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Practical Application of Watson with EHR

Posted on July 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Ever since Watson made its debut on Jeopardy, I haven’t been able to not check out what Watson was doing next. No doubt what Watson did on Jeopardy was impressive. However, it’s one thing to do what it did on Watson. It’s another thing to commercialize the Watson into something useful.

I’d long been hearing that Watson was going to be great for healthcare IT and that healthcare would really benefit from the technology. However, everything I saw felt very conceptual as opposed to practical and implemented. So, I was really interested in talking with Modernizing Medicine about their EHR integration with Watson.

You can find my interview with Daniel Cane and Dr. Michael Sherling, Founders of Modernizing Medicine, talking about Watson and some of the other cool ways they’re trying to help doctors make use of the data in an EHR in the video below. Plus, we even talk ICD-10 and MU 2 delay as well.

Note: Modernizing Medicine is a Healthcare Scene advertiser.

Watson in Healthcare, Malpractice and EHR, Orion and Amalga, and EMR Apps

Posted on October 16, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time again for my weekly round up of healthcare IT and EMR related tweets. Plus, a few thoughts from me about the various tweets.

@Craigley
Craig Bradley
I need a Watson robot in the room to be my knowledge/evidence coach & also EMR scribe while I listen/touch/care. @SeattleMamaDoc #chc11

The good news for Craig is that I’ve seen the people from IBM that did Watson working with the people from Nuance (most famous for Dragon Naturally Speaking) working on this. I don’t think it’s that far away.

@nickgenes
borborygmi
First real recommendation: have good backup plan when #EMR goes down; one makpractice case was lost by inadequate downtime system #SA11

This was pretty interesting. I’d love to learn more details about this malpractice case. No doubt you have to work on a proper system to handle EMR down time. I’ve written before about all the ways you could have EMR down time and the cost of EHR down time. It’s not a question of IF you will have EHR down time, but WHEN.

@JBikman
Jeremy Bikman
I’m very excited to see what Orion can become w/ Amalga HIS. My hope is that they emerge as a legit EHR/EPR/HIE player globally. Very cool.

This is interesting news since Orion is focused on the Asia Pacific market. Coincidentally, I’m just finalizing the details of me attending a Healthcare Informatics Conference in Thailand in March 2012. I’m interested to learn a lot more about Asia. You can read more about the Orion Health Deal for Amalga here.

@EMRDailyNews
EMR Daily News
Over 60 EMR / #EHR Apps Now Available in the iTunes App Store su.pr/1tfhMG

64 iPhone EHR apps on the app store. In February there were only 5 EMR apps in the Android marketplace. I’m sure there are a whole lot more now. Plus, the number of apps in the app store is a bit flawed since it’s not like people purchase their EHR software on the app store. However, it’s interesting to see how many are putting it there.

Expanding the Healthy Patient – Doctor Relationship

Posted on August 9, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Patient Doctor Relationship
It seems like this topic keeps coming up in my online and social media reading. Basically, the discussion usually centers around the role the patient plays in healthcare. Many people like to discuss what has been called the ePatient. I instead want to talk about the motivations of patients and their ability to influence the healthcare system.

Patients in healthcare are unlike “customers” in many other industries. I can’t think of a single patient that wants to go and see a doctor. Ok, maybe they like the doctor and they want to get whatever’s ailing them fixed, but to a person I’m sure we’d say that going to the doctor is the last place we want to be. It’s not like going shopping for a new pair of shoes. There’s nothing you get to take home from the doctor. Well, at least nothing that you really want to take home.

Plus, healthcare is an interesting thing, because often it’s not clear if you should go to the doctor or not. If my A/C is broken, then it’s quite clear that I need to call an A/C repairman. Seeing a doctor is quite different since it’s a fine line between when you need to go and see the doctor versus when your body will heal on its own. I think we’ve all hated the doctor visit where they check you out and basically say there’s nothing they can do for you. Well, other than send you the bill for your visit. I guess that’s the cost of the peace of mind that you get from the visit (I know I’ve done that with my kids a few times).

Please don’t take this as me knocking doctors or the healthcare profession. They provide an absolutely essential and critical role in our lives. Without great doctors many of us wouldn’t be here today. My point in this post is that the patient doctor relationship is quite different than the customer business relationship that we’re use to seeing.

Online Patient Portals
Take for example the online patient portal. Many people love to go on Amazon.com (or insert your preferred shopping site) and browse through all the various things they could buy. We all know people who spend hours shopping. I don’t think I’ve ever heard someone say that they wanted to spend hours browsing through their patient portal. You know, someone who just couldn’t wait to see what great healthcare services their doctor could provide them.

