Watson and Healthcare - What's All the Buzz

Fresh from an exciting and busy week at HIMSS in Orlando that was topped off with a personal highlight - witnessing the space shuttle launch from a Passenger Jet



















and the video:


There continues to be tremendous interest and excitement surrounding the potential for IBM's Jeopardy champion (Watson) to enhance medicine and ignite discussion on artificial intelligence in healthcare. This piece in the Boston Globe: The plan behind Watson: winning hearts captures the excitement and buzz we all felt at HIMSS last week that not only made Waston a household name it also garnered a huge audience with a big ratings swell. As Richard Mack put it:

“Watson has sparked the imaginations of those not just in the technology industry, but for an array of industries around the globe"

Indeed this thought provoking piece from Diagnostic Imaging: Will Watson Replace Radiologists? The question being what will the impact be in healthcare and specifically in radiology where radiologists review numerous images and base our findings on our experience and expertise, which are in turn based on reading articles and textbooks (our knowledge base) and as the author asks:

If we program all of these knowledge bases into a computer, then wouldn’t the computer be as good or likely even better than we are?

Interesting idea but I think this concept is more likely to follow form some of the automated image processing tools that are emerging, for example from Median Technologies and their LMS-Lung application:

that automates the detection, evaluation and follow-up of lesions identified in CT images. (this technology interestingly came out of missile tracking systems). Perhaps given identification of lesions and findings in images this could then be coordinated with existing reports using some component of Watson to link image findings with clinical conditions and provide some level of machine intelligence to support radiologists

But I think Dr Krishnaraj is right:

the personal relationship between a doctor and his patient can never be replaced. It is important, for example, to diagnose cancer, but how is that information communicated? I do not believe a computer will ever be able to demonstrate compassion or rest a hand of comforting support on the shoulder of a patient that is hurting

Watson is exciting technology but it does not replace the clinicians or the clinician patient interaction. Techcrunch reported on some of the back lash and lack of understanding in this piece: The Next Stop for IBM's Watson: Healthcare?. Watson does not replace human intelligence. In fact the opposite is true it supplements human intelligence providing ready access to the large amount of information available today much as we access this information in our daily lives. For example, imagine you are shopping for fruit and come across Papaya in the supermarket, you have heard its good but have no idea how to select a good papaya so you turn to your smartphone and speak or enter "How to tell a ripe papaya" (which returns 17,400 results including pictures, videos and how tos). You apply that knowledge and select a good papaya based on new information and understanding. Watson extends this capability by helping understand the underlying meaning of the terms and linking the right information together to present a closer match to possible answers. In healthcare we are overwhelmed with new information presented in the form of randomized controlled trials, publications and research papers. A quick look at one resource (The Cochrane Collaboration)

that is working to provide the best evidence for healthcare and the ~4,000 published Cochrane Reviews,  the Cochrane Library and the updated list of treatment guidance and review of protocols and you get a sense of the mass of data that clinicians need to read, digest, process and then apply in clinical practice. Dr Watson brings processing power to the clinical coal face to improve diagnostic accuracy, efficiency and patient safety but not to replace clinicians. Or as Dr Krishnaraj put it the

"personal relationship between a doctor and his patient can never be replaced"

Dr Watson Takes on Healthcare

Watson Emerges Champion in Jeopardy

Watson emerged the Jeopardy Champion last night with a resounding $ 77,147, beating both competitors (Ken Jennings:$ 24,000 and Brad Rutter:$21,600) by over 300% ($53,147/$55,547).

Hats off to Ken Jennings and Brad Rutter for taking on the challenge and doing such a great job

This was followed today with the joint Nuance/IBM Press Release: "IBM to Collaborate with Nuance to Apply IBM’s Watson Analytics Technology to Healthcare" (here on IBM and Nuance's site) that recognizes the tremendous value that Watson can bring to healthcare. Watson showed last night the major advances that have been made by IBM's “Deep Question Answering” (QA) research team:

the ability of a computer to understand natural human speech inquiries that pertain to a limitless range of topics, and to make informed judgments about requests

There was plenty of coverage as evidenced by the 15 Million hits in Google for the search (Jeopardy/Watson) with the vast majority highlighting Watson's superiority (Time Magazine: Winner, Dr Watson I presume, ZDNet: Watson's Next Adventure - Healthcare with Nuance, Information Week: IBM Nuance Envision Watson Helping Doctors, NY Times: Computer Wins on Jeopardy, Trivial It's Not andIBM Moving Watson Supercomputer Beyond 'Jeopardy' To Health-Care. Stephen Wolfram of Wolfram Alpha weighed in with this thoughtful post (Jeopardy IBM and Wolfram Alpha) comparing Watson and Wolfram Alpha and this more light hearted post If Google Played Jeopardy: Smartest Search Engine, But It’s No Ken Jennings where he challenged search engines with the simplified task of entering the same Jeopardy Clues

