Artificial Intelligence in the COVID-19 Response

This study was prepared for the Patient-Centered Outcomes Research Institute (PCORI) Emerging Technology and Therapeutics Report series. This study, on the use of artificial intelligence (AI) in the COVID-19 response, is the first of 2 reports examining artificial intelligence in health care.

Problem Statement

Research into AI for health care has grown rapidly in recent years, although adoption has been limited in most domains. The COVID-19 pandemic has been a proving ground for innovation in several other health technology fields, including vaccine development and telehealth. Despite predictions that AI would be critical in the pandemic response, the actual extent to which AI applications have been used in the clinical and public health response to COVID-19 remains unclear.

Approach

We conducted a scoping review to identify AI applications used in the clinical and public health response to COVID-19. Interviews with stakeholders early in the research process helped inform our research questions and guide our study design. We conducted a systematic search, screening, and full text review of both academic and gray literature.

Key Findings

• AI is still an emerging technology in health care, with growing but modest rates of adoption in real-world clinical and public health practice. The COVID-19 pandemic showcased the wide range of clinical and public health functions performed by AI as well as the limited evidence available on most AI products that have entered use.
• We identified 66 AI applications (full list in Appendix A) used to perform a wide range of diagnostic, prognostic, and treatment functions in the clinical response to COVID-19. This included applications used to analyze lung images, evaluate user-reported symptoms, monitor vital signs, predict infections, and aid in breathing tube placement. Some applications were used by health systems to help allocate scarce resources to patients.
• Many clinical applications were deployed early in the pandemic, and most were used in the United States, other high-income countries, or China. A few applications were used to care for hundreds of thousands or even millions of patients, although most were used to an unknown or limited extent.
• We identified 54 AI-based public health applications used in the pandemic response. These included AI-enabled cameras used to monitor health-related behavior and health messaging chatbots used to answer questions about COVID-19. Other applications were used to curate public health information, produce epidemiologic forecasts, or help prioritize communities for vaccine allocation and outreach efforts.
• We found studies supporting the use of 39 clinical applications and 8 public health applications, although few of these were independent evaluations, and we found no clinical trials evaluating any application's impact on patient health. We found little evidence available on entire classes of applications, including some used to inform care decisions such as patient deterioration monitors.
• Further research is needed, particularly independent evaluations on application performance and health impacts in real-world care settings. New guidance may be needed to overcome the unique challenges to evaluating AI application impacts on patient- and population-level health outcomes.