Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-14T09:32:59.299Z Has data issue: false hasContentIssue false

7 - AI Technologies and Accountability in Digital Health

from Part II - Trust and Design

Published online by Cambridge University Press:  08 September 2022

Marcelo Corrales Compagnucci
Affiliation:
University of Copenhagen
Michael Lowery Wilson
Affiliation:
University of Turku, Finland
Mark Fenwick
Affiliation:
Kyushu University, Japan
Nikolaus Forgó
Affiliation:
Universität Wien, Austria
Till Bärnighausen
Affiliation:
Universität Heidelberg
Get access

Summary

How to build an ecosystem of trust in digital health? The availability of large amounts of personal data, combined with AI and ML capacities, Internet of Things and strong computational platforms, has the potential to transform healthcare systems in a disruptive way. The emergence of personalised medicine offers opportunities and raises new legal, ethical and societal challenges. A silent shift towards data-driven preventive and personalised medicine may improve diagnosis and therapies while reducing public health costs. In order to build trust, risks such as data breaches, privacy issues, discrimination and eugenics must be addressed. This chapter presents the disruptive nature of AI and ML technologies in healthcare, and makes specific recommendations to build a trustworthy digital health system. Special attention is given to governance by international institutions as well as key principles like transparency, accountability and decision-making processes in a medical context. We first identify the key parameters to advance the field of digital health in a responsible way. Second, we propose possible solutions to shape a sound policy in digital health taking into account a rights-based governance framework. The last part of the chapter is dedicated to the accountability scheme.

Type
Chapter
Information
AI in eHealth
Human Autonomy, Data Governance and Privacy in Healthcare
, pp. 166 - 206
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adly, AS and others, ‘Approaches Based on Artificial Intelligence and the Internet of Intelligent Things to Prevent the Spread of COVID-19 Scoping Review’ (2020) 22(8), Journal of Medical Internet Research e19104.Google Scholar
ANSSI, Dossier de presse, ‘Cybersécurité, faire face à la menace: la stratégie française’ (2021), 18 February 2021, www.ssi.gouv.fr/, accessed 1 March 2021.Google Scholar
Arenas-Cavalli, JT and others, ‘Clinical Validation of an Artificial Intelligence-Based Diabetic Retinopathy Screening Tool for a National Health System’ (2022) Eye 78.Google Scholar
Beijing AI Principles. Datenschutz Datensich 43, 656 (2019), https://doi.org/10.1007/s11623-019-1183-6, accessed 14 March 2021.CrossRefGoogle Scholar
Belgrave, D and others, ‘Understanding Client Support Strategies to Improve Clinical Outcomes in An Online Mental Health Intervention’ (2020), Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems, 1–16.Google Scholar
Bennett, CR and others, ‘Visitors and Resident Autonomy: Spoken and Unspoken Rules in Assisted Living’ (2017) 57(2) The Gerontologist 252–60.Google ScholarPubMed
Bergé, J-S, Grumbach, S and Zeno-Zencovich, V, ‘The “Datasphere”, Data Flows beyond Control, and the Challenges for Law and Governance’ (2018) 5(2) European Journal of Comparative Law and Governance 144–78.Google Scholar
Bloss, CS and others, ‘Direct-to-Consumer Personalized Genomic Testing’ (2011) 20(R2) Human Molecular Genetics R132–41.Google Scholar
Briganti, G and Le Moine, O, ‘Artificial Intelligence in Medicine: Today and Tomorrow’ (2020) 7 Frontiers in Medicine 27.Google Scholar
Butcher, J and Beridze, I, ‘What Is the State of Artificial Intelligence Governance Globally?’ (2019) 164(5–6) The RUSI Journal 88–96.Google Scholar
