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Regulatory Audit Innovations in Action: Insights from the Healthcare Industry

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TL;DR

This study examines the use of AI-based auditing tools in the US healthcare sector, finding that while they can improve efficiency, heavy reliance on algorithms may raise legitimacy concerns, influence decision-making, and potentially limit healthcare options, highlighting the need to balance technology with professional judgment.

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SUMMARY Prior accounting research in the healthcare field has paid little attention to how regulatory auditing innovations, such as artificial intelligence (AI) algorithms, can influence audit outcomes. Although these innovations may improve efficiency, they may have other consequences. This article summarizes the findings of a field study by Akinyele, Baudot, Koreff, and Sutton (2025), who examined the use of an AI-based auditing tool in the United States healthcare sector. The authors found that the use of this tool can generate debates about the legitimacy of health provider claims, especially when auditors rely heavily on algorithmic decisions. When paired with an incentive-based contract, these tools may be implicated in decision-making process, and even limit healthcare options. This research underscores the importance of balancing technological auditing innovations with professional judgment to ensure effective oversight and service delivery in the healthcare sector. JEL Classifications: M41; M42; M48.

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  • 10.36871/2618-9976.2025.10.003
МОДЕЛЬ НАБЛЮДАТЕЛЬНОЙ ДИАГНОСТИКИ ЗА ПАЦИЕНТАМИ СТОМАТОЛОГИИ С ИСПОЛЬЗОВАНИЕМ ИСКУССТВЕННОГО ИНТЕЛЛЕКТА
  • Jan 1, 2025
  • SOFT MEASUREMENTS AND COMPUTING
  • Stanislav V Kurovsky + 2 more

This article is devoted to the creation of a model of observational diagnostics for patients in dentistry using artificial intelligence as an information and measurement system. Artificial intelligence technology and algorithms in the field of clinical and radiographic image analysis in general dentistry and orthopedics have become the most common systems, contributing to accurate and timely diagnosis of a particular patient. Along with clinical practice images, radiographs are key tools for graphic visualization of the patient's dentition. A model of observational diagnostics for patients using artificial intelligence technology as the latest tool in the healthcare industry can become a structured method of information standardization and measurements in general dentistry. The model of observational diagnostics can serve as a fundamental component of functional diagnostics based on artificial intelligence algorithms, since they have a special potential for increasing the reliability and consistency of diagnostic measurements and information used by a dentist during treatment planning and restoration of the dentition. The model of observational diagnostics of dental patients presented by the authors implies a significant step forward in the development of highprecision methods of functional diagnostics, monitoring and analysis of patient condition measurements. The algorithm of the observational diagnostics model was integrated into the program, the operation of which is based on artificial intelligence technology in order to increase the efficiency, consistency, optimality and accuracy of the processes carried out in clinical practice. The purpose of the study is to determine the characteristics of the model of observational diagnostics of dental patients using artificial intelligence as an information and measuring system. Main results of the study: 1) the characteristics of the practical application of artificial intelligence technology for radiographs, clinical images of patients' teeth are provided; 2) the essential aspects of the model of observational diagnostics of dental patients, as well as the features of its practical application for planning dental treatment of patients are highlighted; 3) the results of practical testing of the model of observational diagnostics of dental patients are reflected (using the example of detection and treatment of caries). Research materials: the results of academic studies on the assessment of functional diagnostics of oral cavity and dentition pathologies using artificial intelligence technology; practical testing of the model of observational diagnostics for dental patients (using the example of detection and treatment of caries in a 49yearold woman). Research methods: systematization, comparative analysis, contrastive analysis, generalization, abstractlogical method, induction, deduction, systems approach, data conceptualization, graphical and tabular visualization of data, construction of informationmeasuring systems, artificial intelligence methods, study of clinical images and radiographs of patients' dental arches. The main conclusions of the study: 1) information and measuring instruments, the operation of which is based on artificial intelligence technology, have become the basis for the rapid processing of significant amounts of information, increasing the accuracy and efficiency of clinical decisions in dentistry. These information and measuring systems allow us to determine complex patterns on radiographs and clinical images of dental arches, to increase the degree of accuracy of functional diagnostics, in particular, in the presence of subtle pathologies and disorders; 2) artificial intelligence technology cannot replace a qualified dentist, such information and measuring systems only complement the accumulated human professional experience, allowing us to jointly carry out functional diagnostics of patients with a dental profile; 3) the potential of artificial intelligence technologies to create comprehensive plans and reports for dental treatment and dental restoration forms the basis for the joint activities of the latest tools and a dentist. In the context of the study, it is noted that artificial intelligence algorithms have become a powerful informationmeasuring tool for improving the decisionmaking process in dental practice, since digital technology promptly and quickly provides feedback to the dentist about missed anomalies or suboptimal methods of dental treatment and restorative medicine. Integration of the model of observational diagnostics for dental patients will make it possible to form an algorithm for the operation of artificial intelligence that fully complies with the recommendations for functional diagnostics and dental treatment of patients, developed on the basis of factual information. The use of artificial intelligence algorithms in dental practice will increase the efficiency of the general industry standard for providing dental services to patients.

