Single coverage site? Acuity of the next patient? Other doctors twiddling their thumbs?)

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