{"id":"https://openalex.org/W4387405016","doi":"https://doi.org/10.1038/s41746-023-00929-1","title":"Autonomous AI systems in the face of liability, regulations and costs","display_name":"Autonomous AI systems in the face of liability, regulations and costs","publication_year":2023,"publication_date":"2023-10-06","ids":{"openalex":"https://openalex.org/W4387405016","doi":"https://doi.org/10.1038/s41746-023-00929-1","pmid":"https://pubmed.ncbi.nlm.nih.gov/37803209","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/10558567"},"language":"en","primary_location":{"id":"doi:10.1038/s41746-023-00929-1","doi":"https://doi.org/10.1038/s41746-023-00929-1","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-023-00929-1","pdf_url":"https://www.nature.com/articles/s41746-023-00929-1.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-2","ki-jl-1","norway-1","oarl","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"npj Digital Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.nature.com/articles/s41746-023-00929-1.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5035317795","display_name":"Agustina D. Saenz","orcid":"https://orcid.org/0000-0003-3666-9075","observed_orcids":["https://orcid.org/0000-0003-3666-9075"]},"institutions":[{"id":"https://openalex.org/I1283280774","display_name":"Brigham and Women's Hospital","ror":"https://ror.org/04b6nzv94","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I121934306","https://openalex.org/I1283280774","https://openalex.org/I48633490"]},{"id":"https://openalex.org/I136199984","display_name":"Harvard University","ror":"https://ror.org/03vek6s52","country_code":"US","type":"education","lineage":["https://openalex.org/I136199984"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Agustina D. Saenz","raw_affiliation_strings":["Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA","Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA","Department of Medicine, Harvard Medical School, Boston, MA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA","institution_ids":["https://openalex.org/I136199984"]},{"raw_affiliation_string":"Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA","institution_ids":["https://openalex.org/I1283280774"]},{"raw_affiliation_string":"Department of Medicine, Harvard Medical School, Boston, MA, USA","institution_ids":["https://openalex.org/I136199984"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5004729754","display_name":"Zach Harned","orcid":"https://orcid.org/0000-0002-2335-2792","observed_orcids":["https://orcid.org/0000-0002-2335-2792"]},"institutions":[{"id":"https://openalex.org/I1308906816","display_name":"NortonLifeLock (United States)","ror":"https://ror.org/0449t3a80","country_code":"US","type":"company","lineage":["https://openalex.org/I1308906816","https://openalex.org/I4405258830"]},{"id":"https://openalex.org/I97018004","display_name":"Stanford University","ror":"https://ror.org/00f54p054","country_code":"US","type":"education","lineage":["https://openalex.org/I97018004"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Zach Harned","raw_affiliation_strings":["Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Palo Alto, CA, USA","Fenwick & West LLP, Mountain View, CA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Palo Alto, CA, USA","institution_ids":["https://openalex.org/I97018004"]},{"raw_affiliation_string":"Fenwick & West LLP, Mountain View, CA, USA","institution_ids":["https://openalex.org/I1308906816"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5057010395","display_name":"Oishi Banerjee","orcid":"https://orcid.org/0009-0004-0097-3555","observed_orcids":["https://orcid.org/0009-0004-0097-3555"]},"institutions":[{"id":"https://openalex.org/I136199984","display_name":"Harvard University","ror":"https://ror.org/03vek6s52","country_code":"US","type":"education","lineage":["https://openalex.org/I136199984"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Oishi Banerjee","raw_affiliation_strings":["Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA","institution_ids":["https://openalex.org/I136199984"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5036660665","display_name":"Michael D. Abr\u00e0moff","orcid":"https://orcid.org/0000-0002-3490-0037","observed_orcids":["https://orcid.org/0000-0002-3490-0037"]},"institutions":[{"id":"https://openalex.org/I126307644","display_name":"University of Iowa","ror":"https://ror.org/036jqmy94","country_code":"US","type":"education","lineage":["https://openalex.org/I126307644"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Michael D. Abr\u00e0moff","raw_affiliation_strings":["Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA","Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA","Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA","Digital Diagnostics Inc, Coralville, IA, USA"],"raw_orcid":"https://orcid.org/0000-0002-3490-0037","affiliations":[{"raw_affiliation_string":"Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA","institution_ids":["https://openalex.org/I126307644"]},{"raw_affiliation_string":"Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA","institution_ids":["https://openalex.org/I126307644"]},{"raw_affiliation_string":"Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA","institution_ids":["https://openalex.org/I126307644"]},{"raw_affiliation_string":"Digital