AI, BIOMEDICINE, AND THE NIH

1st ACM International Health Informatics Symposium

11/11/2010
Milton Corn, M.D., National Library Of Medicine
National Institutes Of Health
What is AI?
—  CIRCULAR: Artificial intelligence (AI) is the intelligence of machines
—  GLOBAL: Understanding the mechanisms underlying thought and intelligent behavior
and their embodiment in machines.
—  SIMPLISTIC: Software that passes the Turing test
—  PRAGMATIC:
—  machines that perform functions that require intelligence when performed by
humans
—  artificial systems that will perform better on tasks that humans currently do better
e.g. in expert systems, speech recognition, machine vision, searching, speech
recognition, reading
—  METHODOLOGIC: solving problems with expert systems, neural nets, machine
learning, genetic algorithms

IS DEEP BLUE AI?

Cousins of AI
—  computational intelligence
—  machine learning
—  intelligence amplifying systems
—  flexible competence
—  human-computer collaboration
—  computational thinking
Hollywood
Knows
AI
Birth Of AI In Modern Era
—  1956 Dartmouth Conference
—  Organizers: Marvin Minsky, John McCarthy and two IBM
scientists, Claude Shannon and Nathan Rochester
—  Conference assertion: "every aspect of learning or any other
feature of intelligence can be so precisely described that a
machine can be made to simulate it".
Promises:
—  1958, H. A. Simon and Allen Newell: "within ten years a
computer will be the world's chess champion" and "within
ten years a digital computer will discover and prove an
important new mathematical theorem.”
—  1965, H. A. Simon: "machines will be capable, within twenty
years, of doing any work a man can do.”
—  1967, Marvin Minsky: "Within a generation ... the problem
of creating 'artificial intelligence' will substantially be solved.”
—  1970, Marvin Minsky (in Life Magazine): "In from three to
eight years we will have a machine with the general
intelligence of an average human being.”
Seasons of AI

Gartner Inc.'s Hype Cycle showing the fluctuating support of a new technology
SOME AI ACHIEVEMENTS
—  machine translation
—  data mining
—  industrial robotics,
—  speech recognition
—  banking software
—  medical diagnosis,
—  Google's search engine
—  fuzzy logic controllers
—  heuristic search
—  data analytics
WHAT IS GOING ON NOW?
Some Important Current AI Projects
—  Personal assistants (e.g. Microsoft)
—  Speech recognition (e.g. Siri)
—  “Watson” for question-answering (IBM)
—  Robo-docs (e.g. X Prize $10 Million For AI Diagnostician)
—  NELL: Never-Ending Language Learning machine that
“reads” (Carnegie Mellon)
—  DARPA Programs e.g Grand Challenges, Semantic Web
—  EU-FP7 Support
HOW DID AI INTERACT WITH
MEDICINE?
—  Analogous “hype” cycle over the decades
—  Early emphasis on “doc in the box” e.g. diagnosis programs
—  Heavy use of rules-based expert systems
Some early focused programs
—  MYCIN: rules-based system, developed at Stanford originally
for the diagnosis and treatment of bacterial infections of the
blood and later extended to handle other infectious diseases
as well.
—  Present Illness Program (PIP), for taking the history of the
present illness of a patient with renal (kidney) disease
—  ABEL, a program for the diagnosis (and eventually
treatment) of acid/base and electrolyte disturbances.
Some General Diagnosis Programs
—  Iliad: Bayesian general diagnosis system that grew out of an
early electronic record, the HELP system
—  INTERNIST-I a computer-assisted diagnostic tool designed
to capture the expertise of just one man, Jack D. Myers, MD
—  Dxplain uses modified Bayes to produce a ranked list of
diagnoses, provide justification for each disease, suggest
further steps
Some Early Lab Programs
—  PUFF Expert System for Interpretation of Pulmonary Function
Data) was probably the first AI system to be used in clinical
practice.  
—  APACHE was one of the first medical decision support systems to
be commercialized - Provides a numerical indicator of severity of
illness, risk of mortality, risk of active treatment (an indication of
appropriate resource utilization) to predict clinical results in the
ICU
—  GermWatcher checks for hospital-acquired (nosocomial)
infections
—  PEIRS (Pathology Expert Interpretative Reporting System) PEIRS
interpreted about 80-100 reports a day with a diagnostic accuracy
of about 95%
WERE AI PROGRAMS WELCOMED BY
HEALTHCARE?
—  Not by clinicians
—  Not by educators
—  Some for clinical surveillance
—  Commonly in laboratories
—  Significantly in signal analysis (ECG, EEG, EMG)
*WHY ARE AI PROGRAMS REJECTED?*
—  Product not wanted or puerile
—  Onerous, time-consuming data input
—  Clumsy interface
—  Program intrusive (esp for reminders)
—  Plethora of single-issue programs
—  Even small error rate not acceptable
—  Inventor makes no effort to disseminate
—  Not interfaced with EHR
—  Not invented here
—  Technophobia
 WHAT ABOUT AI AND HEALTHCARE TODAY?
Dep’t of Extravagant Predictions