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  • Cite Count Icon 14
  • 10.1111/ajo.13661
Artificial intelligence: Friend or foe?
  • Apr 1, 2023
  • Australian and New Zealand Journal of Obstetrics and Gynaecology
  • Anusch Yazdani + 2 more

Artificial intelligence (AI) is the simulation of human intelligence in machines that are programmed to think and learn like humans. AI has the potential to revolutionise the way that healthcare professionals diagnose, treat, and manage conditions affecting the female reproductive system. Machine learning (ML) is a subset of AI which deals with the development of algorithms and statistical models that enable computers to learn from and make predictions or decisions without being explicitly programmed to do so. Deep learning (DL) is a subfield of ML that utilises neural networks with multiple layers, known as deep neural networks (DNNs), to learn from data. DNNs are inspired by the structure and function of the human brain and are capable of automatically learning high-level features from raw data, such as images, audio and text. DL has been very successful in various applications such as image and speech recognition, natural language processing and computer vision. ML algorithms can be divided into three categories: supervised learning, unsupervised learning, and reinforcement learning. Supervised learning algorithms are trained on a labelled dataset, where the desired output (label) is already known. Unsupervised learning algorithms are trained on an unlabelled dataset and are used to discover patterns or relationships in the data. Reinforcement learning algorithms are trained using a trial-and-error approach, where the agent receives a reward or penalty for its actions. The goal of reinforcement learning is to learn a policy that maximises the expected reward over time. AI and ML are increasingly being applied in the field of obstetrics and gynaecology, with the potential to improve diagnostic accuracy, patient outcomes, and efficiency of care. AI has been applied to the field of medicine for several decades. One of the earliest examples of AI in medicine was the development of MYCIN in the 1970s, a computer program that could diagnose bacterial infections and recommend appropriate antibiotic treatments. MYCIN was developed by a team at Stanford University led by Edward Shortliffe, and its success demonstrated the potential of AI in medical decision making. In the 1980s, AI-based expert systems such as DXplain, developed at Massachusetts General Hospital, were used to assist in the diagnosis of diseases. These early AI systems were based on rule-based systems and were limited in their capabilities. One of the earliest examples of AI was the development of computer-aided diagnostic systems for ultrasound images in the 1970s and 1980s. These systems were designed to assist radiologists in identifying fetal anomalies and other conditions. 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In recent years, AI has also been applied in obstetrics and gynaecology for real-time monitoring of high-risk pregnancies and identifying fetal distress. These systems use ML algorithms to analyse data from fetal heart rate monitors and identify patterns that are associated with fetal distress. AI and ML are also being used to develop new tools for the management of gynaecological conditions, such as endometriosis and fibroids. These tools can be used to predict the progression of the disease and guide treatment decisions. One example of the use of AI in benign gynaecology is the development of computer-aided diagnostic systems for endometriosis. These systems use ML algorithms to analyse images of the pelvic region and identify the presence of endometrial tissue, which can be a sign of endometriosis. Another area where AI and ML are being applied is in the management of fibroids. 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This research was exempt from ethics review under National Health and Medical Research Council guidelines.3 ChatGPT was instructed to generate an narrative review based on dialogue with the lead author, AY. The input was informed by collaborative meetings of the study group over the study period. The study group nominated the topic, 'Artificial Intelligence in Gynaecology', but ChatGPT generated the title, structure and content for this paper. The study group defined the input parameters for ChatGPT and each AI output was reviewed by the authors for consistency and context, informing the next input. The dialogue thus became increasingly specific and refined in each iteration, as the initial general outline was expanded to include specific subheadings, academic language and academic references. The review was finalised from the ChatGPT output through an explicit composition protocol, limiting assembly to cut and paste, deletion to whole sentences (but not words) and conversion to Australian English. No grammatical or syntax correction was performed. The AI output was cross-referenced and verified by the study group. In this study, ChatGPT generated 7112 words in over 15 iterations, including 32 references. The output was restricted to the final review of 1809 words and nine unique references after removing duplicates4 and incorrect references (19). The final paper was submitted for blinded peer review. Thus, this study has demonstrated the capacity of an AI system, such as ChatGPT, to generate a scientific review through human academic instruction. AI is anticipated to expand the boundaries of evidence-based medicine through the potential of comprehensive analysis and summation of scientific publications. However, unlike systematic reviews or meta-analyses governed by explicit methodology, AI systems such as ChatGPT are the product of DL algorithms that are dependent upon the quality of the input to train the AI. Consequently, unlike systematic reviews, AI systems are bound by the bias, breadth, depth and quality of the training material. A dedicated medical AI would therefore be trained on an appropriate data set, such as the National Library of Medicine Medline/PubMed database. However, the volume of data is challenging: in 2022 alone, there were over 33 million citations equating to a dataset of almost 200 Gb for the minimum dataset. In contrast, ChatGPT has no external reference capabilities, such as access to the internet, search engines or any other sources of information outside of its own model. If forced outside of this framework, ChatGPT may generate plausible-sounding but incorrect or nonsensical responses.4 Most notably, pushing the AI to include references leads the system to generate bizarre fabrications.5 Our paper demonstrated that only 28% (9/32) of the references were authentic, although better than the 11% reported in a recent paper.6 In contrast to human writing, AI-generated content is more likely to be of limited depth, contain factual errors, fabricated references and repeat the instructions used to seed the output.7 The latter results in a formulaic language redundancy that all but identifies AI content. The human authors thus echo the conclusion of ChatGPT that AI is a complementary tool to the specialist and not meant to replace human expertise. For the moment. The authors report no conflicts of interest.

