With the problem of physician burnout reaching epidemic proportions, cognitive computing is being leveraged by providers to reduce clinician workloads as well as simplify workflows and increase efficiency.
As a practicing primary care physician, Anil Jain, MD, chief health informatics officer for value-based care at IBM Watson Health, comments that the amount of healthcare information is growing exponentially and with it the “number of medical journals I need to keep track of.”
However, Jain contends that leveraging big health data is an impossible task without cognitive computing systems, which understand natural language and actually learn, analyzing patient information against a vast array of data and human expertise to provide evidence-based treatment options.
“We’re excited about the vision and promise of cognitive computing,” says William Morris, MD, the Cleveland Clinic’s associate chief information officer. “We feel like it has a strong potential to address the problem of physician burnout and the challenge of being mired in data and not actually having synthesized knowledge.”
IBM’s Watson Health, the first commercially available cognitive computing capability delivered through the cloud to provide actionable insights from large amounts of unstructured data, has been “working very hard on mastering the complexity of the medical lexicon and actually getting it from a bench-top research project into a clinical workflow,” according to Morris.
In December 2016, the Cleveland Clinic and IBM announced a five-year agreement to expand the Clinic’s health information technology capabilities, including the use of Watson Health across its clinical and administrative operations.
“We’re going to need capabilities outside the four walls of the Cleveland Clinic,” says Morris. “While we have a rich history of partnering with many vendors well beyond just IBM, including Apple and Microsoft, I think forging this strategic relationship will help us start tackling some of our key clinical and operational challenges.”
As part of a decades-long relationship, IBM initiated an ongoing collaboration with Cleveland Clinic faculty, physicians and medical students to develop a Watson electronic health record assistant to help physicians quickly summarize and cull relevant insights from EHRs.
At the same time, Morris emphasizes that the “physician will always be the physician” and Watson “is there to augment the clinical thought process, not to replace it.” Jain agrees noting that human expertise is ultimately what trains cognitive computing systems like Watson.
“It’s another critical tool in our future success with the amount of data and the need to extract knowledge,” says Morris. “Getting to the ‘unknown unknown’ is the whole idea around cognitive computing,” he adds, referencing the term coined by former Defense Secretary Donald Rumsfeld for the problem of “unknown unknowns”— information that an organization doesn’t know that it doesn’t know.
Cognitive computing, self-learning systems that use data mining, pattern recognition and natural language processing, is designed to uncover actionable insights and the unknown unknowns. IBM’s Watson Health mimics the way the human brain works through understanding, reasoning and learning, translating information into knowledge that can help drive more informed decision-making.
There is a “mountain of information that is almost impossible to digest as an individual human being,” observes Joe Kimura, MD, chief medical officer of Atrius Health, a large multi-specialty ambulatory group practice in the Boston area serving more than 675,000 patients. “You need computer-assisted decision making to make sense” of it. Inevitably, that “kind of augmented clinical care decision-making is going to be the reality,” he adds.
In particular, Kimura believes that cognitive computing has tremendous potential for alleviating the widespread problem of physician burnout, which is linked to decreased quality of care and medical errors as well as an increase in the likelihood doctors will cut back their work hours or leave the profession altogether. He contends that physician burnout for Atrius Health’s 875 doctors is the single biggest challenge facing his healthcare organization and is a huge problem for providers across the country.
“To do good clinical care, there is an overwhelming amount of things you have to do and it’s getting more complicated all the time,” according to Kimura. “There is a tsunami of data and you feel guilty if you’re not processing all the data to make good decisions for your patients. Our clinicians are staying up until midnight making those decisions and documenting them.”
He references results of a national survey of more than 6,500 practicing physicians, released in 2016 from the Mayo Clinic, which found that the use of EHRs and computerized physician order entry is resulting in higher rates of professional burnout among doctors.
“We have to fundamentally change the work that clinicians are doing to allow them to really get back to caring for patients,” Kimura concludes. “This is where technology can have a tremendous impact.”
Toward that end, Atrius Health and Watson Health announced at the HIMSS17 conference last week in Orlando that they have entered into an agreement to develop a cloud-based service which would be integrated into the physician’s workflow in the EHR, summarizing key cognitive insights about a patient's health status, assembling a de-identified cohort of patients similar to the individual, and describing the outcomes of those patients under various treatment options.
“Atrius Health is committed to increasing the joy in the practice of medicine for our clinicians and staff,” said Steve Strongwater, MD, president and CEO of Atrius Health, in a written statement. “Working with IBM Watson Health offers a unique opportunity to help our Atrius Health clinicians make greater use of the mountains of digitalized information generated daily through our care of patients. The unique capabilities of Watson Cognitive Insights will help our primary care clinicians increase both effectiveness and efficiency.”
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