HHS: We must seize the promise and manage risks of AI, information chief says

National Coordinator for Health Information Technology Micky Tripathi, PhD, MPP, testifies Dec. 13, 2023, in the hearing "Leveraging Agency Expertise To Foster American AI Leadership And Innovation," of the House of Representatives’ Committee on Energy & Commerce. This image was taken from the committee's webcast of the hearing.

Leaders in the U.S. Department of Health and Human Services (HHS) are “AI optimists” about the future of artificial intelligence in medicine.

However, they won’t trust without verifying, said National Coordinator for Health Information Technology Micky Tripathi, PhD, MPP. He testified Dec. 13, 2023, in the hearing "Leveraging Agency Expertise To Foster American AI Leadership And Innovation," of the House of Representatives’ Committee on Energy & Commerce.

“We in the department are AI optimists,” Tripathi said in his opening statement. “AI-based technologies have the potential to accelerate innovation, increase competition, help to ameliorate health inequities, reduce clinician burnout, and improve care and the care experience for patients.

“We also know that there are lots of potential downsides,” so HHS leaders believe their posture on AI must be to trust but verify and look for proof, he said.

“It's vital that we both seize the promise and manage the risks,” Tripathi said.

Actions so far

HHS already is overseeing research and drafting rules about AI in health care. The Food and Drug Administration already has approved almost 700 AI-enabled devices for use in the market. The National Institutes of Health, the Office of Civil Rights and the Centers for Medicare & Medicaid Services all have programs underway to study and regulate AI, Tripathi said.

He noted the same day, HHS published its final Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing rule (HTI-1). The rule governs patient access, standards, algorithm transparency, information blocking requirements, and interoperability-focused reporting metrics for certified health IT.

AI and EHR

The Office of the National Coordinator for Health IT (ONC) certifies the electronic health records now used by 97% of hospitals and 80% of physician offices.

“EHRs are a key enabler of AI in health care,” Tripathi said. “They are increasingly the source of data that feeds machine learning algorithms, and they are the place where AI works behind the scenes and user interfaces and workflows to influence data to this day-to-day decision-making that affects, directly affects, patient lives.”

But health care providers are concerned about AI serving as a “black box on their system,” and that is hindering adoption of the new technologies, Tripathi said. HHS leaders believe the new rule could spur adoption, he said.

“By using transparency and risk management to instill public trust and confidence, AI opens up vast opportunities to improve our country's health care, public health and social services capabilities to better serve the American people,” Tripathi said.

Five priorities

In his written testimony, Tripathi presented a list of a dozen HHS actions already taken on AI. He noted HHS has five priorities relating to work on AI:

They are:

• Develop resources and policies to enable the safe, responsible adoption and use and manage risks of AI in health care, public health, and human services.
• Advance quality and safety of AI in health through assurance standards and quality management processes.
• Leverage grantmaking and contracting to advance the development and responsible use of AI across the health and human services delivery value chain.
• Provide public education across the health care ecosystem and constituents – from individuals to organizations and states – on AI development and use in health and human services delivery.
• Evaluate and deploy AI capabilities across HHS to drive process innovation and modernization.

“Taken together, these objectives will enable HHS to fully mobilize its components to seamlessly integrate with and meaningfully contribute to a whole-of-government-and-industry approach to improving quality, efficiency, trustworthiness, access, and outcomes in health and human services through the safe, ethical, and responsible use of AI,” he said.

Committee discourse

Committee Chair Rep. Cathy McMorris Rodgers (R-Washington) and Ranking Member Rep. Frank Pallone (D-New Jersey) proffered opening statements. Additional testimony came from Helena Fu, director of the Office of Critical and Emerging Technologies in the U.S. Department of Energy, and Saif Khan, senior adviser to the Secretary for Critical and Emerging Technologies in the U.S. Department of Commerce. Those departments, along with HHS, are responding to President Joe Biden’s Executive Order on “Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence.”

In their questions, committee members touched on AI-related issues ranging from making supercomputers energy efficient, to availability of technology, to climate change, to data collection, individual online privacy, and getting children hooked on apps on their mobile devices.

Paying doctors — 'kind of common sense'

Rep. Michael Burgess, MD (R-Texas), said Tripathi “provoked” him to comment about physician well-being. He asked Tripathi to relay a message to HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure.

“I don’t know if it takes artificial intelligence or not, but here’s the equation: You work your doctors and nurses during the pandemic literally to the bone and then you turn around and say, but we don't really value what you do. And the way you signal that is through the physician fee schedule at the Center for Medicare and Medicaid Services,” Burgess said. “If you're concerned about physician burnout and retaining people in the clinical settings, you're going to have to stop year after year with the erosion of reimbursement, because in today's inflationary environment, literally doctors and nurses just simply can't keep up with their practices. Again, it doesn't take artificial intelligence, it’s kind of common sense.”