Will machines take our work? – Part 1: Healthcare and unempathetic artificial intelligence

The Finnish population is getting older, which is creating pressures in the healthcare system. Robots have been envisioned as a potential means for alleviating the workload of nurses. But is artificial intelligence suited for nursing? Would you want a robot to steer your physiotherapy? Can a surgical robot perform as well as a surgeon?

It is generally thought that robots steered by artificial intelligence (AI) will replace people in increasingly complex work tasks. I personally examine the matter from the perspective of work research. On this basis, I can sense if some suggested technological development path appears difficult to implement. On the other hand, work research offers a good perspective on the development of technology, because it offers a medium for identifying the needs of employees, and the division of labour between a human and a machine.

In this article, in addition to healthcare, I touch upon the meaning of empathy in practical work. People have their own experience of what it means to be a human being, so they are capable of placing themselves in some other people’s position, in other words, considering a matter with his or her situation, perspective and feelings in mind. Almost all work tasks require some sense of empathy, since work almost always serves other people’s needs. In most professions, you work for either a customer or an employer, and generally in collaboration with others.

Artificial intelligence is good at playing games

How people act at work is largely based on the expectations of other people and their more or less emphatic understanding of other people’s points of view. Robot, on the other hand, executes rules programmed in it. In addition, a machine can be programmed to edit its own rules, or to learn. Provided with a massive amount of data, a learning AI may develop quite extensive skills within operating environments with clearly definable rules, causal connections and goals. An AI may be good at playing games, and it can be used, for example, for increasing the productivity of a social media marketing campaign.

Even though there are certain rules in healthcare, nursing is not strictly steered by rules, since the work requires situation-specific flexibility. Every patient has a different body, mind and precise clinical status. Therefore, also the way the patient is medicated, washed, operated on, massaged or nursed in general varies. It is not advisable to treat patients with a formal routine. Even though the work may appear as being routine, research shows that nursing includes continuous and discreet micro-level decision-making and adaptation of working methods. Besides on medical training, this decision-making is based on intuition and – as I at least assume – the personal experience of an empathetic care worker of what it means to be a human being.

In a greater degree than most other sectors, healthcare is characterised by uncertainty, since, at an individual level, the outcomes are difficult to predict. Patient’s recovery from, say, a surgical procedure always involves an element of chance, regardless of how well the operation went.

Empathy enhances the quality of treatment

Even though it is not advisable for a care worker to start feeling what the patient is feeling, a good employee acknowledges that the patient’s feelings are of importance with a view to recovery and the quality of treatment. Without empathy, it would be difficult to calm down a patient verbally or by touching.

As a rule, being incapable of empathy, AI is not well suited to replace humans in care work, since care work is difficult to model in the language of mathematics due to the complexity of the phenomena involved. Feelings, the bodily and verbal interaction between people, and intuitive patient-specific decision-making at micro level are phenomena that are difficult to measure and control.

The existing care robots perform simple tasks in hospital logistics, provide entertainment and activate patients. Toylike robots with slight resemblance to humans may act as physical trainers for patients. Research results seem to indicate that patients find robots more motivating and pleasant than exercise videos. Some robot-like intelligence may be programmed in physiotherapeutic devices, i.e., the exact form and challenge level of therapy can be automatically adapted to the patient’s performance. However, the ability of AI to provide personal advice or guidance to patients is very limited or non-existent. In other words, robots will not replace physiotherapists. Devices are not capable of providing hands-on guidance or making comprehensive analyses of patients.

The surgeon’s responsibility and the patient’s destiny

I have personally studied surgical work in particular. In surgical procedures, good experiences have been gained from automation performing certain limited and precisely defined parts of an operation. This takes place under the surgeon’s close control, and the robot has no responsibility whatsoever for the overall performance of the operation. Surgical robots are devices surgeons steer with their hands and feet. The operation is performed through tubes, and the surgical robot also provides a 3D view inside the patient’s body. Viewed through a robot’s eyes the world looks strange and peculiar; object recognition is a real challenge for a surgeon in such an environment. Further development of sensor technology could be of assistance in this matter.

If I personally end up under a surgeon’s robot one day, I would not want the operation to be performed by a superficially skilful surgeon who is in a way playing a computer game with my body. A surgeon follows a pre-agreed surgical plan, but changes are made as the situation requires, because the view of the patient’s clinical status may become more accurate or even change during surgery. Furthermore, a surgical procedure always involves a difficult conflict: the goal is to treat the patient, but surgery always causes some damage as well. For example, in a prostate surgery, the aim is usually to remove the prostate gland containing cancer cells from the body. If you remove too much tissue, the nerves and muscles important for erection and continence may suffer, but if you do not remove enough, cancer treatment does not work. A comprehensive understanding of the patient helps in the decision-making, when the surgeon needs to solve this conflict during the surgery – sometimes the patient may even be so old that it does not matter much whether he maintains his erectile function or not. It is difficult to draw a scientifically established direct connection between sense of empathy and surgical decision-making, but I would personally hope that the surgeon performing the operation would understand at a personal level how important sex and continence are.

