Artificial Intelligence In Medicine 103 (2020) 101793
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Artificial Intelligence In Medicine
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Guest Editorial Article
Seven pillars of precision digital health and medicine☆
1. Introduction
According to the National Institutes of Health, precision medicine is
“an emerging approach for disease treatment and prevention that takes
into account individual variability in genes, environment, and lifestyle
for each person.” Similarly, precision health targets public health
challenges (e.g. disease prevention, health disparities, etc.) in a popu-
lation by using omics, social, cultural, behavioral and environmental
data to account for differences between populations in the development
and use of health interventions [1,2]. Here we highlight seven key areas
that must be considered to realize the full potential of precision medi-
cine and health.
1. Precision Observation and Assessment: Timely and accurate
observation and assessment and consistent classification [37] are cru-
cial tasks for achieving early diagnosis [3], informed planning, re-
flecting on the suitability of treatment options, information exchanging
and designing better health interventions. Observation is a key tool for
an informed assessment. Examples include precision molecular mon-
itoring [4], precision personalized medical imaging [5], precision po-
pulation health surveillance [6], and precision mental health assess-
ment and monitoring [7].
2. Precision Health Promotion: Health promotion empowers po-
pulations and communities to gain control over their own wellbeing
and its determinants through a wide range of social environmental and
economic interventions by targeting and preventing the root causes of
diseases, rather than just focusing on treatment. The three main ele-
ments [8] of health promotion are i) Good governance for more co-
ordinated informed health policymaking; ii) improving people’s health
literacy to facilitate making healthier choices; and iii) Creating healthy
cities through healthy urban planning. Digital tools and platforms for
personalized Health Coaching [9], workplace health promotion,
healthy food prescription, and research has shown that improved health
literacy leads to better health outcomes for people [10].
3. Precision Engagement: The targeted use of digital technologies
(e.g. smartphones [11], web portals, blogs, etc.) can engage specific
population to improve their health awareness and adoption of healthy
behaviors. Patient decision-making and compliance with treatment can
also be improved by leveraging artificial intelligence and mobile plat-
forms and targeting individuals to improve specific outcomes [12].
Engagement is also improved through personalized patient education
based on intelligent tutoring systems (ITS), which use Artificial In-
telligence (AI) to model an explicit encoding of domain knowledge and
pedagogic expertise [13]. ITS have been widely used in education and
corporate training tools as well as tools to support clinician education
☆
This article belongs to the Special Issue: Digital Medicine & Health.
https://doi.org/10.1016/j.artmed.2020.101793
Received 21 November 2019
0933-3657/ © 2020 Elsevier B.V. All rights reserved.
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T
[34–36].
4. Precision Early Detection: Precision diagnosis has been defined
[14] as “the accurate and timely explanation of each patient's [or po-
pulation’s] health problem and further requires communication of that
explanation to patients and surrogate decision-makers”. Using health
intelligence tools and techniques [15] enables healthcare professionals
or organizations to identify individuals (or population) at risk for a
specific condition (e.g. cancer), determine the most appropriate
screening/testing medium (imaging, microbiology lab, epidemiological
evidence, etc.), and assess the severity/urgency of the condition and the
speed of its progression. In addition, precision methods can assist re-
searchers and decision makers to build more accurate predictive models
[16–19], at individual, community [20] or global levels [21].
5. Precision Prevention: Precision Prevention is focused on “tai-
loring behavioral interventions to individuals’ characteristics” [22]. It
can also aim at specific groups or populations by adjusting the
healthcare delivery systems, optimizing transmission through social
networks, or instituting targeted policy or macroenvironmental changes
that are different from one community to the next [22,23]. Precision
prevention is usually focused on “the “how” (e.g., the most cost-effec-
tive implementation approach) as much as the “what” (which behaviors
to target) or the “why” (the biological mechanisms that mediate pre-
vention effectiveness)” [22]. The key task for precision prevention is
design, implementation and, near real-time evaluation of preventive
measures and interventions [24].
