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ARTIFICIAL INTELLIGENCE, COVID-19, AND THE FUTURE OF PANDEMICS

RICHARD E. ANDERSON, MD, FACP, CHAIRMAN AND CHIEF EXECUTIVE OFFICER, THE DOCTORS COMPANY AND TDC GROUP

Artificial intelligence (AI) has proven of value in the COVID-19 pandemic and shows promise for mitigating future healthcare crises. During the pandemic’s first wave in New York, for example, Mount Sinai Health System used an algorithm to help identify patients ready for discharge. Such systems can help overburdened hospitals manage personnel and the flow of supplies in a medical crisis so they can continue to provide superior patient care.

Pandemic applications have demonstrated AI’s potential not only to lift administrative burdens, but also to give physicians back what Eric Topol, MD, founder and director of Scripps Research Translational Institute and author of Deep Medicine, calls “the gift of time.” More time with patients contributes to clear communication and positive relationships, which lower the odds of medical errors, enhance patient safety, and potentially reduce physicians’ risks of certain types of litigation.

However, physicians and health systems will need to approach AI with caution. Many unknowns remain—including potential liability risks and the potential for worsening pre-existing bias. The law will need to evolve to account for AI-related liability scenarios, some of which are yet to be imagined.

Like any emerging technology, AI brings risk, but its promise of benefit should outweigh the probability of negative consequences— provided we remain aware of and mitigate the potential for AIinduced adverse events.

AI’S PANDEMIC SUCCESS LIMITED DUE TO FRAGMENTED DATA

Innovation is the key to success in any crisis, and many healthcare providers have shown their ability to innovate with AI during the pandemic. For example, researchers at the University of California, San Diego (UCSD) health system who were designing an AI program to help doctors spot pneumonia on a chest x-ray retooled their application to assist physicians fighting coronavirus.

Meanwhile, AI has been used to distinguish COVID-19specific symptoms: It was a computer sifting medical records that took anosmia, loss of the sense of smell, from an anecdotal connection to an officially recognized early symptom of the virus. This information now helps physicians distinguish COVID-19 from influenza.

However, holding back more innovation is the fragmentation of healthcare data in the U.S. Most AI applications for medicine rely on machine learning; that is, they train on historical patient data to recognize patterns. Therefore, “Everything that we’re doing gets better with a lot more annotated datasets,” Dr. Topol says. Unfortunately, due to our disparate systems, we don’t have centralized data. And even if our data were centralized, researchers lack enough reliable COVID-19 data to perfect algorithms in the short term.

Or, put in bleaker terms by the Washington Post: “One of the biggest challenges has been that much data remains siloed inside incompatible computer systems, hoarded by business interests and tangled in geopolitics.”

The good news is that machine learning and data science platform Kaggle is hosting the COVID-19 Open Research Dataset, or CORD-19, which contains well over 100,000 scholarly articles on COVID-19, SARS, and other relevant infections. In lieu of a true central repository of anonymized health data, such large datasets can help train new AI applications in search of new diagnostic tools and therapies.

To find out more about what differentiates The Doctors Company from other medical malpractice insurance carriers as a physician-first insurer, contact Matt Lawrence at 310.492.4845 or mlawrence@thedoctors.com. CCMA members receive additional savings!

AI INTRODUCES NEW QUESTIONS AROUND LIABILITY

While AI may eventually be assigned legal personhood, it is not, in fact, a person: It is a tool wielded by individual clinicians, by teams, by health systems, even multiple systems collaborating. Our current liability laws are not ready for the era of digital medicine.

AI algorithms are not perfect. Because we know that diagnostic error is already a major allegation in malpractice claims, we must ask: What happens when a patient alleges that diagnostic error occurred because a physician or physicians leaned too heavily on AI?

In the U.S., testing delays have threatened the safety of patients, physicians, and the public by delaying diagnosis of COVID-19. But again, healthcare providers have applied real innovation— generating novel and useful ideas and applying those ideas—to this problem. For example, researchers at Mount Sinai became the first in the country to combine AI with imaging and clinical data to produce an algorithm that can detect COVID-19 based on computed tomography (CT) scans of the chest, in combination with patient information and exposure history.

AI IN HEALTHCARE CAN HELP MITIGATE BIAS—OR WORSEN IT

Machine learning is only as good as the information provided to train the machine. Models trained on partial datasets can skew toward demographics that turned up more often in the data—for example, Caucasians or men over 60. There is concern that “analyses based on faulty or biased algorithms could exacerbate existing racial gaps and other disparities in health care.” Already during the pandemic’s first waves, multiple AI systems used to classify

x-rays have been found to show racial, gender, and socioeconomic biases.

