the health strategist
institute for research & strategy

Joaquim Cardoso MSc.

Chief Research and Strategy Officer (CRSO),
Chief Editor and Senior Advisor

August 14, 2023

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The article discusses the growing role of artificial intelligence (AI) in healthcare, particularly focusing on its potential to improve clinical outcomes, patient-centered care, quality, and equity.

JAMA, a leading medical journal, emphasizes its commitment to rigorously evaluating AI advancements’ impact on patient health, health systems, and societal fairness.

The article outlines AI’s potential applications, ranging from clinical care enhancement to addressing medical bias and disparities.

One page summary:

The article titled “AI in Medicine—JAMA’s Focus on Clinical Outcomes, Patient-Centered Care, Quality, and Equity” delves into the significant role that artificial intelligence (AI) is beginning to play in the healthcare sector.

While the concept of AI’s transformative potential in medicine has been discussed for years, recent technological advancements have brought this vision closer to reality. Notably, the emergence of large language models (LLMs) in interactive applications has ignited interest in how AI can revolutionize patient care, public health, clinical practice, and more.

JAMA, one of the most prominent general medicine journals globally, is determined to support the scientific development, evaluation, and implementation of AI in healthcare.

The article underscores JAMA’s commitment to rigorous evaluation of AI advances, their implications for patient health and healthcare systems, and their potential to address historical medical biases and inequities.

The journal aims to communicate AI’s scientific breakthroughs in a manner that enhances the collective understanding of AI’s domain among stakeholders in medicine and public health.

Drawing parallels with established frameworks for scientific development in health-related sciences, the article envisions a similar trajectory for AI research.

It suggests that AI’s journey—from identifying mechanisms of disease to testing interventions to studying outcomes for populations—can be mapped onto this framework, thus emphasizing the importance of methodical and evidence-based exploration.

The editors of JAMA are particularly interested in original science that focuses on the development, testing, and deployment of AI in studies that aim to enhance patient outcomes and public health.

The article identifies key areas of emphasis, including:

1. Clinical Care and Outcomes: JAMA is keen on studies that showcase the practical translation of novel AI technologies into effective clinical care, as the potential for tangible clinical impact serves as a crucial benchmark for evaluating AI studies.
2. Patient-Centered Care: Acknowledging that AI has the potential to reshape patient care experiences and outcomes, the article highlights the need for research that examines how algorithmic care affects individuals and their health-related decisions. This includes considerations of autonomy, accessibility, education, and other aspects that contribute to the patient’s well-being.
3. Health Care Quality: AI has the capacity to address challenges in delivering evidence-based care to diverse patient populations. JAMA is interested in research that evaluates how AI technologies can improve access to high-quality healthcare for all patients, particularly in complex clinical scenarios.
4. Fairness in AI Algorithms: The article emphasizes the importance of assessing the fairness of AI algorithms and their potential to either bridge or exacerbate health disparities. Research that investigates algorithmic bias and proposes strategies to mitigate such biases is encouraged.
5. Medical Education and Clinician Experience: As digital health technologies contribute to information overload for clinicians, the article highlights the relevance of studies exploring how AI can alleviate these challenges, enabling healthcare teams to function optimally and enhance patient care.
6. Global Solutions: The article underscores the importance of adapting critical AI technologies to low-resource settings, with the goal of improving healthcare access and reducing health disparities across diverse societies.

In addition to fostering scientific research, JAMA aims to engage with experts and thought leaders across various domains to ensure the ethical and inclusive advancement of AI in medicine.

The journal seeks to serve as a platform for the publication of transformative AI-driven work and to communicate scientific findings effectively to a broad audience through digital, multimedia, and social media channels.

With its extensive reach, the JAMA Network is positioned to amplify the impact of AI research on healthcare delivery, patient outcomes, and global health equity.

DEEP DIVE

AI in Medicine—JAMA’s Focus on Clinical Outcomes, Patient-Centered Care, Quality, and Equity [excerpt]

JAMA Network

Rohan Khera, MD, MS –  Atul J. Butte, MD, PhD –  Michael Berkwits, MD, MSCE –  et alYulin Hswen, ScD, MPH – Annette Flanagin, RN, MA –  Hannah Park –  Gregory Curfman, MD – Kirsten Bibbins-Domingo, PhD, MD, MAS

August 11, 2023

The transformative role of artificial intelligence (AI) in health care has been forecast for decades,¹ but only recently have technological advances appeared to capture some of the complexity of health and disease and how health care is delivered.² Recent emergence of large language models (LLMs) in highly visible and interactive applications³ has ignited interest in how new AI technologies can improve medicine and health for patients, the public, clinicians, health systems, and more. The rapidity of these developments, their potential impact on health care, and JAMA’s mission to publish the best science that advances medicine and public health compel the journal to renew its commitment to facilitating the rigorous scientific development, evaluation, and implementation of AI in health care.

JAMA editors are committed to promoting discoveries in AI science, rigorously evaluating new advances for their impact on the health of patients and populations, assessing the value such advances bring to health systems and society nationally and globally, and examining progress toward equity, fairness, and the reduction of historical medical bias. Moreover, JAMA’s mission is to ensure that these scientific advances are clearly communicated in a manner that enhances the collective understanding of the domain for all stakeholders in medicine and public health.⁴ For scientific development of AI to be most effective for improving medicine and public health requires a platform that recognizes and supports the vision of rapid cycle innovation and is also fundamentally grounded in the principles of reliable and reproducible clinical research that is ethically sound, respectful of rights to privacy, and representative of diverse populations.^2,3,5

The scientific development in AI can be viewed through the framework used to describe other health-related sciences.⁶ In these domains, scientific discoveries begin with identifying biological mechanisms of disease. Then inventions that target these mechanisms are tested in progressively larger groups of people with and without diseases to assess the effectiveness and safety of these interventions. These are then scaled to large studies evaluating outcomes for individuals and populations with the disease. This well-established scientific development framework can work for research in AI as well, with reportable stages as inventions and findings move from one stage to the next.

