During and after Watson’s debut on Jeopardy last year, IBM discussed how the technology could be applied to vertical fields, health care high among them (see this story on a presentation IBM’s research staff member Aditya Kalyanpur gave at San Francisco’s SemTech in May). Now those visions are coming to life, as WellPoint, the nation’s largest health benefits company in terms of medical membership, and IBM team on applying Watson’s DeepQA technology to driving better outcomes for oncology patients.
The initial focus of the strategic partnership will be on breast, lung and colon cancers. According to the National Cancer Institute, in 2010, more than half of all new cancers were cancers of the prostate, female breast, lung, and colon/rectum.
The applications to be developed will take advantage of Watson’s ability to analyze tremendous amounts of structured and unstructured information to help improve the diagnosis and treatment of patients. The plan is to have Watson apply what it learns from its ingestion of medical evidence – information from research and diagnostic studies, medical journal articles, treatment protocols, and so on – to what it gleans about specific cases, in order to help physicians with their diagnosis and with choosing best treatment protocols with higher levels of accuracy.
“That will lower overall medical costs and provide much better outcomes for patients. With that focus and direction we see the value of the Wellpoint-IBM Watson solution,” says Andrew J. Lang, WellPoint’s senior vice president of information technology and CIO. The treatment protocols for the cancers in question tend to be very complex and extensive, and it can be a game-changer increasing positive patient outcomes for Watson to reduce the variability of their applications by delivering probability-based treatment options. “There’s an opportunity to make a big improvement and difference,” says Lang.
Behind the Scenes
WellPoint will be training the Watson engine, including leveraging oncological expertise from its recently announced partnership with Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute to provide positive and negative case information, which will help grow the system’s knowledge about applying medical evidence against specific cases. “That gets us to the point where Watson can become a physician knowledge source,” he says.
Then, as part of surrounding systems, WellPoint also will bring patient information to the table, such as electronic medical record or claims information, as part of enabling greater accuracy into individual diagnosis and probability-based treatment options. (In all cases, patient information will be de-identified and will not be permanently stored, ensuring privacy is protected.)
Watson will be ingesting new medical evidence as it becomes available, and it’s equally important for the system to have longitudinal patient records be current in order to drive the most relevant and accurate results during physician interactions with Watson. “After the results of a procedure we’ll also want to take that information and add it back to a patient record and likely have another dialog with Watson by the physician to apply new findings, to see if there should be any adjustments to the treatment protocol,” says Lang.
In addition to having patient information as structured as possible (such as lab results), as the project moves forward physician notes may also be included as unstructured components of patient records. Pathways and treatment protocols also should form some of the structured data components, and genomic information may also come into play in terms of its linkages to different cancer types.
The Importance of Currency
“One reason why we need to continue to ingest the latest [medical research and other] information, and continually apply the cases to Watson, is so that it continues to learn and apply new information as it becomes available, and build out linkages,” says Lang. In fact, with medical information doubling every five years or so, it’s very difficult if not impossible for any individual to try to keep up with it all on his or her own.
“With the Watson engine and the WellPoint-Watson solution, that allows that information to be presented to the physician in a manner that’s more consumable, in a way that gives them higher probability. So, rather than reading pages and pages of a Google search, this will be a response back of structured and unstructured data, applied against patient information, so it’s relevant to the patient."
To be clear, Watson isn’t making the final decisions for physicians. The probability-based response is a reply back of a number of options that Watson sees, and the probability of those options being the correct options based on medical evidence. Then, it provides that linkage to the medical evidence it used to deduce that probability, Lang explains. “So it’s not a Jeopardy yes or no answer, but a list of options that come back. Think of it as the physician using that as a learning tool.”
Tuned to Physicians' Needs
WellPoint, which has the first Watson engine for medicine running in its data center in Virginia (with full failover capability) in partnership with IBM, is piloting using Watson with internal nurses doing medical evidence research as procedure requests come in. WellPoint is still early on in building out its relationships with oncology groups for the project focusing on breast, lung and colon cancers, with the Cedars Sinai one being a key first step. Lang expects there’s some six or so months of work around training and educating Watson for the job before it has live pilots running with physicians.
In addition to that, it’s also important to make the system work seamlessly with physicians’ existing workflows, and that’s part of the tasks it’s tackling with partners such as Cedars Sinai, as well.
Initially physicians will be able to gain access to the Watson engine in WellPoint’s data center through their desktops via a GUI, web-based interface. But Lang does envision providing hosted access at some point through mobile devices such as iPads, so that Watson can be an asset to doctors as they make their daily rounds. Also, speech recognition is expected to come online down the road, so that physicians can dialogue with Watson as easily as Alex Trebek did.
WellPoint is looking at expanding the project to include other cancer types in the future, Lang says, as well as other complex or chronic diseases – cardiovascular problems and diabetes, for instance.