JAMA. 2019 May 20. doi: 10.1001/jama.2019.4914. [Epub ahead of print]
Emanuel EJ1,2, Wachter RM3.
Artificial intelligence (AI) and its many related applications (ie, big data, deep analytics, machine learning) have entered medicine’s “magic bullet” phase. Desperate for a solution for the never-ending challenges of cost, quality, equity, and access, a steady stream of books, articles, and corporate pronouncements makes it seem like health care is on the cusp of an “AI revolution,” one that will finally result in high-value care. While AI has been responsible for some stunning advances, particularly in the area of visual pattern recognition,1-3 a major challenge will be in converting AI-derived predictions or recommendations into effective action. The most pressing problem with the US health care system is not a lack of data or analytics but changing the behavior of millions of patients and clinicians. Physician behaviors, including ordering tests, procedures, pharmaceuticals, and other treatments, are responsible for 80% of health care costs. Similarly, patient behaviors, including eating well, exercising, not smoking, moderate alcohol consumption, and medication adherence, influence more than half of the development of and outcomes related to chronic diseases. A narrow focus on data and analytics will distract the health system from what is needed to achieve health care transformation: meaningful behavior change.
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