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Introduction




Artificial intelligence can help transform healthcare by improving diagnosis, treatment, and the delivery of

patient care. Researchers in academia, the private sector, and government have gained increasing access to

large amounts of health data and high-powered Al-ready computing systems. These powerful tools can greatly

improve doctors’ abilities to diagnose their patients’ medical issues, classify risk at a patient level by drawing on

the power of population data, and provide much-needed support to clinics and hospitals in under-resourced

areas. Al can also expand the operational capacity of different organizations, identify potentially fraudulent

health claims, and streamline manual tasks to boost productivity.


Much of this progress depends on sharing and utilizing large amounts of health data, which informs the

development of algorithms and machine learning. While the private sector has driven much of the innovation in

this field, the federal government and its partners can play a major role by both sharing their own data and

addressing challenges across the sector. HHS, private sector stakeholders, and academic and clinical

researchers can support this transformation by collaborating to apply Al both inside and outside of

government.


Researchers and practitioners now face multiple challenges in using Al to improve healthcare. These challenges

include limited access to data, poor data quality, concerns over data governance, and the ethical use of data,

including accountability and liability for data applications. Multiple stakeholders will need to work together to

address these challenges as new technical applications emerge.


The HHS Office of the CTO is now exploring the potential for a department-wide Al strategy to help realize the

potential of Al, and to establish policies and practices for facilitating Al development. This strategy comes in

tandem with the February 2019 “Executive Order on Maintaining American Leadership in Artificial

Intelligence” and The State of Data Sharing at the U.S. Department of Health and Human Services report, published

by the HHS Office of the CTO in September 2018."


The Roundtable on Sharing and Utilizing Health Data for Al Applications was designed to bring together HHS

leaders, and experts in Al and health data from other federal and state government agencies, industry,

academia, and patient-centered research organizations. The Roundtable began with calls to action by Mona

Siddiqui, the HHS Chief Data Officer, and Ed Simcox, the HHS Chief Technology Officer. Following these

keynotes, several speakers gave lightning talks on high-priority use cases for Al in healthcare, including

representatives from Verily, Amazon Web Services, Health Catalyst, and the Michael J. Fox Foundation. The

second part of the Roundtable transitioned into possibilities for Al strategies, where representatives from

Pfizer, the Center for Medicare and Medicaid Innovation (CMMI), the Government Accountability Office

(GAO), and the Assistant Secretary for Preparedness and Response at HHS outlined possible paths forward.

The day also featured a keynote address from Eric Hargan, the Deputy Secretary of HHS, who spoke about how

Al is being deployed within the department.


Throughout the day, Roundtable participants engaged in three in-depth breakout sessions. These sessions

focused on the following topics: (1) Identifying high-priority Al applications, (2) Improving and using data for Al

applications, and (3) Outlining key issues and objectives for an HHS Al strategy. The day concluded with a

presentation of highlights and actionable recommendations for HHS to advance its own Al strategy across the

department.




? The White House, “Executive Order on Maintaining American Leadership in Artificial Intelligence,” February 11, 2019,

Retrieved from


bttps: bitehouse.gov/presidential-actions/executive-order-maintaining-american-leadership-artificial-intelligence

3 U.S. Department of Health and Human Services Office of the Chief Technology Officer, ‘The State of Data Sharing at the

U.S. Department of Health and Human Services,” September 2018, Retrieved from


bttps: bhs. gov/sites/default/files/HHS StateofDataSharing 0915 pdf


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Background and Key Concepts




Artificial intelligence has gained significant attention in recent years, particularly in the context of improving

health and well-being. The following section presents an overview of key concepts and terminology related to

artificial intelligence. For more information on the use of Al in healthcare, please refer to the briefing paper that

CODE developed in preparation for the Roundtable on Sharing and Utilizing Health Data for Al Applications*


At the core of artificial intelligence is the need for high-quality, clean and accurate data to fuel the development

of algorithms. Researchers emphasize the need for large, multifaceted datasets that allow machine learning

processes to incorporate as many factors as possible into analysis.° Artificial intelligence also demands clear,

accountable data governance with defined data elements and processes for ensuring data quality and access.®

Researchers are now attempting to tap large troves of health data - from electronic health records (EHRs) to

data collected from wearable devices and sensors - to improve diagnostics and predictive analytics. More

connected and interoperable data in the healthcare system will enable more transformative Al applications in

the future.


Most Al applications depend on algorithms, which describe a logical process that follows a set of rules.

Computers can be taught a series of steps in order to process large amounts of data to produce a desired

outcome. There are two forms of algorithm:


1. Supervised algorithms use ‘training datasets’ in which the input factors and output are known in

advance. Supervised processes can produce highly accurate algorithms because the ‘right answers’ are

already known. For example, scientists may feed a dataset of retina images into the algorithm in which

board-certified physicians have already identified and agreed upon diagnoses for each image.


2. Unsupervised algorithms are developed through a process whereby data is fed into the algorithm and

the computer has to ‘learn’ what to look for. Unlike the training datasets fed into supervised

algorithms, the data fed into unsupervised algorithms does not necessarily include the ‘right answers.’

Unsupervised algorithms are adept at finding clusters of relationships between observations in the

data, but may identify erroneous relationships because they are not instructed what to look for.


Machine learning is the process by which computers are trained to ‘learn’ by exposing them to data. Machine

learning is a subset of Al, and deep learning is a further subset of machine learning. Deep learning is the process

by which algorithms can learn to identify hierarchies within data that allow for truly complex understandings of

data. Natural language processing (NLP) refers to the subfield of machine learning designed to allow computers

to examine, extract, and interpret data that is structured within a language.


Augmented Intelligence is a form of Al that enhances human capabilities rather than replacing physicians and

healthcare providers. Augmented Intelligence has been embraced as a concept by physician organizations to

underscore that emerging Al systems are designed to aid humans in clinical decision-making, implementation,




*The Center for Open Data Enterprise, Briefing Paper: Roundtable on Sharing and Utilizing Health Data for Al Applications, April

2019, Retrieved from bttp://reports opendataenterprise ore/RI 1470 Briefing 2420 Paper pdf


> Nick Ismail, “The Success of Artificial Intelligence Depends on Data,” Information Age, April 23, 2018. Retrieved from

bttps: information-age.com/success-artificial-intelligence-data-17347160


® Rob Thomas, “The Road to Al Leads through Information Architecture.” VentureBeat, January 12, 2018. Retrieved from

bttps:-//venturebeatcom/?018/01/17 he-road-to-ai-leads-through-information-architecture


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and administration to scale healthcare.’ In a 2019 white paper, Intel framed augmented intelligence as the Al

tools that perform specific tasks and are designed to support users, rather than replacing human experts.®


Stages of Al Development


Existing and potential Al applications vary in their level of sophistication, ranging from simple augmentation of

common tasks to full automation of systems and processes. Experts have begun categorizing these stages of Al

development. Among them, venture capitalist and author Kai-Fu Lee has characterized four “waves” of Al

applications:’




Wave 1 | Internet Al






Wave 2 | Business Al






Wave 3 | Perception Al






Wave 4 | Autonomous Al










Figure 1. “The Four Waves of Al”

Adapted from Kai-Fu Lee (2018)


According to Lee, the first wave of Al applications uses data generated on the Internet to better understand

the habits, interests, and desires of an individual or population.*° The second wave of Al applications uses

algorithms to inform and improve decision making. Clinical researchers, for example, can construct treatment

plans by using algorithms “to digest enormous quantities of data on patient diagnoses, genomic profiles,

resultant therapies, and subsequent health outcomes.”** The third wave of Al applications relates to the

proliferation of sensors and devices that collect data about the physical world such as smart watches and

virtual assistants. The fourth wave of Al applications integrates all previous waves and gives machines the

ability to make decisions without human intervention.?? This includes technologies such as automated vehicles.




