How Mayo's "Dr. Google" Deal Disrupts Medicine

[think]

Information access is kind of a big deal. Looking forward to what transpires.

How Mayo's "Dr. Google" Deal Disrupts Medicine

By Michael Millenson - Contributor 2/25/2015 @ 8:46AM


“Dr. Google” has joined the Mayo Clinic, quietly signaling a powerful disruption for all of medicine.

Back in 1997 I wrote: “The information age is to medicine as the Protestant Reformation was to the Catholic Church.” The Church didn’t disappear when information once held tightly by the priesthood became widely available, but religion changed forever.

In that context, Mayo’s agreement to produce clinical summaries under its name for common Google medical searches is like a medieval pope happily handing out Bible translations. The mission of the most-used search engine on the planet is to make the world’s information “universally accessible and useful.” Mayo, in contrast, has for decades been a global symbol of doctor-knows-best. Recommending a Google search “as the first stop for those needing health information,” in the words of a Mayo physician executive, represents a true paradigm change.

But there’s much more going on here than search. From the Fitbit to medicine’s front lines, information technology is forcing a new doctor-patient relationship with new rules for new roles.


Full article (There does not appear to be any content on page 2):
http://www.forbes.com/sites/michaelmillenson/2015/02/25/how-mayos-dr-google-deal-disrupts-medicine/

{Edit:} Just looked and there are many additional articles on this if one wants more information:

http://goo.gl/JZ5Lzj

[Bosonic]

1. It's going to get even more disruptive in the next 10 years

IBM’s Watson interns at Memorial Sloan-Kettering

When IBM’s Watson supercomputer took down Jeopardy champ Ken Jennings just about two years ago, IBM let slip that Watson’s next gig would be as a voice-enabled physician’s assistant. Now IBM is giving us a little more information, releasing a video demo that shows how Watson might help an oncologist diagnose and treat a cancer patient.

The demo, which warns that it’s “not necessarily a direct reflection of systems under development,” was created in partnership with Memorial Sloan-Kettering Cancer Center in New York City.

It showcases the IBM Watson Cancer Diagnosis and Treatment Adviser as an aid for the physician, never interacting directly with the patient. In the scenario in the video, a patient has just been referred to an oncologist after a biopsy and CT scan tested positive for lung cancer. Just before the first consultation, the doctor feeds Watson the patient’s EMR, and Watson runs that data — her basic information plus her recent test results — through an extensive database of tens of thousands of medical journals, industry association guidelines, and specific hospital best practices. It tells the doctor, in a few minutes, a tentative list of treatment options (accompanied by confidence levels) and a suggested list of tests and areas where it needs more information. It also provides a list of ongoing clinical trials for which the patient might be eligible.

If the doctor orders the tests Watson suggests, Watson will use the results to present a better list of treatment options, with higher confidence levels, and to narrow down the list of clinical trials. Watson can also take into account patient preferences (the example in the demo is a patient who would prefer to avoid losing her hair) and new symptoms as they come up. Watson’s process is transparent — if the doctor wants to know why it chose a certain course of action, he or she can always click on a button for more information.

http://mobihealthnews.com/20255/ibms-watson-interns-at-memorial-sloan-kettering/

The evolution of IBM’s Watson and where it’s taking healthcare

...

The team at IBM will continue to steer Watson into new territory. Just recently the company announced the second of four phases of Watson in the pipeline, according to Wolpert (the first was the question and answer engine that debuted on Jeopardy). The Watson Discovery Advisor allows Watson to go to work on large data sets looking for patterns, rather than the answer to a specific question. Bon Appetit’s Chef Watson program uses Discovery Advisor, but it’s also been set to work on research projects. For instance, Watson has worked with Baylor College of Medicine to help advance the study of kinases, a not-yet-well understood enzyme that can sometimes indicate cancer.

“The entire field of kinase researchers, worldwide, will produce one therapeutic target a year,” said Wolpert. “We fed Watson all of the kinase research, just unstructured text of those journal articles and MedLine abstracts and stuff like that. And it found six high probability targets in one go. Just because it was able to consume all of everyone’s knowledge simultaneously, draw the connections, find co-ocurrences and, with a practitioner, with people who know this kind of research, it’s just invaluable.”

After the discovery analysis, the next two phases in the pipeline are a policy advisor, which will be able to deal with probabilistic thinking, and a decision advisor, which will bring Watson back around to the sort of work it was doing at Memorial Sloan Kettering, but making that scalable and extensible.

While they advance the capabilities of the system, IBM is turning the keys to Watson — specifically a new API that has grown considerably from the one that won Jeopardy — over to business partners that think they can do big things with the capabilities Watson has already shown off. A few healthcare examples, MD Buyline and Welltok’s Cafewell, kicked off last fall. Watson also recently announced a partnership with the Mayo Clinic.

http://mobihealthnews.com/36874/the-evolution-of-ibms-watson-and-where-its-taking-healthcare/

[Buzz Clik]

3. Bad advice in milliseconds. Can't wait.

[longship]

8. Geez! Nope! Keeping the standard of care current.

This Watson deal is a really important advance in medical care. A data base of outcomes would keep the standards of care up to date for all physicians. That already is what most physicians do. In fact, studies indicate that when a procedure is shown to be unhelpful, or not worth the risk, physicians are quick to ditch it. On the other hand, the same studies indicate that they are relatively slow to adopt new procedures. On the whole, physicians are fairly conservative.

