Review of the AMLAS Methodology for Application in Healthcare

In recent years, the number of machine learning (ML) technologies gaining regulatory approval for healthcare has increased significantly allowing them to be placed on the market. However, the regulatory frameworks applied to them were originally devised for traditional software, which has largely rule-based behaviour, compared to the data-driven and learnt behaviour of ML. As the frameworks are in the process of reformation, there is a need to proactively assure the safety of ML to prevent patient safety being compromised. The Assurance of Machine Learning for use in Autonomous Systems (AMLAS) methodology was developed by the Assuring Autonomy International Programme based on well-established concepts in system safety. This review has appraised the methodology by consulting ML manufacturers to understand if it converges or diverges from their current safety assurance practices, whether there are gaps and limitations in its structure and if it is fit for purpose when applied to the healthcare domain. Through this work we offer the view that there is clear utility for AMLAS as a safety assurance methodology when applied to healthcare machine learning technologies, although development of healthcare specific supplementary guidance would benefit those implementing the methodology

Reporting guideline for the early-stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI

A growing number of artificial intelligence (AI)-based clinical decision support systems are showing promising performance in preclinical, in silico evaluation, but few have yet demonstrated real benefit to patient care. Early-stage clinical evaluation is important to assess an AI system's actual clinical performance at small scale, ensure its safety, evaluate the human factors surrounding its use and pave the way to further large-scale trials. However, the reporting of these early studies remains inadequate. The present statement provides a multi-stakeholder, consensus-based reporting guideline for the Developmental and Exploratory Clinical Investigations of DEcision support systems driven by Artificial Intelligence (DECIDE-AI). We conducted a two-round, modified Delphi process to collect and analyze expert opinion on the reporting of early clinical evaluation of AI systems. Experts were recruited from 20 pre-defined stakeholder categories. The final composition and wording of the guideline was determined at a virtual consensus meeting. The checklist and the Explanation & Elaboration (E&E) sections were refined based on feedback from a qualitative evaluation process. In total, 123 experts participated in the first round of Delphi, 138 in the second round, 16 in the consensus meeting and 16 in the qualitative evaluation. The DECIDE-AI reporting guideline comprises 17 AI-specific reporting items (made of 28 subitems) and ten generic reporting items, with an E&E paragraph provided for each. Through consultation and consensus with a range of stakeholders, we developed a guideline comprising key items that should be reported in early-stage clinical studies of AI-based decision support systems in healthcare. By providing an actionable checklist of minimal reporting items, the DECIDE-AI guideline will facilitate the appraisal of these studies and replicability of their findings