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.

Will robots make us better persons?

How will our society change as artificial intelligence and robotics develop? To what kind of new humanity will robotics liberate us? Will the added value brought by robots be available for the well-to-do only? We must start discussing ethics of new technology before this technology becomes an integral part of our everyday lives. The essential thing is to keep posing questions, even if there were no answers to be found right away.

Often it is even more essential to keep posing questions than finding answers to them. This is true at least when faced with ethical questions. Ethical questions related to the use and instilling of technology require asking questions, consideration and debate from versatile perspectives and at different levels. This is particularly important, when we are in the process of pushing people whose voice is not always very clearly heard in our society to use technology: those living in the margins of our society. They need us others, who might be able to give them a voice through our own deliberations.

Very seldom ethical consideration of matters reaches a fruitful level if they are discussed between own team members or colleagues only; Establishing a wider perspective requires views from various angles and stakeholders.

Ethical technology and many-voiced approach

I ran a workshop that VTT organised in collaboration with RoboBisnes operators, or the North Karelia Municipal Education and Training Consortium and Karelia University of Applied Sciences. With a group of 40 people, we spent a whole afternoon delving deep into the opportunities offered and the concerns raised by robotics and artificial intelligence. We sought perspectives, for example, from the everyday lives of older people and the mentally disabled.

Ari Tarkiainen, Project Manager at Karelia University of Applied Sciences, made an important observation at the session: “In a way, ethics is kind of an inherent part of new technology, since new applications and opportunities produce a lot of situations of which we have no previous experience. It is also descriptive of the current situation that such new situations have not been taken into account in legislation and no practices have been established for managing them. Therefore, ethical questions should be strongly highlighted all the time. VTT has been acting as a key expert and developer in this collaboration between ethics and technology”.

Technology is not black and white

Even though universal ethical values guide us to consider what is good and bad, or right and wrong, technology is never black and white. When we listen to each other – and also really hear what is being said – the border between black and white begins to waver and we begin to see bright colours and different shades of grey. In the hum of voices (and North Karelians are known for being eager to talk!), the values shared by most of us find a fairly comprehensible form within the Finnish framework.

After a while, that clarity fades away, when we keep on examining these values from a multicultural perspective:

  • Which values can take us forward?
  • What creates trust in society?
  • What kind of fringe areas does digitisation create, and who live in these fringes?
  • To what kind of new humanity would technology going beyond our thinking capacity liberate us?
  • Why does technology sometimes raise issues of insecurity and vulnerability regardless of the fact that it also opens up new enchanting paths in our everyday lives.
  • What is the ethical thread that will last until the end?

When discussing these questions, and going forwards and backwards, we came up with some positive visions of robotics. “Robots enable easy-to-use user interfaces and increase digital inclusion. Maybe, with the help of ugly robots, we also learn to accept the different appearances of people. It is great that robots do not know how to have tantrums! I could quite easily trust them with all cleaning duties.” Some female participants were also of the opinion that, luckily, robots are quite advanced, unlike human males, which are still being developed in the right direction in many households. Tears were running down people’s cheeks with laughter, and there was room for all kinds of opinions at the session venue, near the Joensuu market place.

Talking and laughing together, sharing our common experiences, does good to us people. That is something a robot is unlikely to be capable of any time soon. But robots can liberate us of from many dull tasks to having the kind of ‘quality time’ together as described above.

We will organise more similar workshops in the future. Consideration of the borders and framework conditions of humanity is important, and right now, in the middle of major changes, it is particularly important.

Read more at www.vttresearch.com/services/digital-society

jaana_leikas

Jaana Leikas
Principal Scientist, VTT
jaana.leikas(a)vtt.fi
Cell: +358 407 500 211

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