Possible domains for integrating Artificial Intelligence (AI) in healthcare sector

Artificial intelligence (AI) is an emerging technology with significant potential to transform the economies of every nation across the globe. The term AI describes a machine’s capacity to carry out cognitive functions such as reasoning, perception, learning, problem-solving, and judgment, which mimic and enhance human intelligence. With advancements and developments in data gathering, processing, and computing power, these intelligent AI systems can significantly handle a wide range of tasks, boost productivity, improve economies, and further enhance the quality of life of people. AI has a significant impact on a wide range of sectors and domains, such as manufacturing and production, fashion, autonomous vehicles, sports analytics and activities, healthcare, and the medical system. In the healthcare sector, it holds great promise and has already contributed to important advances in fields such as drug discovery, genomics, radiology, pathology, and prevention. In addition to offering a plethora of advantages and benefits, all of the new technologies raise grave concerns about potential abuse and social harm. The design, development, implementation, and use of AI in the healthcare industry must prioritize ethics with appropriate regulatory mechanisms to address the ethical concerns about social and health disparities, monitoring, intrusions of privacy and autonomy, and the proper use of data-intensive technologies in the medical field.[1] AI must benefit the healthcare systems, and the beneficiaries without harming the integrity of the system and people both. When applied appropriately, AI can help patients and communities better understand their evolving needs and take control of their healthcare. ARTIFICIAL INTELLIGENCE AND INDIA: ENDEAVORS AND INITIATIVES In June 2018, the Indian Government, led by National Institution for Transforming India (NITI) Aayog, unveiled its ambitious strategy to establish India as a leader in AI by utilizing the technology for inclusive and sustainable growth, based on the idea of “AI for All,” emphasizes harnessing AI advancements to improve and empower all facets of society. NITI Aayog has decided to focus on five sectors envisioned to benefit the most from AI in solving societal needs, namely, healthcare, agriculture, education, smart cities and infrastructure, and smart mobility and transportation.[2] The government has launched initiatives such as “AI for All” incorporating AI into several areas, such as governance and education. The nation’s complex socioeconomic status and diversified population mandate AI solutions for emerging issues and needs. India is on the verge of an AI revolution and can lead the way in inclusive and sustainable AI development to address the key challenges in healthcare, agriculture, education, smart cities, and infrastructure, and further tackle regional and global issues. Recognizing the potential of AI to revolutionize the economy of the nation, the NITI Aayog established the National Program for AI to guide the research and development of new and emerging technologies, and the National AI Portal, “INDIAai” has also been launched as an online resource for advancements in AI in India.[3] Various initiatives have been taken by the government in the direction of fully leveraging the potential of AI in the nation such as setting up a Model International Center for Transformative AI, a joint venture of NITI Aayog, Intel, and Tata Institute of Fundamental Research to develop and deploy AI-led application-based research projects, facilitating collaboration with industry leaders, startups, and AI services and product companies and to support skilling and talent development for world-class AI talent.[4] In 2020, Intel India and the National e-Governance Division (NeGD) of the Ministry of Electronics and Information Technology (MeitY), Government of India, worked together to launch responsible AI for youth, a nationwide initiative that aims to prepare government school children throughout the country for the future of AI, following the success of which NeGD, MeitY, and Intel India partnered to introduce the “Youth for Unnati and Vikas with AI” program to provide students in grades 8 through 12 throughout the country the necessary mentality and skill sets and enable them to become human-centric AI designers and users.[5] The state government has also taken various measures to increase the utilization of AI through their various policies and initiatives such as Tamil Nadu Safe and Ethical AI Policy 2020; Centre of Excellence for Data Science and AI (Karnataka); and AI System To Fight Agricultural Risks-MahaAgriTech project (Maharashtra).[6-8] The initiative “AI for India 2.0” was taken in the recent past by the Ministry of Skill Development and Entrepreneurship, under which various courses are being offered to young enthusiasts in multiple Indian languages with the goal of breaking the language barriers that exist in technology education and preparing the young people for future employment markets by providing them with the necessary AI capabilities.[9] Under the umbrella of “AI for India 2.0,” various other crucial steps taken by the government include the launch of the Skill India AI Portal, the National AI Skilling Program, AI Youth Bootcamp, AI in Vocational Training, and AI Research and Innovation Fund, etc.[9] India also hosted the Global IndiaAI Summit at Bharat Mandapam, New Delhi, marking a significant milestone in the AI journey of the nation. The summit served as a platform for leading international AI experts from various sectors – science, industry, civil society, governments, international organizations, and academia – to present their insights on key AI issues and challenges, addressing the crucial components of the AI ecosystem, including compute capacity, foundational models, datasets, application development, future skills, startup financing, and safe and trusted AI. The summit brought together around 2000 global AI experts, policy makers, AI practitioners, industry/startups, and academia, over 10,000 AI enthusiasts from 50 countries, and brought together Global Partnership in AI (GPAI) members, AI experts, and industry representatives to identify mechanisms to overcome the global AI divide.