Unmasking Bias in AI: A Systematic Review of Bias Detection and Mitigation Strategies in Electronic Health Record-based Models
It addresses bias in AI for healthcare to prevent worsening disparities, but is incremental as it reviews existing literature without new methods.
This systematic review tackled the problem of bias in AI models using electronic health records by identifying six major bias types and analyzing detection and mitigation strategies, finding that 60 studies proposed methods like resampling and reweighting, with four focusing on detection using fairness metrics.
Objectives: Leveraging artificial intelligence (AI) in conjunction with electronic health records (EHRs) holds transformative potential to improve healthcare. Yet, addressing bias in AI, which risks worsening healthcare disparities, cannot be overlooked. This study reviews methods to detect and mitigate diverse forms of bias in AI models developed using EHR data. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, analyzing articles from PubMed, Web of Science, and IEEE published between January 1, 2010, and Dec 17, 2023. The review identified key biases, outlined strategies for detecting and mitigating bias throughout the AI model development process, and analyzed metrics for bias assessment. Results: Of the 450 articles retrieved, 20 met our criteria, revealing six major bias types: algorithmic, confounding, implicit, measurement, selection, and temporal. The AI models were primarily developed for predictive tasks in healthcare settings. Four studies concentrated on the detection of implicit and algorithmic biases employing fairness metrics like statistical parity, equal opportunity, and predictive equity. Sixty proposed various strategies for mitigating biases, especially targeting implicit and selection biases. These strategies, evaluated through both performance (e.g., accuracy, AUROC) and fairness metrics, predominantly involved data collection and preprocessing techniques like resampling, reweighting, and transformation. Discussion: This review highlights the varied and evolving nature of strategies to address bias in EHR-based AI models, emphasizing the urgent needs for the establishment of standardized, generalizable, and interpretable methodologies to foster the creation of ethical AI systems that promote fairness and equity in healthcare.