Ensuring the benefits of AI in healthcare for all: Designing a Sustainable Platform for Public and Professional Stakeholder Engagement

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Japan and the UK are both investing heavily in national programmes to accelerate the implementation of AI in healthcare delivery (1,2,3). The perceived benefits of this technology include increased efficiacy and cutting costs by using software and algorithms to 'identify patterns too subtle to be detected by human observation, and to use those patterns to generate accurate insights and inform better decision making (4,5). While the use of AI in healthcare promises to be transformative, its ability to approximate conclusions without direct human input using large datasets of personal information, raises a number of concerns about responsibility, transparency and accountability, and public acceptance (6,7). The use of AI in clinical settings challenges the principles that underpin healthcare delivery: the patient's trust in a system governed by professional codes of conduct; the belief that the primary concern of healthcare is to safeguard well-being, and the subsequent legal and regulatory safety nets that have evolved (8). Expert reports have identified a number of issues surrounding the use of AI, such as: privacy concerns associated with access to clinical data; how it might influence people's legal right to know how decisions about them are made; and the possibility of discrimination of vulnerable populations due to database and algorithm implicit biases (8,9). In the UK, concerns have already been expressed about whether access to publicly-generated data by AI companies might erode public trust in the National Health Service (NHS), potentially jeopardising wide-spread adoption of AI and undermining the basic tenets of healthcare practice (1). For these reasons, a number of reports have recommended that patients and wider public, who will be most impacted by these technologies, are central to the future development of AI and involved in the design, implementation and governance of software for healthcare, as part of a co-design process (8), that will improve success rates and enhance patient-centred care. To date, very few studies have focused on public concerns regarding AI implementation, or the best strategies for engaging not just with patients, but healthcare professionals and wider publics. What is needed is an engagement platform to support a sustained dialogue with a broad range of stakeholders, so the implementation of AI is in accordance with changing public concerns and for the benefit of humanity. This research will be situated in research hospitals in the UK and Japan that are pioneering the use of AI systems, to allow us to identify effective models for sustained dialogue and engagement that can inform policy recommendations for future use of AI in healthcare. We will co-design an innovative programme of research to elicit the views of stakeholders, including patients and the public regarding: 1) the current and anticipated use of AI in treatment, diagnostic decision-making and precision medicine 2) the issues that stakeholders perceive will influence the adoption and implementation of AI in healthcare; 3) the types of engagement mechanisms, safeguards and regulatory controls they would like to see in place; and 4) how to develop a platform for engagement that can address issues of trust, responsibility, accountability and transparency, and influence normative practice. This will provide insights for both countries, leading to better sustained public dialogue, as well as informing global policy-making.