Dr. Edward H. (Ted) Shortliffe

Chair Emeritus and Adjunct Professor, Department of Biomedical Informatics, Columbia University
President Emeritus, American Medical Informatics Association

AI Today: Are We Forgetting Our Roots?

Abstract

Five decades have passed in the evolution of Artificial Intelligence in Medicine (AIM), a vibrant research and development field that has made great progress, tracking the corresponding evolution of computer science, hardware technology, communications, and biomedicine. Emerging from medical schools and computer science departments in its early years, the AIM field is now more visible and influential than ever before, paralleling the enthusiasm and accomplishments of artificial intelligence more generally. This talk will briefly summarize some of that AIM history, providing an update on the status of the field as we enter our second half-century. Early predictions of AI’s medical capabilities and rapid impact were stymied by a variety of technical and logistical challenges. Accordingly, it is prudent to exercise caution in assessing the speed at which further progress will be made, despite today’s enthusiastic predictions in the press and significant investments by industry and health systems. My remarks on this subject will reflect the perspective of an informatics journal’s editor-in-chief who sees many state-of-the-art AIM papers and thereby recognizes the tension between applying existing methods to new problems and developing new science that advances the field in a generalizable way. The inherent complexity of medicine and of clinical care necessitates that we address not only decision-making performance but also issues of usability, workflow, transparency, safety, and the pursuit of persuasive results from formal clinical trials. These requirements contribute to an ongoing investigative agenda that means fundamental AIM research will continue to be crucial and will define our accomplishments in the decades ahead.

Biography

Ted Shortliffe is Chair Emeritus and Adjunct Professor of Biomedical Informatics at Columbia University's College of Physicians and Surgeons. He is also Adjunct Professor in Biomedical Informatics at the College of Health Solutions at Arizona State University and Adjunct Professor of Population Health Sciences (Health Informatics) at Weill Cornell Medical College. A Senior Executive Consultant to IBM Watson Health, he previously served as President and Chief Executive Officer of the American Medical Informatics Association (AMIA). Earlier he held positions as Professor of Biomedical Informatics at the University of Texas Health Science Center, Professor of Biomedical Informatics at Arizona State University, and Professor of Basic Medical Sciences and Professor of Medicine at the University of Arizona College of Medicine. He served as the founding dean of the Phoenix campus of the University of Arizona’s College of Medicine. Before that he was the Rolf A. Scholdager Professor and Chair of the Department of Biomedical Informatics at Columbia and Professor of Medicine and of Computer Science at Stanford University.

After receiving an A.B. in Applied Mathematics from Harvard College in 1970, he moved to Stanford University where he was awarded a Ph.D. in Medical Information Sciences in 1975 and an M.D. in 1976. During the early-1970s, he was principal developer of the medical expert system known as MYCIN. After a pause for internal medicine house-staff training at Massachusetts General Hospital and Stanford Hospital between 1976 and 1979, he joined the Stanford internal medicine faculty where he served as Chief of General Internal Medicine while directing an active research program in clinical computing and decision support. He spearheaded the formation of the Stanford graduate degree program in biomedical informatics and nurtured a similar program at Columbia after moving there in 2000. Throughout his academic career he divided his time between clinical medicine and biomedical informatics research.

Dr. Shortliffe is an elected member of the National Academy of Medicine and an elected fellow of both the American College of Medical Informatics and the Association for the Advancement of Artificial Intelligence. Editor-in-Chief of the Journal of Biomedical Informatics, he is also senior editor of Biomedical Informatics: Computer Applications in Health Care and Biomedicine (a Springer textbook soon to appear in its fifth edition). He also received the Morris F. Collen Award of the American College of Medical Informatics in 2006. Dr. Shortliffe has authored over 350 articles and books in the fields of biomedical computing and artificial intelligence.

Dr. Vimla. L. Patel 

Senior Research Scientist and Director, Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Science
Adjunct Professor, Department of Biomedical Informatics, Columbia University

Human Cognition: A Guide to the Evolution of AI in Medicine

Abstract

Since medical practice is a human endeavor, rapid technologic advances create a need for bridging disciplines to enable clinicians to benefit from them. In turn, this necessitates a broadening of disciplinary boundaries to consider cognitive and social factors related to the design and use of technology in the medical context. My awareness of these issues began when I studied the development of models of medical expertise in the late 1980s. By the next decade, as I learned about increasing efforts by others to offer clinical expertise by computer, I began to connect my own studies of medical expertise to the development of expert systems and initiated work at the intersection of these disciplines. Subsequently, we began to witness an increasing emphasis on clinical workflow and socio-technical considerations among the design issues for the AIM community. My group’s cognitive research accordingly began to focus on clinical environments that were characterized by complexity, especially due to requirements that involve multitasking, rapid decision making, and intense stressful demands. In health care there has traditionally been a gulf between technologic artifacts and practitioners. Technologies mediate human performance and transform how health practitioners, individuals, and groups think and make decisions. Our data clearly show that they do not merely augment, enhance, or expedite performance but profoundly influence the human mind.

One lesson learned from the last 30 years of research on medical cognition in our laboratory is the remarkable importance of cognitive factors that determine how health professionals comprehend information, solve problems, and make decisions. Cognitive investigations into the process of medical reasoning have made significant contributions to design of clinical AI systems. AI’s role in medicine is a frequent topic of discussion by health practitioners, the scientific community, vendors, and the general public. However, we still have much to learn regarding the nature of such technologies intended for health professionals. We have not focused adequately on how AI tools can influence the cognitive processes of these practitioners. Our focus on automation and efficiency has tended to neglect some of the critical clinical-safety issues related to the intersection of technology with how expert users think and behave. My talk will elaborate on what we have learned about how medical practitioners acquire and utilize expertise, thereby defining key lessons and challenges for the development of usable, useful, and safe AI systems to augment human intelligence in the clinical world.

Biography

Vimla L Patel is a Senior Research Scientist and Director of the Center for Cognitive Studies in Medicine and Public Health at the New York Academy of Medicine. She is also adjunct Professor of Biomedical Informatics at both Columbia University, Population Health Sciences (Health Informatics) at Weill Cornell Medical College. and the College of Health Solutions at Arizona State University. A cognitive science PhD graduate of McGill University in Montreal, she was a Professor of Medicine and the Director of Cognitive Science Center there. Her early research focused on medical decision-making and expertise with an interest in scientific foundations for medical education. She subsequently served on several biomedical informatics faculties as Professor at Columbia (2000-2007), Professor and Chair at Arizona State University (2007-2009), and Professor at the University of Texas Health Sciences Center in Houston (2009-20011).

An elected fellow of the Royal Society of Canada, the American College of Medical Informatics, and the International Academy of Health Information Sciences, she was recipient of the 1999 Swedish Women of Science award. She received an honorary doctorate from the University of Victoria in 1998. An associate editor of the Journal of Biomedical Informatics and editor of the Springer book series on Cognitive Informatics in Biomedicine and Healthcare, and she is also on the editorial board of the Journal of Intelligence-based Medicine. She is a past assistant editor of Artificial Intelligence in Medicine and a member of the editorial boards of Medical Decision Making, the Journal of Experimental Psychology, and Topics in Cognitive Science. As an active researcher, her current studies deal with the impact of technology on human cognition for safe and effective clinical practice. Her general interest lies in bridging natural and artificial intelligence, and the role of AI in augmenting human intelligence. She has over 300 scholarly publications spanning books and journals in biomedical informatics, education, clinical medicine, and cognitive science.