Was Künstliche Intelligenz heute schon im Gesundheitswesen leistet
KI könnte die gesunden Lebensjahre vieler Menschen verlängern. Aber der technische Fortschritt schafft es nicht in die praktische Umsetzung. Wir erforschen, wie man die Hindernisse überwinden kann.
Alle reden von Generativer Künstlicher Intelligenz (ChatGPT & Co). Ihre Leistungen sind beeindruckend: ChatGPT kann komplexe Konzepte zugleich genau und verständlich erklären, unter anderem wie es selbst funktioniert. Allerdings stellt generative KI keine vernünftigen kognitiven Überlegungen an, wenn es etwas erklärt. So kannte ChatGPT im April das Konzept des Geschlechts noch nicht. Fragte man nach weiblichen Autorinnen, wurden in männlich dominierten Wissensbereichen primär männliche Autoren vorgeschlagen.
Solche Defizite überraschen nicht. Generative KI produziert nicht kognitive Schlüsse, sondern Artefakte – Texte, Bilder, Code – die gefallen und situativ funktionieren sollen. Kunstschaffende verwenden sie beispielsweise als Störfaktor, der ihre Kreativität provoziert. Sie funktioniert dann genau dadurch, dass sie Fehler produziert. Aber sie hilft auch in vielerlei anderer Hinsicht. Sie nimmt den Kunstschaffenden Arbeit ab und ermöglicht neue Kunstpraktiken. Auch das überrascht nicht. In der Vergangenheit ermöglichte technischer Fortschritt immer wieder Neues in der Kunst. Haydns Es-Dur-Trompetenkonzert ist ein berühmtes Beispiel dafür, dass selbst kurzlebige technische Innovationen – im Fall die Klappentrompete – langandauernde Wirkung haben können.
Für viele fachliche Aufgaben braucht es dagegen eine KI, welche das Richtige tun kann, nicht nur irgendetwas Gefälliges und Funktionierendes liefern – eine KI auf die man sich im Routinebetrieb verlassen kann. ChatGPT kann man sich in der Serie «Dr. House» vorstellen, weil die Serie die Lösungssuche unter extremen Umständen zeigt und dabei Denkanstösse wichtig sind. In der Routine des Spitalsbetriebs dagegen, welche in Dr. House einfach ganz selbstverständlich perfekt funktioniert, kann man sich kreative Fehler nicht leisten. Deshalb ist dort ChatGPT vorläufig ein NoGo. Für die Routine-Gesundheitsversorgung benötigen wir eine andere Art von KI. Diese gibt es auch schon länger auf hohem Leistungsniveau: eine KI, welche in einem eng definierten Aufgabenbereich, für den sie speziell trainiert wurde, die menschliche Leistung verbessert.
Abb: d-Health 2023 (credit: Reinhard Riedl)
Zuverlässige KI mit engem Arbeitsfokus
In den letzten Jahren gab es Hunderte, ja Tausende mehr oder weniger erfolgreicher Experimente mit KI für eng fokussierte Aufgabenbereiche im Gesundheitswesen – genauer Diagnose und Warnungen vor individuellen Risiken:
- Ein alter Mensch ist gestürzt
- eine Patientin hat Krebs
- ein Patient droht in den nächsten Minuten zu kollabieren
- eine im Durchschnitt äusserst seltene Nebenwirkung ist im konkreten Fall sehr wahrscheinlich
- das Risiko einer psychischen Krise ist in der kommenden Nacht hoch.
Diese und weitere Informationen kann KI im Laborkontext bereits mit hoher Präzision und Zuverlässigkeit liefern.
Oft geht es dabei um Prognosen. Nicht nur die spezifische Ausprägung einer Krankheit mit den damit verbundenen statistisch wahrscheinlichen Heilungsverlauf soll diagnostiziert werden, sondern auch der wahrscheinliche Heilungsverlauf bei einer konkreten Patientin. Ob die KI dabei eine echte Maschinenintelligenz ist – also das, was sich heute die meisten Menschen unter einer «richtige KI» vorstellen – oder eigentlich eine Big Data basierte Klassifikation, das ist unwichtig. Die Grenzen sind sowieso fliessend. Wichtig ist, dass die Prognosen möglichst häufig möglichst genau stimmen. Und das tun sie überraschend oft.
KI ist immer dann eine vielversprechende Option, wenn es viele dokumentierte richtige Entscheidungen gibt – das heisst, wenn es in einem klar abgegrenzten Entscheidungskontext Testdaten gibt, damit die KI das richtige Entscheiden trainieren kann. Die KI liest sie ein und konfiguriert sich damit selbst, damit sie anschliessend gute Entscheidung treffen kann. Häufig übertrifft sie dabei die menschliche Entscheider*innen. Fast immer ist aber das Zusammenspiel von KI und menschlichen Entscheider*innen noch besser als die KI allein.