Diagnostics Inc, Coralville, IA, USA","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5001094226","display_name":"Pranav Rajpurkar","orcid":"https://orcid.org/0000-0002-8030-3727","observed_orcids":["https://orcid.org/0000-0002-8030-3727"]},"institutions":[{"id":"https://openalex.org/I136199984","display_name":"Harvard University","ror":"https://ror.org/03vek6s52","country_code":"US","type":"education","lineage":["https://openalex.org/I136199984"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Pranav Rajpurkar","raw_affiliation_strings":["Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA. pranav_rajpurkar@hms.harvard.edu","Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA"],"raw_orcid":"https://orcid.org/0000-0002-8030-3727","affiliations":[{"raw_affiliation_string":"Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA. pranav_rajpurkar@hms.harvard.edu","institution_ids":["https://openalex.org/I136199984"]},{"raw_affiliation_string":"Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA","institution_ids":["https://openalex.org/I136199984"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5001094226"],"corresponding_institution_ids":["https://openalex.org/I136199984"],"apc_list":{"value":3590,"currency":"USD","value_usd":3590},"apc_paid":{"value":3590,"currency":"USD","value_usd":3590},"fwci":3.2672,"has_fulltext":true,"cited_by_count":83,"citation_normalized_percentile":{"value":0.93396546,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":97,"max":100},"biblio":{"volume":"6","issue":"1","first_page":"185","last_page":"185"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.9365000128746033,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.9365000128746033,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12339","display_name":"Medical Malpractice and Liability Issues","score":0.02879999950528145,"subfield":{"id":"https://openalex.org/subfields/3611","display_name":"Pharmacy"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13364","display_name":"Digitalization, Law, and Regulation","score":0.024900000542402267,"subfield":{"id":"https://openalex.org/subfields/3308","display_name":"Law"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/autonomous-ai-systems","display_name":"autonomous AI systems","score":0.9610000252723694},{"id":"https://openalex.org/keywords/artificial-intelligence-in-healthcare","display_name":"artificial intelligence in healthcare","score":0.628000020980835},{"id":"https://openalex.org/keywords/liability","display_name":"liability","score":0.8159999847412109},{"id":"https://openalex.org/keywords/malpractice","display_name":"malpractice","score":0.8320000171661377},{"id":"https://openalex.org/keywords/ai-regulation","display_name":"AI regulation","score":0.652999997138977},{"id":"https://openalex.org/keywords/fda-oversight","display_name":"FDA oversight","score":0.7020000219345093},{"id":"https://openalex.org/keywords/large-language-models","display_name":"large language models","score":0.8679999709129333},{"id":"https://openalex.org/keywords/payment-models","display_name":"payment models","score":0.7400000095367432},{"id":"https://openalex.org/keywords/commercial-payers","display_name":"commercial payers","score":0.8519999980926514},{"id":"https://openalex.org/keywords/physician-liability","display_name":"physician liability","score":0.6610000133514404},{"id":"https://openalex.org/keywords/clinical-workflow","display_name":"clinical workflow","score":0.3930000066757202},{"id":"https://openalex.org/keywords/health-care-costs","display_name":"health care costs","score":0.5799999833106995}],"concepts":[{"id":"https://openalex.org/C2777834853","wikidata":"https://www.wikidata.org/wiki/Q96776939","display_name":"Liability","level":2,"score":0.7293972373008728},{"id":"https://openalex.org/C177212765","wikidata":"https://www.wikidata.org/wiki/Q627335","display_name":"Workflow","level":2,"score":0.6270854473114014},{"id":"https://openalex.org/C145097563","wikidata":"https://www.wikidata.org/wiki/Q1148747","display_name":"Payment","level":2,"score":0.5914331674575806},{"id":"https://openalex.org/C2776798817","wikidata":"https://www.wikidata.org/wiki/Q318836","display_name":"Malpractice","level":2,"score":0.5720565915107727},{"id":"https://openalex.org/C2780233690","wikidata":"https://www.wikidata.org/wiki/Q535347","display_name":"Transparency (behavior)","level":2,"score":0.527757465839386},{"id":"https://openalex.org/C2779304628","wikidata":"https://www.wikidata.org/wiki/Q3503480","display_name":"Face (sociological concept)","level":2,"score":0.5211015939712524},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.4945788085460663},{"id":"https://openalex.org/C112930515","wikidata":"https://www.wikidata.org/wiki/Q4389547","display_name":"Risk analysis (engineering)","level":1,"score":0.4693252444267273},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.3548903465270996},{"id":"https://openalex.org/C38652104","wikidata":"https://www.wikidata.org/wiki/Q3510521","display_name":"Computer