Stead et al, Academic Medicine 86:1-6, 2011

—  List patients in order of acuity based on continuing analysis of
EHRs
—  Propose differential diagnosis based on literature and
computational biological model of patient
—  Display costs of alternate management plans with explanation
—  Base dx/rx on local disease prevalence/experience
—  Discuss whether recommended management differs from
that of general community
AI AND HEALTHCARE TODAY
Topics for which funding available

—  Decision support (CDDS)

—  Generating alerts and reminders
—  Diagnostic assistance
—  Therapy critiquing and planning
—  Guidelines
—  HCI/Behavioral aspects of CDDS

—  Agents for information retrieval

—  Image recognition and interpretation

WHAT SORT OF PROJECTS ARE BEING PUBLISHED?
Artificial Intelligence in Medicine
Vol 50, issue 2, Oct 2010
RESEARCH ARTICLES

—  Semantic relations for problem-oriented medical records

—  Detecting ‘wrong blood in tube’ errors: Evaluation of a Bayesian network approach

—  Automatic image-based assessment of lesion development during hemangioma follow-up

examinations

—  Decision support in heart failure through processing of electro- and echocardiograms

—  Missing data imputation using statistical and machine learning methods in a real breast cancer
problem

—  Evolving fuzzy medical diagnosis of Pima Indians diabetes and of dermatological diseases

—  Quantitative prediction of MHC-II binding affinity using particle swarm optimization
THE TWO WORLDS OF AI
Grand Challenges Feasible Miniature Projects
—  Personal Assistants —  Wrong blood in tube
—  Watson —  Dx diabetes Pima Indians
—  Nell —  Missing data in breast ca pt.

USUALLY: USUALLY:
Private sector funding Federal funding
Profit potential Promotion potential
Dissemination likely Dissemination rare
DOES NIH CARE ABOUT HEALTH-CARE AI?
—  NLM funds healthcare informatics, including AI
—  (mostly feasible miniatures through standard NIH grant
programs)
—  NIBIB might be receptive to image , bio-engineering, or
robotics projects
—  Other Institutes not focused on health-care delivery but
—  Could be interested in AI for clinical research
—  Could be interested in secondary use of EHR data
—  Are interested in computational solutions to genome-related
problems
Why Is NLM Interested in AI?
NLM MISSION IS ABOUT BIOMEDICAL INFORMATION

Task 1: store and archive information

Task 2: make the information accessible

Task 3: facilitate utilization of information

Premise: vast and rapidly expanding stores of biomedical
information can be exploited more efficiently if human
cognition is extended with AI tools
NLM AI CHALLENGE GRANTS & AI
2009-10
Challenge Grants Using Federal Stimulus Funds
—  Intelligent search tool for answering clinical questions
—  Self-documenting encounters between clinician and
patient or research subject
—  Informatics for post-marketing surveillance
—  Presenting individual genome information in patient-
relevant, decision-supporting form
—  Computational hypothesis generation for biology and
medicine by analysis of databases
—  In silico hypothesis testing for biology and medicine
—  Create intelligent summary of an electronic health record
NLM RFP For Computational Thinking
Spring-Summer 2010
—  Propose creative hypotheses based on an interrogation of
heterogeneous (experimental or computational) data sets.
—  Language understanding of medical records
—  Interpretation and intelligent summarization/visualization of
data, text, or images
—  Decision support under uncertainty with associated
explanations
—  Intelligent retrieval
—  Programs that can explain their output
—  13 AWARDS MADE; TO BE ANNOUNCED SHORTLY
Program To Read, Explain, Answer Questions About Rx
Label, Side-effects, And Picture Of Tablet/Capsule
Applying To NIH
—  Monitor NIH Guide for Announcements
—  Consider needs of each Institute
—  Address a problem (AI is an approach, not the goal)
—  Try email to judge interest before writing entire application
—  Have clinical expertise on your team
—  Get help from NIH veteran if you are novice
For Further Information
—  cornm@mail.nih.gov

—  NLM EXTRAMURAL PROGRAMS AND GRANTS

http://www.nlm.nih.gov/ep/index.html

•  KEY SITE FOR NIH COMPUTING ACTIVITIES

http://www.bisti.nih.gov/

•  SITE FOR SMALL BUSINESS GRANTS

http://grants.nih.gov/grants/funding/sbir.htm