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Purpose The global health crisis represents an unprecedented opportunity for the development of artificial intelligence (AI) solutions. This paper aims to integrate explainable AI into the decision-making process in emergency scenarios to help mitigate the high levels of complexity and uncertainty associated with these situations. An AI solution is designed to extract insights into opioid overdose (OD) that can help government agencies to improve their medical emergency response and reduce opioid-related deaths. Design/methodology/approach This paper employs the design science research paradigm as an overarching framework. Open-access digital data and AI, two essential components within the digital transformation domain, are used to accurately predict OD survival rates. Findings The proposed AI solution has two primary implications for the advancement of informed emergency management. Results show that it can help not only local agencies plan their resources for timely response to OD incidents, thus improving survival rates, but also governments to identify geographical areas with lower survival rates and their primary contributing factor; hence, they can plan and allocate long-term resources to increase survival rates and help in developing effective emergency-related policies. Originality/value This paper illustrates that digital transformation, particularly open-access digital data and AI, can improve the emergency management framework (EMF). It also demonstrates that the AI models developed in this study can identify opioid OD trends and determine the significant factors improving survival rates.
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JOURNAL TITLE: Industrial management + data systems
USER JOURNAL TITLE: Industrial Management & Data Systems
ARTICLE TITLE: Digital transformation to mitigate emergency situations: increasing opioid overdose survival rates
through explainable artificial intelligence
ARTICLE AUTHOR: Johnson, Marina
VOLUME: ahead-of-print
ISSUE: ahead-of-print
YEAR: 2021
ISSN: 0263-5577
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Digital transformation to mitigate
emergency situations: increasing
opioid overdose survival rates
through explainable
artificial intelligence
Marina Johnson and Abdullah Albizri
Feliciano School of Business, Montclair State University, Montclair, New Jersey, USA
Antoine Harfouche
Paris-Nanterre University, Nanterre, France, and
Salih Tutun
John M. Olin Business School, Washington University in St. Louis, St. Louis, Missouri, USA
Purpose The global health crisis represents an unprecedented opportunity for the development of artificial
intelligence (AI) solutions. This paper aims to integrate explainable AI into the decision-making process in
emergency scenarios to help mitigate the high levels of complexity and uncertainty associated with these
situations. An AI solution is designed to extract insights into opioid overdose (OD) that can help government
agencies to improve their medical emergency response and reduce opioid-related deaths.
Design/methodology/approach This paper employs the design science research paradigm as an
overarching framework. Open-access digital data and AI, two essential components within the digital
transformation domain, are used to accurately predict OD survival rates.
Findings The proposed AI solution has two primary implications for the advancement of informed
emergency management. Results show that it can help not only local agencies plan their resources for timely
response to OD incidents, thus improving survival rates, but also governments to identify geographical areas
with lower survival rates and their primary contributing factor; hence, they can plan and allocate long-term
resources to increase survival rates and help in developing effective emergency-related policies.
Originality/value This paper illustrates that digital transformation, particularly open-access digital data
and AI, can improve the emergency management framework (EMF). It also demonstrates that the AI models
developed in this study can identify opioid OD trends and determine the significant factors improving
survival rates.
Keywords Digital transformation, Explainable artificial intelligence, Machine learning, Emergency
management framework, Opioid OD, Survival prediction
Paper type Research paper
1. Introduction
Digital transformation refers to the integration of digital technology into all areas of a
business or an organization, fundamentally changing their processes and operations (Vial,
2019). Digital transformation, artificial intelligence (AI) and machine learning (ML)
revolutionize various industry domains (Kapletia et al., 2019;Roscoe et al., 2019;Wamba
and Queiroz, 2020). Such disruptive technologies are garnering significant attention due to
their many advantages, including maturity speed, limitless possibilities and power of
transforming organizations (Bohr and Memarzadeh, 2020;Delmolino and Whitehouse, 2018).
Following the private sector, governments at all levels have started employing digital
transformation, AI and ML in order to deliver services and programs more productively,
transparently and cost-effectively (Luna-Reyes and Gil-Garcia, 2014). Many government
agencies collect and store data as part of their digital transformation efforts and encourage
intelligence for
The current issue and full text archive of this journal is available on Emerald Insight at:
Received 21 April 2021
Revised 14 September 2021
Accepted 25 September 2021
Industrial Management & Data
© Emerald Publishing Limited
DOI 10.1108/IMDS-04-2021-0248
researchers to extract insights and create applications for data-driven decision-making
through AI (Luna-Reyes and Gil-Garcia, 2014).
The outbreak of the COVID-19 pandemic has given rise to a dramatic increase in the opioid
crisis, a disruptive situation that has significantly increased the number of weekly visits to
hospital emergency departments. Compared to prepandemic rates, opioid overdose (OD) has
increased by 45% in this context (Nissen, 2021). In pre-COVID times, the opioid epidemic was
already ranked by government agencies and health organizations as one of the worst public
health crises in a generation with far-reaching social and economic effects (Centers for
Medicare and Medicaid Services, 2018). Opioids are a class of prescription drugs used for pain
relievers, including not only oxycodone, hydrocodone, fentanyl and tramadol, but also the
illegal drug heroin (NIH, 2020). Opioid addiction is defined by a strong and compulsive urge to
use opioid drugs due to their ability to produce feelings of pleasure, even when they are no
longer required medically (MedlinePlus US National Library of Medicine, 2020). Opioid OD
refers to taking high doses of opioids (WHO, 2020). Opioid OD is signaled by pinpoint pupils,
unconsciousness and breathing troubles and can cause death when the brain function of
regulating breathing is seriously damaged (WHO, 2020).
The death toll of opioid OD in the USA alone stood around 450,000 between 1999 and 2018
(CDC, 2020). Moreover, opioid OD deaths were four-folds more in 2018 vis-
a-vis 1999,
indicating an accelerating trend of the opioid epidemic (CDC, 2020). Globally, 115,000
individuals died of opioid OD in 2017 only, while the number of nonfatal OD cases was several
times higher than the fatal OD cases (WHO, 2020). The annual economic burden and societal
costs (e.g. healthcare and loss in wages) of the opioid epidemic are estimated to be as high as
$1.02 trillion in 2017 in the USA alone (Florence et al., 2021). While guidelines and
recommendations to address the opioid epidemic are available, the gap between suggested
courses of action and reality is significant (WHO, 2020). Therefore, government agencies,
private organizations and emergency response teams need to mitigate, plan and direct their
resources to reduce the impacts of the opioid epidemic.
There have been growing investments in AI interventions to combat the opioid-driven OD
epidemic plaguing the entire world (Ti et al., 2021). We aim to examine the use of digital
transformation particularly open-source digital government data and AI in helping
government agencies and organizations to address opioid OD incidents, which account for an
emergency crisis. More specifically, this studys primary research objective is to investigate
the role of AI in emergency mitigation and preparedness efforts concerning opioid OD and
provide government agencies with the adequate relevant insights. Additionally, we address
the following research questions throughout this study: (1) What are the important factors
increasing the survival rates of victims after an OD incident? (2) How do these factors
contribute to OD survival rates?
To attain the research objective and answer the aforementioned research questions, we
construct an information technology(IT) artifact using thedesign science research paradigm as
an overarching framework (Abbasi et al., 2012;Hevner et al.,2004). Based on the design science
research paradigm, this paper presents an IT artifact (i.e. an AI-based solution) utilizing state-
of-the-art AI algorithms. We employ the emergency management framework (EMF)
(McLoughlin, 1985) as the kernel theory guiding the design of the IT artifact. To build this
AI-based solution, we curate a dataset that includes the OD incidents of the past two years, from
the open data portal of the US government. We then create an explainable AI framework that is
consistently capable of predicting OD survival rates and identifying important variables. This
research has two primary implications in medical emergency situations: (1) it can help local
agencies plan their resources for a timely response to OD incidents, thus improving survival
rates. (2) It can be harnessed by state and federal governments to identify geographical areas
with lower survival rates and their primary contributing variables while planning and
allocating long-term resources to increase survival rates.
The remainder of the paper includes a literature review in Section 2 and the description of
the theoretical development in Section 3.Section 4 outlines the proposed methodology, while
Section 5 presents the results and provides insights into the factors affecting OD survival
rates. The studys implications are described in Section 6, while Section 7 serves as the
concluding remarks and future research directions.
2. Literature review
In this section, we conduct a literature review and examine published articles on the use of
digital transformation, AI, ML and emergency situations. We use Scopus to obtain the
relevant research because it is regarded as the largest abstract and citation database of
peer-reviewed literature. We employ two different search queries to capture all relevant and
important studies. In the first query, we aim to extract the articles studying digital
transformation, AI and ML in the context of emergency situations by using various keywords,
such as Digital Transformation,”“Artificial Intelligence,”“Machine Learning,and
Emergency Situations.We then limit the search results to the articles published in
business-related journals since 2010 by using Australian Business Deans Council (ABDC) and
Association of Business School (ABS) journal rankings. In the second query, we extract the
research studies exploring the use of digital transformation, AI and ML in the context of opioid
OD. We use various keywords (e.g. Artificial Intelligence,”“Machine Learningand OD).