7ACT | The App Association, “Appendix: Key Terminology for Al in Health,” Connected Health, Retrieved from

bitp://actonline org/wp-content/uploads/Artificial- Intelligence-in-Health-Appendix pdf


® Intel, “Intel's Recommendations for the U.S. National Strategy on Artificial Intelligence,” Retrieved from

bttps://newsroom,intelL.com/wp-content/uploads/sites/11/2019/03/intel-ai-white-paper pdf.


; er iu Lee, “The Four Waves of Al.” “Fortune, October 22, 2018, Retrieved from




bttp: fortune com/?018/10/22, artificial- intelligence- ak deep- learning- kai-fu-lee/

1 Kai-Fu Lee, “The Four Waves of Al.” Fortune, October 22, 2018, Retrieved from

bttp.//fortune.com/7018/10/9 2 /artificial-intelligence-ai-deep-learming-kai-fi-lee,

? kai-Fu Lee, “The Four Waves of Al.” Fortune, October 22, 2018, Retrieved from

bttp.//fortune.com/7018/10/9 2 /artificial-intelligence-ai-deep-learming-kai-fi-lee,

18 Kai-Fu Lee, “The Four Waves of Al.” Fortune, October 22, 2018, Retrieved from

bttp.//fortune.com/7018/10/9 2 /artificial-intelligence-ai-deep-learming-kai-fi-lee,


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Al Applications in Healthcare




The following section outlines five general uses of Al in healthcare, including examples of existing and

near-term applications. These applications, while not mutually exclusive, are examples of cross-cutting themes

that emerged from the Roundtable discussions.


Roundtable participants emphasized the value of Al in improving clinician and administrative workflows.

Through NLP and other Al tools, machines can rapidly process EHRs and automatically transcribe medical

notes. Automation can free up time and reduce costs by eliminating manual data entry. Moreover, participants

noted that Al helps reduce administrative burden by correcting human errors in billing processes.


e Interpreting handwritten medical records. Amazon Web Services has used NLP to extract and

interpret handwritten notes and text from medical records.’* NLP is particularly well-suited to

deciphering physician input since EHRs do not follow a single, unified structure, yet contain important

information for understanding diagnostic trends and risk profiles of individuals.’


e Detecting fraud and improper payments. The Centers for Medicare and Medicaid Services (CMS)

uses statistical analysis to identify fraudulent and improper payments made to healthcare providers. In

2018, CMS determined that 8.12 percent of all Medicare payments were improper. In order to

address this problem, CMS employs a testing methodology called Comprehensive Error Rate Testing

(CERT) and uses Al to engage in predictive analysis of fraudulent and improper healthcare payments.

This process has saved the government approximately $42 billion, according to CMS.*6


Roundtable participants emphasized the value of using Al to connect patients with available resources and

care, especially in rural areas. Examples include:


e Providing patients with personalized healthcare recommendations. Sage Bionetworks launched

mPower as a study using surveys and phone sensors to track symptoms of Parkinson's Disease.” The

results can help patients, doctors, and caregivers better understand changes over time and the impact

of exercise or medication. Using artificial intelligence, data from mPower could also be used to develop

specific healthcare recommendations for patients.


e Creating virtual care programs for patients with chronic conditions. Verily Health's Onduo project,

which combines a smart device and mobile application, offers virtual care for people with type 2

diabetes. Onduo can measure blood glucose levels as well as provide information on nutrition and

medication management. The app also offers a coaching dimension that identifies lifestyle patterns and

gives patients feedback to improve their health.




* Rachel Arndt, “Amazon Technology Deciphers Text in Electronic Health Record,” Modern Healthcare, November 27, 2018,

Retrieved from


https: modernhealthcare.com/article/?0181127/TRANSFORMATIONO1/18112995 1/amazon-technology-deciph

4 Mike Miliard, “EHR Natural Language Processing Isn't Perfect, but It’s Really Useful,” Healthcare IT News, May 18, 2017.

Retrieved from ttps: bealthcareitnews. com/news/ebr-natural- language-processing-isnt-perfect-its-really-useful


46 Jack McCarthy, “CMS Snags $42 Billion in Medicare and Medicaid Fraud with Predictive Analytics.” Healthcare IT News,

July 22, 2016, Retrieved from


bttps: bealthcareitnews.com/news/cms-snags-47-pillion-medicare-and-medicaid-fraud-predictive-analytic


1” Sage Bionetworks, “mPower Parkinson Study and Public Researcher Portal,” Retrieved from


bttp.//sagebionetworks ore/research-projects/mpower-researcher-portal


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e Expanding treatment access for rural populations. Through voice assistants and chatbots, Al has the

potential to improve and increase access to treatment in rural and other resource-constrained

environments. There is increasing evidence that Al-driven chatbots can address routine patient

questions and help doctors communicate with patients about their diagnosis and risk evaluations.®


Informing Population Health Management


Population health management (PHM) involves using population-level data to identify broad health risks and

treatment opportunities for a group of individuals or community. Al can contribute to PHM by combining,

synthesizing, and analyzing datasets from third parties with clinical or patient-generated data. For example,

researchers and health providers can use Al to aggregate longitudinal patient-generated data into larger

datasets that tell better stories about the incidence and prevalence of disease.


e Identifying at-risk populations. Al can be used to identify populations at risk for opioid abuse or

overdose. One population health management company, for example, integrates data on social

determinants of health and pharmacy claims to better understand the diverse “spectrum of opioid

abuse cases.”?


Improving Diagnosis and Early Detection


Diagnostic errors are a major problem in the healthcare system, with most patients experiencing at least one

diagnostic error in their lifetime.2° Al promises to help physicians accurately diagnose medical conditions in

their patients and treat disease at an early stage. Al algorithms draw upon large datasets on medical and social

determinants of health to better identify patterns and assist physicians in making diagnoses and developing

treatment plans.*?


