Table Of ContentThe Thinking Healthcare System
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The Thinking Healthcare
System
Artificial Intelligence and Human Equity
Dominique J. Monlezun, MD, PhD, PhD, MPH
UT MDAnderson Cancer Center,
Houston, TX, United States
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Dedication
To Mary, who started this whole thing.
d
To Susan, Lucy, Andre´, and Jude you are
the best of me.
To my parents, siblings, and extended
family, for showing me some things are
worth fighting for.
To Dr. Colleen Gallagher,
Dr. Cezar Iliescu, Dr. Alberto Garcia,
Dr. Timothy Harlan, Dr. Richard Velkley,
Dr. Rebecca Mark, Dr. Shane Courtland,
d
and Dr. B. your mentorship echoes in
every one of my pages.
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Contents
1. Healthcare systems: challenges, crises, and cures
1.1 Background, purpose, andstructure: whyisthisworthyour
time? 1
1.2 Rationale:avoidingthe graftrejectionandomitted variable
traps 3
1.3 Thebook’sdefining value-add þaudience 5
1.4 Foundational definitionsandconcepts 7
1.5 Historicaldevelopment 9
1.6 Value-based healthcaresystems:health’sfuture? 10
1.7 Politics,economics, andregulation 12
1.8 Presentproblems:poorquality,safety,prevention,andcost 15
1.8.1 Presentproblems:poorquality 15
1.8.2 Presentproblems:poorsafety 18
1.8.3 Presentproblems:poorprevention 19
1.8.4 Presentproblems:poorcost 21
1.9 Emergingsolutions: digital,personalized,globalized, fair 23
1.9.1 Emergingsolutions:digital 23
1.9.2 Emergingsolutions:personalized 25
1.9.3 Emergingsolutions:globalized 26
1.9.4 Emergingsolutions:fair 27
1.10 AI: fromsurvivaltosustainablehealthcaresystems 28
References 28
2. AI þ healthcare systems: efficiency and equity
2.1 Objectivesandscope 37
2.2 AIoverview 39
2.3 HealthcareAIoverview 41
2.4 Digitaltransformationofhealthcare:healthcareAI’sdata
infrastructure andsystemintegration 44
2.4.1 Structureofthemodernhealthcaresystem 44
2.4.2 Digitalizationofhealthcare:fromthedigitalrevolutionto
AIdatainfrastructure 46
2.5 HealthcareAI’sR&D process 48
2.5.1 AIR&Dcoreareas 48
2.5.2 AIR&Dpipelinedesign:trustworthy,ethical,and
effectiveAI 49
vii
viii Contents
2.6 HealthcareAIgovernanceandworkflow 50
2.6.1 HealthcareAIgovernance 50
2.6.2 HealthcareAIworkflow 52
2.7 HealthcareAIinsystemdesignandoperation 57
2.8 Frontrunner for thefuture’sAI-drivenhealthcaresystem 61
2.9 Thegenome oftheAI-poweredfuture healthcaresystem 62
References 63
3. AI þ precision medicine: data science and multiomics
3.1 Precisionversus personalizedmedicine 69
3.1.1 Conceptualdistinction 69
3.1.2 Genomicmatchingwithumbrella,basket,andN-of-1
trials 70
3.2 Precisionmedicine’shistoricaldevelopment 71
3.3 Precisionmedicineversus publichealth: fightingfor
healthcare’sfuture 73
3.4 AIþhealthcare BigData¼precisionmedicine:BigData,
chaostheory,andAIoverfitting 75
3.4.1 HealthcareBigData:clinicalandorganizational
structures 75
3.4.2 HealthcareAIanalytics:modelfitconceptualoverview 77
3.4.3 HealthcareAIanalytics:AI-HealthSIPsandmodel-
informeddecisions 80
3.4.4 AI-HealthBD:impactonfuturehealthcaresystemdesign 81
3.5 Value-based systemapproach toprecisionmedicine:open
practically,closedconceptually 83
3.5.1 OpenhealthcaresystemmodelinAI-HealthBD 83
3.5.2 EarlyscalingofPrMedvalueusecaseofAI-HealthBD 85
3.5.3 AI-HealthBDdata “oceans,”valuebarriers,and
countermeasures 87
3.6 AI-enabled omicsinprecisionmedicine:60%socialþ30%
genes þ10%medical¼healthdeterminants 88
3.6.1 Mutiomicsbarriersandbreakthroughs 88
3.6.2 Translationalmultiomics,pharmacogenetics,and
radiogenomicsusecases 91
3.7 AI-enabled data scienceþmultiomics¼Personalized
medicine’sfuture 93
References 93
4. AI þ public health: effective and fair collaboration
4.1 History,concepts,andterms 99
4.1.1 Recap 99
4.1.2 Quarantinestovaccines 99
4.2 “Globalhealth” reformulationandanticolonialresistance 102
4.2.1 PubHealth’sconceptualreformulationas“globalhealth” 102
4.2.2 Anticolonialcritiqueofglobalhealth 103
Contents ix
4.3 ThegreatCOVIDreset 105
4.3.1 FromCOVID-19stresstest forPubHealthtoAI
pressureforPubHealthredesign 105
4.3.2 Post-COVIDethicalAIresetforPubHealth 107
4.4 Emerging trendsframing ethicalAI-enabled PubHealth 108
4.5 AI-enabled PubHealthpiloted applications 112
4.6 AIhealthashealthcaresystem-basedAI-PubHealth:
sovereignty,solidarity,success 118
4.6.1 AIhealthconceptualupdate 118
4.6.2 AIhealth:PubHealth’s contributiontosovereignty,
solidarity,andsurvival 123
References 124
5. AI þ telehealth: plugging into the digital ecosystem
5.1 Telehealthoverview 131
5.1.1 Conceptualframework 131
5.1.2 Telehealth¼eHealthþtelemedicine 133
5.2 Post-COVIDsurging usageþinvestments 134
5.3 Digitalecosystem:disparities anddevelopmentsinhealth
infrastructure andregulations 136
5.3.1 Globaldigitalecosystem 136
5.3.2 Digitalhealthecosystem 136
5.3.3 Digitalhealthinfrastructureþtelehealthblockchain 138
5.3.4 Regulations 140
5.4 Bridgingtelehealth’sdigitaldividewithedgecomputing 142
5.4.1 Thedigitaldivide’sthreattodisparities andtelehealth 142
5.4.2 Cloud-fog-edgecomputinginITarchitecture 144
5.4.3 Edgetelehealthreducingdisparities 145
5.5 Bridgingtelehealth’sdigitaldividewithAI-enabled collective
intelligentnetworkconnectivity 147
5.5.1 Connectivitydisparities 147
5.5.2 Nonterrestrialnetworks 147
5.5.3 AI-enabledconnectivity 148
5.6 AI-enabled telehealthusescases expandinghealthcare
systems’borders 149
5.6.1 Value-basedstrategicexpansion 149
5.6.2 SystemdesignwithAI-enabledandgeospatialinformed
telehealth 151
5.6.3 Telehealthimplicationsforpatientsafety 152
References 153
6. AI þ patient safety: adaptive, embedded, intelligent
6.1 Patientsafety:debatesanddefinitions 159
6.1.1 Overviewofscopeandaims 159
6.1.2 Conceptualizingpatientsafety 160
6.1.3 WHO’spatientsafetyframework 162
