Many Artificial Intelligence (AI) tools are designed specifically for healthcare and developed for therapeutic purposes such as diagnosing and treating kiritaki hauora (patient|health consumer). Others are general purpose and are being applied in a healthcare setting such as medical scribing tools to support workload management and efficiency in practice to develop or edit documents.
AI technology is a rapidly developing area and transforming how Physiotherapists work. The Physiotherapy Board | Te Poari Tiaki Tinana is continually reviewing the development and use of AI technology within healthcare in Aotearoa New Zealand.
It is acknowledged that the use of AI as a tool can be appropriate and indeed useful as a physiotherapist practising in Aotearoa New Zealand, however, the speed at which AI is developing does present unique challenges for all healthcare professionals including physiotherapists.
Background
AI can be defined as ‘computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision making, and translation between languages’1.
There are different types of AI including machine learning which encompasses generative AI, natural language processing and computer vision.
With respect to the use of AI in the context of working as a physiotherapist, the Physiotherapy Code of Ethics and Professional Conduct states – Physiotherapists must:
5.8 and have a full understanding of and comply with the laws and regulations that govern and impact on the practice of physiotherapy in New Zealand.
The Physiotherapy Practice Thresholds also state:
Registered physiotherapists in Australia and Aotearoa New Zealand are able to:
2.1 comply with legal, professional, ethical, cultural and other relevant standards, codes and guidelines.
This applies to all contexts of physiotherapy (including privacy and data protection laws), and the Physiotherapy Standard Framework.
Responsibility
Physiotherapists must assess and make informed decisions regarding the suitability and use of AI technology, including Generative AI in their practice. Due diligence must be done prior to using AI as a tool.
Where a physiotherapist’s responsibility lies within AI it is likely context specific, however, it must be noted that physiotherapists cannot ignore or delegate their professional responsibilities and requirements. If kiritaki hauora consult a physiotherapist, the physiotherapist is professionally accountable for the consultation including assessment, advice, clinical reasoning, documentation and recording of the interaction.
Responsibility cannot be ‘outsourced’ to an AI tool (in the same way that responsibility for clinical judgement cannot be outsourced to a textbook or other practitioner). In other words, human oversight remains, and the physiotherapist is responsible and accountable for delivering safe and quality care.
AI is likely only as good as the information presented to it so ensuring the correct information is input is also the responsibility of the physio.
Informed Consent
Physiotherapists must involve ngā kiritaki hauora in the decision to use AI tools that require input of their personal data, such as a Generative AI note scribing tool. If a physiotherapist is using Generative AI to record consultations, informed consent is required, before proceeding with use of the tool. This should be clearly recorded in the health records. This process allows the opportunity for ngā kiritaki hauora to accept or decline the use of AI.
As part of the informed consent process, the physiotherapist needs to provide kiritaki hauora with information about how the AI tool works, including the collection and use of their personal information.
Relating to Te Tiriti o Waitangi as a physiotherapist in Aotearoa New Zealand
With rapid development of AI continuing, physiotherapist’s obligations to Te Tiriti o Waitangi when using AI are still being navigated to understand the implications.
However, it is important to have conversations with kiritaki hauora to ensure an awareness of these issues, and potential consequences and implications for Māori and Tauiwi are considered.
Cultural Considerations
Physiotherapists must be aware that GenAI models are often trained on large datasets that may under-represent or misrepresent minority populations, potentially reinforcing existing social and health inequities and amplifying inherent biases in practice. Examples of this may be a lack of understanding of different models of health which may not be considered by AI when providing answers or output.
If the training data for a GenAI model lacks diverse linguistic and cultural representation, such as Te Reo Māori or various accents, it could introduce biases and affect the accuracy of the model’s suggestions. This can lead to misunderstandings, or misinterpretations.
Ethical and Legal Issues
It is the responsibility of physiotherapists to ensure the confidentiality and privacy of kiritaki hauora information, as required by privacy and health record legislation in Aotearoa New Zealand, regardless of how it is collected or recorded.
Physiotherapists must be aware and consider whether ngā kiritaki hauora data being used/recorded is also used to train the AI tool, and whether identifiable data could then find its way into that learning database. They must then consider whether this information should be input.
GenAI tools may also store or process data in locations outside Aotearoa New Zealand. This may lead to potential breaches of local data protection laws and regulations, which require that data involving Aotearoa New Zealand citizens be handled in compliance with Aotearoa New Zealand’s privacy standards.
Considerations when using AI:
- Is the AI tool suitable for my needs?
- What are the limitations of the tool, and in which contexts should it not be used?
- Am I using the tool to assist or replace my critical thinking and analysis?
- Have I obtained informed consent from kiritaki hauora to use the tool and have I documented this?
- Have I checked that the output such as health records is a true and accurate reflection of the consultation with kiritaki hauora and makes sense within the context?
- Data privacy – how is data used to retrain the AI tool, where is data located and how is it stored?
- Does the AI tool comply with data and privacy regulations in Aotearoa New Zealand?
- Security and Confidentiality – what measures are in place to protect the security and confidentiality of kiritaki hauora data?
Also consider:
- Physiotherapists must also be aware of any policies in place for the organisation that they are working for, and follow these policies.
- AI tools may have built-in biases or inaccuracies, and physiotherapists must consider how those might manifest and be managed.
- How the AI tool was trained, whether its data sources reflect the diversity of your kiritaki hauora, and how that might impact on its suggestions. Is it a Aotearoa New Zealand based tool, with an appropriate Aotearoa New Zealand context, or one developed overseas.
Helpful Resources:
The Health Information Privacy Code (2020)
Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct
Physiotherapy Health Records Standard
Statement from the Office of the Privacy Commissioner