Al can deploy technologies like image recognition, NLP, and deep learning to quickly detect life-threatening

conditions and assess risk for diseases like brain cancer or heart disease. Roundtable participants noted that it

may be more accurate to think of these applications as “augmented intelligence” rather than artificial

intelligence. The goal is not to replace the doctor’s clinical judgment, but to help physicians rapidly prioritize

patient symptoms and assess a range of diagnostic possibilities rather than ask patients a standard slate of

questions. Examples from the Roundtable include:


e Diagnosing diabetic retinopathy through image recognition. Al can help doctors diagnose diabetic

retinopathy, the world’s leading cause of blindness, by using image recognition. Researchers at Google

have trained algorithms to analyze images of retinas and diagnose this disease with over 90 percent

accuracy.**




18 Rachel Arndt, “Healthcare providers are teaming with chatbots to assist patients,” Modern Healthcare, December 8, 2018,

Retrieved from


bttps: modernhealthcare.com/article/70181708/TRANSFORMATIONO1/181709977//healthcare-providers-are-te

aming-with-chatbots-to-assist-patient


ZeOmega, “ZeOmega Launches Jiva Opioid Al to Stem Drug Abuse Crisis,” May 28, 2019, Retrieved from

bttp: eomega,com/zeomega-media-center/press-releases/?019-press-releases/7zeomega-launches-jiva-opioid-ait

22 The National Academies of Sciences, Engineering, and Medicine (2015) Improving Diagnosis in Health Care, Washington,

DC: The National Academies Press, Retrieved from bttps://daotore/10.1/276/91/94


1 | aura Landro, “The Key to Reducing Doctors’ Misdiagnoses,” The Wall Street Journal, September 13, 2017, Retrieved from

bttps: jcom/articles/the-key-to-reducing-doctors-misdiagnoses-1505276691.


22 Rohit Varma, “Using Artificial Intelligence to Automate Screening for Diabetic Retinopathy,” Ophthalmology Times,

October 22, 2018, Retrieved from


bttps: opbthalmologytimes.com/article/using-artificial intelligence-automate-screening-diabetic-retinapath


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e Predicting brain deterioration using advanced machine learning. Al can be used to analyze a

diverse array of datasets and identify potential biomarkers that can indicate the onset of deterioration

in cases that range from concussion to coma”?


Drug development is a costly and time-consuming process. Al can help improve drug development through the

entire development lifecycle, from identifying gaps in current therapeutics to bringing new products to market.

Pharmaceutical researchers can use Al to sort through huge numbers of research papers and patents, as well as

comprehensive lists of chemical compounds and their properties, to suggest opportunities for drug

development. By analyzing the growing databases of biomarker data, they can then work to target different

treatments to different types of patients. And when drugs or other treatments reach the clinical trial stage, Al

can help match ideal patients to the right trials. Examples include:


e Improving clinical trial participation. HHS recently completed a “tech sprint” engaging external

experts, such as TrialX and Intel, to develop Al applications to match patients to appropriate clinical

trials. This kind of matching can help researchers find appropriate subjects for their studies and help

patients find potentially valuable treatments at the same time. “


e Supporting precision medicine. The National Institutes of Health (NIH) defines precision medicine as

“an emerging approach for disease treatment and prevention that takes into account individual

variability in genes, environment and lifestyle for each person.””? Researchers at startups like Lam

Therapeutics and Lantern Pharma are using supervised machine learning strategies to generate new

correlations between genomic biomarkers and drug activity to pilot individualized cancer treatments.




3 Suzanne Leigh, “Artificial Intelligence Aids Scientists in Uncovering Hallmarks of Mystery Concussion,” University of

California San Francisco Blog. Retrieved from

bttps: ucsfedu/news/2017/03/405297 6/artificial-intelligence-aids-scientists-uncovering-hallmarks-mystery-concu


200.


* Gil Alterovitz and Kristen Honey, “TOP Health’ Tech Sprint Unleashes the Power of Open Data and Al,” U.S. Department

of Health and Human Services Office of the Chief Technology Officer Blog, January 17, 2019, Retrieved from

https: bhs.gov/cto/blog/?019/1/17/top-health-tech-s print-unleashes-the-power-of-open-data-and-ai html


25 National Institutes of Health, “All of Us Research Program,” Retrieved from bttps://allofus nihov/


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Health Data for Al Applications




Data is the foundation of all Al applications. During the Roundtable, participants identified a number of

high-value health data types that can be used for Al development. Building on the expert feedback gathered at

the Roundtable and subsequent research, this section provides a summary of six major health data types and

the challenges associated with their use.


High-Value Health Data Types


Clinical Trials Data


EHR Data




lol Data


Social Media Data




Registry Data


Survey Data


Vitals Data


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Administrative and Claims Data generally comes from federal, state, and local government agencies as well as

healthcare providers and insurers. This can range from hospital discharge summaries to payment records

between insured patients and the healthcare system.


Clinical Data is a broad term that encompasses different kinds of data generated “in a clinical setting and

controlled by aclinician, as opposed to a patient or caregiver.’*”


e Clinical Trials Data includes registries and results from publicly and privately funded clinical studies.

Large amounts of data, including sensitive information about participants, are generated over the

course of a clinical trial. Researchers must obtain regulatory approval to collect and use this data.


e EHR Data is focused on individual patients, and can include information on routine checkups,

prescriptions, and medical procedures. Physicians can draw upon EHR data to develop individual

treatment plans and diagnose conditions. This data can also be combined with social determinants of

health to develop rich longitudinal profiles of individual patients and populations.


Genomic Data can include many different characteristics, ranging from full DNA sequences to individual DNA

variants.2° Recent advances have made it possible to analyze and store data on a person's entire genome

sequence. According to the National Institutes of Health, “Genome-based research is already enabling medical

researchers to develop improved diagnostics, more effective therapeutic strategies, evidence-based

approaches for demonstrating clinical efficacy, and better decision-making tools for patients and providers.”@”

Genomic data is considered highly sensitive and must be shared and used under carefully controlled conditions.


Patient-Generated Data includes “health-related data created and recorded by or from patients outside of the

clinical setting to help address a health concern.”*° This data type is becoming increasingly prevalent through

the creation of mobile health applications and wearable health devices.


e = loT Data includes data from mobile software applications, voice assistants, and wearable devices such

as smart watches. These technologies are part of the “internet of things,” or loT, which refers to the

growing system of machines and devices connected to the internet. This data is generally collected

under “terms of service” agreements and has the potential to provide important information on a

variety of critical health indicators, such as heart rate, sleep cycles, and diet.


e Social Media Data includes interactions on social media platforms such as Facebook and Twitter.

Researchers have noted that “Social media may offer insight into the relationship between an

individual's health and their everyday life, as well as attitudes towards health and the perceived quality

of healthcare services,” among other opportunities.*! Like loT data, social media data is collected under

“terms of service” agreements.




