eveloping a shared language and standardizing definitions are important as we bring together disparate stakeholders. For example, primary care has been defined differently by organizations. The World Health Organization defines primary health care as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain.” Its Declaration of Alma Ata goes on to state that “[primary health care] forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.” Finally, “[It] addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly.” 12
Barbara Starfield echoed some of these ideas when she characterized primary care as first-contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease, or organ system.13
Similarly, the Institute of Medicine defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”14
John McCarthy coined the term AI, calling it the idea of getting a computer to do things which, when done by people, are said to involve intelligence.15 Marvin Minsky added to this definition by calling it “the study of ideas to bring into being machines that respond to stimulation consistent with the traditional response from humans, given the human capacity for contemplation, judgment, and intention.”16 These tasks include problem-solving, reasoning, understanding language, and learning. A subset of AI – machine learning – focuses on the learning aspect of intelligence. In his book Machine Learning, Tom Mitchell defined the field as “concerned with the question of how to construct computer programs that automatically improve with experience.” He goes on to describe machine learning as a computer program that can “learn from experience E with respect to some class of tasks T and performance measure P, if its performance at tasks in T, as measured by P, improves with experience E.”17
Primary Care research, like the enterprise itself, is complex, with questions that lend themselves to approaches with commensurate complexity. Yet the use of AI in family medicine and primary care research is limited. In their recent commentary “Family Medicine & AI: Better Together”, Liaw et al note:
Without our input, AI risks following the path of EHRs. When the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, policy makers believed that EHRs would lead to care that was more efficient, effective, and equitable,15 and EHRs have led to important advances in population health and quality.16 However, with increasing burnout and decreasing time with patients, many lament that EHRs cater to the needs of administrators and EHR vendors rather than physicians and patients.17 The usability and interoperability failures underlying these complaints are not the result of gaps in technological expertise. Instead, these failures emerged, in part, because end-users like ourselves have been insufficiently engaged in relevant design, policy, and implementation decisions.
They further note the natural ability of AI wed itself to integrate multiple data sources including geographic, EHR, claims, and pharmacy data to identify those individuals at high risk for multiple chronic diseases, to facilitate timely referral and appropriate treatment, to streamline and facilitate quality measurement and to enhance primary care of patients directly.