[10] With the objective of inclusivity at the core of the AI policy of India, it is envisioned that the advantages of AI are available to all, entailing the development of ethical frameworks. ARTIFICIAL INTELLIGENCE AND HEALTHCARE SECTOR OF INDIA The healthcare sector of India has changed significantly over the last few decades owing to advancements and developments in accessibility, technology, and infrastructure. It is anticipated that the Indian healthcare market, which was worth US$ 110 billion in 2016, will grow to US$ 638 billion by 2025.[11] An increase in funding the healthcare sector has been visible in the recent past, where the proportion of GDP, from 1.2% in 2014 to 2015 has been increased to 2.1%, with a proposal to further raise the public health expenditure of Union and State Governments to 2.5% of GDP by 2025.[12] The recent digital initiatives such as Ayushman Bharat Digital Mission (ABDM) and e-Sanjeevani represent a paradigm shift in the healthcare delivery sector, further improving the accessibility and quality of healthcare in the nation. The utilization of AI in the healthcare sector of India has witnessed a significant surge in its enormous potential to transform medical practices, improve patient outcomes, and lower the strain on the existing healthcare system in India. According to recent statistics, the Indian healthcare AI market is expected to reach USD 1.6 billion by 2025, with a compound annual growth rate of 40.5% from 2020 to 2025.[13] The appropriate use of AI in healthcare can assist in addressing the problem of significant obstacles in terms of quality, price, and accessibility for a significant portion of the population due to the lack of skilled healthcare personnel and services; and nonuniform physical access to healthcare services. These obstacles can be overcome by implementing AI in the segments of diagnostics, individualized care, early pandemic detection, imaging diagnostics, and others. The various potential segments of the healthcare sector to democratize access to AI technologies across different strata of the nation are depicted in Figure 1.Figure 1: Potential segments of possible collaboration in healthcare sectorAI solutions can help overcome the hurdles to accessibility through early detection, diagnosis, decision-making, and treatment, efficiently catering to a larger part of the nation. In various domains of medicine, AI-powered diagnostic systems have shown accuracy and reliability, in sectors ranging from radiology and pathology to cardiology and oncology. Through a combination of machine learning algorithms and deep learning techniques, AI has shown tremendous promise in identifying subtle patterns and anomalies in medical images and patient data, leading to more precise and reliable diagnoses, can help identify hidden tumors through the analysis of health patterns, and focused resource allocation and preventive interventions, AI-enabled foresight can lessens the impact of outbreaks.[14] In India, AI and its applications have been extremely proven their significant role in addressing the COVID-19 crisis through its innovative approaches such as monitoring the pandemic, screening for COVID-19 cases, tracing down the contacts, followed by implementation of social distancing and quarantine strategies in the proximity of the contact, as well as developing vaccines, etc. The country has witnessed the highest increase in the use of AI during the COVID-19 era, with approximately 73% of the healthcare and pharmaceutical industries adopting AI technologies.[15] ETHICAL CONSIDERATION: ARTIFICIAL INTELLIGENCE IN HEALTHCARE Even though AI can significantly increase value across many industries and sectors, its adoption at every stratum still requires large-scale adoption strategies, particularly national policies which can address several ethical, legal, and societal issues, particularly concerning its creation and application. To fully achieve the potential of AI in healthcare, four major ethical issues must be addressed which include the concerns over informed consent to use data; safety and transparency; algorithmic fairness and biases; data privacy; and further necessitates cybersecurity of related vulnerabilities, algorithmic transparency, privacy, and protection of all beneficiaries.[16] The World Health Organization (WHO) has published a guidance report on the “Ethics and Governance of AI for Health” to promote the ethical use of AI for health at every stage of the technology’s design, development, and deployment. The publication endorsed six key ethical principles that focus on protecting human autonomy, promoting human well-being and safety and the public interest, ensuring transparency, explaining ability and intelligibility, fostering responsibility and accountability, ensuring inclusiveness and equity, and promoting responsive and sustainable AI.[17] Considering the rising concerns over the use of AI in healthcare and its potential beneficial role in biomedical research, the Indian Council of Medical Research has formulated ethical guidance in consultation with experts from these two fields to guide effective yet safe development, deployment, and adoption of AI-based technologies in biomedical research and healthcare delivery, which are applicable and accessible to health professionals, technology developers, researchers, entrepreneurs, hospitals, research institutions, organization(s), and laypersons. In a nutshell, it has been stated that one should adhere to the basic ethical principles of respect for persons (autonomy), do good (beneficence), do no harm (nonmalfeasance), and distributive justice, to ensure the protection of dignity, rights, safety, and well-being of the community and the participants. The role of AI in health to a large extent depends on data obtained from human participants and invokes additional concerns such as potential biases, data handling, interpretation, autonomy, risk minimization, professional competence, data sharing, and confidentiality, hence, necessitates an ethical framework to addresses these issues. The ten ethical principles developed in consideration to address the issues specific to AI for healthcare are depicted in Figure 2.