Several studies utilize digital transformation, along with AI, for effective emergency
management (Cavdur and Sebatli, 2019;Chaudhuri and Bose, 2020;Fertier et al., 2020;Hayes
and Kelly, 2018;Lee and Lee, 2021;Pekar et al., 2020;Zhu et al., 2021). Some of these studies
focus on resource allocation to mitigate the impact of emergency situations. For example,
Chaudhuri and Bose (2020) apply deep learning to images of earthquake-hit regions to
identify survivors. They propose that their research can be utilized to better allocate the
search and rescue resources. Zhang et al. (2016) develop a resource allocation model for
emergency rescue using two-stage mixed-integer programming to optimize resource
allocation for rescue service within the rescue time horizon. Zhang et al. (2012) employ
linear programming and network optimization to allocate resources to emergency incident
locations. They take into account a potential secondary emergency situation and determine
the priority of preference regarding how the resources are allocated. Several studies focus on
minimizing the response time to emergency situations. For instance, Cavdur and Sebatli
(2019) develop a decision support tool to allocate temporary disaster response facilities using
ML to reduce the response times. Erdoǧan et al. (2010) employ the tabu search algorithm to
determine the best emergency response team locations to minimize the incident response
times. Various studies use AI, Big Data, optimization and simulation to create emergency
response plans and evaluate their effectiveness. For example, Hayes and Kelly (2018) process
data from social media to create action plans for natural disaster response. De Maio et al.
(2011) propose a framework utilizing semantic web technologies and soft computing to devise
an emergency response plan. Tinguaro Rodr
ıguez et al. (2010) design a decision support
system for emergency response teams using a two-level knowledge-based methodology. Gul
et al. (2020) design a hybrid framework to evaluate the preparedness of emergency
departments by predicting demand using artificial neural networks (ANNs) and assess the
performance of emergency departments via discrete event simulation. Tang and Shen (2015)
develop an emergency response plan through AI and empirically test its effectiveness within
an emergency evacuation context after a typhoon incident.
With regard to the opioid OD literature, recent research has shown interest in the use of
digital transformation, particularly AI and ML to tackle the issue. Lo-Ciganic et al. (2021)
improve the accuracy of ML algorithms in predicting opioid OD risk and capture the social
determinants of OD risk by integrating data from human services and criminal justice health
intelligence for
claims. Yao et al. (2020) extract suicidal posts from among opioid users on Reddit and classify
OD incidents as intentional or unintentional using ANNs, with a view to better understanding
the rationale for such usersbehavior, providing new insights into the attitude of those
involved in the opioid epidemic. Boslett et al. (2020) use logistic regression and random forests
(RFs) to predict opioid involvement in unclassified drug ODs and estimate the number of fatal
opioid ODs. Prieto et al. (2020) develop a natural language processing method combined with
various ML algorithms (e.g. RF, k-nearest neighbors, support vector machines [SVMs] and
L1-regularized logistic regression) to identify potential opioid misuse from paramedic
documentation. Ward et al. (2019) develop an ML method to classify death certificates as drug
ODs to provide faster drug OD mortality surveillance and inform public health responses to
the drug OD epidemic in near-real time instead of several weeks following events. Badger
et al. (2019) develop ML models (i.e. RFs and regularized logistic regression) for classifying the
severity of opioid OD events from clinical data. Lo-Ciganic et al. (2019) utilize RF, gradient
boosting machine and deep neural network (DNN) approaches to predict opioid OD risk
among medicare beneficiaries. Dong et al. (2019) build ML and deep learning models to predict
opioid OD of patients based on both the history of patientselectronic health records and New
York State claims data. Neill and Herlands (2018) apply ML approaches to 17 years of county-
aggregated data for monthly opioid OD deaths in the New York City metropolitan area to
detect and characterize emerging OD patterns (e.g. geographic, demographic and behavioral
patterns). The literature review has demonstrated that there is no study exploring the opioid
epidemic and predicting opioid OD survival rates based on an explainable AI approach,
particularly in the context of emergency situations. This study bridges this gap by
developing AI-based models to predict opioid survival rates and identify its contributing
3. Theoretical development
Digital transformation, AI and ML can facilitate and improve emergency response activities
during pandemics, man-made or natural disasters, and disruptions. Therefore, we employ the
EMF (McLoughlin, 1985) as the kernel theory to guide the design of the IT artifact and
integrate it with AI and ML to improve its effectiveness. The EMF comprised four stages,
namely mitigation, preparedness, response and recovery.
The mitigation phase of the EMF aims to determine the actions that should be taken
before emergency incidents to eliminate or reduce their impacts and risks (McLoughlin, 1985).
This phase is significant to identify effective prevention plans and design standards to reduce
the risk of loss of life. Although traditional methods of collecting and organizing expert
opinions (e.g. surveys) can identify emergency risk factors, they are expensive, time-
consuming and not very accurate (Bellaire et al., 2017). AI can revolutionize this first phase by
analyzing large volumes of data using AI and ML. Based on insights from analyses, decision-
makers can develop effective mitigation strategies (Gama et al., 2016), such as identifying
management priorities (Canon et al.,2019) and developing contingency plans (Dou
et al., 2014).
The preparedness phase comprises identifying future emergency incidents and sending
out early warnings (McLoughlin, 1985). Traditionally, human experts measure, analyze and
plan emergency actions to deal with specific situations. AI can be a cost-efficient alternative
tool to predict potential emergency situations (i.e. disasters) and estimate the damage and
prepare an action plan (Ko and Kwak, 2012). AI has the potential to exhaustively analyze and
simulate various response plans to emergency situations with different magnitudes and
impacts, thus identifying the best plan (Sun et al., 2020). For example, it can help determine the
best evacuation plan or devise a resource allocation program after an earthquake (Zheng and
Liu, 2019).
The response phase requires decision-makers to act decisively within tight time frames
(Sun et al., 2020) with often incomplete information and too much data from which it is
difficult to extract relevant information (i.e. information overload) (Carver and Turoff, 2007).
AI can be applied to collect, consolidate and analyze data rapidly, check its relevance and
reliability, and help decision-makers synthesize the best options for action (Ramchurn et al.,
2016). In an emergency, AI is able to rapidly classify information from a vast number of calls
and share the urgent needs of the victims to relevant emergency services (Sun et al., 2020).
AI can help automatically recognize voices, identify keywords and rapidly process voice data
(Ramchurn et al., 2016) to improve the response.
The recovery phase requires a quick understanding of emergency complexity, the
identification of operational needs and recovery plans, and the achievement of rehabilitation
and reconstruction activities (Sun et al., 2020). Traditionally, the loss and repair costs are
usually estimated based on tabulating data from different sources, such as insurance claims
and postdisaster assessments (Kim et al., 2016). However, the lack of standardized methods
for collecting and analyzing data may lead to different estimates (Ladds et al., 2017). The
availability of big data and the rapid development of AI contributes to assessing the disaster-
induced impact, establishing postevent recovery plans and conducting recovery and renewal
activities (Jamali et al., 2019). AI can also help identify potential fraud (Dutta et al., 2017) and
fake news (Zubiaga et al., 2018). Table 1 demonstrates the role of digital transformation and
disruptive technologies in improving the EMF.
4. Methodology
We develop an AI-based framework to achieve the research objective and answer the
research questions. This three-stage framework is illustrated in Figure 1. While the first stage
creates a dataset from various open data sources (e.g. OpenDataPA), the second trains three
AI algorithms RF, ANN and SVM to predict the survival probabilities of ODed people.
Lens/Phase Mitigation Preparedness Response Recovery
Industry lens:
Federal Emergency
Agency FEMA
(McLoughlin, 1985)
Identify long-
term risk of
diminish long-
term risk
Prepare and plan
capabilities and
simulate their
React immediately
to emergency
Timely support to
vital-life and work
to resume regular-
Academic lens
(Petak, 1985)
potential risk and
design risk
Present response
plan, identify
critical resources
and train first
React to reduce
damage and
intervention time
Provide immediate
support to
activities and
install processes to
return to normalcy
Activities by
(Reddick, 2011)
situations and
reduce damage
Enhance readiness
of organizations
Provide emergency
Provide pre-
emergency well-
Activities that can
be done by digital
Identify impact
and risks of
emergency and
predict potential
risk factors (Dou
et al., 2014)
Develop optimal
response plan and
help train
(Mendonça and
Wallace, 2007)
Collect, consolidate
and analyze data
rapidly. Check its
relevance and
(Ramchurn et al.,
Assess loss and
devise strategy to
return to normalcy
and help
(Deryugina, 2017)
Table 1.
AI for emergency
intelligence for
During model training, cross-validation (CV) is used to prevent overfitting, which refers to
obtaining superior performance in the training set and poor performance in the test set, as the
model captures the signal and the noise in the training set. After training the AI models, the
third stage employs Shapley Additive Explanations (SHAP) to obtain insights into the factors
affecting survival rates. Emergency responders and policymakers can use these insights to
address OD incidents and improve the response plan, thus increasing the survival rates.
4.1 Data description and processing
Many government agencies in the USA have adopted digital transformation and taken
numerous steps to increase transparency and accountability to their citizens and taxpayers
(Luna-Reyes and Gil-Garcia, 2014). Notably, these agencies adopted open data initiatives that
promote increased access to government data to stimulate innovation and demonstrate the
effectiveness of their policies and programs (The United States Open Data, 2018). Open data
particularly open government data remain primarily untapped though it is an excellent
resource for obtaining insights and resolving societal and economic problems
(TheGovLab, 2020).
In 2018, many states in the USA started sharing their data with the public and launched
their open data initiatives (The United States Open Data, 2018), such as Pennsylvanias (PA)
centralized and official data portal (OpenDataPA), which includes thousands of datasets that
are easily accessible to the public and can be used and redistributed without any restrictions.
