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Q&A with Big Blue:

HMT asked IBM Research medical scientist Dr. Josko Silobrcic, M.D., the following questions about Watson in healthcare:

Q: One of the ways Watson technology will be utilized in healthcare is in clinical decision support for diagnosing and treating clinical conditions. Can you describe in detail how that process might take place? A: Step 1 – Question Analysis: As in all its applications,

the Watson-enabled system will parse and analyze the question’s structured and unstructured (textual) data, to determine what type of inquiry is being pursued and what precisely it is looking for. In the clinical context, the “question” is represented by all the information that is known about the patient – ideally, comprehensively obtained from various electronic sources. Step 2 – Hypothesis Generation: The Watson-enabled solution will look through vast and diverse medical sources that allow it to build a comprehensive list of possible answers.

Step 3 – Hypothesis and Evidence Scoring: The solution will find relevant passages from a vast number and array of medical evidence sources and use hundreds of complex algorithms to, in parallel, score the candidate answers in terms of their degree of probability. Step 4 – Final Merging and Ranking: The Watson- enabled solution will use the training/learning experience it gains and refi nes over time to appropriately select, weigh and combine the algorithms that it has determined work best for this question. Step 5 – Results Review and Refi nement: As output, the clinician will see a list of suggested diagnoses and/or treatments, displayed with their likelihood/confi dence – refl ecting the combined strength of available evidence that supports them. The solution will be able to suggest obtaining additional information that may increase the likelihood/confi dence of diagnoses. When this missing information is provided (i.e., when it becomes available in the patient’s electronic records automatically, or is simply entered by the user), the system will cycle back through its process steps and return a more-confi dent set of diagnostic or therapeutic suggestions.

Q: Watson’s ability to understand nuance (no pun intended) was often touted on “Jeopardy!” Will that ability help with parsing the physician notes to reach a diagnosis of condition and lay out treatment plan options? A: It will. The Watson system’s use of sophisticated natural language processing (NLP) will be leveraged in both handling and interpreting textual data inputs, such

as physician notes, and in specifically matching

y patient information

with the most pertinent reference sources, such as medical journals, treatment guidelines and the like. The system’s ability to detect and interpret the subtle differences and meaning in any text associated with the patient may make the difference in whether it can identify the most personalized evidence for that patient or not. Sophisticated textual analysis may “understand” that “cut down from two to one pack a day” in a patient’s notes means the patient is currently a smoker (which may impact both the diagnostic and treatment decisions for that person), even if this fact is not explicitly recorded anywhere else in the patient’s records. Therefore, it will be able to discover and interpret even the most complex and nuanced data and evidence.

Q: As a physician, what do you think will be the challenges of accommodating the Watson system in the physician workfl ow? A: Watson-enabled solutions will never make patient-

care decisions, but only inform them. Thus, one of the key initial challenges actually lies in properly managing expectations about the technology itself, as well as its potential impact on the workfl ow. In considering workfl ow integration requirements, it is very possible that a physician and her/his patient may be reviewing some suggestions provided by a Watson-enabled solution together, and/or even jointly providing some additional information to the system. Moreover, different activities in using a Watson-enabled solution may be shared with other members of the care team, and may thus also be distributed over and integrated into their workfl ows.

Q: Can you describe some other areas of healthcare IT where the Watson technology could prove useful? A: While IT in clinical diagnosis and treatment immediately come to mind for many, the array of healthcare areas where the Watson technology could provide important value is almost boundless. You can simply start by thinking of all the circumstances where important healthcare-relevant information may currently be “locked” in vast amounts of continuously expanding and evolving textual data. Or, you can think of any situation in healthcare where someone needs to access and interpret large and diverse quantities of textual and other information/evidence. Finally, Watson technology could be used by everyone from patients to various clinicians, healthcare researchers and biomedical scientists.


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Photo courtesy IBM

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