“Nothing endures but change,” said a Greek philosopher, and healthcare is changing rapidly in so many ways as we better utilize technology.
The next major frontier may well be the manner in which patients share information with their physicians, physician assistants, and nurse practitioners.
Picture yourself as a patient sharing the details of a recent illness with a computer, which listens patiently and responds in perfect English (or whatever language you are most comfortable with) by asking pertinent questions. As you give your history, the computer weighs the odds of possible diagnoses along with appropriate therapies.
This scenario used to sound like science fiction, but is now being developed by IBM’s Watson computer. Watson made a huge public splash recently when it—I don’t know whether to say “it” or “he” or “she”—impressively played Jeopardy! against the best human players in the game show’s history. Watson was not connected to the Internet but was able to understand English, deal with most of the nuances of our language, quickly search through enormous databases, and answer in the appropriate manner.
The real utility of Watson is not its ability to win at TV game shows, but rather the fact that Watson can change the way we practice medicine. Here’s why:
• Watson possesses strong communication skills;
• It combines that with the ability to search immense databases almost instantly;
• And then logically comes up with correct solutions to problems.
Imagine patient Jones or physician Smith speaking with Watson about a clinical situation.
All the already-digitized forms of information about Ms. Jones—such as laboratory results, vital signs and past medical history—would be readily available and easily inputted.
Dr. Smith or a mid-level provider could add the results of a current physical exam, and Watson would begin to calculate the probabilities of having a specific disease.
Cornerstone of Care
Watson would have the luxury in this situation of asking additional questions, suggesting other tests be completed, perhaps recommending a therapeutic trail, or just observing. The physician would remain the cornerstone of care. But now he would have a powerful ally.
Today, a physician does exactly what Watson will be doing. But the physician depends on his/her memory and knowledge base which is a small fraction of what Watson utilizes. And once Watson is functional for one patient, the cost of diagnosing and caring for additional patients is minimal.
Dr. Herbert Chase at the College of Physicians and Surgeons of Columbia University (my alma mater) has welcomed Watson to campus. Winning Jeopardy! is entertaining, but changing medicine is serious business. As the complexity of healthcare has grown along with the costs which need to be managed, Watson—or son of Watson—may be the solution.
Think back to other revolutionary solutions such as the invention of gunpowder, Gutenberg’s printing press, the airplane, the Internet, and how each one changed civilization. We are now in the middle of a healthcare computer revolution which will have a more profound effect on healthcare reform than the current acrimonious national debate about “Accountable Care.”
Computer technology and the Internet have changed the way so many things function. Consider just a few venues:
• Political revolutions: Egypt’s dramatic change was fueled by Facebook and Twitter.
• Dating: Online matchmaking spawned one in eight marriages last year.
• Higher education: The University of Phoenix, online, has by far the largest number of MBA students in the country.
• Financial services: Instant updates and rapid communication with ubiquitous email.
And then we come to healthcare.
• There are many disease-centered websites where patients can log in as themselves (or anonymously with a pseudonym) to share experiences, provide support, keep up on the latest treatments, and most importantly, be active participants in their care.
• The old paternalistic model of care where “Father Knows Best” has been turned upside down as patients aggregate knowledge on sites such as “Patients Like Me”— http://www.patientslikeme.com/ —where you can search for patients with the same disease or symptom complex, get answers to questions, and help others.
Watson could help a patient in the privacy of his or her own home, changing that person from a passive to an active participant. That’s a game changer. Think about the disparity of care for those who are insured vs. those who are uninsured and impoverished. Once Watson is up and running, each additional patient cared for means only a small additional cost.
Collaborative Healthcare
The Internet is global and seamless when it comes to boundaries. Watson will surely understand all the world’s languages; many are already in the voice recognition vocabulary of existing software which has been used for medical transcription for more than a decade.
In fact, I was using voice recognition in my medical office successfully from 1998 to 2000 when I left my solo office practice to work with the NCH Healthcare System. Back in that “last century” (a little more than a decade ago!), new patients could leave my office with a copy of their consultation note in hand. It had been created with the patient watching me dictate their history, physical, my impressions and the therapeutic plan into the medical record while using a microphone and a commercially available computer.
The internet will also encourage collaborative healthcare. For example, patient-produced content would be shared much the same way that Wikipedia shares content generated by contributors.
This shift—from a small group having knowledge to shared, participatory involvement—parallels the change from the Middle Ages to the Renaissance (which was catalyzed by Gutenberg’s press). We now have the equivalent, namely the Internet. Add Watson as the interface and health care can be changed in profound ways that were unimaginable just a few years ago. And to be frank, some of these changes will be unwelcome by those whose previous positions of power and importance are being undermined.
Nonetheless, when huge population studies can be done quickly, and vast data troves can be aggregated and shared, the entire global community will better understand illness and disease. The whole idea of evidence-based medicine will mature much faster as everyone shares medical experiences.
Privacy and confidentiality issues will always be valid concerns, but there are good working models in the banking and financial industry of how to safeguard privacy.
Finally, will everyone have a personal home health page started at birth (or conception) to carry with them throughout their lives? This is an interesting concept, and the technology backbone for it is already in place.
Having your medical information in one place will empower you to watch your weight over decades, monitor your cholesterol as you modify your eating habits, predict when you will have problems and make changes in the 70% of your habits which cause illness and which you can control. Today you can go to a site called Real Age, take a short quiz about your past health, and see how your chronologic age compares to your physiological age. http://www.realage.com/landing/entry4?cbr=MSNSRCH025
I believe that technology, the internet, and Watson will change the face of healthcare forever. We will probably resist change for a while, because that’s typical of human nature. But when you consider the enormous rate of change of just the last two decades, I think you’ll have an idea of how quickly we can evolve.
“Dr. Watson” was Sherlock Holmes’ companion and narrator. Now Watson takes on a new role.
Allen S. Weiss, M.D., President and CEO, NCH Healthcare System
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