On the payer side of health care, IBM partnered with WellPoint, one of the largest U.S. health insurance networks, operating in 14 states and covering one in nine Americans. This collaboration yielded the other two apps, WellPoint Interactive Care Guide and Interactive Care Reviewer, which are designed to help payers and providers, respectively, to quickly review claims and pre-authorizations and either approve or flag treatments as either appropriate or out-of-step with the latest, evidence-based treatment options.
WellPoint has trained the apps on 25,000 test-case scenarios and 1,500 live cases as part of a pilot project, and they are now in a learning mode. The Interactive Care Reviewer is being used by a handful of selected providers in the Midwest, and WellPoint expects 1,600 to be up and running on the application by year end. The key benefit is expected to be faster review times for pre-authorizations, moving away from faxes and phone calls to evidence-based decisions.
Of course other vendors, including business rules and analytics vendors, have been working on better, faster and more reliable healthcare utilization and adjudication apps, but Watson stands apart from systems that rely on rules and decision trees, according to IBM. "Those systems tend to be brittle and static, so it's hard to constantly learn from new clinical trials and research," said Stephen Gold, worldwide director of marketing for IBM Watson, in an interview with InformationWeek. "Those tools also tend to be deterministic, which means they try to get to 'yes' or 'no,' whereas Watson is probabilistic, so it gives you a degree of confidence in various choices based on the specific circumstances of the patient."
It remains to be seen whether the Watson-based apps have an edge over analytics-based applications, from vendors such as SAS, or blended rules-and-analytics systems, such as those from Pegasystems. Healthcare is a $2 trillion industry worldwide, so it has attracted plenty of vendors to work on tough problems.
Watson stands on the shoulders of earlier achievements, including search technologies like Google and language-processing technologies such as Apple's Siri. "But you can't ask Google, 'What is the appropriate initial dosage of antibiotic for a 7-year-old child with a history of asthma?'" said Saxena. At least you can't and expect something more concise than a jumble of thousands of hits. The top search results might be on the right track, but the Watson applications are designed to deliver concise, evidence-based advice, such as, "two teaspoons, 80% confidence; one-and-half teaspoons, 45% confidence" accompanied by citations and links to supporting research. "It's a deep, semantic question that has to be supported not just by keywords, but by actual medical evidence," Saxena said.
To apply Watson to an industry-specific problem, IBM has over the last two years streamlined the code and focused the body of knowledge the technology has to work with. To play Jeopardy, Watson had to train on a smorgasbord of information ranging from history, literature and science to politics, the arts and pop culture. Instead of learning a broad range of idioms, slang and regional dialects, the technology had to target domain-specific jargon such as that used in the medical profession. As a result, the conference-room sized Watson that played Jeopardy has been shrunk down to a single server that can be scaled out on racks, according to IBM. The applications can be delivered as a cloud-based service, which is how The Maine Center for Cancer Medicine & Blood Disorders plans to use the Interactive Care Insights for Oncology app.
"Our state has real problems with access to care, particularly in its rural areas," said Tracey Weisberg, medical oncology president at the center. "This will enable us to provide comprehensive, evidence-based treatment we could have only dreamed of in the past, yet our patients won't have to leave the state and travel to a big-city hospital."
The release of three Watson applications doesn't guarantee success, but WellPoint executives said its nurses reviewing patient-care cases are already seeing 90% accuracy rates on the treatments advised by the Interactive Care Guide and Interactive Care Reviewer apps. Given the increasing number of new medical treatments and technologies, the complexity of managing multiple chronic diseases and the growing personalization of treatments and diagnostics, the challenge is to soak all that information in, retain it and "deliver practical evidence that clinicians and patients can follow," said Dr. Samuel Nussbaum, WellPoint's Chief Medical Officer. "That's something Watson can address, and it will revolutionize the quality of care."
IBM has its problems like many tech companies, including high-profile legal battles, low-margin businesses needing restructuring, and mature businesses facing long-term decline. But when it comes to efforts such as Watson, which is now the IBM Software Group's single largest investment, you have to acknowledge that the company is operating on a higher level, setting more audacious goals than any company in IT.