Application of comprehensive evaluation framework to Coronavirus Disease 19 studies: A systematic review of translational aspects of artificial intelligence in health care

Background Despite immense progress in artificial intelligence (AI) models, there has been limited deployment in healthcare environments. The gap between potential and actual AI applications is likely due to the lack of translatability between controlled research environments (where these models are developed) and clinical environments for which the AI tools are ultimately intended. Objective We have previously developed the Translational Evaluation of Healthcare AI (TEHAI) framework to assess the translational value of AI models and to support successful transition to healthcare environments. In this study, we apply the TEHAI to COVID-19 literature in order to assess how well translational topics are covered. Methods A systematic literature search for COVID-AI studies published between December 2019-2020 resulted in 3,830 records. A subset of 102 papers that passed inclusion criteria were sampled for full review. Nine reviewers assessed the papers for translational value and collected descriptive data (each study was assessed by two reviewers). Evaluation scores and extracted data were compared by a third reviewer for resolution of discrepancies. The review process was conducted on the Covidence software platform. Results We observed a significant trend for studies to attain high scores for technical capability but low scores for the areas essential for clinical translatability. Specific questions regarding external model validation, safety, non-maleficence and service adoption received failed scores in most studies. Conclusions Using TEHAI, we identified notable gaps in how well translational topics of AI models are covered in the COVID-19 clinical sphere. These gaps in areas crucial for clinical translatability could, and should, be considered already at the model development stage to increase translatability into real COVID-19 healthcare environments. ### Competing Interest Statement S.R. holds Directorship in Medi-AI. The other authors have no conflicts of interest to declare. ### Clinical Protocols ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * AI : Artificial Intelligence COVID-19 : Corona Virus Disease 2019 SE : Standard Error TEHAI : ‘Translational Evaluation of Healthcare Artificial Intelligence