The only partial exception to the above reasoning is possibly the chronic patient. If I’m a diabetic patient, then I am going to have an ongoing dialogue with my care provider and the services they provide. I’m going to be interested in monitoring and tracking my care in collaboration with the treatments that my doctor provides.

Is there a reason why we don’t want this kind of interaction for our general healthcare?

Regular Online Interaction with Doctors
Why shouldn’t I go online on a regular basis so that my doctor can assist me in total wellness even when I’m a healthy patient? The difference here of course lies in doctors treating symptoms and illness as opposed to a very different form of care: wellness. To be honest, I’m not sure I’ve seen any doctors who treat healthy patients. Sure, some doctors do provide some pro-active wellness information during a sick visit to the doctor. Regular physicals are the closest we come to doctors treating healthy patients, but how many health people get those? It feels counter intuitive that we would go and see a doctor when we’re healthy or appear to be healthy. However, maybe that’s the shift our healthcare system needs.

Reimbursement Model Challenge
One real challenge with what I just described is the reimbursement model we have in healthcare. We’ve incentivized treatment of sickness and illness. We haven’t (yet?) incentivized treatment of healthy patients and promotion of wellness. This sounds a bit like the ACO discussion that’s become so popular these days. I’ll be interested to see how these incentives play out. Word on the street is the train has left the building and reimbursement is going to be tied to healthcare outcomes in the future.

Healthy Patient Motivation
Unfortunately, another major challenge I see is that healthy patients aren’t really motivated by wellness initiatives. I’m sure that there are people that understand this phenomenon a lot better than I. Although, I think it’s abundantly illustrated when you talk to someone who’s getting older and starting to lose their health.

It seems particularly poignant for highly successful people that start to get older. How many times have we heard during Oprah or a Barbara Walters interview someone talk about being willing to give up all their riches and fame to just have their health (and they often throw family in there too)? All the time! The problem is that it takes old age or some other health incident for people to make healthy living and wellness an important part of their life. Which begs the question of whether even a change in the reimbursement model for healthcare will get unmotivated people to visit their doctors and be “treated” even when they’re a healthy patient.

Gamification of Healthcare
One idea that I find incredibly intriguing is the idea of gamification of healthcare and wellness. The basic concept behind gamification is to create incentives for people to do the behaviors you want them to do. I believe Foursquare was one of the first applications to do this. They would give you electronic badges and crown you as mayor as you did certain things on their mobile app. It was (and still is) amazing to see what people will do for a little electronic badge and the electronic title of mayor (Turns out this works in the offline world as well. There’s a reason boy scouts give out badges, beads and pins.). The question is how can we apply rewards systems to incentivize healthy behavior and wellness?

To be completely honest, I don’t think I’ve seen anyone crack the gamification code in healthcare. Although, I think the concept is just beginning. I predict in the next couple years that we’re going to see some amazing mobile and web applications that really drastically impact our motivation to healthy living.

The closest I’ve seen so far has been something like the Nike+ device and website. It’s a simple device that tracks your running habits either in a watch, iPod or even in your shoe. Then, that device uploads your running data to a website where you can create and track your running progress. It also provides a social experience, but that’s a topic for another day.

I actually find these tracking device/website combinations (see the FitBit and DigiFit as other examples) to be some of the most interesting things happening when it comes to pro active treating of healthy patients. A while back I predicted a whole plethora of medical tracking devices are going to hit the market. This is happening and will continue for many years to come. I heard one guy interviewed who talked about one day (many years from now) having little mini processors attached to every nerve or blood cell in our body. Ok, that’s kind of creepy to think about, but personal monitoring of our body is a burgeoning field in healthcare.

Crunching All the Personal Healthcare Device Data
The question once we’re monitoring all of these various vital signs and health information is what are we going to do with that information. Is it reasonable to think that we’ll be able to use computers to crunch through all the data and provide a self service analysis of all the data collected? Yes, Watson did some amazing things on Jeopardy, but I think we’re far away from the day when this type of self service crunching of all the medical data we collect will be possible.

Yes, that means we’re still going to need doctors and other healthcare professionals who help us analyze the data that we’re collecting and dealing with the health issues that are related to that data. In fact, I predict a whole new breed of doctor will come together that will be specialized at analyzing this data and treating even the healthy patients.

Future Healthy Patient Doctor Relationship
This all comes full circle when you go back to the start of this discussion: the doctor patient relationship. How are doctors going to see all this health information we’re collecting? Where are we going to have these healthy patient interactions with doctors? I predict that it will be through patient portals that are connected to a physician’s EHR.