76 University of Washington Health Sciences Library, “Data Resources in the Health Sciences,” Retrieved from .

bttp://guides lib uw.edu/hsl/data/findclin


27 Office of the National Coordinator for Health Information Technology, Conceptualizing a Data Infrastructure for the

Capture, Use, and Sharing of Patient-Generated Health Data in Care Delivery and Research through 2024, January 2018,

Retrieved from bttps: healthit gov/sites/default/files/onc pghd final white paperpdf


78 BHG Foundation at the University of Cambridge, {dentification and genomic data, December 2017, Retrieved from


bttp: phgfoundationore/documents/PHGF-|dentification-and-genomic-data pdt


?? National Institutes of Health National Human Genome Research Institute, “A Brief Guide to Genomics,” Retrieved from

https: genome.gov/about-genomics/fact-sheets/A-Brief-Guide-to-Genamic


%° Office of the National Coordinator for Health Information Technology, Conceptualizing a Data Infrastructure for the

Capture, Use, and Sharing of Patient-Generated Health Data in Care Delivery and Research through 2024, January 2018,

Retrieved from bttps: healthit gov/sites/default/files/onc pghd final white paperpdf


3? Kevin Padrez et al, “Linking social media and medical record data: a study of adults presenting to an academic, urban

emergency department,” BMJ Quality & Safety, 2016, Retrieved from bttp//dxdoiore/10.1136/bmiqs-7015-004489


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Social Determinants of Health Data represent “conditions in the environments in which people are born, live,

learn, [and] work...that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”°4

Examples of these social determinants include access to transportation, education, and job opportunities as

well as the availability of food and housing options. Social determinants of health data can come from many

sources inside and outside of government, and can be used to better understand population health.


Surveillance Data is a broad term that encompasses the “ongoing, systematic collection, analysis, and

interpretation of health-related data essential to planning, implementation, and evaluation of public health

practice.”*?


e Registry Data includes data shared voluntarily by individuals that is generally focused around a

specific diagnosis or condition such as cancer or cystic fibrosis. This data can be used to track trends

and better understand conditions over time. According to the NIH, this data “belongs to the sponsor of

the registry and..may be shared with the participants and their families, and approved health care

professionals and researchers. However, personal, identifying information is kept private.”™*


e Survey Data includes the results of surveys and studies conducted to assess population health. This

data can help stakeholders monitor the spread of disease, track health insurance coverage across

regions, and assess trends in nutrition and exercise, among other uses.°°


e Vitals Data is generally collected and exchanged between local jurisdictions and the federal

government. This data represents “vital events,” such as births, deaths, marriages, divorces, and fetal

deaths.**


Roundtable participants identified numerous legal, cultural, and technical challenges associated with sharing

and utilizing health data for Al applications. While some of these challenges are specific to Al development,

others are general issues that impact all applications of health data.


Legal challenges


e Inconsistent restrictions on data use. Among the legal challenges, participants noted that health data

types have different legal and regulatory constraints on their use. For example, administrative and

claims data, clinical data, and certain types of surveillance data, such as survey data, can include

sensitive, individual-level information.*” The use of these data types is often restricted under existing

privacy frameworks such as HIPAA. Patient-generated data, such as data collected from mobile

applications and wearable devices, can also contain sensitive information about individuals ranging

from fertility treatments to mental health conditions. However, there are relatively few legal guidelines

that protect this emerging data type from misuse.




*2 Office of Disease Prevention, and Health Promotion, “Social Determinants of Health,” Retrieved from










bttps: bealthypeaple gow/7070/topics-objectives/tapic/social-determinants-of-health

33 World Health Organization, “Public health surveillance,” Retrieved from


bttps: bojnt/topics/public health surveillance/en


* National Institutes of Health, “List of Registries,” Retrieved from


bttps: nibgov/health-information/nih-clinical-research-trials-you/list-registrie


°° National Center for Health Statistics, “Resources for Survey Participants,” Retrieved from

https: cdcgov/nchs/nchs for you/survey participants htm


%¢ National Center for Health Statistics, “National Vital Statistics System,” Retrieved from

bttps: cdcogov/nchs/n Index btm




3” Amy Bernstein and Marie Haring Sweeney, Marie Haring, “Public Health Surveillance Data: Legal, Policy, Ethical,

Regulatory, and Practical Issues,” Morbidity and Mortality Weekly Report. Retrieved from

https: cdcgov/mmwr/preview/mmwrhtml/sué 10337 btm


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Concerns about intellectual property. Roundtable participants also discussed the challenges of using

and sharing proprietary data and algorithms. Data collected in drug development trials, through

private-sector health surveys, or in other ways could benefit researchers and organizations in the

health sector developing Al applications, and proprietary Al models could be developed for greater

accuracy if the algorithms they use were shared. But while all parties stand to benefit from sharing

data and algorithms, it is difficult to balance that benefit against companies’ need to protect their

intellectual property for competitive advantage.


Cultural challenges


Underlying bias in health data. Some Roundtable participants highlighted concerns about bias and

lack of diversity in health data, which can have serious consequences when utilized for Al development.

As one expert notes, “If the data are flawed, missing pieces, or don’t accurately represent a population

of patients, then any algorithm relying on the data is at a higher risk of making a mistake.”?


Data silos and administrative hurdles. While HHS is developing more efficient ways for its operating

agencies to share data - for example, by developing common data use agreements (DUAs) - it is still

difficult for HHS agencies to share data with each other, and can be difficult for organizations outside

of government to obtain data from HHS. Roundtable participants said that tt can take 12 to 18 months

to get access to data from various agencies and offices within HHS. Culture changes are needed to

reduce the administrative hurdles that prevent timely data sharing.


Overly restrictive interpretations of HIPAA. Some Roundtable participants noted that fears about

violating HIPAA have created a risk-averse environment for data sharing. While HIPAA is intended to

protect patient privacy, it does allow data sharing and use under specific conditions.°*’ Participants

suggested that HHS could provide more guidance on what is and is not permissible under HIPAA in

different contexts.


Technical challenges


Limited technical capacity for data management and analysis. Roundtable participants inside and

outside of government noted the need for more staff with data science training. In particular, both

government and the private sector need more experts in Al and its application to health data and

issues.


Inadequate IT infrastructure for hosting and analyzing large datasets. Al applications require large

quantities of data, and large computational capacity, to train and test algorithms. The increasing

demand for real-time data adds to these technical requirements. Both HHS and the stakeholders that

work with the department may need to upgrade their infrastructure to meet these challenges.


Poor data interoperability. Roundtable participants flagged a number of challenges related to joining

and combining health datasets. Across the healthcare system, large amounts of data are structured in

different ways, preventing stakeholders from easily exchanging and integrating this information.

Participants attributed these challenges to a lack of common data standards and issues with

enforcement where standards do exist.




