Transcript
Page 1: Calling Dr Watson To Radiology - RSNA Presentation

Calling Dr Watson to RadiologyWatson in Healthcare from NuanceNick van Terheyden, M.D.Chief Medical Information Officer – Clinical Language UnderstandingNuance

Page 2: Calling Dr Watson To Radiology - RSNA Presentation

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

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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)- That’s 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

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Watson DeepQAHOW DOES IT WORK

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. . .

Answer Scoring

Models

Answer & Confidence

Question

Evidence Sources

Models

Models

Models

Models

ModelsPrimarySearch

CandidateAnswer

Generation

Hypothesis

Generation

Hypothesis and Evidence Scoring

Final Confidence Merging & Ranking

Synthesis

Answer Sources

Question & Topic Analysis

EvidenceRetrieval

Deep Evidence Scoring

Learned Modelshelp combine and

weigh the Evidence

HypothesisGeneration

Hypothesis and Evidence Scoring

QuestionDecompositio

n

1000’s of Pieces of Evidence

Multiple Interpretations

100,000’s Scores from many Deep Analysis

Algorithms

100’s sources

100’s Possible Answers

Balance& Combine

DeepQA: The Technology Behind Watson

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Architecture

Cloud to Cloud

…..community of CASE Content Partners

…..community of consumers – large and small

CLU……

User ExperienceBy Nuance and Partners…..

….community ofContent Publishers

DeepQA Solutions

for Healthcare

Large Institutio

nal Providers

EMRs

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How Does Watson Perform in Healthcare

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Question and Answer SetsSuccess

Question: This hormone deficiency is associated with Kallmann's 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.

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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

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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

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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

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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

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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

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Calling Dr Watson to RadiologyWatson in Healthcare from NuanceNick van Terheyden, M.D.Chief Medical Information Officer – Clinical Language UnderstandingNuance


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