The primary goal of OpenDataPA is to engage citizens and include researchers to help
government agencies make data-driven decisions and develop policy solutions (The Office of
Governor Tom Wolf, 2016).
Utilizing OpenDataPA as a primary source, this study curates a dataset to realize the
research objective and answer the primary research questions. This arduous data acquisition
process is described in Figure 2. The opioid OD incidents used as the primary dataset are
obtained from a source containing information on OD responses that were provided by PAs
first responders (e.g. primarily police officers, secondarily firefighters and emergency medical
services staff) between December 2018 and November 2020 [1]. This data source includes
22,423 OD incidents with 34 variables, such as the overdosing persons age, the drug
regularly taken by the victim ODed, the county where the OD incident took place, incident
response time and whether the overdosing person survived.
At the county level, more variables from secondary data sources on OpenDataPA are
added to enrich the OD dataset and provide more insights to government agencies and
policymakers. First, the number of drug and alcohol treatment facilities within the counties is
calculated using a dataset from OpenDataPA [2] and merged into the primary dataset. This
variable represents the level of access to treatment in the county. Several other proxy
Figure 1.
AI-based framework
variables are obtained from the US Census Bureau and OpenDataPA and appended to the
primary dataset. These variables define the countiesfinancial health and resources and
include the number of registered businesses [3], unemployment rate [4], income per capita [5]
and poverty rate [6]. Lastly, the countys population in which the OD incidents took place and
the number of transportation vehicles [7] they provide are merged with the primary dataset to
indicate if the county is considered urban or rural. The dataset used in this study is described
in Table 2.
4.2 AI algorithms
We use RF, ANN and SVM algorithms to train AI models based on the preliminary analysis.
RF is a tree-based supervised AI algorithm comprising multiple decision trees (DTs)
represented by if-then-else rules(Breiman, 2001). DTs within an RF model consist of nodes,
branches and leaves. The nodes stand for the test cases (e.g. if statements), while the
branches indicate the result of the test cases (e.g. rules)(Breiman, 2002). On the other hand,
the leaves represent the predicted outcome and are connected to the nodes via branches.
During the DT algorithm, the variables within the training set with the most discriminative
power to classify the instances (e.g. survived, deceased) are iteratively selected. These
selected variables become the nodes, and their values used to split the training set are
determined using a metric named information gain, indicating the reduction in entropy (e.g.
uncertainty, impurity). The RF algorithm uses the DT algorithm and builds many
uncorrelated DTs by sampling observations with replacement from the training dataset
(Cutler et al., 2012). Then, these individual DTs are combined using a function, such as simple
averages or majority voting. Since RF uses multiple uncorrelated DTs by sampling the
training set, it tends to provide lower model variance and better accuracy rates, which is
considered very robust. Readers interested in obtaining more information regarding RF are
referred to Breiman (2001) and Cutler et al. (2012).
The ANN is a supervised AI algorithm with self-learning capabilities to generate accurate
predictions and can model highly nonlinear relationships between input and target variables
Figure 2.
Data collection process
intelligence for
(James et al., 2013). ANNs are composed of input, hidden and output layers, each containing
various artificial neurons. The input layer neurons represent the input variables and receive
the input data in the training set, while the output layer neuron stands for the target variable.
The hidden layer is located between the input and output layers. The hidden layer is used to
nonlinearly transform and combine the existing variables, so as to create new features that
Variable name Description Summary
Day Day of OD incident 7 levels (e.g. Monday)
County name County of OD incident 67 levels (e.g. Bucks, York)
Gender Gender of ODing person 3 levels (i.e. M, F, unknown)
Age range Age range of ODing person 10 levels (e.g. 3039)
Race Race of ODing person 5 levels (e.g. White, Black)
Ethnicity Ethnicity of ODing person 3 levels (e.g. Hispanic)
Susp OD drug Drug person ODed on 19 levels (e.g. heroin)
Response time Response time to OD incident 6 levels (e.g. <3 min, >3 min
and <5 min)
Third party admin Responders to OD incident 4 levels (e.g. EMS, FD)
Season Season of OD incident 4 levels (e.g. Summer)
Naloxone administered Whether responders administered
2 levels (i.e. yes, no)
Year Year OD occurred in 3 levels (i.e. 2018, 2019, 2020)
Month Month of OD incident 12 levels (e.g. January)
Month day Day of the month OD occurred Min: 1, Mean: 15.2, Max: 31
Weekend Whether OD occurred on a weekend 2 levels (i.e. yes, no)
Time block Time block of OD incident 4 levels (e.g. 00:0003:59)
Dose count Dose of Naloxone administered Min: 0, Mean: 1.0, Max: 9
Dose unit Dose count of Naloxone administered Min: 0, Mean: 1.7, Max: 4
Time Approximate time of OD incident Min: 0, Mean: 12.4, Max: 24
Number of trans Number of public transportation
Min: 2, Mean: 9.3, Max: 19
Labor force Number of employed and unemployed
Min: 1800, Mean: 251079, Max:
Employed Number of employed people Min: 1700, Mean: 239494, Max:
Unemployed Number of unemployed people Min: 100, Mean: 11573, Max: 39300
Unemployment rate Percent of people unemployed Min: 0.9, Mean: 4.8, Max: 8.1
Number of registered
Number of corporations Min: 373, Mean: 73713, Max:
Children in poverty Number of children living in poverty Min: 23, Mean: 4678, Max: 38729
Percent children in poverty Percent of children living in poverty Min: 8.1, Mean: 18.6, Max: 36.6
Per capita income Median income per person Min: 14325, Mean: 27770, Max:
Median household income Median income per household Min: 34796, Mean: 54099, Max:
Median family income Median income per family Min: 43750, Mean: 66769, Max:
Number of households Number of households Min: 2273, Mean: 199573, Max:
Number of drug treatment
Number of drug/alcohol treatment
Min: 1, Mean: 33, Max: 121
Population Population Min: 4447, Mean: 481308, Max:
High pop Whether county of OD incident is rural
or not
3 levels (i.e. rural, mid-rural, urban)
Survive Whether ODed person survived 2 levels (e.g. yes, no)
Table 2.
Summary of variables
used in this study
are not readily available in the training set (Ramachandran et al., 2017). The neurons located
within different layers are interconnected via weights determining the connections strength
(Haykin, 2009). The ANN first processes the external training set from the input layer to the
output layer in order to acquire the predicted target values. This step is called feedforward.
Then, the errors between the predicted and actual target values and their partial derivative
are computed. Another step consists of backpropagating the partial derivatives of the errors
with respect to weights, with a view to adjusting the weights. The ANN learns the optimal
weights that minimize the difference between the predicted and actual target variables by
iteratively feedforwarding the training set and backpropagating the errors.
The SVM is a supervised learning algorithm mainly used for classification. The SVMs
goal is to find a hyperplane that optimally divides the dataset into two classes (i.e. died vs.
survived), with the most significant gap possible using quadratic programming (Cortes and
Vapnik, 1995;Noble, 2006). It is important to note that the SVM can utilize various kernel
functions (e.g. radial) to classify datasets that are not linearly separable. We use the sigmoid
kernel for the SVM algorithm based on our preliminary analysis, allowing it to operate in high
dimensional space with high accuracy rates efficiently.
4.3 Performance measures
In this study, RF and ANN classifiers are used to predict the class probabilities (e.g. the
likelihood of an overdosing person to survive). Therefore, these probabilities need to be
binarized using a discrimination threshold to determine true positive (TP), true negative (TN),
false positive (FP) and false negative (FN) rates. In the context of this study, TP represents an
outcome in which the AI model correctly predicts the positive class overdosing person to
survive, while TN indicates an outcome in which the AI model accurately predicts the
negative class overdosing person to decease. FP and FN are outcomes where the model
incorrectly predicts the positive and negative classes, respectively.
Primary performance metrics of AI models used for classification include accuracy,
sensitivity, specificity and the area under the curve (AUC). Accuracy indicates the percentage
of correctly classified observations (TP and TN). Sensitivity provides information regarding
the AI models ability to identify true positive (TP) instances (e.g. survived). Specificity
determines the AI modelsability to detect true negative (TN) instances (e.g. deceased). The
AUC is obtained by first creating a receiver operating characteristic (ROC) curve and
computing the area underneath. The ROC plots sensitivity against 1- specificity by varying
the threshold values used to binarize the class probabilities, thus eliminating the need for
selecting a discrimination threshold.
4.4 Data balancing
The categorical target variable used in AI models may have a class imbalance problem,
referring to one category (i.e. level) dominating the other. The category with more instances is
called the majority class, while the category dominated by the majority class is called the
minority class (Johnson et al.,2021). AI algorithms tend to learn the patterns in the majority
class, while ignoring the information in the minority class if the training dataset is imbalanced.
As a result, the AI algorithms tend to label most instances in the test set with the majority class
label, yielding low performance measures. Hence, it is critical to balance the training set during
CV while building AI models. Generally, oversampling and undersampling techniques are used
to balance the imbalanced training set (Chawla et al.,2011;Fern
andez et al.,2018). Observations
from the majority class are randomly removed in undersampling, while new synthetic
observations are added to the minority class in oversampling.