Cappelleri, DJ, Bi, C and Guix, M, ‘Tumbling Microrobots for Future Medicine: Robots Smaller than a Grain of Sand Could Move through the Body by Tumbling End Over End, Opening up the Possibility of Intriguing Biomedical Applications’ (2018) 106(4) American Scientist 210–14.Google Scholar
Carrillo, MR, ‘Artificial Intelligence: From Ethics to Law’ (2020) 44(6) Telecommunications Policy 101937.Google Scholar
Cath, C, ‘Governing Artificial Intelligence: Ethical, Legal and Technical Opportunities and Challenges’ (2018) 44(6) Telecommunications Policy 101937.Google Scholar
Clarke, R, ‘Principles and Business Processes for Responsible AI’ (2019) 35(4) Computer Law and Security Review 410–22.Google Scholar
De la Garza, A, ‘Contact Tracing Apps Were Big Tech’s Best Idea for Fighting COVID-19. Why Haven’t They Helped?’ Time, 10 November 2020.Google Scholar
Dimitrov, DV, ‘Medical Internet of Things and Big Data in Healthcare’ (2016) 22(3) Healthcare Informatics Research 156.CrossRefGoogle ScholarPubMed
European Commission’s High Level Expert Group on Artificial Intelligence, “Ethics Guidelines for Trustworthy AI”, 8 April 2019, 5.Google Scholar
European Parliament Resolution of 20 October 2020 with recommendations to the Commission on a civil liability regime for artificial intelligence (2020/2014(INL)), 20 October 2020, P9_TA(2020)0276, www.europarl.europa.eu/doceo/document/TA-9-2020-0276_EN.html, accessed 20 March.Google Scholar
Eysenbach, G, ‘What Is Digital Health?’ (2001) 3(2) Journal of Medical Internet Research e20.Google Scholar
Fellay, J, ‘Le Champ des Possibles: Recherche Translationnelle et Médecine de Précision’ (La Rencontre entre la Science et le Droit dans le Numérique 2. Les Défis Juridiques de l’Intelligence Artificielle: Regards Croisés entre Santé et Justice, Lausanne, 13 February 2020).Google Scholar
Floridi, L and Strait, A, ‘Ethical Foresight Analysis: What It Is and Why It Is Needed?’ (2020) 30(1) Minds and Machines 77.CrossRefGoogle Scholar
Fox, C, ‘The Ethical Dilemma We Face on AI and Autonomous Tech’ (New Rules, TEDxMidAtlantic Event, Washington DC, 21 October 2016).Google Scholar
Global Digital Health Outlook, 2020 (2019), 23 August 2019, Frost & Sullivan.Google Scholar
Guarda, P, ‘Ok Google, Am I Sick?”: Artificial Intelligence, e-Health, and Data Protection Regulation’ (2019) 15(1) BioLaw Journal-Rivista di BioDiritto 359–75.Google Scholar
High-Level Expert Group on AI presented Ethics Guidelines for Trustworthy Artificial Intelligence, https://ec.europa.eu/digital-single-market/en/news/ethics-guidelines-trustworthy-ai, accessed 14 March 2021.Google Scholar
Hu, J, Perer, A and Wang, F, ‘Data Driven Analytics for Personalized Healthcare’ in Weaver, CA and others (eds), Healthcare Information Management Systems: Cases, Strategies, and Solutions (Springer 2016).Google Scholar
ITU/WHO Focus Group on Digital Health, www.itu.int/en/ITU-T/focusgroups/ai4h/Pages/default.aspx, accessed 14 March 2021.Google Scholar
Knott, GJ and Doudna, JA, ‘CRISPR-Cas Guides the Future of Genetic Engineering’ (2018) 361(6405) Science 866–69.Google Scholar
Koene, A and others, ‘Governance Framework for Algorithmic Accountability and Transparency’, Publications Office, https://data.europa.eu/doi/10.2861/59990, accessed 14 March 2021.Google Scholar
Kroll, JA and others, ‘Accountable Algorithms’ (2017) 165(3) University of Pennsylvania Law Review 633.Google Scholar
Lapao, LV and others, ‘Implementing an Online Pharmaceutical Service Using Design Science Research’ (2017) 17(1) BMC Medical Informatics and Decision Making 1–14.Google Scholar
Levin, D, ‘Lessons Learned in Using Live Red Teams in IA Experiments’ in Proceedings DARPA Information Survivability Conference and Exposition (IEEE Computer Society 2003), 110–19.Google Scholar
