Paging Dr. Watson to the Oncology Ward

It wasn't all fun and games for Watson, the IBM super computer that played and won on "Jeopardy." Watson is going to work. One of the first commercial applications of Watson will be its partnership with the health insurance company, Wellpoint, Inc.

Wellpoint currently has two use-cases/pilots in the works with Watson:

Utilization Management (UM) RN Assistant

This pilot will help Wellpoint nurses process treatment requests at a faster rate and with  more efficiency. With the use of Watson Wellpoint nurses can streamline the UM process and support members by providing the best care in accordance with evidence-based guidelines. Wellpoint hopes to reduce administrative costs associated with UM and better manage the health of it's members. The pilot is also designed to teach Watson to provide beneficial clinical information.

Oncology Pilot

The other more exciting pilot involves Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, which is partnering with Wellpoint and IBM-Watson to help shape the first health care solution utilizing Watson's technology. The goal for Watson is to assist physicians in evaluating evidence-based treatment options in a matter of seconds. Watson's ability to respond to inquiries posed in natural language and it's powerful processing speeds, allow for evidence-based, scientific analysis of health care data can be done within minutes and empower the physicians and patients to make the best and most effective treatment plan and improve the quality of patient care.


Here's a snippet from the press on the oncology pilot:

WellPoint Inc., which has 34.2 million members, will integrate Watson's lightning speed and deep health care database into its existing patient information, helping it choose among treatment options and medicines.

"This very much fits into the sweet spot of what we envisioned for the applications of Watson," said Manoj Saxena, general manager of an IBM division looking at how the computer can be marketed.

Lori Beer, an executive vice president at Indianapolis-based WellPoint, agreed.

"It's really a game-changer in health care," she said.

The WellPoint application will combine data from three sources: a patient's chart and electronic records that a doctor or hospital has, the insurance company's history of medicines and treatments, and Watson's huge library of textbooks and medical journals.

IBM says the computer can then sift through it all and answer a question in moments, providing several possible diagnoses or treatments, ranked in order of the computer's confidence, along with the basis for its answer.

"Imagine having the ability within three seconds to look through all of that information, to have it be up to date, scientifically presented to you, and based on that patients' medical needs at the moment you're caring for that patient," said WellPoint's chief medical officer, Dr. Sam Nussbaum.

“Quite Elementary My Dear Waston”

I remember the much talked about 1996 & 1997 Chess championship matches between then reigning champ Garry Kasparov and IBM’s “Deep Blue” super-computer. Kasparov beat Deep Blue in ’96 series only to have his tail handed to him in ’97. What made the difference a year later was pure “brute force”:

It was a massively parallel, RS/6000 SP Thin P2SC-based system with 30 nodes, with each node containing a 120 MHz P2SC microprocessor for a total of 30, enhanced with 480 special purpose VLSI chess chips. Its chess playing program was written in C and ran under the AIX operating system. It was capable of evaluating 200 million positions per second, twice as fast as the 1996 version. In June 1997, Deep Blue was the 259th most powerful supercomputer according to the TOP500 list, achieving 11.38 GFLOPS on the High-Performance LINPACK benchmark.  

My teenage self was impressed.

But looking back, Deep Blue’s achievement seems not so awe-inspiring. After-all there was no real artificial intelligence (AI) at work, and Deep Blue could not do much else than play chess. Chess -- though a complex game--is confined to a 64sq board and fixed rules of play. If we can build a computer fast enough to process all possible lines of play after each move, to figure out the optimal strategy, then such a computer can become nearly unbeatable at chess.

Even IBM admitted as much, and at the end of the day Deep Blue was a publicity stunt more than a real advancement for AI.

Enter Watson. IBM’s latest super-computer, and it's no gimmick. 

IBM’s latest invention is the fastest, smartest super computer on the planet and what really sets Watson apart is its ability to understand natural language. 

IBM put Watson to the test last year by making it compete in a Jeopardy challenge against two of the smartest brains to compete on the game show. Watson took on Ken Jennings, who holds the record for longest winning streak on the show, and Brad Rutter, the biggest all-time money winner.

And Watson won!

IBM chose the Jeopardy challenge to test Watson, since to compete effectively on the show, Watson needed to be fast, be able to understand human conversational language and the nuances associated with it, form a statistical analysis of the correct possible answers after querying it databases, and then make a risk/reward assessment as to whether to buzz in. In the initial test runs Watson’s performance was dismal. It failed to understand subtle differences in language and elementary distinctions easy for the human brain to process. 

But what enabled Watson to improve was its ability to learn from examples as it goes, using a complex statistical algorithm, powerful processors and memory, and vast database of human knowledge. The key proved to be it's ability to learn from it's mistakes and building on patter recognition to process natural language. In other words, Watson learns as it goes. Once Watson is fed the right answer it incorporates that pattern into its databases to make a better analysis and return a better result next time. 

