AI-driven Optimization in Healthcare: the Diagnostic Process

Purpose: Process optimization in healthcare using artificial intelligence (AI) is still in its infancy. In this study, we address the research question “To what extent can an AI-driven chatbot help to optimize the diagnostic process?” Design / Method / Approach: First, we developed a mathematical model for the utility (i.e., total satisfaction received from consuming a good or service) resulting from the diagnostic process in primary healthcare. We calculated this model using MS Excel. Second, after identifying the main pain points for optimization (e.g., waiting time in the queue), we ran a small experiment (n = 25) in which we looked at time to diagnosis, average waiting time, and their standard deviations. In addition, we used a questionnaire to examine patient perceptions of the interaction with an AI-driven chatbot. Findings: Our results show that scheduling is the main factor causing issues in a physician’s work. An AI-driven chatbot may help to optimize waiting time as well as provide data for faster and more accurate diagnosis. We found that patients trust AI-driven solutions primarily when a real (not virtual) physician is also involved in the diagnostic process. Practical Implications: AI-driven chatbots may indeed help to optimize diagnostic processes. Nevertheless, physicians need to remain involved in the process in order to establish patient trust in the diagnosis. Originality / Value: We analyze the utility to physicians and patients of a diagnostic process and show that, while scheduling may reduce the overall process utility, AI-based solutions may increase the overall process utility. Research Limitations / Future Research: First, our simulation includes a number of assumptions with regard to the distribution of mean times for encounter and treatment. Second, the data we used for our model were obtained from different papers, and thus from different healthcare systems. Third, our experimental study has a very small sample size and only one test-physician. Paper type: Empirical

Economic evaluation of process utility: elucidating preferences for a non-invasive procedure to treat restenosis

Background In health economic evaluation, utility associated with a health state is outcome-oriented and usually measured using the QALY methodology. Even though there is consistent evidence of utility not only being derived from outcomes but also from procedures, process utility has not been fully integrated in QALY calculations. The aim of this paper is twofold: first, to provide evidence of process utility associated with an alternative treatment to angioplasty, and second, to estimate a monetary value of such process utility using the willingness to pay (WTP) approach. Methods A total of 1514 people were polled on their WTP to avoid angioplasty to have a drug-eluting stent (DES) implanted. WTP is estimated with a contingent valuation (CV) survey. Individuals are also asked if they would be WTP for a non-invasive procedure with similar results being achieved. WTP responses were analyzed using a double bounded (DB) logit model. Results Most of the participants showed positive preferences for avoiding angioplasty, with an estimated mean WTP of €5692.87. Using QALY gains for avoiding angioplasty, varying from 0.0035 to 0.08 QALYs, our WTP estimate imply monetary values per QALY that range from €71,160.87 to €1,626,534.28. Discussion A WTP of €5692.87 to avoid angioplasty imply a monetary value per QALY that greatly exceed the cost per QALY thresholds established in different countries to consider health programs as beneficial to society. Our results reflect how different methodologies for HTA may lead to different conclusions. From the ICER perspective, the cost that would make the treatment with pills option cost-effective, using a threshold of €40,000/QALY, would be €224. However, a cost-benefit approach could support health programs even with a higher cost. Conclusion WTP methodology captures outcome and process factors related to angioplasty as our WTP estimations are non-significantly different for the costs of angioplasty. WTP approach must be considered as a genuine alternative to QALY approaches to value process utility.

ANALISA KINERJA CNG COOLER PADA SISTEM CNG PLANT

CNG Cooler is a heat exchanger in CNG Plant System which has function to reduce CNG temperature. CNG (Compressed Natural Gas) is natural gas which compressed by gas compressor from normal pressure up to certain high pressure. CNG Plant is gas storage and supply facility for PLTGU when it work at peak load hours. CNG Cooler reduce temperature of CNG which out from gas compressor before saved in storage utility which purpose to avoid over heating in the next process, increase durability of the next process utility, and make gas storage utility design easy.

Case study of a method of development of a selection process for community health workers in sub-Saharan Africa

Background Choosing who should be recruited as a community health worker (CHW) is an important task, for their future performance partly depends on their ability to learn the required knowledge and skills, and their personal attributes. Developing a fair and effective selection process for CHWs is a challenging task, and reports of attempts to do so are rare. This paper describes a five-stage process of development and initial testing of a CHW selection process in two CHW programmes, one in Malawi and one in Ghana, highlighting the lessons learned at each stage and offering recommendations to other CHW programme providers seeking to develop their own selection processes. Case presentation The five stages of selection process development were as follows: (1) review an existing selection process, (2) conduct a job analysis, (3) elicit stakeholder opinions, (4) co-design the selection process and (5) test the selection process. Good practice in selection process development from the human resource literature and the principles of co-design were considered throughout. Validity, reliability, fairness, acceptability and feasibility—the determinants of selection process utility—were considered as appropriate during stages 1 to 4 and used to guide the testing in stage 5. The selection methods used by each local team were a written test and a short interview. Conclusions Working with stakeholders, including CHWs, helped to ensure the acceptability of the selection processes developed. Expectations of intensiveness—in particular the number of interviewers—needed to be managed as resources for selection are limited, and CHWs reported that any form of interview may be stressful. Testing highlighted the importance of piloting with CHWs to ensure clarity of wording of questions, interviewer training to maximise inter-rater reliability and the provision of guidance to applicants in advance of any selection events. Trade-offs between the different components of selection process utility are also likely to be required. Further refinements and evaluation of predictive validity (i.e. a sixth stage of development) would be recommended before roll-out.

Thoughts of Using Economic Decision-Making to Systems Engineering and Systems Thinking

System engineering is an art that tries to capture the requirements that are imposed by stakeholders. Economic decision-making is an essential tool for systems engineers to accomplish that goal. However, a decision as a whole in systems engineering can be summed up in the following three element process: utility analysis by 17 evaluation criteria, human behavioral analysis by 6 evaluation criteria, the calculation of Net Present Value, IRR, and other economic decision-making indicators. The author will further discuss the NPV and IRR methods to discover some hidden pitfalls. Also, this article will discuss some newer methods/techniques that avoid these pitfalls in economic decision-making by accounting for the risk associated with these methodologies.