Lupton, D, ‘Data Mattering and Self-Tracking: What Can Personal Data Do?’ (2020) 34(1) Continuum 1–13.Google Scholar
Lupton, D, ‘The Internet of Things: Social Dimensions’ (2020) 14(4) Sociology Compass e12770, https://onlinelibrary.wiley.com/doi/abs/10.1111/soc4.12770, accessed 14 March 2021.Google Scholar
Lupton, D, ‘A More-Than-Human Approach to Bioethics: The Example of Digital Health’ (2020) 34(9) Bioethics 969–76.Google Scholar
Lupton, D, ‘Teaching and Learning Guide – The Internet of Things: Social Dimensions’ (2020) 14(4) Sociology Compass e12777, https://onlinelibrary.wiley.com/doi/10.1111/soc4.12777, accessed 14 March 2021.Google Scholar
Lupton, D, ‘Thinking with Care about Personal Data Profiling: A More-Than-Human Approach’ (2020) 14 International Journal of Communication 3165–83, https://ijoc.org/index.php/ijoc/article/view/13540, accessed 19 March 2021.Google Scholar
Marescaux, J and others, ‘Transatlantic Robot-Assisted Telesurgery’ (2001) 413(6854) Nature 379–80.Google Scholar
Martin, K, ‘Ethical Implications and Accountability of Algorithms’ (2019) 160(4) Journal of Business Ethics 835–50.Google Scholar
McDowell, JC, ‘The Low Earth Orbit Satellite Population and Impacts of the SpaceX Starlink Constellation’ (2020) 892(2) The Astrophysical Journal Letters L36.Google Scholar
McGhin, T and others, ‘Blockchain in Healthcare Applications: Research Challenges and Opportunities’ (2019) 135 Journal of Network and Computer Applications 62–75.Google Scholar
McPadden, J and others, ‘Health Care and Precision Medicine Research: Analysis of a Scalable Data Science Platform’ (2019) 21(4) Journal of Medical Internet Research e13043.Google Scholar
Minoli, D, Sohraby, K and Kouns, J, ‘IoT Security (IoTSec) Considerations, Requirements, and Architectures’ (2017) 14th IEEE Annual Consumer Communications & Networking Conference (CCNC), IEEE 1006–7.CrossRefGoogle Scholar
Mittelstaadt, B, ‘Principles Alone Cannot Guarantee Ethical AI’ (2019) 1(11) Nature Machine Intelligence 501–07.CrossRefGoogle Scholar
Mittelstaadt, BD and others, ‘The Ethics of Algorithms: Mapping the Debate’ (2016) 3(2) Big Data and Society 2053951716679679.Google Scholar
Mouchet, C and others, ‘Multiparty Homomorphic Encryption from Ring-Learning-With-Errors’ (2020), Report 2020/304, Cryptology ePrint Archive, https://eprint.iacr.org/2020/304, accessed 1 March 2021.Google Scholar
Nanni, M and others, ‘Give More Data, Awareness and Control to Individual Citizens, and They Will Help COVID-19 Containment’ (2021) 23(1) Ethics and Information Technology 1–6, https://doi.org/10.1007/s10676-020-09572-w, accessed 19 March 2021.Google Scholar
Nebeker, C, Torous, J and Ellis, RJB, ‘Building the Case for Actionable Ethics in Digital Health Research Supported by Artificial Intelligence’ (2019) 17(1) BMC Medicine 1–7.Google Scholar
OECD Principles on AI, www.oecd.org/going-digital/ai/principles/, accessed 14 March 2021. Park, Y and others, ‘Emergence of New Disease: How Can Artificial Intelligence Help?’ (2020) 26(7) Trends in Molecular Medicine 627–29.Google Scholar
Pentland, A, ‘Healthwear: Medical Technology Becomes Wearable’ (2004) 37(5) Computer 42–49.Google Scholar
Pointer, P, ‘The Rise of Telemedicine: How to Mitigate Potential Fraud’ (2020) 2020(6) Computer Fraud and Security 6–8.Google Scholar
Radin, JM and others, ‘Harnessing Wearable Device Data to Improve State-Level Real-Time Surveillance of Influenza-Like Illness in the USA: A Population-Based Study’ (16 January 2020), https://doi.org/10.1016/S2589-7500(19)30222-5, accessed 16 March 2021.CrossRefGoogle Scholar
Rahwan, I, ‘Society-in-the-Loop: Programming the Algorithmic Social Contract’ (2018) 20(1) Ethics and Information Technology 5–14.CrossRefGoogle Scholar