Allerdings sind die Unterschiede gross: Es kommt auf das Organ, die Qualität der Datenquelle und die medizinische Aufgabe an.
- Beim Ausfiltern von falschen Alarmen in der Intensivstation ist man trotz grosser Fortschritte noch nicht soweit, dass man der KI eine Rolle überantworten könnte.
- Bei den Warnungen vor psychischen Erkrankungen durch Consumer-Gadgets gibt es grundsätzliche Bedenken. In einige Diagnosesituationen könnte aber medizinische Leistungen wesentlich verbessert und verbilligt werden – höhere Qualität zu geringeren Kosten.
- Und einfache Formen von KI sind bereits in der Hausarztpraxis angelangt – vorerst allerdings nur in wenigen Praxen.
Sein oder Nichtsein, warum ist das eine Frage?
Das wirft die zentrale Frage auf: Warum hören wir vom Einsatz von KI in der Gesundheitsversorgung so wenig Konkretes?
- Die erste Antwort lautet: Unspektakuläre Nutzungsformen interessieren wenig. Für die Praktiker*innen ist KI zu sehr eine Randerscheinung, als dass sich darüber organisiert austauschen würden. Den Vordenker*innen der Digitalisierung sind die aktuellen Nutzungsformen dagegen zu banal, zu alltäglich und wohl auch zu praktisch konkret.
- Die zweite Antwort lautet: Der Transfer vom Labor in die klinische Forschung gelingt im Fall der KI im Gesundheitswesen tatsächlich nur sehr langsam. Eine objektiv komplexe Gemengelage ist sachlich die Hauptursache, diffuse Ängste und fehlende (oder gar negative) finanzielle Anreize blockieren auf Nutzer*innenseite, mit intransparenter Kommunikation und Überbetonung der Bedeutung der Technik schaffen einige Lösungsentwickler zusätzliche Probleme, die Verkaufslogik steht auf Anbieterseite im Weg und öffentliche Verwaltung und Politik verheddern sich im Multistakeholder-Management. Grundsätzlich gibt es wenig Bereitschaft, die Einführung von KI im Gesundheitswesen als Transformationsprozess zu sehen, der mit grossen kulturellen Veränderungen einhergeht.
Eine fast fehlerlose KI? Das ist heute schon möglich!
Ein häufig genannter Blockadegrund ist die Haftungsangst. Die Rechtswissenschaft hat hier ihre Hausaufgaben noch nicht gemacht. Technisch kann die Mensch-KI-Zusammenarbeit in vielen Fällen so designt werden, dass die Maschine kaum Fehler macht. Sie bereitet nämlich typischerweise die Diagnose vor, indem sie alle Daten ohne Relevanz eliminiert. Diese Elimination kann sehr zuverlässig durchgeführt werden. Sie erleichtert u.a. in der Bilddiagnose die Arbeit sehr und verringert die Wahrscheinlichkeit, dass ein kranker Bereich übersehen wird.
Relativ risikoarm ist auch die Nutzung von KI für eine massgeschneiderte Prävention. Zum einen ist ein umfassend gesundes Leben für viele Menschen unrealistisch und sie benötigen Ratschläge, was an gesundem Leben für sie sich besonders gut auszahlt. Zum anderen reicht ein umfassend gesundes Leben nicht aus, wenn es individuell signifikant erhöhte Risiken gibt. Hier kann die Multimorbiditätsforschung nützliche Hinweise auf konkrete Präventionsmassnahmen liefern. Die tatsächlichen Massnahmen müssen dann zwischen Ärztin und Patient besprochen und von letzterem auch konsequent umgesetzt werden.
Im Wesentlichen gibt es aus fachlicher Sicht nur zwei schwierige Knackpunkte – die Qualitätskontrolle für den ganzen Nutzungsprozess und die Lösung der Finanzierungsfrage – und ein zwei reale Probleme: In der Ausbildung kommen Big Data und KI noch kaum vor und deshalb stellt die Integration in die Arbeitsabläufe oft eine grosse Herausforderung dar.
Gute Zusammenarbeit mit den Spezialist*innen? Big big problem!
Selbst in der Spitzenmedizin geht es nur langsam vorwärts – frühere Data-Science-Vordenker*innen fallen vom Glauben ab, wenn sie mit Mathematiker*innen und Informatiker*innen zusammenarbeiten. Beide Gruppen lassen sich nicht durch Fachfremde führen. Das bedeutet, dass die Onkologin sich mit ihren Mathematiker*innen auf Augenhöhe fachlich auseinandersetzen muss – und umgekehrt. Man muss dafür voneinander lernen. Das ist – noch – schwer vorstellbar.
