From left: Betsy Nabel and Atul Gawande

There is a tremendous amount of interest and innovation in health care surrounding the use of artificial intelligence (AI), a branch of computer science in which machines are trained to perform or simulate human tasks. Successful implementations are harder to find, however.

That disconnect between expectation and reality occurs when excitement about new technology overshadows the less glamorous, but essential, work of ensuring any new tool fits into how frontline staff currently do their jobs, explained BWH surgeon, researcher and author Atul Gawande, MD, MPH, during a discussion with Brigham Health President Betsy Nabel, MD, at the World Medical Innovation Forum in Boston on April 24. 

To describe the current state of the industry, Gawande cited a comparison made by a pharmaceutical executive: “We’re building Star Wars medicine, but we have a Flintstones health care delivery system.”

Gawande and Nabel were among a cadre of international experts featured at the forum, which brought together health care leaders to highlight advancements and opportunities at the intersection of patient care and AI. The event, hosted by Partners HealthCare, also included presentations and panel discussions with several BWH clinicians and researchers who shared their insights and discoveries in this emerging field of medicine. 

Lessons from the Past

Striking the balance between cutting-edge technologies and real-world practices was a common theme throughout the forum. In her conversation with Gawande, Nabel noted the widespread, lasting and proven success of low-tech tools in health care – namely, safety checklists in surgery.

“Essentially, it’s a list on a wall. That’s about as far away from artificial intelligence as you can get,” Nabel said. “How do you reconcile disruptive technology and its rate of development alongside such prosaic processes?”

Gawande noted that when looking at the future of medicine, there is much to be learned from the past. He turned to two innovations from the 19th century that transformed surgical care: anesthesia and antiseptics. When anesthesia debuted, it was practically an overnight success. Conversely, antiseptics – which required hospital staff to disinfect surgical tools one by one using a harsh acid – took more than two decades to gain traction.

The difference? “One was good for the patient and good for the clinician. Anesthesia had an immediate visible effect that made life better for both,” Gawande said. “The other one was pain now for gain later.” 

Eventually, famed businessman Robert Wood Johnson met with Joseph Lister, a pioneer of antiseptic surgery. Johnson founded the company Johnson & Johnson around an idea that would transform the field: prepackaged sterilized sutures and dressings. “He made it easier to do the right thing for the patient,” Gawande said. 

The same lesson can be applied to the innovations of today. Through his work at Ariadne Labs – a joint center of BWH and Harvard T.H. Chan School of Public Health – Gawande and his team are designing and deploying innovations that make it easier to deliver better care today and to identify strategies that support successful implementations at large scale. 

“We need equal commitments to breakthrough innovation and follow-through innovation,” said Gawande, Ariadne’s founder and executive director.

AI at the Bench and Bedside

Throughout the four-day forum, experts from across the Brigham participated in sessions exploring the opportunities and challenges of AI in medicine from a variety of perspectives.

Krishna Yeshwant, MD, a physician in the Phyllis Jen Center for Primary Care and a partner at Google Ventures, and Stephen Wiviott, MD, a cardiologist in the Division of Cardiovascular Medicine and a senior investigator in the TIMI Study Group, participated in a panel discussion on AI’s potential to reduce the cost of clinical trials. Noting that trials have always had mathematical and statistical tools at their core, speakers discussed how AI could enable researchers to more efficiently identify large cohorts, analyze data and automate other resource-intensive tasks. 

In a roundtable discussion, Calum MacRae, MD, PhD, vice chair for Scientific Innovation in BWH’s Department of Medicine, reflected on where AI is today and what’s needed for it to succeed.

“In the convergence between modern and existing technologies, the only constant is the underlying biology, which doesn’t fit within the silos we define in our health care system,” he said. “We are going to have to redefine everything we do to cross those spaces.”

Read more WMIF coverage in BWH Clinical and Research News.