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Mikael Wahlström
Senior Scientist, PhD (Soc Psych)
mikael.wahlstrom(a)vtt.fi

 

The author has participated in various automation projects and analysed security-critical work, for example, as a head of the Academy of Finland project called WOBLE that studied the work of surgeons who use robotic systems. WOBLE was funded by the Finnish Work Environment Fund and it was implemented in collaboration with the Finnish Institute of Occupational Health and Tampere University Hospital. The final report of the WOBLE project in Finnish can be found here.

The next two parts of the three-part series of articles will focus on logistics and on modelling machines after humans.

Good Life for Finland – Time to launch a health data & AI ecosystem in Finland

Health data

An American serial entrepreneur and investor Bill Gross gave a popular TED Talk in 2015, in which he stated that timing is the single most important reason for startups to prosper. Perfect timing was the main reason in the successes of Uber, AirBnB, YouTube, and LinkedIn. As examples of failures Gross mentioned e.g. the food delivery service Webvan and the social media pioneer Friendster, both of which entered the market a bit too early. Launching too late doesn’t work either, since the market has already been conquered by others.

Nailing the perfect timing concerns businesses beyond startups. It is also very vital in research and the commercialization of research results. Research groups should have their eyes and ears open for trends in consumer behavior, legislation reforms, and technological innovations.

Finnish health data into use

We are now in the verge of such pivotal moment in the area of health data. From spring 2018 onwards, a new EU GDPR legislation is going to be in effect. GDPR is going to enable a secondary usage of health data. By virtue of this new legislation health data can be utilized in research a lot better than earlier. At the same time, The National Institute of Health and Welfare is going to become a governmental body granting permissions for data usage (link in Finnish).

Why should this be of interest to Finland and the Finnish research and business scene? First of all, Finland already has top quality research in and around the health sector. Furthermore, Finland has excellent ICT know-how and applying artificial intelligence (AI) is supported by the government (link in Finnish).

An even more significant reason, however, is the fact that Finland has a unique health and genomic data population. Health registries have been in use for long and one can get into hospitals with the same credentials across Finland. In this sense Finland is one of a kind.

Added value for health care

The government stated in their midterm resolutions, that the ecosystem model is the way to go in order to speed up digitalization (link in Finnish). Clearly one of the most important ecosystems is in the area of health data and ICT: “Good Life for Finland”. Last spring a strategic research agenda (SRA) in this area was prepared by VTT together with companies and research institutes. The SRA lays out the most significant priorities of the area.

As a unique health data possessor Finland has the opportunity of attracting also international stakeholders to this new ecosystem. We can provide a testbed for validation of research results and trying out new innovations before global launches. In other words, the ecosystem model of operating benefits both research and business, domestic and international alike.

And what’s most important, all these findings and innovations will in the end result in decrease in diseases, increase in life expectancy, less costs in healthcare, as well as overall growth in wellbeing.

All the puzzle pieces are at hand for completing the ecosystem. VTT is already starting operations for reaching the SRA goals. Now is the time to act for making the most of what health data can offer us!

Tua Huomo VTT

Tua Huomo
Vice President, Data-driven solutions
Twitter: @tuajh

A brave, smart new world of healthcare

Where is healthcare heading? Where will the new smart technology take it? Here are some answers by Research Professors Minna Pikkarainen and Heikki Ailisto and Principal Scientist Eero Punkka.

Is the world moving towards a day when new materials, micro-sensors, and data analytics and networks will become combined and we no longer refer to smartphones, smart cars or smart homes – instead, we have a world in which intelligence is a natural, seamlessly built-in and integral element?  This still lies at the end of a long development path, but it is the direction we are inevitably taking and will shape the future of healthcare.

There is a buzz among healthcare providers. Many companies have realised that a billion-euro business lies in personalised and preventative healthcare and the related services. New technologies are enabling us to measure and monitor people more comprehensively. If only we could affect people’s behaviour and prevent even some of their chronic illnesses.

The MyData model (a healthcare data management model suggested in Finland) enables individuals to share data which is currently stored in silos. Otherwise, this would often be difficult due to data protection provisions. In any case, utilising data from various sources such as shopping behaviour, bank services, healthcare or from personal trainers will require reliable technology free of major data security risks.