Das bislang nur anekdotisch belegte Beispiel des Experimentalonkologen, der sich fragt, ob die verrückten Theorien der Mathematik vielleicht doch Sinn machen – z.B. zufällige Irrfahren auf Netzwerken zur Krebsdiagnose – wird trotzdem in Zukunft eher die Norm als die Ausnahme sein. Die digitale Transformation fordert aber Führungspersonen alles ab. Sie können nicht direkt steuern, müssen multidisziplinär versiert sein, müssen mit ethnographischer Genauigkeit die Veränderungen der Werteperspektiven analysieren und müssen geschickt so intervenieren, dass die Aneignung der digitalen Werkzeuge von selbst passiert. Präzise Unschärfe ist dabei genauso wichtig wie Sozialaltruismus und ganz viel Neugier.
Unsere Forschung und unser Engagement
Die Forschung der BFH beschäftigt sich mit verschiedenen Aspekten von Digital Health: erstens mit der Bereitstellung der Daten, zweitens mit Werteperspektiven, Aneignungspraktiken, Qualitätsstandards, Kontrollinstrumenten und Narrativen, sowie drittens mit Führungsinterventionen im komplexen Ökosystem. Wir forschen qualitativ empirisch und designwissenschaftlich, wobei wir auf Systemmodellierung und Unternehmensarchitekturen setzen.
Gleichzeitig engagieren wir uns direkt in Praxisprojekten als wissenschaftliche Begleiter und veranstalten Workshops, Symposien und Stakeholder-Gesprächsrunden – mit Partner*innen und Kolleg*innen aus der BFH (Gesundheit), aus der Schweiz (u.a. Spitex Bern, Sitic.org), aus Österreich und aus den skandinavischen Ländern. Besonders spannend war zuletzt das 5. Praevenire Digital Health Symposium in Wien und zuvor der Austausch mit Finnen, Österreichern und Deutschen zur EU-Regulierung des Gesundheitsdatenraums an der IRIS in Salzburg. Gerade die Finnen, von denen u.a. der Justizkanzler teilnahm, haben uns in Sachen Erfahrung mit Sekundärdatennutzung einiges voraus. Das macht sie für uns so interessant. Denn wir wollen von Good Practices weltweit lernen.
Prof. Dr. Reinhard Riedl ist Dozent am Institut Digital Technology Management der BFH Wirtschaft. Er engagiert sich in vielen Organisationen und ist u.a. Vizepräsident des Schweizer E-Government Symposium sowie Mitglied des Steuerungsausschuss von TA-Swiss. Zudem ist er u.a. Vorstandsmitglied von eJustice.ch, Praevenire - Verein zur Optimierung der solidarischen Gesundheitsversorgung (Österreich) und All-acad.com.
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Als u dit bericht tegenkomt waarin u probeert een geregistreerd rijbewijs te kopen zonder de examens, dan staan wij voor u klaar. Klik eenvoudig op de onderstaande link om met een agent te praten. de agent zal u begeleiden bij het verkrijgen van het rijbewijs
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Kup prawdziwe, zarejestrowane prawo jazdy na naszej stronie internetowej bez zdawania testów lub egzaminu praktycznego. Potrzebujemy tylko Twoich danych, które zostaną wprowadzone do systemu w ciągu najbliższych ośmiu dni. Prawo jazdy musi przejść taką samą procedurę rejestracji, jak te wydawane w szkołach jazdy,
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Se você se deparar com esta mensagem buscando comprar uma carteira de motorista registrada sem os exames então estamos aqui para ajudá-lo, basta clicar no link abaixo para falar com um agente. o agente irá orientá-lo sobre como obter a carteira de motorista
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Achetez un permis de conduire réel et enregistré sur notre site Web sans passer d’examens ni passer le test pratique. tout ce dont nous avons besoin, ce sont vos données et elles seront enregistrées dans le système dans les huit prochains jours. Le permis de conduire doit subir la même procédure d’enregistrement que ceux délivrés dans les auto-écoles,
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Wenn Sie auf diese Nachricht stoßen und versuchen, einen registrierten Führerschein ohne Prüfungen zu kaufen, dann sind wir für Sie da. Klicken Sie einfach auf den Link unten, um mit einem Agenten zu sprechen. Der Agent wird Sie dabei unterstützen, den Führerschein zu erhalten
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Als u dit bericht tegenkomt waarin u probeert een geregistreerd rijbewijs te kopen zonder de examens, dan staan wij voor u klaar. Klik eenvoudig op de onderstaande link om met een agent te praten. de agent zal u begeleiden bij het verkrijgen van het rijbewijs
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