According to IBM,  

“Watson is a workload optimized system designed for complex analytics, made possible by integrating massively parallel POWER7 processors and the IBM DeepQA software to answer Jeopardy! questions in under three seconds. Watson is made up of a cluster of ninety IBM Power 750 servers (plus additional I/O, network and cluster controller nodes in 10 racks) with a total of 2880 POWER7 processor cores and 16 Terabytes of RAM. Each Power 750 server uses a 3.5 GHz POWER7 eight core processor, with four threads per core. The POWER7 processor's massively parallel processing capability is an ideal match for Watson's IBM DeepQA software which is embarrassingly parallel (that is a workload that is easily split up into multiple parallel tasks)."

"Nova on PBS" recently aired an episode on Watson and its trials with Jeopardy. You can watch it here:

Watch Smartest Machine on Earth on PBS. See more from NOVA.

In my future posts I will look at some of the business application of Watson including its use in healthcare.

Thoughts on Mobile vs Native App Debate

In my last (&first) post, I commented on the exciting developments in Mobile Technology that allow health care companies to develop a mobile strategy that can help drive down administrative costs,  and add value to our customers. 

In this post, I’d like to dig a little deeper and discuss a central question that all IT organizations must answer when developing a mobile strategy: What type of app to build – native or mobile?

A google search on the topic will return a wealth of material from supporters and naysayers for both. Here is a collection of polemics from experts. Below I will summarize this debate and offer some thoughts on how to think through a strategy for healthcare companies (and other industries as well).

This Worklight webinar offers an excellent overview of the pros and cons for both native and mobile apps, and “hybrid” models. 

Native Apps

 

Simply put, native apps are those that you typically buy/download from an app store or market-place such as iTunes, Google Play, Windows Phone store, etc. They are built uniquely for a mobile device (iPhone, Droids, Blackberry, etc.) and the app’s functionalities are contingent on the device’s API environment.  A native app built on iOS is not portable/usable in an android phone and vice versa.

Native apps have several advantages:

-apps can utilize other device functionalities such as cameras, geo-location, address book, etc. to offer a more enhanced, immersive user experience.

-apps can be run offline, not requiring a wifi connection. Content data can be cached and re-used.

-apps get a lot more market exposure being part of the app store; will show up in search results and can gain traction from user ratings. This also allows the developers to get instant feedback and improve their apps based on user needs.

-apps can include revenue generating advertising. 

There are also several disadvantages:

-they’re costly to develop and deploy, requiring a diverse mobile architecture.

-they require resources trained in the various platforms.   

-they require approval from third party store owners before deployment, and involve a vendor fee.

Mobile Apps

 

Mobile apps are those that require a browser app-shell to run on. They’re designed using web languages (java script, html5) and can be run on any device using any browser (Safari, Dolphin, Opera, etc.). Mobile apps are accessed through a URL or hyperlink.

The disadvantages we saw with native apps are all advantages for mobile apps:

-they’re not dependent on the device, and therefore only require a single development team.

-they can be updated and modified faster, cheaper, without relying on third-party, store approval.

On the flip-side, mobile apps cannot provide the same level of functionality and user experience as native apps. They are typically only accessed by those already familiar with your site by typing the URL or clicking on the hyper-link to get there. They are also dependent on a wifi connection to execute.

Given these benefits and downsides to both native and mobile apps, what direction should health care organizations choose?

Mobile Strategy

I don’t have a specific answer (and will be shot if I revealed the thinking within my company :)) but I believe the answer must start with (1) an understanding of who is in our customer base and what they want. (2) We must also look ahead and understand how our business and technology will evolve in the future. (3) What the return-on-investment (ROI) from each will be.

Market research of mobile users, and customer segmentation specific to the industry will provide the data we need to understand how our customers prefer to relate to our business. Currently, several studies show a dead heat between mobile app vs native app users. I have reviewed several case studies (not available online) that show customers are split in terms of their preference. There’s a clear advantage when it comes to the number of native app offerings (400,000+ according to one study) as opposed to mobile apps (48,000+ or 10% of native apps). But this number is misleading as several native apps are quickly designed games and catalogs pushed to the market, as opposed to more robust applications.

Secondly, as we look ahead to the future, both the demographic shifts and the individual mandate coming into effect, we can expect an influx of younger customers entering the health care market. Younger people tend to prefer native apps but consumers generally prefer to shop using a web browser (mobile sites and apps). As browsers and web languages develop further (like html 5) some of the functionalities of native apps can now be incorporated into mobile apps (such as geo-location, connecting to google contacts, etc.). 