In the context of this study, the number of ODed people who survived is much higher than
the number of ODed people who died. To address this issue, an oversampling technique
intelligence for
named Synthetic Minority Oversampling Technique (SMOTE) is used. The primary reason
for choosing SMOTE over other undersampling methods is to avoid removing observations
with valuable information. In SMOTE, a random observation from the minority class is first
selected, and then the distance between this observation and other observations in the same
class is computed. Using the distance values, the knearest neighbors of this random
observation are determined. One of these kneighbors is randomly selected, and a straight line
between this neighbor and the observation is drawn. Then, a new observation is created at
random on this straight line. The steps to create new observations are iterated until the
number of observations in the minority class is the same as the majority class. Readers
interested in learning more about SMOTE are referred to the articles written by Chawla et al.
(2011) and Fern
andez et al. (2018).
4.5 Cross-validation (CV)
K-fold CV is used to validate the AI models and prevent overfitting (Johnson et al., 2020;
Simsek et al., 2021). A completely independent dataset is needed to test the performance of the
AI models after K-fold CV. Thus, the dataset is split into training and test sets before K-fold
CV. The training and test sets contain 70 and 30% of the observations in the dataset. The
70:30 split ensures that the training data have enough instances with different patterns to fit
robust AI models. Additionally, the 70:30 split guarantees enough observations in the test set
to measure the AI modelsperformance and generalizability on the unseen dataset (Johnson
et al., 2021).
In K-fold CV, the training set is randomly partitioned into ksubsets. One of these ksubsets
is used as a test set, while the remaining k1 subsets are put together to form the training set
used for training the AI model. In other words, an AI model is run ktimes, and performance
measures (e.g. AUC) across all ktrials are recorded. The final performance of the CV process is
acquired by averaging the performance measures of the kfolds. It is critical to note that the
data imbalance problem is addressed during CV. If the combination of k1 subsets used as a
training set is imbalanced, SMOTE is used to correct that imbalance.
The advantage of k-fold CV is that each observation in the dataset gets to be used as a test
case. Determining the right kvalue is critical for obtaining robust AI models. High kvalues
increase computational run time and reduce the number of unique iterations with different
observations, leading to high model bias, referring to obtaining an erroneous model due to
missing relevant relations in the dataset. Low kvalues form drastically different k1 training
sets, which may increase the model variance, referring to the sensitivity to small fluctuations
in the dataset. Therefore, the kvalue should be selected by taking into account the
bias-variance tradeoff as well as the computational run time. This study uses five-fold CV (i.e.
k55) because previous studies have demonstrated that k55 provides a well-balanced trade-
off among computational run time, model bias and variance (Kohavi, 1995;Olson and Delen,
2008). The AUC is chosen as the primary metric to evaluate AI modelsperformance because
it does not require a discrimination threshold.
4.6 Model explainability
SHAP was developed by Lundberg and Lee (2017) and is used to explain and interpret AI
models at the individual observation level. The SHAP algorithm computes the contribution of
an input variable to a particular prediction as follows (Aas et al., 2020;Ancona et al., 2019;
Lundberg and Lee, 2017): (1) It builds models using all the permutations of the remaining
input variables with and without this specific feature; (2) The marginal contributions of this
feature are computed by subtracting the predictions obtained from these models; (3) These
marginal contributions across all permutations are averaged to determine the features
Shapley value. Hence, the Shapley value of a variable at the individual observation level
identifies how much this feature contributes to this observations prediction (Lundberg and
Lee, 2017). To obtain the SHAP feature importance, the absolute Shapley values of a feature
for individual observations are averaged.
5. Results
5.1 AI modelsresults
Table 3 summarizes the performance measures of the AI models obtained from the test set.
Table 3 shows the AUC rates for the AI models indicating that the RF model outperforms the
ANN and SVM models. We think RFs ability to handle outliers and prevent overfitting may
play a role in its superior performance on the test set. Additionally, the set of if-then-else
rules created by the RF model may be well-suited for predicting OD survivals. For example, a
30-year-old person who is administrated Naloxone after a heroin OD may have a higher
chance of surviving than a 50-year-old who is not given Naloxone after a fentanyl OD. The RF
algorithm can model such relations with a high degree of accuracy using if-then-elserules,
yielding better results.
Table 3 also summarizes the accuracy, sensitivity and specificity rates of the AI models.
The RF model produces the best accuracy with an accuracy rate of 83.22%, showing that the
RF model inaccurately predicts the outcome of approximately 16 out of 100 OD instances.
Table 3 indicates that the RF model also yields better sensitivity and specificity rates than the
ANN and SVM models. The sensitivity indicates the models ability to identify the ODed
people who survived, while specificity shows how capable the AI model is in determining the
ODed people who did not survive.
5.2 Model explainability
The results described above indicate that the RF model performs the best to predict if an
ODing person will survive, given the input variables. The ANN model is the second-best
model. Thus, these two models are selected to be further explained. The ANN model has a
black-box nature and is not interpretable, and the interpretation of the RF model is limited.
Thus, SHAP is applied to these two AI models as part of the posthoc analysis. SHAP aims to
explore each input variables contribution to the prediction and identifies the critical input
variables that play a role in improving OD survival rates. Particularly, understanding the
relationship between the input and the target variables through SHAP can help government
agencies create policies and design interventions that can increase the survival rates after OD
The SHAP algorithm computes the Shapley values of input variables at the individual
observation level and determines how they contribute to this observations prediction. The
force plots, as provided in Figure 3, are used to demonstrate the Shapley values. The Shapley
value of each input variable is a forcethat either increases or decreases the prediction of a
particular observation. The base value on the force plots shows the average of all the
predictions in the test case. Each Shapley value on the force plot is an arrow displayed in
either blue or red, pushing to decrease or increase the prediction, respectively.
Performance measures RF ANN SVM
Accuracy % 83.22 79.33 76.54
Sensitivity % 82.06 77.95 74.01
Specificity % 87.36 84.25 80.04
AUC % 84.71 81.10 78.57
Table 3.
Performance measures
of AI models on test set
intelligence for
Figure 3 provides four force plots, two for each AI model. Two OD incidents one with a
surviving ODed person and one with a deceased ODed person are randomly selected from
the test set to plot these force plots. It is critical to note that the force plots can be created for
each observation in the test set. Figure 3a suggests that the average predicted value for the
test set (i.e. the base value) is 0.4001, while the predicted target value for this observation is
0.25, indicating a low chance for the ODed person to survive. It is observed from this force
plot that the person ODed on fentanyl, and the response time to this emergency incident was
recorded as unknown. These specific values (i.e. fentanyl and unknown response time)
decreased this ODed persons chances to survive. The ODed person, as shown in Figure 3a,
was administered a dose of Naloxone, which increased his/her chances to survive. Figure 3b
shows that the OD incident was responded to within a minute, and the ODed person was
given two doses of Naloxone, which increased his/her chances to survive. These results
indicate that the rapid response to an OD emergency case and administering Naloxone, when
the drug is heroin or fentanyl, is crucial to increasing survival rates.
Figure 3c suggests that the unknown response time and fentanyl decreased the ODed
persons chance to survive while administering a dose of Naloxone increased his/her chances
to survive. In Figure 3d, rapid response to the incident raised the ODed persons chances to
survive. The labor force and employed variables may be correlated with other input variables
and indirectly impact the ODed persons likelihood to survive. For example, areas with
higher labor force and employment rates may have the resources to respond to emergency
OD incidents faster.
Figure 4 provides a summary plot that combines the importance of variables with effects.
Each point on the plot indicates a Shapley value of a feature for a given observation. The
position on the x-axis is the Shapley value, and the position on the y-axis is determined based
on the SHAP variable importance, which is the average of absolute Shapley values across all
Figure 3.
SHAP force plots
observations. The color represents the value for the input variables. The overlapping points
are stacked vertically; thus, the Shapley valuesoverall distribution for a given input variable
can be observed.
According to the SHAP summary plot in Figure 4a, fast response time to OD instances
drastically reduces the predicted probability of death. Administering Naloxone increases the
chance to survive. Additionally, certain drugs encoded with higher numbers, such as heroin
and fentanyl, are substantially more dangerous, which may cause an ODing person to die.
Low age values reduce the risk of death, while high age values increase the risk of death.
People ODing earlier in the day and responded by police officers have higher chances of
surviving than people ODing later in the day and responded by a third party. This may be
related to two factors: (1) the person may be taking the first dose of the drug earlier in the day,
so the drug is not built up in his/her system, (2) there may be more available resources (e.g.
first responders, vehicles, etc.) earlier in the day so the OD incidents can be responded much
faster, thus reducing the risk of death.
According to the SHAP summary plot in Figure 4b, it is observed that the low response
time to an OD incident increases the risk of death, while high values in the population variable
(e.g. urban areas) decrease the risk of death. In other words, the risk of death after an OD in
urban areas is less than the rural areas. This may be associated with the resources that urban
areas have in the community. High values in employment, labor force, median household
income and low unemployment values increase the survival rate after an OD incident. This
means that people who ODed in areas with high employment and median household income
rates have higher chances of survival. These observations indicate that people have higher
chances to survive after an OD incident in counties with better resources.
Table 4 provides the SHAP variable importance values for each AI model obtained by
averaging the absolute Shapley values across all observations. According to this table,
response time to OD incidents is the most crucial variable that increases survival probability.
This variable is followed by administering Naloxone and its dose. Additionally, ODing on
specific drugs, such as fentanyl and heroin, drastically reduces the survival rates. The age
range variable is also critical in determining if the ODing person survives. According to the
dataset, ODed people between 40 and 60 have a significantly lower chance of surviving than
people younger than 40. The time block of the OD incident affects the probability of survival.
It appears that lower time block values indicating earlier times in a day increase the
survival rates.