I and every blogger I’ve ever known has been a stats junkie. We’re addicted to checking our stats. There’s no reason we wouldn’t be just as addicted to checking our health stats on a patient portal. The problem is that the patient portals I’ve seen aren’t there yet. Plus, most doctors aren’t yet ready for this type of healthy patient interaction around such a large set of data. Although, I predict we’ll get there and it will change the doctor patient relationship forever.

IBM’s Watson Addresses Errors of Diagnosis

Posted on June 2, 2011 I Written By

I’m beginning to see a pattern here. Two weeks ago, I wrote about clinical decision support in context of Dr. Larry Weed’s new book. Two weeks before that, I commented about physicians worrying that patients would perceive them as being incompetent if they relied on CDS. Today, I’m back to the same topic.

Deny the obvious all you want, physicians, but clinical decision support is coming, and once it’s here, it’s not going away.

I just got back back from the new IBM Healthcare Innovation Lab in downtown Chicago, the company’s third such center in the U.S. and eighth worldwide. While kickoff included a “healthcare leadership exchange” with such thought leaders as HIMSS CEO Steve Lieber and Allscripts Healthcare Solutions Chief Innovation Officer Stanley Crane, the real star was not a person, but a computer. IBM’s Watson, to be specific.

People stayed after lunch mostly to see a demo of Watson processing healthcare data—and IBM Chief Medical Scientist Dr. Marty Kohn said this was the first audience to see this demo. Make no mistake, IBM is positioning Watson as a clinical decision support tool, particularly for the much-ignored area of diagnostic decision support.

Saying that perhaps 25 percent of all healthcare errors are errors of diagnosis, Kohn noted how getting the diagnosis right can prevent all kinds of unnecessary complications and spending. “Of course, if you’ve made the wrong diagnosis, picking the right course of treatment becomes a challenge,” Kohn said.

And after the diagnosis, Watson can prevent treatment errors by, say, scanning EMR data for patient allergies to recommend against a drug that might cause a harmful interaction, then suggest alternative therapies. Kohn presented the case of a 29-year-old pregnant woman who was diagnosed with Lyme disease. A common treatment is the antibiotic doxycyline, but Kohn noted that it’s contraindicated during pregnancy.

Watson, according to Kohn, draws preliminary conclusions according to presenting symptoms, then scans multiple sources of information to present recommendations. Watson does look at the notoriously incomplete and inaccurate Wikipedia, Kohn said, mostly because that user-edited site covers so many topics, but then verifies information from other sources.

Watson then displays reasons why it believes the diagnosis may be correct so the doctor can make an informed decision. “It won’t let you ignore all the possible diagnoses,” Kohn said. But it won’t actually make the final call. “Watson is going to be in a supportive role rather than actually making decisions.” Kohn added.

What the supercomputer does is process vast amounts of data in a short amount of time., something that even the sharpest human mind could never do. And that’s what clinical decision support is supposed to be all about.

Jeopardy!’s Watson Computer and Healthcare

Posted on May 25, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m sure like many of you, I was completely intrigued by the demonstration of the Watson computer competing against the best Jeopardy! stars. It was amazing to watch not only how Watson was able to come up with the answer, but also how quickly it was able to reach the correct answer.

The hype at the IBM booth at HIMSS was really strong since it had been announced that healthcare was one of the first places that IBM wanted to work on implementing the “Watson” technology (read more about the Watson Technology in Healthcare in this AP article). Although, I found the most interesting conversation about Watson in the Nuance booth when I was talking to Dr. Nick Van Terheyden. The idea of combining the Watson technology with the voice recognition and natural language processing technologies that Nuance has available makes for a really compelling product offering.

One of the keys in the AP article above and was also mentioned by Dr. Nick from Nuance was that the Watson technology in healthcare would be applied differently than it was on Jeopardy!. In healthcare it wouldn’t try and make the decision and provide the correct answer for you. Instead, the Watson technology would be about providing you a number of possible answers and the likelihood of that answer possibly being the issue.

Some of this takes me back to Neil Versel’s posts about Clinical Decision Support and doctors resistance to CDS. There’s no doubt that the Watson technology is another form of Clinical Decision Support, but there’s little about the Watson technology which takes power away from the doctor’s decision making. It certainly could have an influence on a doctor’s ability to provide care, but that’s a great thing. Not that I want doctors constantly second guessing themselves. Not that I want doctors relying solely on the information that Watson or some other related technology provides. It’s like most clinical tools. When used properly, they can provide a great benefit to the doctor using them. When used improperly, it can lead to issues. However, it’s quite clear that Watson technology does little to take away from the decision making of doctors. In fact, I’d say it empowers doctors to do what they do better.

Personally I’m very excited to see technologies like Watson implemented in healthcare. Plus, I think we’re just at the beginning of what will be possible with this type of computing.