security","level":1,"score":0.30381715297698975},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.16846317052841187},{"id":"https://openalex.org/C144024400","wikidata":"https://www.wikidata.org/wiki/Q21201","display_name":"Sociology","level":0,"score":0.16595330834388733},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.15111342072486877},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.14135536551475525},{"id":"https://openalex.org/C77088390","wikidata":"https://www.wikidata.org/wiki/Q8513","display_name":"Database","level":1,"score":0.0},{"id":"https://openalex.org/C36289849","wikidata":"https://www.wikidata.org/wiki/Q34749","display_name":"Social science","level":1,"score":0.0}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.1038/s41746-023-00929-1","doi":"https://doi.org/10.1038/s41746-023-00929-1","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-023-00929-1","pdf_url":"https://www.nature.com/articles/s41746-023-00929-1.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-2","ki-jl-1","norway-1","oarl","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"npj Digital Medicine","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:10558567","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10558567","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10558567/pdf/41746_2023_Article_929.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"NPJ Digit Med","raw_type":"Text"},{"id":"pmid:37803209","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/37803209","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"NPJ digital medicine","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:6aa9cefda34540829c406a8199835773","doi":null,"is_oa":true,"landing_page_url":"https://doaj.org/article/6aa9cefda34540829c406a8199835773","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"npj Digital Medicine, Vol 6, Iss 1, Pp 1-3 (2023)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1038/s41746-023-00929-1","doi":"https://doi.org/10.1038/s41746-023-00929-1","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-023-00929-1","pdf_url":"https://www.nature.com/articles/s41746-023-00929-1.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-2","ki-jl-1","norway-1","oarl","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"npj Digital Medicine","raw_type":"journal-article"},"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4387405016.pdf","grobid_xml":"https://content.openalex.org/works/W4387405016.grobid-xml"},"referenced_works_count":11,"referenced_works":["https://openalex.org/W2888424632","https://openalex.org/W2979186816","https://openalex.org/W2979279941","https://openalex.org/W3039734504","https://openalex.org/W3086667591","https://openalex.org/W3154910625","https://openalex.org/W4205805845","https://openalex.org/W4206698631","https://openalex.org/W4256659255","https://openalex.org/W4281706229","https://openalex.org/W4360600530"],"related_works":["https://openalex.org/W4390234382","https://openalex.org/W7157773142","https://openalex.org/W7163390762","https://openalex.org/W3206676099","https://openalex.org/W7064186500","https://openalex.org/W4413100843","https://openalex.org/W4406771938","https://openalex.org/W7122345317","https://openalex.org/W4389055737","https://openalex.org/W7152018728"],"abstract_inverted_index":{"Autonomous":[0],"AI":[1,44,58,82,85,119,140],"systems":[2,141],"in":[3,74],"medicine":[4],"promise":[5],"improved":[6],"outcomes":[7],"but":[8],"raise":[9],"concerns":[10,34],"about":[11],"liability,":[12],"regulation,":[13],"and":[14,25,55,67,100,115,128,146],"costs.":[15],"With":[16],"the":[17,29,49,63,108,152],"advent":[18],"of":[19,57,118,138,155],"large-language":[20],"models,":[21],"which":[22],"can":[23,142],"understand":[24],"generate":[26],"medical":[27],"text,":[28],"urgency":[30],"for":[31,40,52,90],"addressing":[32],"these":[33],"increases":[35],"as":[36,60,62,125],"they":[37,78],"create":[38],"opportunities":[39],"more":[41],"sophisticated":[42],"autonomous":[43,139],"systems.":[45],"This":[46],"perspective":[47],"explores":[48],"liability":[50,89],"implications":[51],"physicians,":[53],"hospitals,":[54],"creators":[56],"technology,":[59],"well":[61],"evolving":[64,103],"regulatory":[65,104],"landscape":[66],"payment":[68,122],"models.":[69],"Physicians":[70],"may":[71,87],"be":[72],"favored":[73],"malpractice":[75],"cases":[76],"if":[77],"follow":[79],"rigorously":[80],"validated":[81],"recommendations.":[83],"However,":[84],"developers":[86],"face":[88],"failing":[91],"to":[92,94,111,132,149],"adhere":[93],"industry-standard":[95],"best":[96],"practices":[97],"during":[98],"development":[99],"implementation.":[101],"The":[102,135],"landscape,":[105],"led":[106],"by":[107],"FDA,":[109],"seeks":[110],"ensure":[112],"transparency,":[113],"evaluation,":[114],"real-world":[116],"monitoring":[117],"systems,":[120],"while":[121],"models":[123],"such":[124],"MPFS,":[126],"NTAP,":[127],"commercial":[129],"payers":[130],"adapt":[131],"accommodate":[133],"them.":[134],"widespread":[136],"adoption":[137],"potentially":[143],"streamline":[144],"workflows":[145],"allow":[147],"doctors":[148],"concentrate":[150],"on":[151],"human":[153],"aspects":[154],"healthcare.":[156]},"counts_by_year":[{"year":2026,"cited_by_count":29},{"year":2025,"cited_by_count":30},{"year":2024,"cited_by_count":20},{"year":2023,"cited_by_count":4}],"updated_date":"2026-11-02T09:45:03.842371","created_date":"2023-10-07T00:00:00"}