Additionally, certain counties, such as Juniata, Warren and Clarion, have much lower
survival rates than the other counties, including Mercer, Alleghany and Philadelphia. All of
these afore-mentioned counties are less populated than the latter, indicating that urban areas
Figure 4.
SHAP summary plot
intelligence for
better cope with OD instances. Variables that identify if a county is an urban or rural area and
are used as a proxy to define its resources positively affect the survival rates. For example,
the variables related to the population employed, number of households, median household
income and number of registered businesses have a direct relationship with survival rates,
which means that increased levels of population, number of households and median
household income improve the survival rates.
6. Discussions
6.1 Summary of key findings
This study examines the OD incidents in the USA, particularly in PA, and develops an
AI-based solution to predict opioid OD survival rates. The proposed AI-based solution
contains three stages. The first stage creates a dataset from various open data sources to
realize the research objective. Thus, results show that properly transforming, cleaning and
normalizing the input data is a must. Processing the input data is the key to the entire process.
Not every input feature in a given dataset will be informative for predicting the output labels.
Including irrelevant features can lead to overfitting, which refers to obtaining superior
performance in the training set and poor performance in the test set. Our study shows how CV
can be used to prevent such a risk.
The second phase trains AI algorithms. Our study develops three useful AI models the
RF, ANN SVM models to predict the survival probabilities of victims after an opioid OD.
This refers to a serious of back-and-forth steps aimed at finding the optimal set of model
parameters that translate the features in the input data into accurate predictions of the labels.
After many evaluations, error identifications, corrections and tests, the model performance
reaches its optimal level, while the model errors touch their minimum. Results show that the
RF model satisfies the best the solution objectives, since it yields high accuracy rates of 84.71.
These results indicate that the model can reliably predict if an ODed victim will survive,
given the input variables.
The third phase utilizes SHAP to make the models more transparent and interpretable.
This phase makes it possible to generate insights into the significant factors affecting OD
survival rates. Moreover, it identifies how the characteristics of the geographic locations in
which opioid OD occurs impact the response to the OD incident and the survival probability,
due to the SHAP ability to show how much each feature contributes to the target variable
prediction. Furthermore, it shows how features can influence the prediction movement
towards the two labels.
Variable RF ANN Average Variable RF ANN Average
Response time 0.249 0.020 0.135 Time 0.012 0.001 0.006
Dose count 0.046 0.000 0.023 Employed 0.002 0.009 0.006
0.043 0.002 0.022 Labor force 0.003 0.006 0.005
Susp OD drug 0.039 0.002 0.021 Number of drug treatment
0.009 0.001 0.005
Third party admin 0.022 0.002 0.012 Race 0.009 0.000 0.005
Age range 0.023 0.001 0.012 Number of registered
0.008 0.001 0.004
Time block 0.019 0.001 0.01 Children under in poverty 0.005 0.001 0.003
County name 0.018 0.001 0.009 Median household income 0.003 0.003 0.003
Dose unit 0.015 0.001 0.008 Number of households 0.005 0.002 0.003
Population 0.003 0.012 0.008 Day 0.006 0.001 0.003
Table 4.
SHAP variable
importance top 20
6.2 Theoretical implications and contributions
Digital transformation capabilities and the availability of data and the rapid development of
ML applications offer an unprecedented opportunity to promote AI solutions. This paper
demonstrates the importance of integrating AI solutions into decision-making processes in
emergency scenarios to help mitigate the high levels of complexity and uncertainty
associated with these situations.
Our proposed AI solution covers different types of factors, contributing to the
advancement of informed emergency management at different phases. The two phases of
emergency mitigation and preparedness are the most complex because they cannot be easily
anticipated (Waugh and Streib, 2006).
However, as shown in the results section, the proposed AI solution can support emergency
mitigation management while making emergency organizations more resilient. Indeed, it can
help decision-makers in identifying potential risks based on geographical and socioeconomic
factors, predict possible impact, assess vulnerability, gain better situation awareness with
more confidence and help decision-makers to develop effective mitigation strategies and
emergency-related policies.
The proposed AI solution can also help in the preparedness phase when it comes to
identifying the upcoming emergencies in real time. Indeed, AI outperforms humans in terms
of data analysis speed and the volume of analyzable data that can be processed. As shown in
the results section, the proposed AI can help in proposing accurate predictions and
suggestions that may be needed by decision-makers to deploy resources and develop
emergency plans in an optimal way. It is a powerful and a cost-effective tool to support
decision-making in emergencies where speed is a matter of life and death.
The two phases of response and recovery are multifaceted processes, involving many
actors. As shown in the results section, the proposed AI solution can help these numerous
actors in quickly sharing the same understanding of the situation and, therefore, supporting
the emergency team in improving the efficiency of its response efforts.
As emergency recovery usually takes a long time, the proposed AI solution can be an
important module in quickly completing the damage assessment and supporting the
recovery in less time. Therefore, emergency organizations need to integrate AI tools with
their existing ICT to improve their performance in emergency recovery.
6.3 Practical implications and contributions
The center for disease control and prevention reports that 67,367 opioid OD deaths occurred
in the USA in 2018. Thus, there is a need for governments to use a solution similar to the one
proposed in this study to identify the primary variables increasing survival rates of OD
incidents. The practical implications of this study are as follows.
The drug type that victims use impacts survival rates. Mainly, fentanyl and heroin
decrease the survival odds, as compared to other drugs, such as marijuana. This result
implicates that policies are needed to eliminate highly addicted drugs from the community.
Additionally, safe sites providing a medically supervised environment in which drug addicts
can use the drug of their choice, particularly heroin, can be considered. The response time is
the most crucial variable, increasing survival rates; thus, safe sites can immediately respond
to the OD incidents. Moreover, these safe sites can provide mental health services and help
addicts reconnect with society. However, there is a risk that safe sites encourage opioid usage
and increase crime rates in their surroundings.
ODed victimsage determines his/her likelihood to survive. People younger than 40 have
higher survival rates than people older than 40. The primary goal should be to prevent OD,
particularly among older adults. Since older adults tend to have more health problems (e.g.
chronic pain), they are more likely to be prescribed opioids, causing them to get addicted.
intelligence for
Governments can develop and manage programs designed for older adults to prevent them
from getting addicted to prescription/opioid drugs.
The time and day of the OD incident impact the survival rates. People who ODed earlier in
the day and during the weekend are more likely to survive. Government agencies managing
the emergency response team should consider the OD rates when allocating resources. For
example, the survival rates during earlier times in a day are much higher. This may indicate
that the resources are being scarce later in the day, delaying the response time.
Counties and regions that are more populated and considered urban have better survival
rates. This may be related to the revenues and resources of the counties. For example, urban
counties have better job opportunities, more business, lower unemployment rates and higher
median household incomes. Thus, these counties may have more tax revenue that can be
utilized to increase their resources (e.g. purchasing equipment and vehicles or hiring
emergency medical technicians and police officers), thus having a better response capability
to OD incidents.
There are some challenges related to the usage of such AI in practice. First, AI typically
requires large amounts of accurate data as input. These data can be available in some regions
of the world or for some communities, but not in other regions or for other communities due to
legal or technical reasons. For example, most of developed countries have documented data
detailed enough and sufficient in size to make AI predictions accurate, which may not be the
case for many developing countries. In some countries, even if data are available, some of
them may be inaccurate. Therefore, we recommend that the implementation of such
application must be accompanied by the establishment of policies and regulations for
appropriate data collection and management.
Second, we suggest that, given the unique environment of emergency management, the
use of AI needs to be more deliberate and careful so that proper attention can be paid to
aligning its usage to human values, such as optimizing the human well-being, and not as a
tool to reduce cost.
6.4 Limitations and future research
This study is not without limitations. One of them is the proposed study is implemented using
one source of data. Future research can apply our proposed AI-based solution to datasets
from different areas, states and countries. This will make the results more generalizable.
Another limitation resides in the fact this study focuses only on the first stage of the EMF
the mitigation phase. Future studies can be conducted to improve the four phases of the EMF.
Additionally, future studies can combine this proposed methodology with optimization
techniques and simulation tools to develop resource allocation models.
7. Conclusion
This study examines how digital transformation particularly open access digital data AI
and ML can be utilized in emergency management. This study focuses on the opioid epidemic,
which impacts hundreds of thousands of people annually and costs trillions of dollars to the
worldwide economy. Using the design science research paradigm, this research integrates AI
with a well-established frameworkEMFto improve it by developing an explainable AI
solution that identifies opioid OD trends and determines the significant factors improving
survival rates. The proposed AI-based solution contains three stages. The first stage creates a
dataset from various open data sources, while the second phase trains three AI algorithms:
RF, ANN and SVM. The third phase utilizes SHAP to make the models more transparent and
generate insights into the significant factors affecting OD survival rates.
Governments and their policymakers can develop new strategies and allocate resources
by using this studys results to fight and control this epidemic, which requires urgent
attention. To this end, the findings discussed above provide a demonstration of how AI can
support informed decision-making in emergency management. Specifically, the explainable
AI-based solution shows an example of how AI can revolutionize the first stage of the EMF
the mitigation phase. In providing government and emergency response agencies with
insights into the survival rates and resource allocation, the explainable AI-based solution also
helps in the second stage of the EMF the preparation phase.
