Artificial Intelligence Framework for Simulating Clinical Decision-Making: A Markov Decision Process Approach

TL;DR

This paper presents a versatile AI framework using Markov decision processes to simulate and improve clinical decision-making, demonstrating significant cost reductions and outcome improvements with real patient data.

Contribution

It introduces a general-purpose AI simulation framework that models healthcare decisions and outperforms traditional treatment models in cost and patient outcomes.

Findings

Cost per unit change reduced from $497 to $189

Patient outcomes increased by 30-35%

Parameter tuning further improves results by 50%

Abstract

In the modern healthcare system, rapidly expanding costs/complexity, the growing myriad of treatment options, and exploding information streams that often do not effectively reach the front lines hinder the ability to choose optimal treatment decisions over time. The goal in this paper is to develop a general purpose (non-disease-specific) computational/artificial intelligence (AI) framework to address these challenges. This serves two potential functions: 1) a simulation environment for exploring various healthcare policies, payment methodologies, etc., and 2) the basis for clinical artificial intelligence - an AI that can think like a doctor. This approach combines Markov decision processes and dynamic decision networks to learn from clinical data and develop complex plans via simulation of alternative sequential decision paths while capturing the sometimes conflicting, sometimes synergistic interactions of various components in the healthcare system. It can operate in partially observable environments (in the case of missing observations or data) by maintaining belief states about patient health status and functions as an online agent that plans and re-plans. This framework was evaluated using real patient data from an electronic health record. Such an AI framework easily outperforms the current treatment-as-usual (TAU) case-rate/fee-for-service models of healthcare (Cost per Unit Change: $189 vs. $497) while obtaining a 30-35% increase in patient outcomes. Tweaking certain model parameters further enhances this advantage, obtaining roughly 50% more improvement for roughly half the costs. Given careful design and problem formulation, an AI simulation framework can approximate optimal decisions even in complex and uncertain environments. Future work is described that outlines potential lines of research and integration of machine learning algorithms for personalized medicine.