The Health Insurance Review & Assessment Service (HIRA) said on the 1st that it will for the first time apply Deep Learning-based artificial intelligence (AI) medical imaging readings to its claims review work. It plans to link AI reading results, which had been used only as reference materials, to the actual review process to improve the quality and productivity of reviews.
HIRA has built a reading system that automatically analyzes medical images using AI technology since 2018. It has used reading results for medical images such as the spine, knee joint, and urolithiasis as review references, while accumulating related data and improving the model's accuracy.
After expert validation confirmed reading accuracy, it decided to begin applying AI reading results to actual review work starting with knee osteoarthritis.
Going forward, reviewers will check AI reading results alongside other review materials and use them in their work. When professional or medical judgment is needed, a review committee will conduct additional checks. Review outcomes will not be determined by AI readings alone, and the final decision will be made by a person.
HIRA expected to improve the efficiency of review work by reducing the time spent on repetitive medical image checks and to shorten the period until providers can confirm their claims results. It plans to focus the time saved on reviews that require professional judgment to raise both the quality and productivity of reviews.
It also set operating principles for AI use. Before applying AI reading results to review work, HIRA established the "internal operating and ethics standards for applying AI medical imaging reading results to work." The standards define the scope and procedures for using AI reading results and specify the principle that the final decision is made by a person.
Starting with this application in the knee joint field, HIRA plans to gradually expand the scope of AI reading use to areas such as the spine and urolithiasis. It will also continuously monitor operational outcomes and reading accuracy.
HIRA President Hong Seung-gwon said, "This case is significant in that AI medical imaging reading results, which have been used for reference, were applied to reviews for the first time," adding, "We will continue to actively promote AI transformation (AX) based on AI operating and ethics principles to enhance the expertise and efficiency of reviews and lead digital health care innovation that the public can feel."