The editors seek original science that focuses on developing, testing, and deploying AI in studies that improve understanding of its effects on the health outcomes of patients and populations. The starting point is original research rigorously examining the challenges and potential solutions to optimizing clinical care with AI. In addition, to ensure our readers remain abreast of major scientific development across the entire continuum of scientific innovation, we invite reviews, special communications, and opinion articles that summarize the potential health care applications of emerging technology written for our journal’s broad readership.

While highlighting new developments, JAMA will focus on these essential areas (Figure):

Figure.  The Continuum of Scientific Development in Artificial Intelligence and Thematic Priority Areas

• Clinical care and outcomes: JAMA’s key interest is in clinically impactful science, and we will be most interested in studies demonstrating the effective translation of novel AI technologies to improve clinical care and outcomes. The potential for clinical impact will represent an important yardstick in our evaluation of all AI studies.
• Patient-centered care: Early phases of scientific development have focused on directly measurable outcomes, reflecting the broader availability of data on these outcomes. However, how algorithmic care may shape the care experience of individuals and outcomes of interest to patients remains an understudied domain.⁷ Implementing novel technology to enhance patient care and experience can only achieve its intended effect when patients believe that it offers them an advance—either through more time with their clinicians, more accessible information on their care decisions, or personalized interventions that target the outcomes of interest to them. We encourage studies that consider domains of autonomy, mobility, comfort, education, or other aspects of health not measured in traditional outcome assessments.
• Health care quality: Advances in modern medicine are often stymied by the inability to translate evidence-based care to all patients. As clinicians increasingly provide care for more complex patient conditions in an ever-expanding therapeutic landscape, AI can play a crucial role in alleviating current challenges in optimizing clinical care,⁸ if stewarded appropriately when positioned in the medical enterprise.⁹ We are interested in studies that assess the potential for AI technologies to improve access to high-quality health care for all patients.
• Fairness in AI algorithms: We encourage the explicit assessment of the fairness of algorithms and their potential effect on health inequities. Through development on biased data sources or restricted deployment in privileged health care settings, algorithms can potentially exacerbate health outcome gaps across socioeconomic and sociocultural axes.⁹ We are interested in studies that assess the fairness of algorithms, their potential impact on health disparities, and strategies to mitigate biases.
• Medical education and clinician experience: In addition to patient-facing science, we seek investigations into the role of AI in addressing the challenges clinicians face in medical training and in the practice of medicine. The information overload through digital health technologies has posed an increasing burden on clinicians, with unintended consequences for their health and well-being. This remains a central area to target for AI in health. The investigations in this domain will evaluate the use of AI to enable a health care team and its members to function to the highest and best use of their expertise.
• Global solutions: To advance health care beyond well-resourced countries, critical technologies would need to adapt to the infrastructural, technological, and health care milieu across the globe. We invite investigations to submit science that demonstrates and evaluates AI applications that enhance care within the limitations of low-resource settings. AI-driven method development that enables low-cost tools to be even more effective at diagnosis and treatment, and those that guide the fair and appropriate allocation of limited resources, may move the needle on bridging the health disparities across societies across the globe.

JAMA is one of the most widely circulated general medicine journals in the world and the flagship journal of the JAMA Network, which includes 11 specialty journals and JAMA Network Open. Submissions are welcome to all the JAMA Network journals. The Network also offers the advantage of coordinated publications, as well as amplification of findings to specific audiences of interest. With a mission to reach clinicians, scientists, patients, policymakers, and the general public globally, the value of JAMA and the JAMA Network for authors and readers interested in AI in medicine is clear.

We seek to engage scientists and other thought leaders advancing AI and medicine across clinical, computational, health policy, and public health domains. We invite authors to communicate directly with the editors about topics they believe can impact health care delivery and to connect with the editors to discuss further the development of your science and our approach to its evaluation; such engagement is critical in this rapidly evolving field.

We are committed to including diverse opinions and voices in the journal and urge experts from across the career spectrum and the globe to participate in the discourse. The editors are committed to communicating science effectively to a broad range of stakeholders across our digital, multimedia, and social media avenues. As AI promises to enable major health care transformation, JAMA and the JAMA Network are positioned to serve as a platform for the publication of this transformative work.

Article Information

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References

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Authors and Affiliations

Rohan Khera, MD, MS¹; Atul J. Butte, MD, PhD²; Michael Berkwits, MD, MSCE³; et alYulin Hswen, ScD, MPH⁴; Annette Flanagin, RN, MA⁵; Hannah Park⁶; Gregory Curfman, MD⁷; Kirsten Bibbins-Domingo, PhD, MD, MAS⁸

¹Associate Editor, JAMA; and Yale School of Medicine, New Haven, Connecticut

²Editorial Board member, JAMA; and University of California, San Francisco

³Electronic Editor, JAMA and JAMA Network

⁴Associate Editor, JAMA; and University of California, San Francisco

⁵Executive Managing Editor, JAMA and JAMA Network

⁶Managing Director of Strategy and Planning, JAMA and JAMA Network

⁷Executive Editor, JAMA and JAMA Network

⁸Editor in Chief, JAMA and JAMA Network

Originally published at https://jamanetwork.com/journals/jama