6. Precision Treatments: Precision treatment, which has been the
central focus of precision medicine so far, aims to find the most effec-
tive and least harmful personalized therapeutic interventions for an
individual patient or a population according to their specific conditions
and characteristics. Precision treatment often focuses on ““what” (e.g.,
the best drug for a patient), more than the “how” (e.g., delivery system
reform to accommodate the increased need for genetic counseling)”
[22]. Automated reasoning, a sub-area of AI, is used to develop in-
tegrated reasoning frameworks that identify and mitigate adverse in-
teractions when concurrently applying multiple clinical practice
guidelines to develop precision treatment for multi-morbid patients
[25–27]. Such a framework can provide an explicit representation of
properties and relationships in clinical practice guidelines (and sec-
ondary sources like adverse interaction libraries and genomic data-
bases) to identify and fix adverse interactions while applying patient
preferences. Work extending such frameworks to support the con-
tinuing evolution and complexity of new evidence captured in guide-
lines (i.e., time, duration, classes of drugs and actions) applies first-
order logic and AI planning approaches to tackle these issues [28,29].
Guest Editorial Article
7. Precision Equity: According to the World Health Organization
‘Equity’ is “the absence of avoidable or remediable differences among
groups of people, whether those groups are defined socially, econom-
ically, demographically, or geographically” [30]. One of the major
concerns in applying precision medicine and health is “concentrating
resources to those that already experience greater access to healthcare
and power in society, nationally as well as globally. Healthcare payers,
clinicians, and patients must all be involved in optimizing the potential
of precision medicine, without reducing equity” [31]. From their early
days, precision medicine and health raised hopes that they can help to
decrease the deep health disparities gap [32] between different in-
dividuals and groups across the globe. One example of such work is the
analysis of retrospective EHR data to quantify health inequity and to
understand relationships between health inequity and health care
outcomes [33]. Another example is using computational methods to
reveal the pathways from social and environmental disparities to health
disparities among disadvantaged population [20,38].
2. Special issue on precision digital health and medicine
This special issue attracted 24 contributions presenting results on
theory, methods, systems, and applications of data mining, machine
learning, databases, network theory, natural language processing,
knowledge representation, artificial intelligence, semantic web, and big
data analytics, focused on applications in precision health and digital
medicine. After a rigorous highly selective peer-review process three
papers (acceptance rate of 12.5 %) have been approved for publication.
The guest editorial committee assembled a highly skilled team of
computer and data scientists, epidemiologists and clinicians to review
the submitted articles. Each article was reviewed (in a single-blind
process) by at least two independent reviewers as well as the editorial
staff to determine validity, significance, novelty, and potential impact
on the field. Watson et al. [11] explores the evidence that exists to
validate and evaluate the use of medical decision-support smartphone
apps. The findings can inform pragmatic evaluation strategies for future
clinical app developers to maximize precision engagement and provide
a scientific and cultural context for research priorities in this field.
Spänig et al. [18] presents an AI system that interacts with patients
using a speech recognition and speech synthesis system and can assist in
early prediction of type 2 diabetes mellitus based on non-invasive
sensors and deep neural networks. Vrbaški et al. [3] shows how dif-
ferent machine learning methods (linear regression, artificial neural
network, decision tree and random forest) perform in early prediction
and diagnosis of Metabolic Syndrome.
Declaration of Competing Interests
The authors declare no competing interests.
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Arash Shaban-Nejada,* John S. Brownsteind
a
The University of Tennessee Health Science Center – Oak-Ridge National d
Boston Children’s Hospital and Harvard Medical School, Harvard
Lab (UTHSC-ORNL) Center for Biomedical Informatics, Department of University, Boston, MA, USA
Pediatrics, College of Medicine, R492-50 N. Dunlap Street, Memphis, TN
38103, USA David L. Buckeridgee
e
E-mail address: ashabann@uthsc.edu. McGill Clinical and Health Informatics, School of Population and Global
Health, McGill University, Montreal, Quebec H3A 1A3, Canada
Martin Michalowskib
b
School of Nursing, University of Minnesota – Twin Cities, 5-140 Weaver-

⁎
Corresponding author.

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