Continuous digital ‘health monitoring’

The hospital sector is also aware of the potential for using data as part of the hospital services of the future. Based on data and ‘smart’ technology, a care management system and continuous digital ‘health monitoring’ are being designed for patients. This would provide the individual with personalised guidance from healthcare professionals or, say, digital coaching or hospital services.

It looks as though healthcare is undergoing the same transition as bank services once did. Most services will be offered as home-based digital services, with just a fraction being provided from a doctor’s office in the traditional way. Hospitals are also planning to reduce their bed numbers, sending most patients home to be monitored remotely. Operations are more commonly being performed on an outpatient basis. This means that rehabilitation, physiotherapy, follow-ups and patient guidance are moving into the patient’s home.

Home-care services will require easy-to-use and reliable, medically approved devices such as sensors integrated into rooms, furniture, textiles or care robots, combined with the new communication technologies offered by Internet-of-Things. Data produced by sensors will be transferred to decision-support systems, based on which a status report and the best treatment alternatives can be offered to the individual, nurse or doctor.

In addition to the application of a broad range of technologies, the health care of the future will require cooperation between companies from the ecosystem, to ensure that personal data is gathered, processed and transferred easily and securely. Technological development is one of the drivers of this change, but let’s set the goal of ensuring that the brave, smart new world of healthcare enables preventive, personalised, effective and safe treatment, as well as leaving room for a human touch.

Minna Pikkarainen VTT

Minna Pikkarainen, Research Professor

Eero Punkka VTT

Eero Punkka, Principal Scientist 

Heikki Ailisto VTT

Heikki Ailisto, Research Professor
Twitter: @HeikkiAilisto

South Africa’s roadmap to digital health care

Myllyoja Jouko

We are at the Daspoort Clinic in a suburb of Johannesburg. We are told that due to thunderstorms, for example, network connections can sometimes be unavailable even for a week. The key driving force of the clinic are students, who come here to work and learn. 

In spring 2014, VTT initiated two-year long research project ”Digital Health Future – Roadmapping South African Strategy”.  It is an ICI project funded by the Ministry of Foreign Affairs of Finland, aimed at supporting the development of the South African health care system. Long-term impacts of the project are intended to take place through competence building at research partner CSIR-Meraka.

I travelled to South Africa with Torsti Loikkanen and Hannes Toivanen. During our trip, we visited Cape Peninsula University of Technology (CPUT)RLabs, and the Daspoort Clinic. Our visit to CPUT focused on the innovation centre, where students develop their ideas with the support of the staff and together with other students. We paid special attention to how multidisciplinary the activities were, to the powerful hands-on approach of the innovation schemes, and the way the improvement of entrepreneurial skills was supported. Rlabs opened up the dimensions of social innovation in local communities − on the Internet course for women, for example, the most important impact of all might be the opportunity to escape from everyday life and share the challenges it presents with other women. Our visit to the clinic revealed various practical problems of a technological nature, such as the unreliability of Internet connections. Other types of challenges include the ever-changing mobile numbers of local residents and their attitude towards seeking medical treatment.

In addition to meeting local, regional and national challenges, the project involved methodological development work, because the coming together of Foresight and Pro-poor/Inclusive innovation approaches requires the development of a mutual interface. New thinking is also required to address the contents of the Roadmap created under the project – the drivers of change, bottlenecks, technologies or solutions relevant in Western environments may take on a completely different meaning in the context of a developing country. The difference is amplified the closer we get to the local operating environment; for individual clinics, the needs are very concrete and immediate. Talking about megatrends or ten-year plans in such an environment may sound rather hollow.

The local reality, in which history, the political environment, practices, values and practical challenges are different from ours, questions the approaches that are familiar to us, but at the same time provides an opportunity to enrich the way we act and think. We must seize this opportunity, whilst also remembering that the ultimate goal is not to “export” some unique forms of expertise, which will automatically generate new know-how to the recipient. Instead, the purpose is to maintain our ability to stay open to different realities and approaches, share our own know-how, and accept the know-how of our co-operation partners. This mutually beneficial learning process leads to new understanding and competencies that can be applied in various ways – together and separately.

Communication and transparency are also important factors in research when we are operating in a global environment, creating new opportunities for co-operation and aiming for social impact. We will be compiling workshop proposals, research results and other materials generated under the project on the project website at: http://futureshealth.wordpress.com/

Jouko Myllyoja

Senior Scientist 

According to an article in Helsingin Sanomat on 2 June 2014, more than half of the exports of Finnish high technology industry were health-related, making health technology the top field in high technology exports. The same article also noted that the annual growth rate of health technology has remained steady at 6% for the past six years. Health technology is also among the fastest growing industries globally.