Google showed well

Leading them to suggest that

Either he’s (Ken Jennings) an immediate acquisition candidate in Mountain View and Redmond, or he should just start his own search engine and answer queries as they come in

There were other dissenters including this post Could Google Play Jeopardy Like IBM's Watson. Google has certainly cornered search and access of data but even if the data can be found with a google search and there are certainly some shared concepts in the search technologies I'm not sure that finding the data in a search page is the same as answering the question and really understanding the question. But the summary and analysis of Natural Langauge:

Natural Language Reality Check: The reality is that the technology that Watson demonstrates, while amazing in a game show, is overkill for what most people need. Those behind “natural language” search technologies have long trotted out sentences like the “Who’s in the pajamas” example above to demonstrate how “smart” their search tools are. And yet, most searches people do on search engines are only two or three words long.

Missed the mark and the analogy is flawed on several counts.  I would suggest that our interactions are deliberately simplified when we interact with Google - we work around the lack of understanding of the Google search engine. And while Watson may be overkill for "most people" the potential application in multiple areas dealing with ever increasing volumes of unstructured data it is healthcare that has been struggling with the challenge of overwhelming clinical knowledge and our inability to access and apply this at the time of care delivery. In this discussion on the possible healthcare applications of Wtason/DeepQA


Dr Herbert Chase (Professor of Clinical of Medicine at Columbia University) says:

For at least 30 years it has been impossible for a physician to master all the material to practice medicine at the highest level. Biomedical literature has doubled in size every seven years but patients want those facts at the doctors finger tips when they see him (the doctor)

It is this challenge of data that clinicians face every day as they attempt to deliver the best possible care to each and every patient at the time of the consultation and something their patients expect. Definitely not overkill for patients or doctors and given the Tsunami of medical knowledge and the challenge of sharing clinical data. DeepQA will add a new level of medical intelligence to support to clinicians is with the application of Natural Language Processing taken to a new level of understanding.

Back in June I talked about this technology and the potential for application in healthcare (NLP in Healthcare). In October Nuance announced our strategic partnership with IBM and I covered the news in this post: Clinical Documentation Challenges and then again building towards the Jeopardy challenge NLP in Healthcare Part 2 and most recently this week as part of the potential solution to the challenge of shareable clinical data and clinical data models (The PCAST Opportunity, HL7 CDA, UEL and SAGE)

The announcement today builds on a deep research and technology partnership that already exists in multiple areas between the companies. As one person pointed out in a note to me yesterday

"I cannot understand that Watson cannot 'hear' an opponents wrong answer. They text in the question and then Watson parses the english, algorithms swirl, etc. However, when an opponent speaks it cannot hear. So when a bad answer is spoken it is bound to repeat it.. "

That is part of the innovation and solutions that Nuance will contribute to the partnership which will also include the Clinical Language Understanding (CLU) Technology that will be used create new solutions that provide hospitals, physicians and caregivers access to critical and timely information expanding from recognizing what was said and parsing data to now understanding the intent and providing guidance. This will push us one step closer to intelligent medical analysis real time with the clinician to assist hospitals to utilize facts and knowledge as they migrate toward evidence-based and accountable care models:

Recognizing the tremendous value that Watson can bring to healthcare, Nuance and IBM have teamed to co-develop solutions that will transform vast amounts of clinical data into actionable information across the continuum of care. This endeavor is intended to unlock important medical knowledge and facts buried within huge volumes of data repositories, providing healthcare provider organizations, payers and individual physicians a new level of medical intelligence

It has been yet another exciting day in the world of healthcare technology

If you want to see the Jeopardy games you can watch them below
Part 1:

Part 2:

and Part 3:



And it is not just healthcare:

NLP in Healthcare Part 2

Following up from my post back in June (NLP in Health care) the Jeopardy challenge is on - coming to your TV February 14 - 16. There was lots of coverage of the announcement
This from the Washington Post - "'Jeopardy!' to pit humans against IBM machine" and the IBM release
Ken Jennings and Brad Rutter two of the leading Jeopardy winners will go up against Watson. Jennings had the game show's longest winning streak at 74 games in a row and Rutter has won the most money standing at $3.3 million.

What is Watson



But what's important is the possible future applications:

IBM is hoping the technology it exhibits will have some practical uses eventually, for instance helping doctors diagnose illnesses or solving customer problems at technical support centers.

Applying this in healthcare is part of the partnership announced back in October and featured in the posting  "Clinical Documentation Challenges". It will be exciting to see the performance of Watson in Jeopardy on live TV but its the application of this in healthcare that will present some revolutionary opportunities...watch this space