AI+healthcare: Convenience and risk coexist
2024-08-06
At 8 o'clock in the morning, Song Wenzhuo, a village doctor from Xinghe Village, Zhongxing Town, Youxian District, Mianyang City, Sichuan Province, came to the clinic. The first thing he did was to open his computer and log in to the AI (Artificial Intelligence) assisted diagnosis and treatment system. This is a new habit he has developed recently. Dr. Song, my heart is beating a bit fast and I feel a bit breathless. Occasionally, I cough a few times As soon as the clinic opened, Tu, a villager in her late 90s, came to see her accompanied by her husband. Song Wenzhuo asked about the symptoms while inputting the condition into the system, and then clicked the AI assisted diagnosis button. The system quickly connected with the national core knowledge base that has a large number of frequently occurring and common disease cases. By extracting and analyzing the patient's historical medical record information, it provided diagnostic recommendations such as "acute upper respiratory tract infection". Song Wenzhuo conducted a comprehensive evaluation based on his clinical experience and ultimately determined that Tu Po Po was suffering from acute upper respiratory tract infection. Subsequently, the system provides recommended medication based on the doctor's selection, listing the recommendation criteria, examination recommendations, etc. Song Wenzhuo referred to the selected treatment medication and asked the elderly to take the medicine for observation first. In Song Wenzhuo's view, the application of AI assisted diagnosis systems not only improves the accuracy and efficiency of diagnosis, but also helps doctors better cope with complex cases, reduce the risk of misdiagnosis and missed diagnosis, and make medical treatment and medication safer and more reassuring. The application of AI assisted diagnosis and treatment system in grassroots medical institutions in Youxian District, Mianyang City is a vivid epitome of China's promotion of "AI+healthcare". The 14th Five Year Plan for the Development of the Medical Equipment Industry clearly proposes to accelerate the development of intelligent medical equipment; The Opinions on Further Improving the Medical and Health Service System proposed to develop "Internet plus+health care" and accelerate the application of the Internet, artificial intelligence, etc. in the medical and health field... In recent years, China has continuously strengthened top-level design and promoted the development of "AI+health care". Several industry insiders and experts pointed out in an interview with the Legal Daily that the medical field has become an important place to explore AI applications. Currently, it is mainly used in some hospitals for triage, pre consultation, medical record generation and other scenarios, helping patients to seek medical treatment more conveniently and improving the quality of medical services. In the future, AI assisted diagnosis and treatment will become a trend, but we also need to be vigilant about the hidden legal risks behind it. These risks not only involve the protection of patients' personal privacy, but also relate to issues such as algorithm transparency and fairness. AI assisted diagnosis has been launched in multiple places to enhance patients' medical experience. Recently, reporters came to Peking University People's Hospital for thyroid and scar examinations, including B-ultrasound, blood tests, etc. After payment is completed, the doctor reminds you to schedule a check-up time in the system. The reporter opened their phone and, like a "self-service check-in", scheduled the inspection items at relatively concentrated times during optional time periods. This way, they could "run all the inspections in one go" and complete all the inspections in the shortest possible time, avoiding the repeated trips caused by on-site queue rescheduling and different inspection times. This is just a microcosm of AI assisted healthcare. The reporter found through reviewing public information that "AI+healthcare" has been implemented in multiple hospitals. At Tongji Medical College Affiliated Union Hospital of Huazhong University of Science and Technology, if a patient does not know which department to contact, AI can come to help. The hospital launched the "AI Smart Clinic" in May this year, covering functions such as intelligent triage and intelligent plus sign. Taking the "Intelligent Plus" function at that time as an example: patients could click on "Registration Service" and "Online Registration" to enter the department they needed to make an appointment with. If the selected expert number was "fully booked", they could click on "Apply Plus" below and select the expert's plus date on the jump page. After confirming the free appointment, the AI will automatically initiate a conversation to inquire about the condition and other related information, then generate a "condition card", comprehensively evaluate the severity of the condition, determine the eligibility for a plus sign, and finally send it to the expert for confirmation. In addition, the hospital has also launched an "intelligent waiting room" function. After the patient registers, the "Doctor Digital Person" communicates with the patient in advance to understand the patient's symptoms, course of illness, etc., in preparation for the doctor's face-to-face consultation. At Zhejiang Provincial People's Hospital, the digital health person "Anjian'er" can accompany patients for medical treatment. It is understood that "Anjian'er" can provide AI accompaniment services for patients before, during, and after medical treatment. Before the consultation, patients can describe their symptoms to them, and "Anjian'er" matches departments and doctors for patients based on their symptoms to help them make appointments for registration; During diagnosis, "Anxieer" can reasonably arrange the medical treatment process, provide AR intelligent navigation throughout the process, enable patients to directly take numbers online, provide call reminders, and even complete medical insurance payment on Alipay, saving patients' medical treatment time; After diagnosis, the patient will continue to provide services such as electronic medical records, prescriptions, and report inquiries even after leaving the hospital. At Beijing Friendship Hospital, AI can help doctors write medical records. In May of this year, the Yunzhisheng outpatient medical record generation system was applied at Beijing Friendship Hospital. The system is capable of identifying doctor-patient conversations in complex hospital environments, accurately capturing key information, separating doctor-patient roles, and removing content unrelated to the patient's condition. It generates information summaries expressed in professional terms and outpatient electronic medical records that meet the requirements of medical record writing standards. Data shows that with the help of the outpatient medical record generation system, the efficiency of outpatient case entry in relevant departments of Beijing Friendship Hospital has been greatly improved, and the doctor's consultation time has been significantly shortened. Legal risks should not be ignored. Many industry insiders interviewed pointed out that the widespread application of artificial intelligence in the medical field can provide more convenient services for patients, improve the efficiency and accuracy of medical services, and make high-quality medical resources more accessible. However, the legal risks behind it should not be ignored. In the view of Chen Chuan, a lecturer at the Law School of Shanxi