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Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Substantial interest and investment in clinical artificial intelligence (AI) research has not resulted in widespread translation to deployed AI solutions. Current attention has focused on bias and explainability in AI algorithm development, external validity and model generalisability, and lack of equity and representation in existing data. While of great importance, these considerations also reflect a model-centric approach seen in published clinical AI research, which focuses on optimising architecture and performance of an AI model on best available datasets. However, even robustly built models using state-of-the-art algorithms may fail once tested in realistic environments due to unpredictability of real-world conditions, out-of-dataset scenarios, characteristics of deployment infrastructure, and lack of added value to clinical workflows relative to cost and potential clinical risks. In this perspective, we define a vertically integrated approach to AI development that incorporates early, cross-disciplinary, consideration of impact evaluation, data lifecycles, and AI production, and explore its implementation in two contrasting AI development pipelines: a scalable \u201cAI factory\u201d (<jats:italic>Mayo Clinic, Rochester, United States<\/jats:italic>), and an end-to-end cervical cancer screening platform for resource poor settings (<jats:italic>Paps AI, Mbarara, Uganda<\/jats:italic>). We provide practical recommendations for implementers, and discuss future challenges and novel approaches (including a decentralised federated architecture being developed in the NHS (<jats:italic>AI4VBH, London, UK<\/jats:italic>)). Growth in global clinical AI research continues unabated, and introduction of vertically integrated teams and development practices can increase the translational potential of future clinical AI projects.<\/jats:p>","DOI":"10.1038\/s41746-022-00690-x","type":"journal-article","created":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T03:30:33Z","timestamp":1663212633000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Moving towards vertically integrated artificial intelligence development"],"prefix":"10.1038","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6040-2122","authenticated-orcid":false,"given":"Joe","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5377-6142","authenticated-orcid":false,"given":"Sanjay","family":"Budhdeo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0202-1230","authenticated-orcid":false,"given":"Wasswa","family":"William","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Cerrato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6975-5960","authenticated-orcid":false,"given":"Haris","family":"Shuaib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet","family":"Sood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1668-0672","authenticated-orcid":false,"given":"Hutan","family":"Ashrafian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2305-6755","authenticated-orcid":false,"given":"John","family":"Halamka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6899-8319","authenticated-orcid":false,"given":"James T.","family":"Teo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,9,15]]},"reference":[{"key":"690_CR1","doi-asserted-by":"publisher","first-page":"e212","DOI":"10.1016\/S2589-7500(22)00032-2","volume":"4","author":"J Zhang","year":"2022","unstructured":"Zhang, J. et al. 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Towards MLOps: A Framework and Maturity Model. in 2021 47th Euromicro Conference on Software Engineering and Advanced Applications (SEAA) 1\u20138 (IEEE, 2021). https:\/\/doi.org\/10.1109\/SEAA53835.2021.00050.","DOI":"10.1109\/SEAA53835.2021.00050"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-022-00690-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-022-00690-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-022-00690-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,19]],"date-time":"2023-02-19T04:32:56Z","timestamp":1676781176000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-022-00690-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,15]]},"references-count":68,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["690"],"URL":"https:\/\/doi.org\/10.1038\/s41746-022-00690-x","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,15]]},"assertion":[{"value":"10 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 August 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"H.A. declares no Competing non-financial interests, but the following Competing financial interests. H.A. is employed as Chief Scientific Officer, Preemptive Medicine and Health Security, Flagship Pioneering. All other authors declare that they have no non-financial or financial Competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"143"}}