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... Examples of data sources are electronic healthcare records, clinical investigations, administrative data, naloxone administration data from emergency services or law enforcement, accident and emergency attendances, opioid prescription records, sociodemographic information [25], spatial visualizations of the distance to naloxone distribution sites and other harm reduction services [26], and survival rates from an identified opioid overdose [27]. Natural language processing, a form of machine learning which analyses free text and interprets it accurately and meaningfully, can support the robustness of coding of socio-demographic characteristics or risk factors relating to an opioid overdose when applied to healthcare records [28]. ...
... These enhanced data linked resources can then be analysed in several different ways in a variety of settings to provide the necessary community level intelligence to support ROORS delivery. Examples in the literature have included the use of data linked organisational tools to rapidly direct emergency services and community first responders to overdose hotspots and geolocation and time specific forecasts to ensure that communities are adequately resourced at time where there is most need [27]. For example, through spatio-temporal data analysis using geographic information systems, machine learning, and AI, predictive models to identify neighbourhoods more likely to encounter opioid overdoses can be developed, supporting the appropriate redirection of ROORS resources [25]. ...
... Digital phenotyping involves large scale datalinkage from many of the connected devices discussed later in this review such as wearables and smartphones and data discussed above such as medical records and administrative data [32]. By combining these data sources, digital phenotyping may enable a deeper understanding of real-time and real-life physiological changes and the social context of an individual's experience of illness, potentially facilitating person specific interventions [27,32]. ...
Purpose of review: Opioid overdose events are a time sensitive medical emergency, which is often reversible with naloxone administration if detected in time. Many countries are facing rising opioid overdose deaths and have been implementing rapid opioid overdose response Systems (ROORS). We describe how technology is increasingly being used in ROORS design, implementation and delivery. Recent findings: Technology can contribute in significant ways to ROORS design, implementation, and delivery. Artificial intelligence-based modelling and simulations alongside wastewater-based epidemiology can be used to inform policy decisions around naloxone access laws and effective naloxone distribution strategies. Data linkage and machine learning projects can support service delivery organizations to mobilize and distribute community resources in support of ROORS. Digital phenotyping is an advancement in data linkage and machine learning projects, potentially leading to precision overdose responses. At the coalface, opioid overdose detection devices through fixed location or wearable sensors, improved connectivity, smartphone applications and drone-based emergency naloxone delivery all have a role in improving outcomes from opioid overdose. Data driven technologies also have an important role in empowering community responses to opioid overdose. Summary: This review highlights the importance of technology applied to every aspect of ROORS. Key areas of development include the need to protect marginalized groups from algorithmic bias, a better understanding of individual overdose trajectories and new reversal agents and improved drug delivery methods.
... In Table 2, the retrieved scientific contributions and the primary DSR guidelines applied therein are listed with the presumed most fitting outcome designations. Considering the stages of AI evolution, it can be observed that most applications remain on the level of ANI, addressing specific tasks such as classification and prediction [24][25][26][27][28][29][30][31], supporting decision making [32][33][34][35][36][37], or providing conversational agents [38][39][40] (i.e., chatbots). Some practical integrations of AI furthermore utilized different technologies that are expected to play an important role in Society 5.0, such as augmented reality in retailing [41] or the Internet of Things [42]. ...
... A Nudge-Inspired AI-Driven Health Platform for Self-Management of Diabetes [24] Drechsler and Hevner [52] Web application / instantiation Digital transformation to mitigate emergency situations: increasing opioid overdose survival rates through explainable artificial intelligence [35] Hevner et al. [7] Model / instantiation ...
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Every technological or scientific advance is accompanied by a change in social structures, moral concepts, laws and education. As more and more people gain access to the digital world and the technical possibilities increase at the same rate, the excitement to carry out computer-based engineering projects increases. This in turn leads to an elevated demand for appropriate design-oriented methodologies, especially from the field of design science research (DSR), which in a sense democratize digital engineering. The idea of Society 5.0 is one of the major shifts in perspective on the role of technology, humans and their interaction in a shared living world. As a core component, artificial intelligence (AI), together with the Internet of things and big data analytics, is expected to have the most significant impact on the transformation toward smart societies. In this study, a systematic literature review of a total of 137 published articles addressing AI projects using DSR methodologies is conducted with the purpose of establishing a unified methodology for explainable AI-focused DSR projects. The proposed methodology further takes into account the particularities of AI at the varying advanced levels of artificial narrow intelligence (ANI) to the presumed necessities for approaching artificial general intelligence (AGI), which has not yet been fully realized. By allowing AI researchers to rely on a generalized methodological approach, the gap between behavioral science and design science is bridged, with the former laying the foundation for understanding living reality and the latter developing the means to mimic that reality as part of artificiality.KeywordsDesign Science ResearchArtificial IntelligenceBehavior AnalysisSociety 5.0 Research MethodologySystematic Literature Review
... The synergy in views on process risks to DT extend to both discipline's descriptions on the negatives associated with non-sophisticated data management within organisations (Anderson and Ross, 2016; Baiyere et al., 2020;Camposano et al., 2021;Metzler and Muntermann, 2020;Datta and Nwankpa, 2017;Rowland et al., 2022;Zapadhka et al., 2022). Although both disciplines discuss the importance of data as an asset and enabler of DT, particularly with respect to process management, both also outline case studies where the extensive investment in data anlaysis capabilities and disruptive solutions like AI or RPA do not reflect the quality of process enabling outputs expected (Arias-Pérez and Vélez-Jaramillo, 2022a; Eling et al., 2022;Gregory et al., 2018;John et al., 2022;Johnson et al., 2021;Oberländer et al., 2021;Raza et al., 2019). One of the major disctinctions in how data, and by extension process transformation is approached in the literature can be seen in how both disciplines approach the impacts of these disruptive solutions. ...
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Purpose The emergence of digital transformation as a mechanism of enhancing organisational value chains, operating models and ways of working through technology has resulted in a rapid output of research literature in recent years. Although largely a benefit, the sudden uptake in digital transformation research has resulted in a miriad of definitions, views and methodologies being published. These differences can often be seen from discipline to discipline, journal to journal and author to author. Methodology This study compares and contrasts approaches to digital transformation across two disciplines: information systems and management. The study takes a sample of 168 primary studies across both disciplines to compare and contrast how both disicplines approach understanding digital transformaiton. As an initial study, the unit of measurement is digital transformation risk which is a growing area of study for both disicplines within the digital transformation sphere. Findings On the whole, both disciplines identified digital transformation risk across six major domains: Stakeholder, Culture, Organisation, Strategy, Process and Technology. However, both disciplines largely approached these risk domains from different perspectives. For example, information systems studies largely viewed these risks from the perspective of the stakeholder or organisation while management studies generally focused on industry, national or pan-national implications. Implications Although both disciplines approached the same risk domains, the approaches used provide avenues for future research on digital transformation across both disciplines with different definitions, methodologies, views and units of analysis providing opportunities for information systems researchers to augment their research using management techniques and vice versa. The study also identifies a series of risks accompanying digital transformation which should advise practioners on how to identify, monitor and evaluate digital transformation risks as they arise.
... Among these articles, twelve build their research upon existing methodologies while the remaining 23 do not organize their research according to a standard process (see Table 1). [12] x Bohanec, Robnik-Šikonja, & Borštnar (2017a) [43] x x Bohanec, Robnik-Šikonja, & Borštnar (2017b) [44] x x Ming, Qu, & Bertini (2018) [45] x Ventura, Cerquitelli, & Giacalone (2018) [46] x Colace et al. (2019) [47] x Eitle & Buxmann (2019) [48] x Yeganejou, Dick, & Miller (2019) [49] x Alvanpour, Das, Robinson, Nasraoui, & Popa (2020) [50] x Bramhall, Horn, Tieu, & Lohia (2020) [51] x Dolk, Kridel, Dineen, & Castillo (2020) [52] x Harl, Weinzierl, Stierle, & Matzner (2020) [53] x Kim, Srinivasan, & Ram (2020) [54] x Mehdiyev & Fettke (2020) [55] x Yadam, Moharir, & Srivastava (2020) [56] x Zhang, Du, & Zhang (2020) [57] Asmussen, Jørgensen, & Møller (2021) [58] x x Barfar, Padmanabhan, & Hevner (2021) [59] x Garriga, Aarns, Tsigkanos, Tamburri, & Heuvel (2021) [60] x Han et al. (2021) [61] x Herm, Wanner, Seubert, & Janiesch (2021) [62] x Johnson, Albizri, Harfouche, & Tutun (2021) [63] x Liu, Du, Hong, & Fan (2021) [64] x Mehdiyev & Fettke (2021) [65] x Mombini et al. (2021) [66] x Pereira et al. (2021) [67] x Velichety & Ram (2021) [68] x Wang et al. (2021) [69] x Wastensteiner, Michael Weiss, Haag, & Hopf (2021) [70] x Zhou, Wang, Ren, & Chen (2021) [71] x Bodendorf, Xie, Merkl, & Franke (2022) [72] x Johnson, Albizri, Harfouche, & Fosso-Wamba (2022) [73] x Kowalczyk, Röder, Dürr, & Thiesse (2022) [74] x Tao, Zhou, & Hickey (2022) [75] x Yang, Yuan, & Lau (2022) [76] x ...