[18]Figure 2: Ten ethical principles for artificial intelligence in healthcareARTIFICIAL INTELLIGENCE AND TRADITIONAL MEDICINES: INITIATIVES OF MINISTRY OF AYUSH The integration of AI and Traditional Medicine (TM) is one of the emerging and promising areas that have enormous potential to transform healthcare by enabling data-driven decision-making and personalized treatment regimens. AI may augment the TM sector by assisting in early disease detection, providing customized treatment plans, predicting health trends, and enhancing patient engagement. AI algorithms can analyze individual patient data, including genetic information, medical history, and lifestyle, to provide tailored treatment recommendations. AI may supplement TM by identifying early disease, offering individualized treatment regimens, forecasting health trends, and improving patient engagement. AI opens up new avenues for exploring the ancient literature of TM, opening the scope for screening herbs, and disclosing their mechanism of action, followed by the development of alternate lead compounds or plant-based innovative drug development.[1] AI can assist in analyzing and interpreting ancient texts making it easier to understand and for appropriate application of the principles in clinical practice. The use of assistive AI-based diagnostic models is also one of the growing sectors serving as decision-making models through symptom classifications based on a varied range of clinical data as well as to develop different pharmacological databases that can further enhance the potential of ethnopharmacology in healthcare.[19] The integration of AI with TM is a quickly growing sector where numerous AI methods, including data mining, pattern recognition, image processing, and algorithms, can greatly advance the study of TM including Ayurveda. The Ayush sector has expanded in many ways in recent years and has drawn a significant amount of attention across the world. Modern technologies such as AI, decision support systems, and Ayur-genomics are growing in Ayush to meet newer demands and developments in the health sector. AI is one of the new emerging and focused areas of Ayush owing to the potential role of AI in traditional healthcare, particularly in the areas of drug development, clinical decision-making, development of treatment protocols, data mining and analysis, etc. AI in the Ayush sector can be helpful for evidence-based research, identifying correlations between various predisposing factors and personality traits in the occurrence of various disorders, especially lifestyle disorders. The potential segments of TM where AI can revolutionize the sector are depicted in Figure 3.Figure 3: Potential segments for artificial intelligence in traditional medicinesThe Ayush Grid initiative of the Ministry of Ayush is an Ayush-centric Digital Health Platform that works in sync with the ABDM covering all the verticals of the Ayush Sector, namely, health services, education, Ayush research, central sector and centrally sponsored schemes, training programs, citizen centric services, drug licensing portal, and media outreach. The initiative has led to the implementation of the National Ayush Morbidity and Standardized Electronic portal, Ayush Research Portal, development and implementation of Ayushman Bharat Health Account enabled Ayush Hospital Management Information System (A-HMIS), Ayush Sanjivani app (during COVID-19 pandemic), mYoga app, Ayurveda Siddha and Unani International terminologies and morbidity codes (as Module-2, Chapter-26, and ICD-11), development of benchmarks for the use of AI in the field of TM under the “AI for Health (AI4Health)” etc.[20] Recently, All India Institute of Ayurveda in New Delhi, under the ambit of the Ministry of Ayush, India, hosted a global technical meeting on AI applications in TM, organized by the WHO-Global TM Center and Digital Health and Innovation (DHI) on September 11, 2024–September 12, 2024, where sixty delegates from 15 countries from all six WHO regions participated in the hybrid gathering to exchange experiences and deepen understanding the potential of AI in the advancement of the science along with a focus on strengthening capacity building for TM stakeholders across a range of AI applications, accelerating knowledge-sharing across multiple stakeholder groups, from consumers to policymakers, and ensuring equitable access and benefit sharing through intellectual property agreements related to AI.[21] The integration of AI in the TM sector has the potential to revolutionize the TM of medicine making it more accessible, efficient, and effective. Strengthening the connection between technological innovation and traditional treatments is crucial, and part of our strategy for implementing AI includes worker skilling–reskilling and nurturing the future generation of talent in line with the shifting demands of the labor market, through effective collaboration with educational institutions and the private sector. It is necessary to identify and promote the creation of jobs in newer AI-driven TM fields, and the adoption of AI by startups, the private sector, public sector undertakings, and government organizations to fully reap the potential of AI. The utilization of AI is increasing and is assumed to take over the coming decades, thus it must be used ethically and responsibly. The use of AI in health practices should be ethical, accountable, transparent, and explicable, requiring the development of frameworks for sector-specific regulations and data protection, as well as encouraging the adoption of global standards.