38 Dave Gershorn, “If Al is going to be the world’s doctor, it needs better textbooks,” Quartz, September 6, 2018. Retrieved

from bttps://q7.com/author/dgershgorna


% Office of the National Coordinator for Health Information Technology, “How HIPAA Supports Data Sharing,” Retrieved

from https: bealthit gov/topic/interoperability/how-bipaa-supparts-data-sharing


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Recommendations and Actionable Opportunities




The February 2019 “Executive Order on Maintaining American Leadership in Artificial Intelligence” outlined a

number of strategic objectives for developing Al.° These include (text bolded for emphasis):


Executive Order Objectives


A. “Promote sustained investment in Al R&D in collaboration with industry,

academia, international partners and allies, and other non-federal entities to

generate technological breakthroughs in Al and related technologies and to rapidly

transition those breakthroughs into capabilities that contribute to our economic and

national security.


B. Enhance access to high-quality and fully traceable federal data, models, and

computing resources to increase the value of such resources for Al R&D, while

maintaining safety, security, privacy, and confidentiality protections consistent

with applicable laws and policies.


C. Reduce barriers to the use of Al technologies to promote their innovative

application while protecting American technology, economic and national security, civil

liberties, privacy, and values.


D. Ensure that technical standards minimize vulnerability to attacks from malicious

actors and reflect federal priorities for innovation, public trust, and public confidence

in systems that use Al technologies; and develop international standards to promote

and protect those priorities.


E. Train the next generation of American Al researchers and users through

apprenticeships; skills programs; and education in science, technology, engineering,

and mathematics (STEM), with an emphasis on computer science, to ensure that

American workers, including federal workers, are capable of taking full advantage of

the opportunities of Al.


F. Develop and implement an action plan, in accordance with the National Security

Presidential Memorandum of February 11, 2019 (Protecting the United States

Advantage in Artificial Intelligence and Related Critical Technologies) (the NSPM) to

protect the advantage of the United States in Al and technology critical to United

States economic and national security interests against strategic competitors and

foreign adversaries.”


Under the Executive Order, agencies funding and deploying Al are expected to use these government-wide

objectives to inform their work.




4° The White House, “Executive Order on Maintaining American Leadership in Artificial Intelligence,” February 11, 2019,

Retrieved from

bttps: bitehouse.gov/presidential-actions/executive-order-maintaining-american-leadership-artificial-intelligence


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The HHS Office of the CTO is exploring the potential for a department-wide Al strategy to help realize the

value of Al within government, and to establish policies and practices for facilitating its development across the

health sector. Over the course of the Roundtable, participants outlined a number of recommendations for HHS

and other stakeholders that align with the objectives of the Executive Order. These recommendations and

related actionable opportunities are summarized below:


Al demands a robust information technology (IT) infrastructure, including data infrastructure, and staff

with the skills to apply it. Both infrastructure and expertise must be able to manage the large amounts of

data needed to support Al as well as the development of advanced Al applications.


Actionable Opportunities:


e Develop comprehensive technology investment plans to support organizational Al

strategies. Within HHS, this can include improving legacy systems for managing the data

that will fuel Al applications as well as IT modernization overall. It may also include

public-private collaboration to reduce the cost to government of technical

improvements.


e Build expertise in designing and implementing Al applications. Most federal

departments, including HHS, have limited organizational knowledge and experience

needed to develop Al applications with their data. HHS can bridge this gap through

hiring programs, public-private collaborations, or fellowship programs to bring Al

experts into government on a temporary basis.


e Create national testbeds for Al development. |ndustry has led the development of Al

applications, since commercial companies collect massive amounts of data and have the

resources, expertise, and technical capacity to apply tt. HHS and other agencies can help

remove these barriers to entry by creating collaborative environments where data and

code for Al applications can be tested, stored, and shared.


Concerns about privacy are paramount in the application of individual health data. While the use of

health data in EHRs and other medical records is governed by federal and state legislation, other data

types like loT data are only regulated through “terms of service” agreements developed by the private

sector. HHS and its partners will need to ensure that sensitive information is not disclosed or misused

when these data sources are applied. At the same time, researchers need to be able to use sensitive

data appropriately to develop new insights, diagnostic methods, and treatments. (The challenge of

balancing privacy with health data access will be the subject of the next Roundtable in this series.)


Actionable Opportunities:


e Provide guidance for de-identifying sensitive data. In order to protect privacy, health

data can be de-identified in different ways before researchers analyze It. Data scientists,

for example, have utilized codes that make it possible to link data about an individual

from different sources without revealing the person’s identity. HHS could provide

additional guidance on de-identification methods to protect data privacy and security

while encouraging its use for Al applications. This guidance may include updating

HIPAA’s rules around de-identification to meet modern demands.


15 of 20

e Develop credentialing systems for controlled access to sensitive health data. Some

sensitive data maintained by the federal government, such as collections of genomic

data, are now available only to qualified researchers only, under agreements that

prohibit them from sharing the data more widely. HHS could apply this model more

broadly and develop credentialing systems to determine who should have access to what

kinds of data and under what conditions.


Data for Al applications should be clean, timely, accurate, and standardized. Roundtable participants

identified numerous challenges related to integrating data and metadata from multiple sources.

Common standards for data collection and management can ensure that data and metadata are

accurate and consistent across healthcare applications, using a shared library of variables that are

applied across datasets. Standardization also ensures that datasets will be interoperable between

agencies within HHS or between HHS and its external partners. The current lack of interoperability is

amajor obstacle to applying data for Al development.


Actionable Opportunity:


e Adopt and expand existing common data models. Many participants noted the value

of adopting existing common data models for data and metadata, wherever possible.

Common data models standardize the way information is structured and make it easier

to use in combination with other data. Examples of existing common data models include

Patient Centered Outcome Research Network (PCORNet) model and the Observational

Medical Outcomes Partnership (OMOP) model. Participants also mentioned ICD-10,

which is a widely used coding system that could be expanded to improve health data

quality and interoperability nationwide.


Al applications are most effective when they can integrate large amounts of data about diverse facets

of health. However, researchers inside and outside of HHS often have difficulty accessing the data

they need. To share data from other sources, researchers must have DUAs that abide by HIPAA

regulations, whether HHS is sharing data with outside researchers or whether different operating

divisions within HHS are sharing data with each other. Drawing up and approving separate DUAs can

take time and administrative resources that are a burden on researchers and slow down the research

process.


Actionable Opportunity:


e Update and standardize data use agreements. A set of standard DUAs, using common

terms and conditions, could accelerate and simplify data sharing between operating

agencies within HHS. Revised DUAs could substantially reduce the time it takes for HHS

researchers to request and receive important, time-sensitive data: Finalizing DUAs can

now take up to 12 months. Standard DUAs for internal use within HHS could also

become a model for agreements between HHS and outside partners.