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  • Annals of Surgery
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  • Oct 6, 2022
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Artificial Intelligence in the American Healthcare Industry: Looking Forward to 2030

  • Abstract
  • Cite Count Icon 5
  • 10.1016/j.healun.2020.01.1132
Artificial Intelligence for Early Prediction of Pulmonary Hypertension Using Electrocardiography
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  • Front Matter
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Optimizing Water Distribution Networks using Machine Learning and AI Algorithms: Case Studies and Best Practices
  • Aug 30, 2024
  • International Journal of Advanced Multidisciplinary Research and Studies
  • David Adedayo Akokodaripon + 2 more

This paper aims to explore the utilization of machine learning (ML) and artificial intelligence (AI) algorithms as innovative solutions to optimize water distribution networks. Through the analysis of case studies and best practices, we examine various methodologies and techniques employed in leveraging ML and AI for network optimization. The paper discusses key aspects of the optimization process, starting from data collection and preprocessing to model development and deployment. Emphasis is placed on understanding the intricacies of water distribution systems and how ML and AI algorithms can be tailored to address specific challenges within these networks. Real-world examples are presented to illustrate the practical application of ML and AI in optimizing water distribution networks, the paper outlines future opportunities and directions for research in this field. It discusses emerging technologies, novel approaches, and potential collaborations aimed at further advancing the optimization of water distribution networks using ML and AI algorithms. By providing insights from case studies and best practices, this paper seeks to contribute to the ongoing efforts to enhance the efficiency and sustainability of water distribution systems worldwide through the application of ML and AI techniques. Furthermore, we discuss the challenges and future opportunities in utilizing ML and AI algorithms for enhancing the resilience and efficiency of water distribution systems. Moreover, Water distribution networks are crucial for delivering clean and safe water to communities globally. However, these networks encounter challenges such as aging infrastructure, rising demand, and climate variability. To tackle these issues and optimize water distribution network performance, there's a growing interest in utilizing machine learning (ML) and artificial intelligence (AI) algorithms. We investigate various methodologies for data collection, preprocessing, model development, and implementation, supported by real-world instances showcasing successful applications.

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