Innovation is greater than the sum of its parts

Why we probably don't yet see the true innovative potential of AI in healthcare

*Reposted* — originally published on 2/10/2021 on byte2bedside.com

What is innovative about the Apple Watch ECG app? The answer to the above question may differ based on who you ask.

AI enthusiasts will point to the novel deep learning classifier that detects atrial fibrillation from captured ECG waveforms, while others will speak to the sensing capabilities of the hardware or the usability of the app.

The ECG app on the Apple Watch Series 4 detects signals from your pulse that is fed into a deep learning classifier and detects the presence of atrial fibrillation. In a study of 419,297 participants over a median duration of 117 days, the app was found to have a positive predictive value of 84% for detecting atrial fibrillation.

https://www.apple.com/healthcare/apple-watch/

The iPhone and Apple Watch as illustrative examples

When Steve Jobs first unveiled the iPhone in 2007, he cryptically began his introduction by describing three separate products: “a widescreen iPod with touch controls, “a revolutionary mobile phone”, and “a breakthrough internet communications device.” Although the applause from the audience grew with the announcement of each separate “product,” the punchline was of course when he revealed that they are actually features of one product: the iPhone. Jobs then moves on to describe three enabling technologies that made the iPhone revolutionary at the time: the multi-touch screen, a powerful operating system and suite of software, and syncing capabilities with other products in the Apple ecosystem.

The purpose of this post is not to promote Apple products, but to illustrate a concept that I think Apple understands very well: breakthrough innovation does not come from advances in just one type of technology, but from the integration of multiple streams of technologies that creates something greater than the sum of its parts. The same concept applies to the Apple ECG app. The AI, digital health, and hardware components are of course all advanced in their own right, but it is the integration of these capabilities into a product that allows us to think about how these individual technologies can impact health. This is not an easy task, and is part of the great filter that sits between new technologies and great products.

In the case of the Apple ECG app, integration needed to occur both in technology and design. On the technical end, the AI needed to be integrated into the software and hardware systems that ingest and derive the right data into model features at runtime, and enable the delivery of the predictions in a way that creates a viable user experience. A model prediction, however accurate it may be, must also be integrated into a user experience that drives desired behavior changes in order to be impactful on health. The Apple ECG app is innovative precisely because it is not simply just a smartwatch, an AI model, and a sensor. The integration of these three technologies created something that is greater than the sum of its parts.

The AI model predictions generate snippets and clinical interpretations of ECG waveforms that can be saved into the Apple Health Record, which is a digital personal health record that aggregates data from electronic health records from APIs. A notable gap here is the ability to upload data from Apple Health Records into the EHR systems used by physicians (as indicated here, a PDF has be generated and emailed or printed for the physician).

https://support.apple.com/en-us/HT208955

Innovation as an emergent property

In systems science, an emergent property is a property of an entity that cannot be derived from just the sum of its individual parts. For example, a neuron in a human brain is comprised of individual units such as a lipid membrane, organelles, DNA, and neurotransmitters, each with its set of properties and functions. However, as the neuron fires and ultimately leads to a complex emotion such as love or sadness, this “emergent” phenomenon cannot be explained simply be adding up the functions and properties of the individual units.

I like to think of innovation as an emergent property that comes from the interactions between people, processes, and technology. This is important to keep in mind in technology driven fields such as health IT, where it can be easy to fall into the trap of equating innovation with the novelty of a particular technology. Organizations that are looking to update their tech stack with the latest AI, cloud, and digital capabilities need to think about how these technologies interact with each other, and with the people and processes that they are looking to service and improve. Rather than just assessing each technology separately, innovators need to take a step back and look at big picture: what emerges when these components of the tech stack interact with each other and integrate within the ecosystem of people, technologies, and processes where the problems they aim to solve exist?

Apple and Jobs understood this concept well. Otherwise, they may as well have ended up separately developing a phone, music player, and mobile internet browser rather than the iPhone.

Why this is relevant now with AI in healthcare

The recent advances in AI and large language models are impressive, but represent only one of the building blocks for the types of innovation that will truly change healthcare. These capabilities need to be integrated with the rest of the healthcare ecosystem in ways that will allow these innovations to emerge. What they will look like can be anyone’s guess — but likely not just an AI chatbot that answers medical questions.