Participants also highlighted two areas for action that go beyond the Executive Order:


16 of 20

Increasingly, patients are generating data about themselves that can complement research and

clinical data? Patient-generated data includes data collected through sensors and wearables, and

through social media and mobile applications. Large amounts of this data are collected under “terms

of service” agreements and are being used by entities that are not covered by HIPAA.” As interest in

patient-generated data increases, there is a need for clearer rules around its appropriate use,

particularly in the context of Al development.


Actionable Opportunities:


e Develop specific guidelines for entities not covered by HIPAA. HIPAA applies to

traditional entities, such as health plans and healthcare providers, but does not apply to

software development and social media companies that may be collecting

patient-generated data with sensitive health information? While the HHS Office for

Civil Rights has developed several informational resources for health app developers,

entities that are not covered by HIPAA, and the individuals whose data they collect,

would benefit from further guidance and best practices on appropriate uses of

patient-generated data.


Many Al applications that use health data are being developed as a “black box” without clear

information about the algorithms and data being used to make decisions. Al strategies should include

steps to address concerns about accountability, bias, and oversight. This will require improved

transparency for both Al algorithms and the data that supports them.


Actionable Opportunities:


e Develop guidelines for mitigating bias in health-related Al applications. Some

Roundtable participants expressed interest in having HHS and its partners develop

guidance for identifying and reducing bias inAl applications. Participants also suggested

including an internal HHS review function to enforce such guidelines and help increase

transparency.


e Pilot and implement an FDA regulation for health-related Al applications.

Roundtable participants expressed similar concerns about a lack of quality assurance

and oversight for Al development in healthcare. The Food and Drug Administration




411) S. Department of Health and Human Services, “Patient-Generated Health Data,” Retrieved from


https: bealthit gov/topic/scientific-initiatives/patient-generated-health-data


#2 U.S. Department of Health and Human Services, Examining Oversight of the Privacy & Security of Health Data Collected by

Entities Not Regulated by HIPAA, June 2016, Retrieved from


bttps: healthit. gov/sites/default/files/non-covered entities report june 17 7016 pdf


#3 U.S. Department of Health and Human Services, Examining Oversight of the Privacy & Security of Health Data Collected by

Entities Not Regulated by HIPAA, June 2016, Retrieved from


bttps: bealthit gov/sites/default/files/non-covered entities report june 17 7016 pdf


* US. Department of Health and Human Services Office for Civil Rights, “Health app developers, what are your questions


about HIPAA?” Retrieved from bttps://hipaaqsportalbhs gov/


17 of 20

(FDA) has established a set of iterative, agile guidelines to precertify the rapid

development of Software as a Medical Device (SaMD).*? The FDA should continue its

efforts to adopt a revised regulatory framework for Al applications in which proposed

changes to algorithms must be disclosed to the FDA prior to market release. This

framework should take into account the ability of Al applications to adopt in real time

and provide ways to assess any risks from those changes.


e Publish metadata about data sources. Metadata provides information about the

structure of a dataset, the meaning of each variable within the data, the method of

collection, and other important characteristics. Metadata can also provide information

about the source of the data, the way it was collected, and other factors that may

indicate potential causes of bias. Publishing metadata will make it easier to assess

whether the data and the algorithms it supports are at risk of being biased in any way.




“5 US. Food and Drug Administration, “Developing Software Precertification Program: A Working Model,” June 2018,

Retrieved from


https: fdagov/downloads/MedicalDevices/DigitalHealth/DigitalHealthPreCertProgram/UCM611103. pdf


46 US. Food and Drug Administration, “Proposed Regulatory Framework for Modifications to Artificial


Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device,” April 2019, Retrieved from

https: fda gov/media/177535/download


18 of 20

Conclusion




While the promise of Al in healthcare is significant, a number of challenges can impede its successful

implementation. The Roundtable on Sharing and Utilizing Health Data for Al Applications was a first step to finding

solutions by identifying innovative examples of Al applications, high-value data types, and ways that all

stakeholders can contribute to the successful and appropriate use of Al.


In the two months since the Roundtable, HHS has demonstrated its commitment to exploring the use of Al

inside and outside of government. For example, HHS is moving forward with its “Reimagined — Buy Smarter”

program designed to use Al to conduct strategic comparative analysis of industry pricing to ensure that HHS is

saving taxpayers as much money as possible.4”7 HHS and CMS are also working to expand their cloud capacity to

manage the growing data assets that are critical to their daily operations and future Al applications.”


The Executive Office of the President has also advanced government-wide Al initiatives. In addition to the

February 2019 “Executive Order on Maintaining American Leadership in Artificial Intelligence,” the National

Science and Technology Council updated The National Artificial Intelligence Research and Development Strategic

Plan in June 2019. The Plan recommends that the federal government develop a coordinated approach to

maximize the impact of Al technology as it grows in scope. The Plan also proposes eight different strategies to

bolster Al development such as understanding the ethical, legal, and societal implications of Al, adopting

effective strategies for Al-human collaboration, and supporting the safety and security of Al systems.


This summary report presents research and diverse stakeholder input from the Roundtable on Sharing and

Utilizing Health Data for Al Applications that can inform the development of an HHS Al strategy. The report

outlines a number of ways that HHS can take action that align with the Executive Order and other

government-wide Al initiatives.


The same kinds of recommendations and actionable opportunities may be useful to the growing number of

stakeholders outside of government who are working to develop applications based on health data.

Private-sector companies, patients and their advocates, academic researchers, healthcare providers, and other

stakeholders will all play critical roles in the development of health-related Al in the months and years ahead.

CODE hopes that this report will provide context, perspective, and the beginnings of a framework for the

important work to come.




47 Amelia Brust, “HHS wants to use Al to help it ‘Buy Smarter,” Federal News Network, May 17, 2019, Retrieved from

hitps://federalnewsnetwork.com/ai-machine-learning-month/?019/05/hhs-wants-to-use-ai-to-help-it-buy-smarter,


8 Joseph Goedert, “CMS works with MarkLogic to expand cloud platforms,” Health Data Management, April 30, 2019,

Retrieved from https: bealthdatamanagementcom/news/cms-warks-with-marklogic-to-expand-claud-platform


*? The National Science and Technology Council, The National Artificial Intelligence Research and Development Strategic Plan,

June 21, 2019, Retrieved from


https: hitehouse.gov/wp-content/uploads/?2019/06/National-Al-Research-and-Development:-Strategic-Plan-2019


19 of 20

Acknowledgements and Appendices




The Roundtable on Sharing and Utilizing Health Data for Al Applications was

funded through a Patient-Centered Outcomes Research Institute (PCORI) ry

Engagement Award Initiative (12667-CODE). This Roundtable is part of the Corl

Open Data Roundtable Series: Sharing and Utilizing Data to Enhance and Protect °

Health and Well-Being funded through this award.


PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE


CODE would like to thank the HHS Office of the Chief Technology Officer for their partnership in co-hosting

this Roundtable series. We also thank the Multi-Stakeholder Advisory Committee for this series:


Lisa Bari, CMS Innovation Center, Centers for Medicare and Medicaid Services

Sohini Chowdhury, Michael J. Fox Foundation


James Craver, National Center for Health Statistics, Centers for Disease Control and Prevention

Gwen Darien, National Patient Advocate Foundation


Stephanie Devaney, Al! of Us Research Program, National Institutes of Health

Natalie Evans-Harris, BrightHive


Jason Gerson, Patient-Centered Outcomes Research Institute


Joel Gurin, Center for Open Data Enterprise


William Hoffman, World Economic Forum


Charles Keckler, Associate Deputy Secretary, HHS


Lisa Khorey, Allscripts Healthcare Solutions


Michael Seres, 11 Health


Mona Siddiqui, Chief Data Officer, HHS


Paul Tarini, Robert Wood Johnson Foundation


John Wilbanks, Sage Bionetworks


The following resources are included as appendices to this report:


e = List of Participating Organizations

e Roundtable Agenda


20 of 20

Roundtable on Sharing and Utilizing Health Data for Al Applications

PARTICIPATING ORGANIZATIONS


Academia


Dell Medical School, University of Texas at Austin is the graduate medical school of The University of

Texas at Austin in Austin, Texas. The school opened to the inaugural class of 50 students in the summer of

2016 as the newest of 18 colleges and schools on the UT Austin campus.


Duke Margolis Center for Health Policy’s mission is to improve health and the value of health care through

practical, innovative, and evidence-based policy solutions. Duke-Margolis catalyzes Duke University's

leading capabilities to inform policy making and implementation for better health and health care.


Harvard Law School, Petrie-Flom Center founding mission is to promote interdisciplinary analysis and legal

scholarship in the fields of Health Law Policy, Biotechnology, and Bioethics.


University of Maryland School of Public Health offers an unusual breadth of expertise to explore complex

issues through public health disciplines, and lenses as varied as engineering, arts and humanities, business

and public policy.


Stanford University, one of the world's leading teaching and research universities, dedicated to finding

solutions to big challenges and to preparing students for leadership in a complex world.


Hall Center for Law and Health, Indiana University Robert H. McKinney School of Law was established in

1987 to expand the curriculum and teaching of health law and provide opportunities for students.


Civil Society


ACT | The App Association represents more than 5,000 app companies and information technology firms

across the mobile economy. ACT advocates for an environment that inspires and rewards innovation, while

providing the necessary resources to help its members leverage their intellectual assets to raise capital and

create jobs.


American Medical Association (AMC) promotes the art and science of medicine and the betterment of

public health. AMC provides timely, essential resources to empower physicians, residents and medical

students to succeed at every phase of their medical lives.


Center for Data Innovation educates policymakers and the public about the opportunities and challenges

associated with data, as well as technology trends such as predictive analytics, open data, cloud computing,

and the Internet of Things.


Center for Open Data Enterprise (CODE) is an independent nonprofit organization based in Washington,

D.C. whose mission is to maximize the value of open government data for the public good.


Healthcare Leadership Council (HLC)}, a coalition of chief executives from all disciplines within American

healthcare, is the exclusive forum for the nation’s healthcare leaders to jointly develop policies, plans, and

programs to achieve their vision of a 21st century system that makes affordable, high-quality care

accessible to all Americans.


World Economic Forum is the International Organization for Public-Private Cooperation. The Forum

engages the foremost political, business and other leaders of society to shape global, regional and industry

agendas.

Government


The U.S. Department of Health and Human Services is a cabinet-level department of the U.S. federal

government with the goal of protecting the health of all Americans and providing essential human services.


The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make

health care safer, higher quality, more accessible, equitable, and affordable, and to work within the

U.S. Department of Health and Human Services and with other partners to make sure that the

evidence is understood and used.


The Centers for Disease Control and Prevention Center (CDC) works to protect America from

health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or

abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights

disease and supports communities and citizens to do the same.


The National Center for Health Statistics (NCHS), part of the CDC, compiles statistical

information to help guide policies to improve the health of Americans. Holds a biennial data

user conference; consult the NCHS website for date and location. NCHS disseminates data

and statistics online and in print.


Center for Medicare and Medicaid Services (CMS) administers the Medicare program and works in

partnership with state governments to administer Medicaid, the Children's Health Insurance

Program (CHIP), and health insurance portability standards.


The Innovation Center with CMS supports the development and testing of innovative

health care payment and service delivery models.


Food and Drug Administration (FDA) is responsible for protecting the public health by ensuring

the safety, efficacy, and security of human and veterinary drugs, biological products, and medical

devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit

radiation.


Health Resources and Services Administration (HRSA) is the primary federal agency for improving

health care to people who are geographically isolated, economically or medically vulnerable.


The Immediate Office of the Secretary (IOS) is responsible for operations and coordination of the

work of the Secretary.


The National Institutes of Health (NIH) seeks fundamental knowledge about the nature and

behavior of living systems and the application of that knowledge to enhance health, lengthen life,

and reduce illness and disability.


NIH Clinical Center mission is to provide hope through pioneering clinical research to

improve human health. The center has an Individual and collective passion for high

reliability in the safe delivery of patient-centric care in a clinical research environment.


The Office of the Assistant Secretary for Preparedness and Response leads the nation’s medical

and public health preparedness for, response to, and recovery from disasters and public health

emergencies.


The Office of the Chief Technology Officer (CTO) provides leadership and direction on data,

technology, innovation and strategy across the HHS. Areas of focus include promoting open data

and its use to create value, driving more efficient operations through technology utilization, and

coordinating innovation strategy across the Department to improve the lives of the American

people and the performance of the Department.


Office of Inspector General (OIG) mission is to protect the integrity of Department of Health &

Human Services (HHS) programs as well as the health and welfare of program beneficiaries.


Office of the National Coordinator Improve the health and well-being of individuals and

communities through the use of technology and health information that is accessible when and

where it matters most.


U.S. Government Accountability Office (GAO) examines how taxpayer dollars are spent and provides

Congress and federal agencies with objective, reliable information to help the government save money and

work more efficiently.


Healthcare Insurers and Providers


HCA Healthcare is committed to the care and improvement of human life. HCA follows a vision of

healthcare the way it should be: patient-centered, constantly evolving and constantly improving, practiced

with integrity and compassion.


UnitedHealth has a mission to help people live healthier lives and make the health system work better for

everyone and are working to create a system that delivers high quality care, responsive to the needs of each

person and the communities in which they live.


New York Presbyterian Hospital is one of the nation’s most comprehensive, integrated academic health

care delivery systems, dedicated to providing the highest quality, most compassionate care and service to

patients in the New York metropolitan area, nationally, and throughout the globe.


