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J Korean Med Assoc > Volume 61(12); 2018 > Article
Journal of the Korean Medical Association 2018;61(12):765-775.
Published online December 19, 2018.
DOI: https://doi.org/10.5124/jkma.2018.61.12.765   
Principles for evaluating the clinical implementation of novel digital healthcare devices
Seong Ho Park, Kyung Hyun Do, Joon Il Choi, Jung Suk Sim, Dal Mo Yang, Hong Eo, Hyunsik Woo, Jeong Min Lee, Seung Eun Jung, Joo Hyeong Oh
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
3Withsim Clinic, Seongnam, Korea.
4Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
5Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul, Korea.
6Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
7Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
8Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea. ohjh6108@gmail.com
With growing interest in novel digital healthcare devices, such as artificial intelligence (AI) software for medical diagnosis and prediction, and their potential impacts on healthcare, discussions have taken place regarding the regulatory approval, coverage, and clinical implementation of these devices. Despite their potential, ‘digital exceptionalism’ (i.e., skipping the rigorous clinical validation of such digital tools) is creating significant concerns for patients and healthcare stakeholders. This white paper presents the positions of the Korean Society of Radiology, a leader in medical imaging and digital medicine, on the clinical validation, regulatory approval, coverage decisions, and clinical implementation of novel digital healthcare devices, especially AI software for medical diagnosis and prediction, and explains the scientific principles underlying those positions. Mere regulatory approval by the Food and Drug Administration of Korea, the United States, or other countries should be distinguished from coverage decisions and widespread clinical implementation, as regulatory approval only indicates that a digital tool is allowed for use in patients, not that the device is beneficial or recommended for patient care. Coverage or widespread clinical adoption of AI software tools should require a thorough clinical validation of safety, high accuracy proven by robust external validation, documented benefits for patient outcomes, and cost-effectiveness. The Korean Society of Radiology puts patients first when considering novel digital healthcare tools, and as an impartial professional organization that follows scientific principles and evidence, strives to provide correct information to the public, make reasonable policy suggestions, and build collaborative partnerships with industry and government for the good of our patients.
Key Words: Software validation, Device approval, Insurance coverage, Artificial intelligence
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