Such bias could create high potential for poor recommendations, including false positives and false negatives. It’s critical that system builders are able to explain and qualify their training data and that those who best understand AI-related system risks are the ones who influence healthcare systems or alter applications to mitigate AI-related harms.

AI CAN HELP SPOT THE NEXT OUTBREAK

More than a week before the World Health Organization (WHO) released its first warning about a novel coronavirus, the AI platform BlueDot, created in Toronto, Canada, spotted an unusual cluster of pneumonia cases in Wuhan, China. Meanwhile, at Boston Children’s Hospital, the AI application Healthmap was scanning social media and news sites for signs of disease cluster, and it, too, flagged the first signs of what would become the COVID-19 outbreak—days before the WHO’s first formal alert.

These innovative applications of AI in healthcare demonstrate real promise in detecting future outbreaks of new viruses early. This will allow healthcare providers and public health officials get information out sooner, reducing the load on health systems, and ultimately, saving lives.

California’ s Physician Practice Vaccine Support Grants Program

As California continues its efforts to vaccinate all eligible residents against COVID-19, the state is creating new support for communitybased physicians to help our state reach its vaccination goals.

The CalVaxGrant is a new program administered by Physicians for a Healthy California (PHC) that will offer grant funding, oneon-one myCAvax support and vaccine administration resources for physician practices. To be eligible, practices must complete section A of the myCAVax application process.

Funded by the California Department of Public Health (CDPH), the practice support grants will help physicians and medical practices (with 200 or fewer physicians) administer COVID-19 vaccines in their community, as well as reimburse for related expenses incurred since November 2020. Allowable expenses include staffing, training, technology, infrastructure, supplies/equipment, and administrative overhead.

The CalVaxGrant application cycle runs July 12 through August 13, 2021.

Small practice providers can apply to receive $10,000 for up to five vaccination sites for a total of $50,000. Additionally, small practice providers can receive an additional $1,000 per site (up to five sites for an additional $5,000) if their vaccination sites match high priority areas as noted by the CDPH.

For more information www.phcdocs.org/Programs/CalVaxGrant calvaxgrant@phcdocs.org 916.551.2565

TOGETHER WE ARE STRONGER

The Central Coast Medical Association and California Medical Association thank the following physicians for membership and support to protect physicians’ profession and patients.

If your name is not on this list, join your colleagues at www.cmadocs.org/join or by contacting us at memberservice@cmadocs.org or 800.786.4262.

Membership list as of July 15, 2021. Every attempt was made to ensure accuracy. If your information is incorrect, please contact us at 805.683.5333 or ccma@ccmahealth.org.

Mark Steven Abate David Abbott Stephen Lee Abbott Rushdi Abdul-Cader Shields Brewster Abernathy Mitchell Adler Thomas Aguirre Hosam Ahmad Bina Ahmed Michael Edward Aldridge Hamid Alipour Bashir Allahdadi Eric Michael Alltucker Richard Ira Altesman Eric Rey Amador Gilbert O Andersen Seth Eli Anderson, Jr Thomas Gerald Anderson Thomas Robert Anderson John Onssy Anis Henning Ansorg Andrew Martin Anthony Joseph Raymond Aragon, Jr Hiwot Hagos Araya Felipe De Jesus Arce Benton Turner Ashlock Michelle Renee Auran Timothy Leonard Auran Robert Logan Avery Keith Alan Ayrons Wei Bai Bruce R Bailey Rollin C Bailey Summer Baird Dennis Baker Claudia Balderrama Polly Baldwin Julian Xander Valentin Bandura Steven Colin Barkley Vida Baron

