Teresa Scassa - Blog

Friday, 12 November 2021 08:01

AI in Canadian Healthcare - Bias and Discrimination (New Paper)

Written by  Teresa Scassa
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It has been quite a while since I posted to my blog. The reason has simply been a crushing workload that has kept me from writing anything that did not have an urgent deadline! In the meantime, so much has been going on in terms of digital and data law and policy in Canada and around the world. I will try to get back on track!

Artificial intelligence (AI) has been garnering a great deal of attention globally –for its potential to drive innovation, its capacity to solve urgent challenges, and its myriad applications across a broad range of sectors. In an article that is forthcoming in the Canadian Journal of Law and Technology, Bradley Henderson, Colleen Flood and I examine issues of algorithmic and data bias leading to discrimination in the healthcare context. AI technologies have tremendous potential across the healthcare system – AI innovation can improve workflows, enhance diagnostics, accelerate research and refine treatment. Yet at the same time, AI technologies bring with them many concerns, among them, bias and discrimination.

Bias can take many forms. In our paper, we focus on those manifestations of bias that can lead to discrimination of the kind recognized in human rights legislation and the Charter. Discrimination can arise either from flawed assumptions being coded into algorithms, from adaptive AI that makes its own correlations, or from unrepresentative data (or from a combination of these).

There are some significant challenges when it comes to the data used to train AI algorithms. Available data may reflect existing disparities and discrimination within the healthcare system. For example, some communities may be underrepresented in the data because of lack of adequate access to healthcare, or from a lack of trust in the healthcare system that tends to keep them away until health issues become acute. Lack of prescription drug coverage or access to paid sick leave may also impact when and how people access health care services. Racial or gender bias in terms of how symptoms or concerns are recorded or how illness is diagnosed can also affect the quality and representativeness of existing stores of data. AI applications developed and trained on data from US-based hospitals may reflect the socio-economic biases that impact access to health care in the US. It may also be questionable the extent to which they are generalizable to the Canadian population or sub-populations. In some cases, data about race or ethnicity may be important markers for understanding diseases and how they manifest themselves but these data may be lacking.

There are already efforts afoot to ensure better access to high quality health data for research and innovation in Canada, and our paper discusses some of these. Addressing data quality and data gaps is certainly one route to tackling bias and discrimination in AI. Our paper also looks at some of the legal and regulatory mechanisms available. On the legal front, we note that there are some recourses available where things go wrong, including human rights complaints, lawsuits for negligence, or even Charter challenges. However, litigating the harms caused by algorithms and data is likely to be complex, expensive, and fraught with difficulty. It is better by far to prevent harms than to push a system to improve itself after costly litigation. We consider the evolving regulatory landscape in Canada to see what approaches are emerging to avoid or mitigate harms. These include regulatory approaches for AI-enabled medical devices, and advanced therapeutic products. However, these systems focus on harms to human health, and would not apply to AI tools developed to improve access to healthcare, manage workflows, conduct risk assessments, and so on. There are regulatory gaps, and we discuss some of these. The paper also makes recommendations regarding improving access to better data for research and innovation, with the accompanying necessary enhancements to privacy laws and data governance regimes to ensure the protection of the public.

One of the proposals made in the paper is that bias and discrimination in healthcare-related AI applications should be treated as a safety issue, bringing a broader range of applications under Health Canada regulatory regimes. We also discuss lifecycle regulatory approaches (as opposed to one-off approvals), and providing warnings about data gaps and limitations. We also consider enhanced practitioner licensing and competency frameworks, requirements at the procurement stage, certification standards and audits. We call for law reform to human rights legislation which is currently not well-adapted to the AI context.

In many ways, this paper is just a preliminary piece. It lays out the landscape and identifies areas where there are legal and regulatory gaps and a need for both law reform and regulatory innovation. The paper is part of the newly launched Machine MD project at uOttawa, which is funded by the Canadian Institutes for Health Research, and that will run for the next four years.

The full pre-print text of the article can be found here.

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