University, the traditional medical diagnosis process emphasizes the respect and protection of the patient's personal dignity and autonomy by doctors. When making medical decisions, doctors need to comprehensively consider the patient's past medical history and current symptoms, and develop appropriate treatment plans in accordance with relevant laws, regulations, and ethical norms. However, there is a risk of "automation bias" in medical artificial intelligence, where doctors may overly rely on AI technology during the diagnostic process, thereby neglecting their own professional judgment and consideration of individual patient needs. This excessive dependence may lead doctors to inappropriately entrust difficult medical decisions to artificial intelligence for processing. When doctors overly rely on artificial intelligence, patients' treatment decisions may be deprived and handed over to machines for processing, resulting in patients losing their autonomy in managing their own health. In addition, the lack of algorithm transparency and algorithm discrimination issues cannot be ignored. Although the "Interim Measures for the Management of Generative Artificial Intelligence Services" jointly released by the Cyberspace Administration of China and the National Development and Reform Commission in July 2023 proposed requirements for algorithm transparency, the actual working principles and decision-making processes of algorithms are often difficult to understand and supervise by the outside world in the specific implementation process. Due to insufficient algorithm transparency, patients cannot understand how medical artificial intelligence draws diagnostic conclusions, resulting in insufficient protection of their right to know and choose, which may infringe on patients' right to informed consent and independent decision-making, "said Chen Chuan. She proposed that algorithmic discrimination can also lead to inequality in healthcare resources across different regions. Different developers may inadvertently introduce biases when training algorithms, leading to discriminatory decisions made by generative artificial intelligence when facing different groups of patients. For example, some medical artificial intelligence systems may have inaccurate or systematically underestimated diagnostic results when screening patients. For example, if the training data of an algorithm model mainly comes from certain specific groups, it may lead to bias when facing special groups. Chen Chuan believes that currently, the application of artificial intelligence in the medical field is still in the exploratory stage, and it is prone to accountability and attribution issues due to behaviors such as misdiagnosis and data leakage. The Civil Code of our country stipulates that the principle of fault liability applies to medical injury liability, and also considers the issue of liability for damages caused by medical devices. However, artificial intelligence can independently generate medical diagnosis results or recommendations, so under the current legal framework, the accountability for the application of medical artificial intelligence is very complex, and traditional forms of responsibility are difficult to simply apply to medical artificial intelligence. The review process for online drug purchases is virtually non-existent. In addition to the potential legal risks associated with the emerging model of "AI+healthcare" in practical applications, some online medical consultation and drug purchase platforms have brought convenience to patients after introducing AI assistance, but have also exposed many problems. According to the survey, some Internet medical platforms adopt the operation mode of "selecting and purchasing drugs first, then depending on the drug formula, and even automatically generating prescriptions by AI software". Not long ago, after placing an order for the prescription drug calcitriol soft capsules on a certain drug purchasing platform, the platform prompted "Please select offline diagnosed diseases". The reporter randomly checked several items in the "Disease" column, and the "Prescription/Medical Record/Examination Report" column was empty. They confirmed that "the disease has been diagnosed and the drug has been used, and there is no history of allergies, contraindications, or adverse reactions". The verification was quickly passed. After submitting the list, the system jumped to the consultation section. Then, a "doctor" received the patient and sent several messages in a row. The first one emphasized that "Internet hospitals only provide medical services for users who come back for further visits". The following messages were to confirm whether there was any allergy history or in a special period. Without a response, the other party sent a prescription and purchase link. Beijing resident Yang Mu (pseudonym) has also had a similar experience, suspecting that the person being treated behind the screen is not a real practicing doctor: "When buying prescription drugs on the XX platform, I feel that the other person is no different from a robot. As long as I type it, the other person will quickly agree within a few seconds without giving any professional advice." Once, he deliberately described some situations where he did not intend to buy drugs to adapt to the disease, but the other person still quickly prescribed the medication. Many insiders believe that the "space separation" diagnosis and treatment is not suitable for all patients, and the re diagnosis of common and chronic diseases is the positioning of Internet diagnosis and treatment for a long time. However, there has been a lack of specific standards in the industry regarding what constitutes a follow-up visit, resulting in some regulatory vacuum. "If it is a regular Internet hospital, the electronic prescription issued by a qualified doctor should have the signature of the doctor and the electronic seal of the Internet hospital. It is not ruled out that some small Internet medical platforms use artificial intelligence, robots and other tools to automatically generate prescriptions, while some large platforms use AI and other tools to assist doctors in consultation, such as asking patients how old they are and where they are uncomfortable, but prescriptions must be prescribed by doctors. " A doctor surnamed Liu from a tertiary hospital in Beijing said. He also noticed that many platforms, in order to seek profits, adopt the model of "AI prescribing and customers directly taking medication". The prescription issuance and review process is virtually non-existent, either skipping the prescription issuance process directly or not actually reviewing the prescriptions uploaded by users. Such behavior seriously violates China's drug management system and also poses risks and hidden dangers to patient medication safety. The question of whether personal information will be leaked during online health platform consultations and consultations has also been raised by multiple interviewed patients. Once, Yang Mu developed a lot of red rashes on his back and sought medical advice on a certain health platform. However, within a few days, he received multiple advertising calls and text messages, some inquiring about the need for hair transplant, some promoting skincare products, and even receiving sales calls from lending companies. Can the personal information and health status collected by the platform be well preserved during consultations, and will this information flow to third parties
Edit：Lubaikang Responsible editor：Chenze
Source：epaper.legaldaily.com.cn
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