Maria Irmgard Barrows Charish Leann Barry H Richard Barthel Sharon L Basham Robert K Baum Thomas L Beamer David L Bearman Andrew Duane Beckler J Kevin Beckmen Michael Jamison Behrman Christel Bejenke Richard A Belkin Jeremy Stephen Bennett Jeoffrey P Benson Edward Bentley James Benzian Daniel Nathan Berger Alex Glenn Bergman Mica Bergman David A Bernhardt Michael Lewis Bernstein Ryan Scott Berry Tamara Marie Berry Julia Ann Billington Andrew Binder David L Birken Scott Edward Bisheff Jerold Adrian Black Cindy Blifeld Laurel Athena Bliss Jeffrey Martin Bloom Gary M Blum Mark C Bocchicchio Michael Bordofsky Penny Borenstein Jason Edward Boyatt Rabindra Alfred Braganza Sushila Linda Braganza Joel Hershel Brandt Blaine Braniff Stuart Braverman Rene Henry Bravo Daniel Russell Brennan James Gerard Brewer William K Brokken Brittany Alice Bryan Roy Gordon Bryan, II Leanne Renee Buckner Daryl Burgess Chadler Ryan Burgoyne Mark E Burnett William E Buys David Alan Canvasser Kevin Michael Casey Alessandro Attilio Castellarin Kristin Nicole Castorino Thomas Clarence Caves James Cavins Gayle Susan Cekada Julie Adele Chacko Jinny Ei Chang Linda Sian Chen Rosa Sung Eun Choi Bernard Chow Nicole Marie Christiano Katherine Chung Richard Yung Chung Wendy Anne Ciovacco Eduardo Enrique Clark Steve Russell Clarke Michael G Cline Gregory Alexander Cogert Jessica Ann Cohen-Brown Kevin Francis Colton William Charles Conway II Cary Conyers Barry Coughlin Stephen S Couvillion Carin Lynn Craig Daniel F Craviotto, Jr P Kent Cullen, Jr David Michael Cumes Daniel Jay Curhan David d’Ablaing Olga Daiber Gustavo Dascanio Karen B Dasilva Kenneth Daughters Thomas Daughters, Jr Bret E Davis Julian Reed Davis Charity Anne Dean Julia Delgado Philip Delio Vincent Pope DeRosa Arpan Jitendra Desai Kamlesh M Desai Scott Michael Dewhirst

Thank you to CCMA members who have donated to the California Medical Association Political Action Committee (CALPAC)

Eric Michael Alltucker Eric Rey Amador Andrew Martin Anthony Steven Colin Barkley Sharon L Basham Edward Bentley Jeffrey Martin Bloom Rene Henry Bravo James Gerard Brewer Kevin Michael Casey Kevin Francis Colton David Charles Dodson Douglas Barrie Duncan Douglas Etsell Julie Cecilia Fallon P Joseph Frawley Jeffrey Charles Fried Priti Gagneja Stephen Raymond Holtzman Jennifer Hone Douglas R Jackson Samira Kayumi-Rashti Robert A Kolarczyk Garry Richard Kolb Karen S Kolba Roger I Lane Christopher George Lumsdaine Douglas P Murphy Grace Eunmi Park Robert Poulin John Michael Sawyer Joseph Alan Schwartz Thomas Van Meter Fred Steve Vernacchia Steven Zelko

More than ever, health care in California is highly regulated and legislated, with constant threats to your clinical autonomy. Successful advocacy depends upon an integrated approach utilizing lobbying, grassroots activism and political action through CALPAC. If you want to support candidates and legislators who understand health care, make a donation at www.calpac.org.