The third determination, ROI, is the toughest to measure, given the relative newness of this technology. A survey of use-cases I have seen makes a strong case for both, with a slight edge to mobile apps, given their low cost of development. However, the higher visibility of Native Apps help generate more revenue over-time, even if immediate ROI is smaller.

In the final analysis I believe what’s important in choosing the right strategy is flexibility. An initial go with mobile apps might be cost effective and provide an easy transition for customers already familiar with our web portals. But as we move into the world of health-exchanges and individual buyers, native apps can attract new business and provide cost-effective services in a much better way than mobile apps. But as mobile app/browser technology evolves and hybrid apps become more common, an adjustment in strategy might again be necessary.

Lie Luo of Global Intelligence Alliance, based on an extensive study of trends concludes:

So far we have been mainly discussing the choice between native and Web apps for mobile devices. It is important to recognize that we are increasingly moving toward a ‘multi-screen’ world, where brands will want to engage their users across a variety of media touch points. In that light the same debate will carry on to tablet devices and now Web-connected TVs, thanks to the expansion of Android and iOS platforms.
Personally I believe Web apps will take on a larger mind share among both publishers and consumers, as hardware complexity grows and the desire for immediacy increasingly dominates modern media consumption behavior.

Mobile Health Wallet

A week ago I arrived at an MRI appointment just on time, fighting rush hour traffic, only to realize I didn't bring my new insurance card. At least I remembered to bring my wallet. I'm notorious for misplacing it, and once even considered (after watching too many infomercials) to buy a wireless wallet locator.

Well, such devices seem silly now, when one considers the recent trend to forgo the physical wallet altogether for an e-Wallet. Health management organizations have recently jumped on this trend to produce Mobile Health Wallets that carry more than just your digitized insurance cards.

Earlier this year UnitedHealthCare announced the launch of a native app, "Health4me" available through iTunes & Android app stores. The app allows its members to "store their health plan identification card, find the closest hospital or clinic, get information on claims and benefits and keep track of deductible spending."

That's not all:

"Among the technologies that will enhance UnitedHealthcare members' ability to monitor their health is the CareSpeak Communications' medication and disease management application that enables patients to manage their care using two-way text messaging on their mobile phones. The CareSpeak system allows patients to report their medication intakes and biometric data such as blood glucose levels, blood pressure, and weight to their care providers. Patients also receive educational and motivational messages, as well as incentives and rewards for meeting their health goals. 

For those who want to lose weight, Lose It!, created by FitNow, is a mobile app that runs on iPhones or Android devices. The app can improve consumer's ability to track their progress, offering peer support, and providing important caloric and nutritional information on what they eat." 

I agree with Bud Flagstad, Vice President of strategic initiatives at United Health Group, that "[i]n the face of high cost health plans and consumers having to pay more [for the cost of healthcare], these kinds of technology tools have started to become very important." 

A transition from physical ID cards to mobile ID cards alone would save millions of dollars in costs associated  with card activation, print, mail&distribution. Already, Explanation-of-Benefit (EOB) statements are accessible as a pdf document through consumer portals from most major insurers. Even so, pushing the statement to your mobile app would drastically cut down costs associated with portal maintenance and service--and is obviously more cost beneficial (and Eco-friendly) than paper statements. We can also easily add a click-to-chat function to allow for clarification or questions on your EOB with a claims representative. 

Mobile apps that assist consumers to make better health-style choices, such as, helping them develop a customized diet and exercise plan, will contribute to preventative care, saving costs in the long run. If electronic transfer of biometric data becomes refined, many routine checkups, tests, and follow up care can be done from the comfort of ones home and minimize the need for a hospital visit, and save on the associated claim and billing costs.

This trend is not unique to the States. Here are interesting articles on the use of mobile technology in the African context and it's life saving potential. Mobile technology offers the potential to be a great equalizer in the delivery of quality care.

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Welcome to the Technology Innovation & HealthCare Blog

Welcome to Naveen Jaganathan's blog on Technology Innovation & Health Care!

My vision for this blog is to catalog and comment on the latest trends in technology innovation as it relates to health care management and delivery. As we enter a world of gadget-wizadry from mobile phones to tablet computing, voice/facial recognition to biometrics, cloud computing to quantum processors, health care organizations can now leverage disruptive technology to deliver solutions that can revolutionize the management & delivery of health care. Topics I'd like to explore includes: mobile apps, cloud strategy, big data strategy, claim processing, privacy & security, to name a few. I believe disruptive technology can play a role in addressing the dual crises affecting our health care system: growing number of people who lack coverage and access to quality health care, and the rising cost of health administration. Imagine a mobile app that would allow you to video conference with your physician(s) on demand (already exists), or attend a session with your physical therapist using Kinect? Imagine the cost savings and increased access to healthcare such innovations would bring!

I hope you find my posts interesting, and I welcome your feedback.