Will Doctors and Hospitals Accept Help From Watson? For Many The Answer Is No.

Posted on | August 15, 2011 | 1 Comment

Mike Magee
I’ve said many times that the American Health Care System is “intentionally dis-integrated”. By this I mean that the powers that be – doctors and their organizations, hospitals and hospital systems, pharmaceutical and medical device companies, insurers and others – will do almost anything to avoid national rationalization of health care and the market power consolidation that they believe would come with it.

Consolidation of market power for most providers and suppliers of health care devolves with certainty into price compression. More than this, many believe it leads immediately to loss of decision autonomy, restrictions on care, rationing, and a cost-centric versus patient-centric system. And these fears are legitimate.

And yet…and yet…rationalization of health care is inevitable, and should be led by those with the greatest knowledge and experience in care delivery – doctors, nurses, and other health professionals.

Case in point: Watson – the IBM supercomputer that toppled Jeopardy legends Ken Jennings and Brad Rutter in 2009. (1)  Named for IBM’s first president, Thomas J. Watson, Sr., the computer was built in the shadow of the Mayo Clinic in Rochester, MN at a cost, by some estimates of 2 billion dollars. It has the ability to synthesize 100 million pages of data a second. (2,3,4)

According to computer experts, “Performing well on Jeopardy and diagnosing sick patients have similar prerequisites: a broad fund of knowledge, ability to process subtlety and ambiguity in natural language, efficient time management, and probabilistic assessment of different possibilities. Like Jeopardy clues, a patient’s symptoms, medical history, physical exam findings and laboratory results present clues that must be synthesized into a differential diagnosis.”

But….“While computer systems to assist clinical decision-making have existed for decades, adoption of legacy systems has been hindered by rigid algorithms that require translation of natural language into machine language and heavy reliance on user input.” (2,3)

Martin Kohn, MD, IBM’s chief medical scientist at its Watson Research Center in Hawthorne, N.Y. believes that obstacle has been surmounted because Watson is “a natural language processor”. That is to say, “it can take questions spoken in plain English, break them into three or four parts and quickly correlate them with information in a databank. Watson can also ask questions to add to its storehouse of information, and can give answers that are tagged with ratings representing Watson’s “confidence level” in a particular answer.” (3)

In so doing, “Watson combines what has long been a strength of computers, perfect prompted recall from an expansive volume of knowledge, with what has been considered to be the sole province of man, ability to process natural language.” (2,3) So where’s the rub. Why wouldn’t you, as a health professional, accept a little help from your friend?

That’s the question IBM has been probing with health professional leaders for over a year. Recently, in Minneapolis, opinions were mixed. On the positive side: HIT expert Dr. Gary Oftedahl, chief knowledge officer for the Institute for Clinical Systems Improvement, “If a doctor reads medical journals for two hours every night, in one month he or she is 40 years behind due to the sheer volume of new information.” From HealthPartners Chief Information Officer Alan Abramson, “I’m sitting here with this huge data management problem, and Watson reads fast.” From Nicholas LaRusso,MD, director of the Mayo Clinic’s Center for Innovation in Rochester,
“We’ll be 80,000 doctors short in the U.S. by 2020. Are there situations where Watson could answer questions directly to patients? I don’t know.” (2)

For now, Mayo Clinic is not a partner in Watson’s medical education. For Watson to be truely effective, it will need full access to patient records which means dealing with privacy issues. Most agree that could be managed.  Others fear handing over to a computer the power to define “evidence”.  Jeff Schiff MD, medical director of health care programs for the Minnesota Department of Human Services, says  “Doctors do not want another tool that judges their performance…not all medical evidence is equal. How can Watson understand the nuances of what makes a good medical study?” (3)

Others feel any “system” will be gamed. Hospitals and doctors fear that choice and payment will be restricted. Employer advocates, like Carolyn Pare, CEO of Buyers Health Care Action Group of Bloomington, say the shoe will be on the other foot. “Using Watson to preauthorize care or treatment would be an incredible mistake because it doesn’t involve the patient. Doctors will then just recommend the procedure that has the most insurance coverage. And what insurance will pay for and what’s good for the patient are not always the same.”(3)

And the beat goes on. Yet the capacity to resist the growth and utility of technology as it intersects with health costs, inefficiency and growing consumer demands is dwindling fast for “status-quoers”. Harvard’s Jerome Groopman MD has pointed out that information overload leads to shortcuts that lead to mistakes. What kind of mistakes? “Fixation on one diagnosis, settling on a diagnosis that is familiar and quickly comes to mind, and failure to come up with alternative diagnoses and incorrectly attributing symptoms to one cause”. (4,5)

And along comes Watson – superior memory, parallel processing, examines all medical evidence available in natural language, no cognitive shortcuts, and minimal bias.(4)

Make friends with Watson, I say, before others give birth to an evil cousin.

For Health Commentary, I’m Mike Magee.

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