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

日本和英国都在大力投资于国家方案，以加速在医疗保健服务中实施人工智能（1,2,3）。这项技术的好处包括通过使用软件和算法来识别人类观察无法察觉的微妙模式，从而提高效率和降低成本，并利用这些模式产生准确的见解，并为更好的决策提供信息（4,5）。虽然人工智能在医疗保健领域的使用有望带来变革，但它能够在没有直接人工输入的情况下，使用大量个人信息数据集来近似得出结论，这引发了一些关于责任、透明度和问责制以及公众接受度的担忧（6,7）。在临床环境中使用人工智能挑战了支撑医疗保健服务的原则：患者对受专业行为准则约束的系统的信任；认为医疗保健的主要关注点是保障福祉，以及随后发展起来的法律和监管安全网(8)。专家报告已经确定了围绕人工智能使用的一些问题，例如：与获取临床数据相关的隐私问题；它可能如何影响人们知道关于他们的决定是如何做出的合法权利；以及由于数据库和算法的隐式偏见而歧视弱势群体的可能性（8,9）。在英国，人们已经表达了对人工智能公司访问公共生成数据是否会削弱公众对国家医疗服务体系（NHS）的信任的担忧，这可能会危及人工智能的广泛采用，并破坏医疗保健实践的基本原则(1)。由于这些原因，一些报告建议，受这些技术影响最大的患者和更广泛的公众是人工智能未来发展的核心，并参与医疗保健软件的设计、实施和治理，作为共同设计过程的一部分(8)，这将提高成功率并加强以患者为中心的护理。迄今为止，很少有研究关注公众对人工智能实施的关注，或者关注不仅与患者，而且与医疗保健专业人员和更广泛公众接触的最佳策略。我们需要的是一个参与平台，以支持与广泛的利益攸关方进行持续对话，从而使人工智能的实施符合不断变化的公众关切，造福人类。这项研究将在英国和日本率先使用人工智能系统的研究型医院进行，使我们能够确定持续对话和参与的有效模式，从而为未来在医疗保健中使用人工智能提供政策建议。我们将共同设计一个创新的研究计划，以征求包括患者和公众在内的利益相关者对以下方面的看法：1)人工智能在治疗、诊断决策和精准医疗中的当前和预期使用；2)利益相关者认为将影响人工智能在医疗保健中的采用和实施的问题；3)他们希望看到的参与机制、保障措施和监管控制的类型；4)如何开发一个参与平台，以解决信任、责任、问责和透明度问题，并影响规范实践。这将为两国提供见解，促进更持久的公共对话，并为全球决策提供信息。

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.