Raisaro, JL, ‘Privacy-Enhancing Technologies for Medical and Genomic Data: From Theory to Practice’ (PhD thesis, École Polytechnique Fédérale de Lausanne 2018).Google Scholar
Raji, ID and others, ‘Closing the AI Accountability Gap: Defining an End-to-End Framework for Internal Algorithmic Auditing’ (2020) Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency (Association for Computing Machinery 2020).Google Scholar
Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC.Google Scholar
Rocher, L, Hendrickx, JM and de Montjoye, YA, ‘Estimating the Success of Re-identifications in Incomplete Datasets Using Generative Models’ (2019) 10(1) Nature Communications 3069.CrossRefGoogle ScholarPubMed
Roehrs, A and others, ‘Personal Health Records: A Systematic Literature Review’ (2017) 19(1) Journal of Medical Internet Research e13.Google Scholar
Roy, JD and others, La Bioéthique, ses fondements et ses controverses (Renouveau pédagogique 1995).Google Scholar
Salama, MA, Hassanien, AE and Mostafa, A, ‘The Prediction of Virus Mutation Using Neural Networks and Rough Set Techniques’ (2016) 2016(1) EURASIP Journal on Bioinformatics and Systems Biology 1–11.Google Scholar
Salathé, M, Wiegand, T and Wenzeland, M, ‘Focus Group on Artificial Intelligence for Health’ (13 September 2018), https://arxiv.org/abs/1809.04797, accessed 1 March 2022.Google Scholar
Saleiro, P and others, ‘Aequitas: A Bias and Fairness Audit Toolkit’ (v2, 29 April 2019), https://arxiv.org/abs/1811.05577, accessed 1 March 2022.Google Scholar
Sandvig, C and others, ‘Auditing Algorithms: Research Methods for Detecting Discrimination on Internet Platforms’ (Preconference ‘Data and Discrimination: Converting Critical Concerns into Productive Inquiry’ at the 64th Annual Conference of the International Communication Association, Seattle WA, 22 May 2014), http://social.cs.uiuc.edu/papers/pdfs/ICA2014-Sandvig.pdf, accessed 1 March 2022.Google Scholar
Savage, N, ‘How AI Is Improving Cancer Diagnostics’ (2020) Nature Outlook, https://doi.org/10.1038/d41586-020-00847-2, accessed 1 March 2022Google Scholar
Scheibner, J and others, ‘Data Protection and Ethics Requirements for Multisite Research with Health Data: A Comparative Examination of Legislative Governance Frameworks and the Role of Data Protection Technologies’ (2020) 7(1) Journal of Law and the Biosciences l.Google Scholar
Schiff, D and others, ‘What’s Next for AI Ethics, Policy, and Governance? A Global Overview’ (2020) Proceedings of the AAAI/ACM Conference on AI, Ethics, and Society 153–58.Google Scholar
Schwab, K, The Fourth Industrial Revolution (Penguin Books 2016).Google Scholar
Sekiguchi, K and Hori, K, ‘Organic and Dynamic Tool for Use with Knowledge Base of AI Ethics for Promoting Engineers’ Practice of Ethical AI Design’ (2018) 35(1) AI & SOCIETY 51, https://doi.org/10.1007/s00146-018-0867-z, accessed 14 March 2021.Google Scholar
Simacek, KF and others, ‘Patient Engagement in Type 2 Diabetes Mellitus Research: What Patients Want’ (2018) 12 Patient Preference and Adherence 595.Google Scholar
Skevington, SM, Lofty, M and O’Connell, KA, ‘The World Health Organization’s WHOQOL-BREF Quality of Life Assessment: Psychometric Properties and Results of the International Field Trial. A Report from the WHOQOL Group’ (2004) 13(2) Quality of Life Research 299–310, https://doi.org/10.1023/B:QURE.0000018486.91360.00, accessed 18 March 2021.Google Scholar
Sung, M, Marci, C and Pentland, A, ‘Wearable Feedback Systems for Rehabilitation’ (2005) 2(1) Journal of Neuroengineering and Rehabilitation 1–12.Google Scholar
‘Swiss Re and Palantir Technologies Put Pioneering Data and Analytics Platform at the Service of Global Health and Joins The Trinity Challenge’ (The Trinity Challenge, 28 October 2020, updated 3 June 2021), https://thetrinitychallenge.org/news-and-stories/swiss-re-and-palantir-technologies-join-the-trinity-challenge/, accessed 7 March 2022.Google Scholar