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Prediction-oriented machine learning is becoming increasingly valuable to organizations, as it may drive applications in crucial business areas. However, decision-makers from companies across various industries are still largely reluctant to employ applications based on modern machine learning algorithms. We ascribe this issue to the widely held view on advanced machine learning algorithms as "black boxes" whose complexity does not allow for uncovering the factors that drive the output of a corresponding system. To contribute to overcome this adoption barrier, we argue that research in information systems should devote more attention to the design of prototypical prediction-oriented machine learning applications (i.e., artifacts) whose predictions can be explained to human decision-makers. However, despite the recent emergence of a variety of tools that facilitate the development of such artifacts, there has so far been little research on their development. We attribute this research gap to the lack of methodological guidance to support the creation of these artifacts. For this reason, we develop a methodology which unifies methodological knowledge from design science research and predictive analytics with state-of-the-art approaches to explainable artificial intelligence. Moreover, we showcase the methodology using the example of price prediction in the sharing economy (i.e., on Airbnb).
... Maroufkhani et al. (2023) explored the factors influencing the acceptance of BDA among small-and medium-sized enterprises. Meanwhile, Johnson et al. (2023) presented a proposal for an AI system aimed at aiding government entities and agencies in responding to medical emergencies. ...
Purpose The purpose of the article is to contribute to the body of research on digital transformation among members of the supply chain operating in an emerging economy. This paper researches the digital transformation trends happening across Vietnamese supply chains, by investigating the current adoption rates, predicted impact levels and financial investments being made in key Industry 4.0 technologies. Design/methodology/approach By using a semi-structured online survey, the experiences of 281 supply chain professionals in Vietnam were captured. Subsequently, statistical techniques examining variances in means, regression analysis and Monte Carlo simulation were applied. Findings The findings of this study offer a comprehensive understanding of Industry 4.0 technology in Vietnam, highlighting the prevalent technologies being prioritized. Big data analytics and the Internet of things are expected to have the most substantial impact on businesses over the next 5–10 years and have received the most financial investment. Conversely, Blockchain is perceived as having less potential for future investment. The study further identifies several technological synergies, such as combining advanced robotics, artificial intelligence and the Internet of things to build effective and flexible factories, that can lead to more comprehensive solutions. It also extends diffusion of innovation theory, encompassing investment and impact considerations. Originality/value This study offers valuable insights into the impact and financial investment in Industry 4.0 technologies by Vietnamese supply chain firms. It provides a theoretical contribution via an extension of the diffusion of innovation theory and contributes toward a better understanding of the current Industry 4.0 landscape in developing economies. The findings have significant implications for future managerial decision-making, on the impact, viability and resourcing needs when undertaking digital transformation.
... Recent pandemics have also worsened the global mental health crisis (Johnson et al., 2021;Lee et al., 2022). Therefore, governments, policymakers, and mental health professionals (like psychiatrists and counselors) require innovative tools to help them in diagnostic decisions made with greater efficiency and accuracy (Thieme et al., 2020;Tutun et al., 2022). ...
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Mental disorders such as depression and suicidal ideation are hazardous, affecting more than 300 million people over the world. However, on social media, mental disorder symptoms can be observed, and automated approaches are increasingly capable of detecting them. The considerable number of social media users and the tremendous quantity of user-generated data on social platforms provide a unique opportunity for researchers to distinguish patterns that correlate with mental status. This research offers a roadmap for analysis, where mental state detection can be based on machine learning techniques. We describe the common approaches for predicting and identifying the disorder using user-generated content. This research is organized according to the data collection, feature extraction, and prediction algorithms. Furthermore, we review several recent studies conducted to explore different features of candidate profiles and their analytical methods. Following, we debate various aspects of the development of experimental auto-detection frameworks for identifying users who suffer from disorders, and we conclude with a discussion of future trends. The introduced methods can help complement screening procedures, identify at-risk people through social media monitoring on a large scale, and make disorders easier to treat in the future.
... Despite the long history of interest in AI, academic research has focused mainly on the technical aspects of the technology (Rokach, 2010), decision-support (Shrestha et al., 2021), explainable AI (Arrieta et al., 2020;Johnson et al., 2021a), ethical AI Enholm et al., 2021;Tutun et al., 2022), and responsible AI (Johnson et al., 2021bLiu et al., 2021;Merhi, 2022). Whereas relatively less research examines how new organizational knowledge may be obtained through AI (Cockburn et al., 2019;Furman & Teodoridis, 2019). ...
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Artificial intelligence (AI) has increased the ability of organizations to accumulate tacit and explicit knowledge to inform management decision-making. Despite the hype and popularity of AI, there is a noticeable scarcity of research focusing on AI's potential role in enriching and augmenting organizational knowledge. This paper develops a recursive theory of knowledge augmentation in organizations (the KAM model) based on a synthesis of extant literature and a four-year revised canonical action research project. The project aimed to design and implement a human-centric AI (called Project) to solve the lack of integration of tacit and explicit knowledge in a scientific research center (SRC). To explore the patterns of knowledge augmentation in organizations, this study extends Nonaka's SECI (socialization, externalization, combination, and internalization) model by incorporating the human-in-the-loop Informed Artificial Intelligence (IAI) approach. The proposed design offers the possibility to integrate experts' intuition and domain knowledge in AI in an explainable way. The findings show that organizational knowledge can be augmented through a recursive process enabled by the design and implementation of human-in-the-loop IAI. The study has important implications for research and practice.
... If well implemented, these cutting-edge technologies can promote socioeconomic and ecological developments (Fosso Wamba et al., 2015) and enhance the quality of life (De-Arteaga et al., 2018) in Asian countries. They have the potential to bring great value to Asian countries in terms of reshaping competitive advantages (Akter et al., 2020), improving how organizations respond to disasters (Ofli et al., 2016;Zhou et al., 2018) and emergency (Johnson et al., 2021a), reducing inequalities (Korinek and Stiglitz, 2019), developing new knowledge (Harfouche et al., 2017), improving human health (Guo and Li, 2018;Johnson et al., 2021b;Stone et al., 2018;Wahl et al., 2018), improving education (McCalla, 2004), increasing participation in smart cities (Viale Pereira et al., 2017), reshaping agriculture (Harfouche et al., 2019) and empowering farmers by increasing their economic intelligence (Saba et al., 2018). It can also enhance microfinance and social entrepreneurship (Popkova and Sergi, 2020). ...
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Artificial intelligence (AI), Internet of Things (IoT)/Internet of Everything, blockchain and Big Data are expected to disrupt public and private sectors in Asian countries. If well implemented, these cutting-edge technologies can promote socioeconomic and ecological developments (Fosso Wamba et al., 2015) and enhance the quality of life (De-Arteaga et al., 2018) in Asian countries. They have the potential to bring great value to Asian countries in terms of reshaping competitive advantages (Akter et al., 2020), improving how organizations respond to disasters (Ofli et al., 2016; Zhou et al., 2018) and emergency (Johnson et al., 2021a), reducing inequalities (Korinek and Stiglitz, 2019), developing new knowledge (Harfouche et al., 2017), improving human health (Guo and Li, 2018; Johnson et al., 2021b; Stone et al., 2018; Wahl et al., 2018), improving education (McCalla, 2004), increasing participation in smart cities (Viale Pereira et al., 2017), reshaping agriculture (Harfouche et al., 2019) and empowering farmers by increasing their economic intelligence (Saba et al., 2018). It can also enhancemicrofinance and social entrepreneurship (Popkova and Sergi, 2020). Along with these potential positive impacts, cutting-edge technologies can inevitably have negative consequences. As these technologies were designed in developed countries, they could have been built intentionally or inadvertently with biases. If they were created with a bias or their training data collected from different countries, they could potentially produce biased results in the context of developing countries. This reality could lead to unintended consequences such as increased discrimination and racism, inequalities, low security, reduced privacy, digital divide and lack of national sovereignty. The special issue tackles the potential impact of cutting-edge technologies in Asia, shedding light on how these technologies are adopted and implemented, and their effects and causes on the strategic, operational and technical levels.
Conference Paper
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Digital transformation has proliferated within the academic and industry zeitgeist as an integral component of organisational survival over the next 5 years. The benefits of digital transformation and the factors that enable it have been widely documented, however, with a recorded failure rate of up to 90%, it is evident that there are several risks underpinning digital transformation that have yet to be identified. Before developing a framework or methodology to enable organisations to identify, manage and evaluate digital transformation risks as they arise, this systematic literature review (SLR) of 51 journal articles within the management sciences domain responds to several recent calls for research to identify the risks that underpin digital transformation. Consequently, the SLR findings have identified five major risks underpinning digital transformation with respect to: Stakeholders, Culture, Organisation & Strategy, Processes and 2 Technology. These in turn encompass several sub-risks which are explored further with respect to how they pose threats to digital transformations. Additionally, the review also explores the impacts of digital transformation on enabling organisations to contribute to the United Nation's (UN's) Sustainable Development Goals (SDGs). The study found that although the revolutionary nature of digital transformation can pose risks to certain SDGs, as a whole, digital transformation can be viewed as an enabler for organisational sustainable development.
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It is estimated that one out of seven health insurance claims is rejected in the US; hospitals across the country lose approximately $262 billion annually due to denied claims. This widespread problem causes huge cash-flow issues and overburdens patients. Thus, preventing claim denials before claims are submitted to insurers improves profitability, accelerates the revenue cycle, and supports patients’ wellbeing. This study utilizes Design Science Research (DSR) paradigm and develops a Responsible Artificial Intelligence (RAI) solution helping hospital administrators identify potentially denied claims. Guided by five principles, this framework utilizes six AI algorithms – classified as white-box and glass-box – and employs cross-validation to tune hyperparameters and determine the best model. The results show that a white-box algorithm (AdaBoost) model yields an AUC rate of 0.83, outperforming all other models. This research’s primary implications are to (1) help providers reduce operational costs and increase the efficiency of insurance claim processes (2) help patients focus on their recovery instead of dealing with appealing claims.
