calling dr watson to radiology - rsna presentation

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  • 1. Calling Dr Watson to RadiologyWatson in Healthcare from NuanceNick van Terheyden, M.D.Chief Medical Information Officer Clinical Language UnderstandingNuance
  • 2. Medicine used to be simple, ineffective and relatively safe. Now it is complex, effective and potentially dangerous Sir Cyril Chantler, Kings Fund Chantler C. The role and education of doctors in the delivery of health care. Lancet 1999;353:1178-81u
  • 3. Information Overload Big Data Medical information is doubling approximately every 5 years - Brent James, MD, MStat, Chief Quality Officer, Intermountain Health Care 1.8 zetabytes of information created this year majority of it unstructured 57 Billion 32Gb iPods (Source: IDC) - Thats enough information to fill 57 billion 32GB Apple iPads (which could build a mountain of iPads 25 times higher than Mt Fuji Watson can sift through 200 million pages in 3 secs
  • 4. Watson DeepQAHOW DOES IT WORK
  • 5. DeepQA: The Technology Behind Watson Learned Models help combine and weigh the Evidence Evidence Balance Sources & Combine Answer Models Models Sources DeepQuestion Answer Evidence Models Models Evidence Candidate Scoring Retrieval 100,000s Scores from Primary 1000s of Scoring many Deep Analysis Answer Models Models Search Pieces of Evidence Algorithms Generation 100s Possible Answers Multiple 100s Interpretations sourcesQuestion & Final Confidence Question Hypothesis Hypothesis and Evidence Topic Synthesis Merging & Decomposition Generation Scoring Analysis Ranking Hypothesis Hypothesis and Evidence Answer & Generation Scoring Confidence ...
  • 6. ArchitectureUser ExperienceBy Nuance and Partners.. of consumers large and small CLU Cloud to Cloud DeepQA Solutions for .community of HealthcareEMRs Content Publishers LargeInstitutiona of l Providers CASE Content Partners
  • 7. How Does Watson Perform inHealthcare
  • 8. Question and Answer SetsSuccess Question: This hormone deficiency is associated with Kallmanns syndrome. - Passage: Isolated deficiency of GnRH or its receptor causes failure of normal pubertal development and amenorrhea in women. This disorder is termed Kallmann syndrome when it is accompanied by anosmia and has also been termed idiopathic hypogonadotropic hypogonadism (IHH). Answer: GnRH Notes: We know that GnRH is a hormone (from the ontology) so that lets us choose it as the most likely answer.
  • 9. Question and Answer SetsMiss Question: Eponym from Victorian literature for obesity hypoventilation syndrome. - Correct passage: Obesity-hypoventilation syndrome is also known as pickwickian syndrome, in reference to Charles Dickens - Correct answer: Pickiwickian Syndrome - Wrong passage: Other clinical features associated with obesity- hypoventilation syndrome are daytime hypersomnolence and cor pulmonale. - Wrong answer: cor pulmonale
  • 10. Radiology Use Case Radiologists identifies radiological findings in a report - Hepatic Lesion in Woman with History of Breast CA - Too Small to Classify (TSTC) - Offer follow up and alternative assessment criteria helping classify more accurately for interval follow up or imaging work up Ask Watson - discrimination points, appropriate follow up, critical results etc Watson Consumes the report and patient context information - Offers next steps, differential list, new/recent information & links What possible next steps/studies would be appropriate to rule in/out diagnosis and/or determine best course of treatment
  • 11. Generic Use Cases Medical Diagnosis - Consumption of medical records, results etc offering differential diagnosis and probability analysis with links to underlying literature sources - True personalization of medicine based on large cohort historical data analysis Interactive Model - Requires real time access to patient data from multiple sources including provider/patient interaction - Ongoing refinement based on dynamic interaction and learning
  • 12. Challenges Ambiguous human language Integration with existing systems extract of complete data set for history, results etc - Often in disparate systems - Non standard interfaces - Non standard format - Unstructured narrative Medical Data Sources and Ongoing Access and Updating Patient interaction with technology vs humans - Telemedicine and consumer trend towards home based care
  • 13. Replacing the Doctor? Study done by the Mayo Clinic in 2006 identified the most important characteristics patients feel a good doctor must possess The Ideal clinician is - confident, - empathetic, - humane, - personal, - forthright, - respectful, and - thorough These facets are entirely human and will be hard for technology to replace Mayo Clin Proc. 2006;81(3):338-344
  • 14. Calling Dr Watson to RadiologyWatson in Healthcare from NuanceNick van Terheyden, M.D.Chief Medical Information Officer Clinical Language UnderstandingNuance