Nonprofit & Philanthropic Organizations


Michael J. Fox Foundation is dedicated to finding a cure for Parkinson's disease through an aggressively

funded research agenda and to ensuring the development of improved therapies for those living with

Parkinson's today.


Robert Wood Johnson Foundation (RWJF) is the nation’s largest philanthropy dedicated solely to health.

RWJD supports research and programs targeting some of America’s most pressing health issues—from

substance abuse to improving access to quality health care.


Patient Advocacy


National Patient Advocate Foundation (NPAF), the advocacy affiliate of the Patient Advocate Foundation,

represents the patient voice, both the powerful stories of individuals and the collective needs of the

community. The NPAF’s primary objective is to prioritize the patient voice in health system delivery reform

to achieve person-centered care.


Patient-Centered Outcomes Research Institute (PCORI} helps people make informed healthcare decisions,

and improves healthcare delivery and outcomes, by producing and promoting high-integrity,

evidence-based information that comes from research guided by patients, caregivers, and the broader

healthcare community.


Patient Privacy Rights’ purpose is to honor and empower the individual’s right to privacy through personal

control of health information wherever such information is collected and used. They educate, collaborate

and partner with people to ensure privacy in law, policy, technology, and maximize the benefits from the use

of personal health information with consent.


Private Sector


Allscripts is a leader in healthcare information technology solutions that advance clinical, financial and

operational results. Its innovative solutions connect people, places and data across an Open, Connected

Community of Health.


Amazon Web Services is a subsidiary of Amazon that provides on-demand cloud computing platforms to

individuals, companies and governments, on a metered pay-as-you-go basis.


Apple is an American multinational technology company headquartered in Cupertino, California, that

designs, develops, and sells consumer electronics, computer software, and online services.


Blackfynn helps the neuroscience and neurology communities make optimal use of data by powering an

innovative platform that integrates and puts complex data in context.


Booz Allen Hamilton provides management and technology consulting and engineering services to leading

Fortune 500 corporations, governments, and not-for-profits across the globe. Booz Allen partners with

public and private sector clients to solve their most difficult challenges through a combination of consulting,

analytics, mission operations, technology, systems delivery, cybersecurity, engineering, and innovation

expertise.


Epic hires smart and motivated people from all academic majors to code, test, and implement healthcare

software that hundreds of millions of patients and doctors rely on to improve care and ultimately save lives

around the globe.


Flatlron Health is a healthcare technology and services company focused on accelerating cancer research

and improving patient care. Their mission is to improve lives by learning from the experience of every

cancer patient.


Geisinger Healthcare is a coordinated intersection of services and providers - primary care and specialists,

hospitals and trauma centers, insurance, medical education and research. Geisinger has expanded and

evolved to meet regional needs and developed innovative, national programs in the process.


Google LLC is an American multinational technology company that specializes in Internet-related services

and products, which include online advertising technologies, search engine, cloud computing, software, and

hardware.


Google Al conducts research that advances the state-of-the-art in the field, applying Al to products and to

new domains, and developing tools to ensure that everyone can access Al.


Health Catalyst is dedicated to enabling health care organizations to fundamentally improve care by

building the most comprehensive and fully integrated suite of healthcare data warehousing and process

improvement solutions available.


IBM Research is a community of thinkers dedicated to addressing some of the world’s most complex

problems and challenging opportunities for the benefit of all. They are one of the world’s largest and most

influential corporate research labs, with more than 3,000 researchers in 12 labs located across six

continents.

Intel Corporation invents at the boundaries of technology to make amazing experiences possible for

business and society for everyone. Leading on policy, diversity, inclusion, education and sustainability, we

create value for our stockholders, customers, and society.


KB Stack Consulting helps government and non-profit organizations develop creative strategies for using

data, evidence, and innovation to improve the impact of government social programs.


Mathematica Policy Research is dedicated to improving public well-being by bringing the highest standards

of quality, objectivity, and excellence to bear on public policy. It advances its mission through objective,

evidence-based standards, superior data, and collaboration.


Microsoft is an American multinational technology company with headquarters in Redmond, Washington. It

develops, manufactures, licenses, supports and sells computer software, consumer electronics, personal

computers, and related services.


Mpirica Health is a digital health company that uses machine learning, backed by a robust methodology, to

scores hospitals and surgeons based on objective clinical outcomes. Our cloud-based platform and API helps

patients and payers, especially self-insured employers, avoid surgery risks and costs.


Oncology Analytics, Inc. provides health plans with an evidence-based, technologically driven approach to

utilization management, which is purpose-built for oncology. They provide a technology enabled service to

ensure cancer patients get the right treatment at the right time, and at an affordable price.


Pfizer’s purpose is grounded in their commitment to fund programs that provide public benefit, advance

medical care and improve patient outcomes. Their belief is that all people deserve to live healthy lives. This

drives their desire to provide access to medicines that are safe, effective, and affordable.


TrialX brings researchers and patients together, accelerating clinical research to find cures for millions.

They put the patient at the center and build solutions that work together seamlessly to meet the patient

where they are, helping them find the trials they are looking for and connect with investigators close by.


Verily Life Science’s mission is to bring together technology and life sciences to uncover new truths about

health and disease. As an independent company, they are focused on using technology to better understand

health, as well as prevent, detect, and manage disease.


Viz.ai’s world class team of technologists, doctors, executives, and advocates has developed an Al-driven

approach to care that is fast, effective, collaborative, and sustainable.


11 Health and Technologies have a complete care management platform that is the new gold standard in

healthcare for both patients and clinicians by combining Smart Technology with the world's first one to one

Patient Coach Program that provides both technical and emotional support to patients.

Roundtable on Sharing and Utilizing Health Data for Al Applications

U.S. Department of Health and Human Services | April 16, 2019


Purpose: Identify high-priority health applications of Al and key issues for an HHS Al strategy to address.


Registration and Light Breakfast


Welcome

Mona Siddiqui, Chief Data Officer, U.S. Department of Health and Human Services (HHS)


Opening Remarks

Ed Simcox, Chief Technology Officer, HHS


Structure of the Day

Joel Gurin, President, Center for Open Data Enterprise (CODE)


Lightning Talks: Emerging Applications of Al

Sohini Chowdhury, Deputy Chief Executive Officer, Michael J. Fox Foundation

Jason Jones, Chief Data Scientist, Health Catalyst

Vivian Lee, President of Health Platforms, Verily Life Sciences

James Wiggins, Senior Solutions Architect for Academic Medical Centers, Amazon Web Services



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六根、六境、六識、六觸的核心概念:覺察與解脫 六根、六境、六識、六觸的概念在佛法中,不只是讓我們理解「感知世界的過程」,更重要的是,它在傳達一個關鍵的智慧: 我們對世界的認識,都是透過六根感知六境,經由六識來判斷,但這一切都是主觀的,容易生起執著,導致煩惱。 這背後傳遞了幾個重要的
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