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Explaining complex or seemingly simple machine learning models is an important practical problem. We want to explain individual predictions from such models by learning simple, interpretable explanations. Shapley values is a game theoretic concept that can be used for this purpose. The Shapley value framework has a series of desirable theoretical properties, and can in principle handle any predictive model. Kernel SHAP is a computationally efficient approximation to Shapley values in higher dimensions. Like several other existing methods, this approach assumes that the features are independent. Since Shapley values currently suffer from inclusion of unrealistic data instances when features are correlated, the explanations may be very misleading. This is the case even if a simple linear model is used for predictions. In this paper, we extend the Kernel SHAP method to handle dependent features. We provide several examples of linear and non-linear models with various degrees of feature dependence, where our method gives more accurate approximations to the true Shapley values.
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Health system data incompletely capture the social risk factors for drug overdose. This study aimed to improve the accuracy of a machine-learning algorithm to predict opioid overdose risk by integrating human services and criminal justice data with health claims data to capture the social determinants of overdose risk. This prognostic study included Medicaid beneficiaries (n = 237,259) in Allegheny County, Pennsylvania enrolled between 2015 and 2018, randomly divided into training, testing, and validation samples. We measured 290 potential predictors (239 derived from Medicaid claims data) in 30-day periods, beginning with the first observed Medicaid enrollment date during the study period. Using a gradient boosting machine, we predicted a composite outcome (i.e., fatal or nonfatal opioid overdose constructed using medical examiner and claims data) in the subsequent month. We compared prediction performance between a Medicaid claims only model to one integrating human services and criminal justice data with Medicaid claims (i.e., integrated model) using several metrics (e.g., C-statistic, number needed to evaluate [NNE] to identify one overdose). Beneficiaries were stratified into risk-score decile subgroups. The samples (training = 79,087, testing = 79,086, validation = 79,086) had similar characteristics (age = 38±18 years, female = 56%, white = 48%, having at least one overdose = 1.7% during study period). Using the validation sample, the integrated model slightly improved on the Medicaid claims only model (C-statistic = 0.885; 95%CI = 0.877–0.892 vs. C-statistic = 0.871; 95%CI = 0.863–0.878), with small corresponding improvements in the NNE and positive predictive value. Nine of the top 30 most important predictors in the integrated model were human services and criminal justice variables. Using the integrated model, approximately 70% of individuals with overdoses were members of the top risk decile (overdose rates in the subsequent month = 47/10,000 beneficiaries). Few individuals in the bottom 9 deciles had overdose episodes (0-12/10,000). Machine-learning algorithms integrating claims and social service and criminal justice data modestly improved opioid overdose prediction among Medicaid beneficiaries for a large U.S. county heavily affected by the opioid crisis.
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Artificial Intelligence (AI) is critical for data-driven decision making to increase resource utilization, operational performance, and service quality in various industry domains, particularly in healthcare. Using AI in healthcare operations can significantly improve treatment outcomes and enhance patient satisfaction while reducing costs. In this paper, we propose a multi-stage framework to build an AI-based decision support tool that can predict the 5-year survivability of lung cancer patients. We evaluate the proposed framework using the Surveillance, Epidemiology, and End Results dataset pertaining to the 1973–2015 period obtained from the National Institutes of Health. The first stage entails data preprocessing and target creation. The second stage applies six AI algorithms with feature selection through Particle Swarm Optimization and hyperparameter tuning with Cross-Validation. These Algorithms include Logistic Regression, Decision Trees, Random Forests (RF), Adaptive Boosting (AdaBoost), Artificial Neural Network, and Naïve Bayes. The results show that RF and AdaBoost models yield an AUC rate of 0.94 and outperform the other models. Stage 3 utilizes permutation importance to interpret the RF and AdaBoost models and applies Tree-based Augmented Naïve Bayes to gain insights regarding the interrelations among important features. The results of Stage 3 delineate that the number of lymph nodes containing metastases), the number of tumors that patients have had in their lifetime, the patient’s age, and the microscopic composition of cells rank among the topmost important features and can significantly impact patient survivability. We think this study has significant practical implications in helping physicians predict prognosis and develop treatment plans for lung cancer patients.
In recent years, public health emergencies have occurred frequently, posing a serious threat to the regional economy and the safety of people’s lives and property. In particular, the outbreak of the COVID-19 novel coronavirus this year has caused serious losses to the global economy. On this basis, this article attempts to use modern advanced artificial intelligence technology and modern social science and technology to provide technical assistance and support for the prevention and control of major public health incidents, in order to improve the Chinese government’s public relations capabilities and response to public health emergencies. This article attempts to use 3S technology closely related to artificial intelligence technology to design and establish a public health emergency response system, so as to improve the government’s response and decision-making ability to respond to and deal with public health emergencies, and reduce the occurrence of emergencies. The results showed that among the 298 respondents, 145 believed that public health emergencies depend on human-to-human transmission. Most event information is acceptable, while 169 people who rely on mobile phones for information think that most of them are acceptable, and 89 people who rely on TV media for information think that most of them are acceptable. It shows that the use of artificial intelligence technology can effectively solve and prevent the further development of the situation, and at the same time improve the government’s ability and level to respond to major public health emergencies, and increase the government’s prestige in the eyes of the public.
Disaster response operations typically involve multiple decision-makers, and each decision-maker needs to make its decisions given only incomplete information on the current situation. To account for these characteristics – decision making by multiple decision-makers with partial observations to achieve a shared objective –, we formulate the decision problem as a decentralized-partially observable Markov decision process (dec-POMDP) model. To tackle a well-known difficulty of optimally solving a dec-POMDP model, multi-agent reinforcement learning (MARL) has been used as a solution technique. However, typical MARL algorithms are not always effective to solve dec-POMDP models. Motivated by evidence in single-agent RL cases, we propose a MARL algorithm augmented by pretraining. Specifically, we use behavioral cloning (BC) as a means to pretrain a neural network. We verify the effectiveness of the proposed method by solving a dec-POMDP model for a decentralized selective patient admission problem. Experimental results of three disaster scenarios show that the proposed method is a viable solution approach to solving dec-POMDP problems and that augmenting MARL with BC for its pretraining seems to offer advantages over plain MARL in terms of solution quality and computation time.
Background: The United States (U.S.) is experiencing an ongoing opioid crisis. Economic burden estimates that describe the impact of the crisis are needed when considering federal and state resources devoted to addressing overdoses. In this study, we estimate the societal costs for opioid use disorder and fatal overdose from all opioids in 2017. Methods: We estimated costs of fatal overdose from all opioids and opioid use disorder based on the incidence of overdose deaths and the prevalence of past-year opioid use disorder for 2017. Incidence of fatal opioid overdose was obtained from the National Vital Statistics System; prevalence of past-year opioid use disorder was estimated from the National Survey of Drug Use and Health. Costs were estimated for health care, criminal justice and lost productivity. Costs for the reduced quality of life for opioid use disorder and life lost due to fatal opioid overdose were valued using U.S. Department of Health and Human Services guidelines for valuing reductions in morbidity and mortality. Results: Costs for opioid use disorder and fatal opioid overdose in 2017 were estimated to be $1.02 trillion. The majority of the economic burden is due to reduced quality of life from opioid use disorder and the value of life lost due to fatal opioid overdose. Conclusions: These estimates can assist decision makers in understanding the magnitude of opioid use disorder and fatal overdose. Knowing the magnitude and distribution of the economic burden can inform public policy, clinical practice, research, and prevention and response activities.
Purpose Predictive analytics and artificial intelligence are perceived as significant drivers to improve organizational performance and managerial decision-making. Hiring employees and contract renewals are instances of managerial decision-making problems that can incur high financial costs and long-term impacts on organizational performance. The primary goal of this study is to identify the Major League Baseball (MLB) free agents who are likely to receive a contract. Design/methodology/approach This study used the design science research paradigm and the cognitive analytics management (CAM) theory to develop the research framework. A dataset on MLB's free agents between 2013 and 2017 was collected. A decision support tool was built using artificial neural networks. Findings There are clear links between a player's statistical performance and the decision of the player to sign a new offered contract. “Age,” “Wins above Replacement” and “the team on which a player last played” are the most significant factors in determining if a player signs a new contract. Originality/value This paper applied analytical modeling to personnel decision-making using the design science paradigm and guided by CAM as the kernel theory. The study employed machine learning techniques, producing a model that predicts the probability of free agents signing a new contract. Also, a web-based tool was developed to help decision-makers in baseball front offices so they can determine which available free agents to offer contracts.
: There has been growing investment in artificial intelligence (AI) interventions to combat the opioid-driven overdose epidemic plaguing North America. Although the evidence for the use of technology and AI in medicine is mounting, there are a number of ethical, social, and political implications that need to be considered when designing AI interventions. In this commentary, we describe 2 key areas that will require ethical deliberation in order to ensure that AI is being applied ethically with socially vulnerable populations such as people who use drugs: (1) perpetuation of biases in data and (2) consent. We offer ways forward to guide and provide opportunities for interventionists to develop substance use-related AI technologies that account for the inherent biases embedded within conventional data systems. This includes a discussion of how other data generation techniques (eg, qualitative and community-based approaches) can be integrated within AI intervention development efforts to mitigate the limitations of relying on electronic health record data. Finally, we emphasize the need to involve people who use drugs as stakeholders in all phases of AI intervention development.