Q. Why should Healthcare Organisations read the IBV Study on Cognitive Computing?
A. As a relatively new concept in the field of computing and informatics, the nature, value and potential benefit of Cognitive Computing for organisations involved in healthcare needs to be understood and incorporated into their plans. This is as true for those involved in public health, medical care, social care and insurance as it is for those involved in medical research, care system planning and health policy. The IBV Study clearly explains the concepts, the different ways of applying Cognitive Computing (Engage, Discover, Decide), and provides a framework for preparing to use these new capabilities.
Q. What is the general feeling towards Cognitive Computing within the Healthcare industry, and amongst IBM Healthcare clients?
A. I would say that there is a very positive attitude about the potential of Cognitive Computing to improve the quality, accessibility and personal experience of healthcare. This is often expressed in terms of the new things that it will allow us to do, such as self-diagnosis, and comparing different treatment options (at the personal level), and accelerating the discovery of the most effective care pathways, population health insights and new medical knowledge (at the macro level). This enthusiasm is tempered with caution about the extent to which we can trust cognitive systems to augment the experience of the doctor, or to challenge established clinical guidelines. Experience with using such systems in real practice will show the extent to which these fears are valid, and the most important use cases and applications will become very apparent.
Q. Does the Healthcare industry understand the full capability of Cognitive Computing?
A. We are just at the beginning of the journey to understand what we can do. There is general acknowledgement of the inability of even the most diligent researchers and clinicians to keep up with the volume of discoveries, and this is certainly an area where cognitive approaches can help. Similarly the possibility of using cognitive systems to interrogate large datasets, and to augment and scale our knowledge is recognised. What is less clear at this stage is how it can be used to engage citizen in their own health, although there are many app developers looking into this area, and there is clearly potential to reduce demand on healthcare systems with this approach. This challenge may well be taken up first by small entrepreneurial companies, before healthcare systems start to integrate these into their work. Finally, the providers of medical devices, electronic patient records and others generating and storing patient data are clearly starting to understand the power of this idea, as are pharmaceutical companies, for both research and post-market analysis of their medicines.
Q. What is the most exciting/interesting side of Cognitive Computing in Healthcare in your opinion?
A. Cognitive systems will improve quality of care and personalisation, based on integrating all that is known about the patient, when used in conjunction with the doctors and patients, to make better decisions. Doctors are trained to make clinical decisions based on examination, test results and experience from previous cases. However they are usually time-constrained, and often working with incomplete information. The ability to augment this decision making process with a trusted advisor which is capable of filling in knowledge gaps, or prompting for further questions or tests to improve diagnosis or treatment, is something that gets everyone excited. A reduction in medical errors, which can include late or incomplete diagnosis in addition to wrong diagnosis, and the personalisation of treatment based on previous similar cases, is seen as very realisable benefit in the near term.
Healthcare organizations are already grappling with many eHealth challenges, such as implementing modern Electronic Patient Record (EPR) systems, exchanging data between systems, building clinical portals etc. Their ability to absorb more innovation at a time of financial constraint in Europe, and with IT departments already stretched, can be limited. However now is the time to plan for cognitive and to look for use cases that can deliver early benefits. So the planning and work starts now, and we can expect to see significant projects, and successes, within 3 years.
Q. Cognitive computing is often described as being able to outperform humans in many areas – how does this make Healthcare professionals feel?
A. It makes them feel both fascinated and nervous at the same time, but they recognise that this should not be seen as a way to replace the human touch of the doctors and the caring professions, but by working in a collaborative way between man and machine, to provide the promise of higher quality care with better decisions, made with less effort, and a more personalised approach to care.
Q. What other concerns/challenges are voiced about the Cognitive computing future?
A. In medicine, a question which comes up often is evidence that cognitive computing can really deliver the claimed benefits, especially when it comes to decision support for diagnosis and treatment. Clinicians are used to working with a strong evidence base, from randomised clinical trials, case/control studies and observational studies. A comparable level of evidence is sought for cognitive computing, but this is not yet established, so there will be some caution until it exists. Similarly, many European countries have established treatment protocols and pathways which are set down at a national level, sometimes based on best international practice. Again, there will be a level of caution about diverting from the normal guidelines based on a recommendation from a cognitive system, so more work needs to be done to establish accuracy and relevance. There will be many companies staking their claim in the cognitive era, especially as the value and realisable benefits become clearer. IBM currently has a major advantage in that Watson has captured the imagination of the market, but we need to move with speed to make the most of this.
Q. The paper highlights a ‘gap between data quantity and data insights’. Although this is not an issue unique to Healthcare, is there a specific area within Healthcare which this is affecting?
A. Many European countries have been collecting information about the health of their citizens in disease registries, patient record systems, and more recently biobanks and consolidated longitudinal medical records, often called Electronic Health Records (EHR’s), over many years. The value in this data for public health and health systems design is thought to be enormous, but the benefits have not been delivered on a large scale. This is where significant effort needs to be expended. When you then bring in the data from wearable devices and applications on lifestyle and wellness, and combine this with the medical data and social data in the systems of record, we can for the first time start to see how health improvement efforts are making a difference in near real time.
Q. The paper identifies 6 key disruptive forces that are shaping and shifting the Healthcare arena (Rapid digitisation; Increasing demand; Rising Consumer expectations; Shortage of skilled resources; Regulatory complexity; Increasing cost pressure) – are there any specific ones which you believe organizations are concerned about?
Which is the focus for the organizations at the moment? Do they recognise that these are issues which they need to address in the near future?
A. Of the disruptive forces mentioned in the IBV paper, the major concerns today are about increasing demand, especially that coming from complex and frail patients who place high demands on care systems; and increasing cost pressure, as medical inflation runs ahead of growth in the economy. When it comes to data and how this can be used to improve public health and the effectiveness of health systems, regulations are a key issue, as many interpretations of the Data Protection Directive on which local regulations are based can make it difficult to use data for purposes beyond those for which it was collected, and can also make it hard to share across care teams. These issues need to be addressed if data is really to be put to work in our systems of care.
Q. The paper focuses on three key capabilities that organizations need in order to rise above this disruption (Engage, Discover, Decide). Do you have any examples on how healthcare companies are currently focusing on these areas?
A. From these three themes, the most developed in Europe is the Discover one, as clients are now using data to understand much more about the where the demand for care is coming from, and where it is likely to increase in future. The ability to Decide with cognitive systems will require more evidence before it is more widely accepted by the medical profession, but that time will surely come. The dimension of Engagement is likely to start with wellness and fitness applications from entrepreneurial companies, but healthcare systems will gradually incorporate this capability as they realise how it can be used to reduce overall demand on systems of care.