Utah's Experiment With AI-Driven Prescription Renewals

Health insurers and health care provider organizations are increasingly using artificial intelligence (AI) tools in prior authorization and claims processes. AI offers many potential benefits, but its adoption has raised concerns about the role of the “humans in the loop,” users’ understanding of AI, opacity of algorithmic determinations, underperformance in certain tasks, automation bias, and unintended social consequences. To date, institutional governance by insurers and providers has not fully met the challenge of ensuring responsible use. However, several steps could be taken to help realize the benefits of AI use while minimizing risks. Drawing on empirical work on AI use and our own ethical assessments of provider-facing tools as part of the AI governance process at Stanford Health Care, we examine why utilization review has attracted so much AI innovation and why it is challenging to ensure responsible use of AI. We conclude with several steps that could be taken to help realize the benefits of AI use while minimizing risks.

Artificial intelligence (AI) tools for radiology are commonly unmonitored once deployed. The lack of real-time case-by-case assessments of AI prediction confidence requires users to independently distinguish between trustworthy and unreliable AI predictions, which increases cognitive burden, reduces productivity, and potentially leads to misdiagnoses. To address these challenges, we introduce Ensembled Monitoring Model (EMM), a framework inspired by clinical consensus practices using multiple expert reviews. Designed specifically for black-box commercial AI products, EMM operates independently without requiring access to internal AI components or intermediate outputs, while still providing robust confidence measurements. Using intracranial hemorrhage detection as our test case on a large, diverse dataset of 2919 studies, we demonstrate that EMM can successfully categorize confidence in the AI-generated prediction, suggest appropriate actions, and help physicians recognize low confidence scenarios, ultimately reducing cognitive burden. Importantly, we provide key technical considerations and best practices for successfully translating EMM into clinical settings.

In order to realize the potential of mental health AI applications to deliver improved care, a multipronged approach is needed, including representative AI datasets, research practices that reflect and anticipate potential sources of bias, stakeholder engagement, and equitable design practices.