Terzis, POnward for the Freedom of Others: Marching Beyond the AI Ethics’ in Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency (Association for Computing Machinery 2020).Google Scholar
Thieme, A and Belgrave, D, ‘Data-Driven Insights for More Effective, Personalized Care in Online Mental Health Interventions’ (Microsoft Research Blog, 24 March 2020).Google Scholar
Thomasen, K, ‘Ethics for Artificial Intelligence, Ethics for All’ (2019) 10(1) Paladyn, Journal of Behavioral Robotics 359–363, https://doi.org/10.1515/pjbr-2019-0029, accessed 14 March 2021.Google Scholar
Ting, DSW and others, ‘Artificial Intelligence, the Internet of Things, and Virtual Clinics: Ophthalmology at the Digital Translation Forefront’ (2020)2(1) The Lancet Digital Health e8–e9.Google Scholar
Ting, DSW and others, ‘Deep Learning in Ophthalmology: The Technical and Clinical Considerations’ (2019) 72 Progress in Retinal and Eye Research 100759Google Scholar
Tsoi, K and others, ‘Applications of Artificial Intelligence for Hypertension Management’ (2021) 23(3) The Journal of Clinical Hypertension.Google Scholar
Urman, V and others, La revolution épigénétique (Albin Michel 2019).Google Scholar
Vallee, T and others, ‘On Personalization in IoT’ (2016), 2016 International Conference on Computational Science and Computational Intelligence (CSCI), IEEE 186–91.Google Scholar
Vayana, E and others, ‘Ethical Challenges of Big Data in Public Health’ (2015) 11(2) PLOS Computational Biology e1003904.Google Scholar
Vayena, E and others, ‘Digital Health: Meeting the Ethical and Policy Challenges’ (2018) 148 Swiss Medical Weekly w14571.Google Scholar
Webster, P, ‘Virtual Health Care in the era of COVID-19’ (2020) 395(10231) The Lancet 1180–1.Google Scholar
Whittlestone, J and others, ‘The role and limits of principles in AI ethics: towards a focus on tensions’ Proceedings of the 2019 AAAI/ACM Conference on AI, Ethics, and Society (2019) 195–200.Google Scholar
Wicks, P and others, ‘Scaling Patients LikeMe via a “Generalized Platform” for Members with Chronic Illness: Web-Based Survey Study of Benefits Arising’ (2018) 20(5) Journal of Medical Internet Research, e175.Google Scholar
Winfield, AFT and Jirotka, M, ‘Ethical Governance is Essential to Building Trust in Robotics and Artificial Intelligence Systems’ (2018) 376(2133) Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences 20180085.Google Scholar
WHO (World Health Organisation), Guidelines: ‘recommendations on digital interventions for health system strengthening’ (2018), www.who.int/reproductivehealth/publications/digital-interventions-health-system-strengthening/en/, accessed 14 March 2021.Google Scholar
WHO (World Health Organisation), Presentation of Health Systems, www.who.int/healthsystems/about/en/, accessed 19 February 2021.Google Scholar
Yala, A and others, A Deep Learning Mammography-Based Model for Improved Breast Cancer Risk Prediction (July 2019) 292(1) Radiology 60–66, http://doi.org/10.1148/radiol.2019182716, accessed 1 March 2022.Google Scholar
Yue, X, and others, ‘Healthcare Data Gateways: Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control’ (2016) 40(10) Journal of Medical Systems 218.Google Scholar
Zhang, P and others, ‘Blockchain Technology Use Cases in Healthcare’ in Raj P and Deka GC (eds), Advances in Computers, vol. 111: Blockchain Technology: Platforms, Tools and Use Cases (Academic Press 2018) 1–41.Google Scholar
Zyskind, G, Nathan, O and Pentland, A, ‘Enigma: Decentralized Computation Platform with Guaranteed Privacy (10 June 2015), https://arxiv.org/abs/1506.03471, accessed 1 March 2022.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×