Michael Joseph DiBiase Robert Dichmann Benjamin Godfrey Diener David Charles Dodson Barbara Joan Donnelly Charles Christopher Donner Steven Eric Dosch K Charmian Dresel-Velasquez Aroma Dulku William Henry Dunbar, V Douglas Barrie Duncan James Timothy Dunn Margaret L Echt James V Egan John Glen Elder Todd William Engstrom Duard Enoch, III Patricia L Erbe Douglas Etsell Julie Cecilia Fallon Ryan James Fante Donald Omar Fareed Todd Fearer Charles C Fenzi Kevin L Ferguson Mary Elina Ferris Robert I Fishburn Michael Fisher David Thomas Fisk Cary J Fitchmun Lynn Nisbet Fitzgibbons Christopher Flynn Kristin Elizabeth Fontes Peter G Ford Adam James Forrest Garrett Edwin Foulke P Joseph Frawley Joseph Dreyfuss Freeman Jeffrey Charles Fried Gregory John Frye Richard Fulton Priti Gagneja John W Gainor John Gregory Gaitan William Louis Ganske Bryan Joshua Garber William H Gausman, Jr Jeffrey M Gauvin Eric Michael Gavarre William James Gealy, Jr Andrew Scott Gersoff Brett A Gidney Donald Gillies David S Gillon Rebecca D Golgert William Alan Golgert Robert Lawrence Gong Liana Gonzalez Vishal Goyal Gregory Clay Greaney Justin Lee Greene Daniel Reif Greenwald Howard Gross Elizabeth Myers Grossman Alicia Guevara Page Maryam Guiahi Khawar Gul Mukul Gupta Cory Gusland Gloria Hadsall Jeffrey Matthew Hadsall William Victor Hahn Sawyer Bailey Haig Thomas Walter Hale Saida Hamdani Richard E Hammond Jeffrey Hankoff Laurel Hansch Stephen L Hansen Muhammad Salman Ul Haq Bilal Harake Kathryn Claire Haran Robert D Harbaugh Marvin Harrah Anna Harter Jacob L Harter Lawrence Phillip Harter Steven Hartzman Robert A Harway Peter Lee Hasler Farid Hassanpour Robert Hawkins Paul Dietrich Hennig William J Heringer David Hernandez Jeff Herten Stephen A Hilty John Hans Hirschberg David Hirt Bryce Richard Holderness Glenn William Hollingshead Stephen Raymond Holtzman Taylor James Holve Jennifer Hone Bradley E Hope Stephen Hosea Benjamin Michael Howard Bruce Howard Randall Hugh Howard Barbara A Hrach Angela Ai-Chieh Hsu Charles Michael Hubeny Pierre-Alain Hueber Robert Michael Hullander Graham R Hurvitz James P Ingersoll Douglas R Jackson Douglas W Jacobson Lauren Elaine Jacobson Robert Jacoby W Blake Jamison Matti Rose Jansen Karen Jensen Johnson Thomas Harlow Jones Darol D Joseff Mark Christopher Juretic Richard Kahmann Bindu Kamal Karl Kassity Samira Kayumi-Rashti Kyle Richard Kelson Ryan Francis Kendle Rachel Kernoff Robert Jeffrey Kershaw Tamir H Keshen Case H Ketting John Khan-Variba Sylvia Kim C Seybert Kinsell Phillip Kissel Robin P Knauss Bradley C Knox Oma Christine Knox Brian Koch Roger Kohn Robert A Kolarczyk Garry Richard Kolb

Karen S Kolba Ernest Thomas Kolendrianos Li-Sheng Kong Alex Koper, II Tatyana Kopilova Hannah Wilks Kornfeld Jennifer B Kosek Kenneth S Kosik Brent Kovacs Elizabeth Ingrid Krenz Kenneth Dale Krone Sanjay Kumar Bradley Shawn Kurgis Alicia Mikolaycik Kurtz Christopher Kuzminski James Lawrence Kwako Francis Peter Lagattuta Anh Tuan Lam Christopher V Lambert Erica J Lambert Roger I Lane Sarah Elizabeth Langdon David LaPatka Jeremy William Lash Ronald Latimer Baochuong Quy Le Ann Miehyung Lee Arthur Lee Wonuk Lee Kyle Worthington Lemon Stephen Lemon Susan Lemon Hollanda Leon Winifred K Leung Edward Ned Li Danny Leroy Lickness Myron Israel Liebhaber Donald E Lindblad Steven Seth Lipman Anne E Little Keith Llewellyn Morgan Lloyd Mark E Logan Caitlin Rae Loseth Thomas S Lossing Laurence Hamilton Lotz Adam D Lowenstein Miguel Angel Loya Gary Michael Lucchesi Bryant Jay Lum George Philip Lum Christopher George Lumsdaine Kurt Franklin Lundquist Christopher Vaughn Lutman Thuthiri Thandar Lwin Tomas Manuel Machin Richard Joseph Macias Robert Christian Maciel Cory Anderson Malone Robin Elizabeth Malone-Cunnison Laurence Mamlet David Adam Mandel Kateryna Markova Kari K Mathison Rachel May David L McAninch, III John McCaffery Edward J McGinn Stanley Eugene McLain, Jr Lowell McLellan Steven Douglas McMurtry James McNamara David Medina Arnold Medved Anthony Mendesh Marilyn Mendoza Andrew Francis Mester Toni Takiko Meyers Sherif Michael Randall G Michel Monica Micon Kelli Jean Miller Richard Miller James F Mitchell, Jr James Allen Moghtader Arthur Morel Alexander Eduard Morf Peter Morris Karen Moyes Ralph Mozingo Jamil Suheil Muasher Douglas P Murphy Robert M Nagy Ma’an Aziz Nasir Gregg Charles Newman Ted B Newman Joann Ng Dung-Hoa Thi Nguyen Charles H Nicholson Sara Taylor Nimmons Pierre Nizet David L Nomeland Joseph A Nunez David Ernest Nunnelly William Kiernan O’Callaghan Thomas Ochsner Arbi George Ohanian Robert W Olson Michael Jon Omlid Kevin C Osburn Stanley Ostern William Michael Pace Grace Eunmi Park David Paul Michael Paveloff Nancy A Pawlik Steven Pearson Meredith Ann Perrin Timothy J Perrin Monica Renee Phillips David Lockard Phreaner Dante Joseph Pieramici Jordan Eliot Pinsker David C Pires Michael Isidro Polo Theodore Polos Mark Ford Pomerantz Richard S Ponce Robert Poulin Christian Harrington Powell Elliot Prager Liza Presser Belkin Spencer Eugene Price George Primbs Jason J Prystowsky Ralph Quijano William Rack Bruce Dudley Ragsdale Anita Rai Beverly Joy Sanson Ramos Susanne Lucille Ramos Kurt N Ransohoff Rahim Ali Raoufi David Aaron Raphael Karim Rasheed Thomas Reaper Cinnamon Hampikian Redd

