After many years of hype and speculation, artificial intelligence (AI) has begun making its way into GI practices and ASCs, offering potential new ways to improve the delivery of care. This potential has Amiee Mingus, RN, BSN, vice president of clinical operations for PE GI Solutions, a service line of SCA Health, excited for the future.
“I think we are at the beginning of witnessing what AI will be able to do for gastroenterology,” Mingus said. “It’s been just a few years since we started learning about AI and its possible applications for GI. I know a lot of our providers are closely following the news and developments around AI and are eager to try out these new solutions, and some are: We’re now starting to see AI technologies added by our facilities.”
Thus far, the one AI technology that’s made its way into PE GI Solutions’ facilities is computer-aided polyp detection (CADe), which is intended to help reduce the likelihood of missed polyps during colonoscopy. There are two different applications for AI polyp detection in use at PE GI Solutions’ facilities: one costing a flat fee for usage at any time; the other costing several dollars for each individual usage. “This per-use option allows our physicians who want to use it to turn it on while physicians who do not want to use it can leave it off,” Mingus says.
Why would a physician choose not to use AI? The jury is largely still out on the value and viability of the technology in gastroenterology, says Annie Sariego, market president for PE GI Solutions. “I think AI is the future, but before we begin changing practices that have served us and our patients well for many years, we must consider the ramifications of those changes. The focus must always be on outcomes and doing what is in the best interest of patients.”
That, Sariego says, extends to considering the cost of care. “AI can exponentially increase costs. I think it is important that we remain cognizant of our role as leaders in providing low-cost, high-quality care to our communities. This is especially important as we think about serving disparate areas and populations.”
In the case of whether to add a CADe system, Mingus says the questions you will want to answer are how much a difference the AI makes and does that difference justify the investment? “AI potentially enhances the trained eye,” she says. “If the technology can raise the adenoma detection rate, it’s worth considering. But before adding the technology, you must determine whether the financial ramifications could jeopardize your ability to maintain viability and continue to serve your patients.”
Many New AI Technologies on the Way
Asking such questions about outcomes and cost will be essential as more AI technologies come on to the market. Several technologies are on Mingus’ radar. One is computer-aided polyp diagnosis (CADx). “This is the use of a pathology AI algorithm to examine tissue and determine whether it’s cancerous or precancerous, which has the potential to expedite additional care when needed,” she says.
Another use of AI Mingus is monitoring closely concerns natural language processing (NLP). Such applications may be able to help with completing operative or procedure notes and charting. “The technology is designed to detect the conversation in the room, choose what is appropriate for the operative report, and then separate this information from any other conversations people are having in the room,” she says.
CADe, CADx, NLP, and many other AI technologies were discussed in a 2020 position statement on priorities for AI in GI published by the American Society for Gastrointestinal Endoscopy (ASGE). ASGE has also created an AI task force to “develop guidance around clinical implementation, testing/validating algorithms, and building pathways for successful implementation of AI in GI endoscopy.”
Other GI societies are focusing on AI as well. The American Gastroenterological Association is developing a clinical practice update concerning the role of AI and management of colorectal polyps and guidelines concerning the role of AI in colorectal cancer screening. The American College of Gastroenterology is planning an “AI in GI” special issue of Clinical and Translational Gastroenterology to be published in the fall of 2023
GI professionals should pay close attention to information on AI published by these GI organizations as well as research on validation of AI technologies. Physicians interested in AI should speak with colleagues who are using the technologies in their facilities to learn if the tools are enhancing and not impeding their work.
Preparing for a Future With AI
In all likelihood, Mingus expects AI in some form to become commonplace within GI. “There will only be more options for AI technologies, some of which will prove themselves valuable for improving outcomes, and they will become more affordable over time. Some scope manufacturers are already talking about adding AI to their scopes. AI may eventually be part of what comes standard when we purchase scopes.”
If you have added or are planning to add AI technologies, make sure you allocate time and resources for patient education. “There’s so much buzz around AI these days, and not all of it is positive,” says Mingus, citing ChatGPT as one example. “There are some people who may want to come to a center because it advertises the use of an AI solution. Then there are other patients who might be a little nervous about the role AI will play in their care.”
In the case of CADe, Mingus says some patients going to centers with the technology have asked whether the AI will perform their procedure while physicians watched. “People need to know the use of AI does not mean a computer or robot is taking over their care. Rather, it’s still the physician who is firmly in charge and making all the decisions. The AI is there to enhance a physician’s capabilities and essentially serve as a backup.”
As AI makes its way into more facilities, Sariego emphasizes the importance of performing ongoing monitoring and assessment of the technologies and their role in the delivery of GI care. “Even if AI becomes standard, we must closely study our outcomes and costs and then continue to make decisions that always put patients first.”
This story was originally published in the July 2023 issue of the PE GI Journal by PE GI Solutions. PE GI Solutions is now a part of SCA Health. To read more from this and past issues of the journal, click here.