Artificial intelligence set to revolutionise future occupational health delivery

artificial intelligence

Artificial intelligence could take over many professional tasks in future, including in occupational health. OH adviser Susan Carty urges practitioners to embrace change and offers an example in the NHS of how technology can deliver efficiencies.

“Technology will replace many doctors, and other professions.” This headline caught my eye in October 2016 when I was preparing a presentation for the Medgate UK annual conference.

The article, from the Harvard Business Review (Susskind R and Susskind D, 2016), has become my wake-up call. It states that faced with the claim that artificial intelligence (AI) and robots are poised to replace most of today’s workforce, most mainstream professionals — doctors, lawyers, accountants, and so on — believe they will emerge largely unscathed.

But the research and analysis challenges the idea that these professionals will be spared. The researchers expect that within decades, the traditional professions will be dismantled, with most professionals replaced by fewer expert people, new types of experts, and high-performing systems.

My initial reaction was “not on my watch”. Having worked within the field of OH since 1993, I have seen, and been part of, many paradigm shifts.

I began my career as a factory nurse and studied at the Royal College of Nursing when the Occupational Health Certificate was a non-English National Board approved course (the ENB was subsequently replaced by the Nursing and Midwifery Council). I then acquired an occupational health Master’s degree and a Master of Business Administration (MBA).

The key factor behind all the change I have seen and innovations I have implemented has been the use of technology to reduce the effort required to complete

high-volume tasks. This has involved deconstructing some of the traditional ways of working, and challenging statements such as: “Only qualified occupational health advisers [OHAs]/physicians can perform/undertake that task.”

What is artificial intelligence?

AI is an umbrella term for a group of technologies – including machine learning – that enable computers to learn new skills and capabilities based on the data they are exposed to.

Machine learning started making its way into industry in the early 1990s. It began with relatively simple tasks, such as assessing credit risk from loan applications, and sorting the mail by reading handwritten characters from post codes. In recent years there have been many dramatic breakthroughs. Machine learning is now capable of far more complex tasks.

In 2012, the Kaggle data science platform challenged its community to build an algorithm that could grade high-school essays (Goldbloom, 2016). The winning algorithms were able to match the grades given by real teachers.

Last year, Kaggle issued an even more difficult challenge. Can you take images of the eye and diagnose a disease called diabetic retinopathy? Again, the winning algorithms were able to match the diagnoses given by ophthalmologists.

Now, given the right data, machines are going to outperform humans at tasks of this type. A teacher might read 10,000 essays over a 40-year career. An ophthalmologist might see 50,000 eyes. A machine can read millions of essays or see millions of eyes within minutes. We have no chance of competing against machines on frequent, high-volume tasks.

But there are things we can do that machines cannot. Where machines have made very little progress is in tackling novel situations. They cannot handle things they have not seen many times before.

The fundamental limitation of machine learning is that it needs to learn from large volumes of past data.

This is not the case with humans, who have the ability to connect seemingly disparate threads to solve problems we have never seen before.

Artificial intelligence in OH

OH physician Steve Boorman (2016, 2017) believes OH needs to adopt new and developing technologies to meet the OH demands of the modern UK workforce.

He talks about the shortfall in specialist practitioners (from a range of disciplines), referencing the two reports published by a working group led by John Harrison under the auspices of the Council for Work and Health (2014) and the need to reduce the divide from mainstream care.

Boorman says we need to challenge ourselves to think about thought-leading clinician Dr Eric Topol’s call for the medical profession to accept radical and transformational change. Boorman provides two compelling examples:

  1. Wearable, portable, real-time devices provide huge potential to extend our reach and to understand in a more objective way the demands on workers, as opposed to relying on history taking.
  2. The monitoring of occupational exposures in real time. While the technology may be new, the principle is the same as carrying a canary into a mine, according to Boorman.

A theme discussed by Susskinds (2016) is the shrinking effect that has already seen many of the roles of experts disappear. The examples are: nurse prescribers, para-legals, the expansion of the pharmacist’s role, the claims adviser and so on. I have seen this as progress, much of it technology assisted, freeing doctors, solicitors, nurses and pharmacists to add greater value.

We are already seeing professionals adapt so that they can work alongside more intelligent technological systems.

Take your bank manager. When you used to approach him or her for a loan, they would carefully make a decision on whether or not you were a good risk, then either give you the money or send you home. Now, an algorithm determines whether or not you’re awarded the cash, and yet bank managers still exist. The role has simply changed, to become a customer service and sales job rather than an analytical or technical.

Innovation in NHS Wales

At Medgate, we have been working with NHS Wales Shared Services Partnership (NWSSP) and some health boards to develop a link with the NHS electronic staff record (ESR) through a bi-directional interface. The interface enables OH information related to immunisations, checks and incidents for NHS staff to be recorded and monitored to manage the health clearance process for employees.

ESR allows medical assessments, immunisations and checks to be recorded, monitored, managed and reported on at a local level. Up-to-date information relating to immunisations, checks and OH incidents can be securely transferred to future employers on request using the unique inter authority transfer (IAT) process as part of the pre-employment process.

The effective use of ESR is intended to drive efficiency and productivity improvements across the NHS.

Specifically, this means rationalisation of corporate service functions, such as recruitment, HR, and payroll, can be achieved by embracing the opportunities that a national integrated solution, such as ESR, brings to every NHS organisation.

Medgate is also exploring ways in which health level-7 (HL7) standard can further enhance the provision of OH services. HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers.

Electronic medical records are very difficult to construct because the existing electronic data sources – for example, laboratory systems, pharmacy systems, and physician dictation systems reside on many isolated islands with differing structures, differing levels of granularity, and different code systems.

Using HL7 we can resolve record movement problems to improve the quality and coherence of the care process, to automate guidelines and care pathways to assist clinical research, outcomes management, and process improvement.

In general, technology will make many jobs redundant, others easier, and create at least some new ones along the way. But we can still choose to see the potential for intelligent technologies to augment and enhance our OH roles, and not simply replace them.

Susan Carty is an occupational health specialist at Medgate.

References

Boorman S. “A Healthier Tomorrow”. Occupational Health at Work December/January 2016/2017, vol.13(4), pp.34-36.

Goldbloom A. “TED Talk: The jobs we’ll lose to machines – and the ones we won’t”. Posted August 2016.

Harrison J (2014). “Planning the future: delivering a vision of good work and health in the UK for the next 5-20 years and the professional resources to deliver it”. London: Council for Work and Health.

Harrison J (2014). “Planning the future: implications for occupational health; delivery and training”. London: Council for Work and Health.

Susskind R and Susskind D. “Technology will replace many doctors, and other professions”. Harvard Business Review 11 October 2016.

Susskind R and Susskind D. “The future of the professions”.

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