Jonathan Chong Kai Liew

Background: The current landscape of emergency care (EC) is marked by high demand, leading to issues such as emergency department boarding, overcrowding, and subsequent delays that impact the quality and safety of patient care. Integrating data science into EC can enhance decision-making with predictive, preventative, personalized, and participatory approaches. However, gaps in adherence to fairness, accountability, interpretability, and responsibility are evident, particularly due to barriers to data-sharing, which often result in a lack of transparency and robust oversight in these applications. Objective: The FAIR-EC (Fair, Accountable, Interpretable, and Responsible-Emergency Care) collaboration adapts the existing Fair, Accountable, Interpretable, and Responsible principles to address emerging challenges as data science integrates with EC. This initiative aims to transform EC by establishing ethical artificial intelligence standards specifically tailored for this integration. By bridging the gap between EC professionals, data scientists, and other stakeholders, the collaboration promotes international cooperation that leverages advanced data science techniques to enhance EC outcomes across different care settings. Methods: We propose a federated research design to analyze extensive datasets from various global institutions without compromising patient privacy. This approach transforms epidemiological research with advanced data science techniques, emphasizing the harmonization of data for comprehensive analyses across different health care systems. Results: The FAIR-EC initiative has facilitated the identification and harmonization of datasets from diverse geographical regions, enabling the examination of regional variations in EC practices. As of paper submission, participating sites have identified retrospective EC datasets totaling >2 million records (eg, Duke Health >400,000 and Singapore General Hospital >1.7 million records). Initial projects have demonstrated feasibility and operational readiness, including implementation of federated workflows and ongoing development of a federated scoring system, cross-site evaluation, and adaptation of association studies and predictive models across various regions. Cross-site harmonization and pilot analyses are underway (with local ethics approvals in progress), and first multisite results are expected to be submitted in mid-late 2026, with additional project-level publications anticipated in 2027. These efforts highlight the feasibility of leveraging advanced data science techniques to address the complexities of EC while preserving patient privacy without centralizing individual-level data. This project was funded from September 1, 2022, to August 31, 2023. Conclusions: FAIR-EC integrates data science ethically and effectively into EC, addressing challenges such as fragmented data, real-time handoffs, and public health crises. Its federated design harmonizes diverse data streams while preserving privacy, and its emphasis on ethical artificial intelligence aligns with the dynamic nature of EC. Despite challenges in data variability and system complexity, FAIR-EC establishes a strong foundation for innovation in global EC.

Recruitment and retention challenges continue to hinder the success of clinical trials. Artificial intelligence (AI) has emerged as a promising means to optimize various clinical trial processes; however, its impact specifically on recruitment and retention has not been comprehensively evaluated. This scoping review utilized the Joanna Briggs Institute framework and adhered to PRISMA-ScR guidelines, systematically searching literature published between January 2018 and June 2024 across multiple databases. Of the 21,573 records screened, 121 studies were included. A meta-analysis was conducted to quantitatively assess the performance of AI-driven tools. AI applications for patient screening demonstrated strong performance, achieving a pooled sensitivity of 0.91 (95% CI: 0.84–0.95) and an area under the curve (AUC) of 0.79 (95% CI: 0.72–0.85). AI tools employed for eligibility identification and classification also exhibited strong outcomes, with pooled sensitivities of 0.80 (95% CI: 0.76–0.84) and 0.92 (95% CI: 0.84–0.96), respectively, and precisions of 0.84 (95% CI: 0.80–0.88) and 0.91 (95% CI: 0.85–0.95). AI tools aimed at identifying patient cohorts showed moderate effectiveness (pooled sensitivity: 0.70 [95% CI: 0.52–0.84]; AUC: 0.74 [95% CI: 0.61–0.84]). Overall, AI presents significant potential for enhancing clinical trial recruitment and retention, with effectiveness varying across specific applications. These findings underscore AI’s valuable role in improving trial efficiency and data quality.