Jason M Redd Jana Kokkonen Reed Ashton Donnelle Regalado-Magdos Robert Alfred Reid Juan Reynoso Donald Rhodes Mark G Richmond Jonathan Lee Riegler Sylvia Cristina Rivera Brian Michael Roberts H Douglas Roberts Joseph Andrew Robinson Timothy Leigh Rodgers Anne O’meara Rodriguez Alexandra E Rogers Anthony Rogers Anthony C Romero Thomas George Ronay Margot Roseman Frederick Semenov Rosen Joaquin Roses Daniel Roshan Andrew Gregory Ross Barry J Ross Shane Dee Rostermundt, I Stephanie Joy Rothman Lewis Rubin Sergio Rafael Rubio Lynn A Rudman Rebecca Lynn Ruebsamen Andria Ruth Robert Merrill Ruth Paul Ryack Jeffrey Seymour Sager Dustin Gabriel Sanchez Karl Sandin Brian David Santacrose River Liuyuan Saul John Michael Sawyer Matthew Bennett Scales Philip Scheinberg Carl Schlosser Wesley G Schooler Joseph Alan Schwartz Mary-Louise Scully Stuart Douglas Segal Roberta D Sengelmann Laleh Shaban Colin David Shafer Ayesha Shaikh William A Shapiro William Sheehan Michael Mourad Shenoda Eric F Shepherd Anthony W Sheplay Virginia Ann Siegfried Mark Lewis Silverberg John Sim Eric Matthew Sincoff Manu Kush Singh Clinton Andrew Slaughter Margaux Kelly Snider Sean Snodgress Alex Soffici Mark Ian Soll Marta Sovilj Timothy M Spiegel Cameron James St Hilaire Mareeni T Stanislaus Donald Larry Stanton Nathan Christopher Steinle Nicole G Stern Dustin Erin Stevenson Noah Stites-Hallett Monica Leigh Straatmann Gary Strachan Cathy Anne Straits David Strumpf Rachel Subramanian Mark Wayne Surrey Gerald Svedlow Paul John Swedberg Sasha Lynn Szytel Brian Taber Victor Andrew Tacconelli Reyna Maria Talanian Sara Taroumian Dominic John Tedesco Stefan Robert Teitge Heather Irene Terbell Christopher John Thrash Scott Baringer Tobis Casey John Toole Mandana A Toole Michael Trambert Rachel Elisabeth Trautwein Pansy Tsang Kenyon Tsao Vincent C Tubiolo Nedeljko Jakov Uncanin, Jr Ronald G Ungerer Jon R Uyesaka Gary Van Deventer Thomas Van Meter Fred Steve Vernacchia Rafael Sollesa Victoria, Jr David J Vierra Christian J Voge John Vowels Martin Walker Edward R Wallace Sharon Evelyn Watson Alex J Weinstein Marc W Weise Thomas Weisenburger Brandon Marshall Welbourn J Patrick Wheelock Anne White Richard Wikholm Barry Williams Carl Williams Matthew Akira Williams Judith Willis Paul Willis Avery May Kenyon Wilmanns Brett Wilson, II Jay Michael Winner Stuart Robert Winthrop Michelle Withee John D Wrench Robert Simpson Wright Edmund M Wroblewski Michael L Wyatt Steven Yao Jeffrey Bernard Yim John Yoon Mira Han Yoon Hsien Cheng Young Steven H Young Stephanie Patricia Zamora Steven Zelko Marc Zerey David Abram Zisman James Conard Zmolek