Watson may be very helpful resolving these issues.

[Buzz Clik]

9. What could possibly go wrong?

[longship]

10. Please explain.

I think that physicians having more accurate and current information on outcomes of their procedures is a pretty damned good idea. Plus, a nationwide data base would be immensely valuable for medical researchers, who toil in relative obscurity in academia and often have to beg for grants to keep employed.

In other words, this idea is a plus-plus.

Now you explain what can go wrong.

[think]

4. Thank you for the additional info. Appreciated./nt

[cbayer]

2. There is a strong case to be made for "best practices" and verified protocols,

as opposed to every practitioner just doing what they want.

There is also a tricky balance between these things and protecting physician autonomy.

As there is already way too much very bad medical information available on the internet, it is not necessarily a bad thing to have a reputable site that provides data driven information for patients.

The other issue is about allowing patients access to their own information. While this is a big change, IMHO it is a very positive one.

[Exhibit A]

5. Important points. n/t

[think]

6. Internet access to medical information has been very helpful for me.

And it does suck to weed through the very bad medical advice one can find for many subjects. I usually include Mayo Clinic in many of my searches as I value their knowledge & information. Still I usually try to get additional sources.

Hope that patient access to their medical records starts to open up sooner than later. Agree this would be positive.

[cbayer]

7. You apparently have the ability to ascertain what is reliable information

versus junk.

The unfortunate thing is that many, many people can't do that.

So having sources that are widely regarded as legitimate is a good thing.

[jwirr]

12. When I asked my doctor about something I had read on the internet he told me that if I was going

to look on the internet for answers I should be careful that I look a reputable sites. He suggested the Harvard chat site. I have since added Mayo to the list. Our problem is that most of us have not been taught how to determine what a reputable site is.

[longship]

11. This is all about best practices and protocols.

According to research physicians already are fairly diligent about ditching procedures which are shown to be ineffective or above risk. But this would tighten the loop.

But this is an incredibly good idea. A nationwide data base of outcomes and research would tighten the loop. According to HIPAA, it would be anonymized, but the raw data alone would be extremely helpful to both practicing physicians and researchers. And if something bad happened, like a new deadly pandemic, such a thing may be very useful.

Yup! I agree with you.

BTW, countries like Denmark are already collecting massive amounts of outcome data. But it is easier for them due to the fact that they have national healthcare.

[cbayer]

14. I agree. I disagree with the author and particularly with

his mistaken idea that this is a paradigm shift for the Mayo. They have been at the forefront of best practices for a long time.

Medicine practiced in the shadows is often bad medicine.

The VA is the premier system for data collection in the US and I look forward to the day when our data is nationalized.

[daredtowork]

13. Seeking information on the Internet doesn't help patients much

when doctors are the gatekeepers to the remedies and cures: medications, procedures, official "diagnosis" for access to bureaucratic resources.

The irony is as access to Internet "knowledge" expands, access to the expertise of doctors is shrinking. You get 15 minutes with your harried doctor - in which they are likely to download a "lifestyle speech" to you and totally blow off what you are trying to say to them, pushing off major problems down the river for visits that are months apart. For people with complex chronic conditions this is leading to a dramatic lowering of the quality of life, exacerbation of problems that probably didn't even have to happen, and unnecessary deaths.

It seems to me that doctors are looking at patients as the enemy: someone who is using up their precious 15 minutes and who might try to squeeze some "Internet research" into the visit if they don't get cut off at the pass: therefore patient concerns get quashed almost before they are even spoken.

It seems to me that over time doctor's forgot who the customer is and they think they earn the big bucks just for the suffering they went through for going to med school in the first place.

[Tommy_Carcetti]

15. Oh, come on that's ridiculo---OH MY GOD I THINK I HAVE 5 DIFFERENT FORMS OF CANCER!!!!!!!!

I woke up with a cough, so I googled cough and it turns out people who have cancer can sometimes cough!

(Seriously, I'm a hypochondriac so this isn't far off in terms of my thought processes at times.)

[proverbialwisdom]

16. Do NOT test using clinical trials before approval. Really?

http://www.bloomberg.com/news/articles/2015-01-29/this-medical-supercomputer-isn-t-a-pacemaker-ibm-tells-congress

This Medical Supercomputer Isn’t a Pacemaker, IBM Tells Congress

by Anna Edney
2:00 AM PST
January 29, 2015

(Bloomberg) -- Watson, an artificial intelligence technology that IBM wants to sell to help doctors diagnose diseases, will largely escape the oversight of U.S. regulators if the computer giant wins a two-year Washington lobbying push.

International Business Machines Corp.’s argument to Congress is that its supercomputer, famed for victory on quiz show “Jeopardy!,” isn’t a medical device like a cardiac pacemaker and shouldn’t need lengthy clinical trials to prove it’s safe and effective. A draft bill released Tuesday backs that position, and could speed the use of Watson and other decision support technologies.

The artificial intelligence technology already has medical fans. Eric Topol, a genomics professor at the Scripps Research Institute, has used Watson to find research subjects who have serious conditions never before identified. When Watson diagnoses someone -- like it did with a patient with plastic lung, a rare condition that restricts airflow -- Topol can scratch them off his list of candidates.

“We’re enamored with it,” Topol said. “No human being can read five billion pages of medical literature in two seconds.” Since doctors ultimately make a final diagnosis, Topol said, there’s not the need for regulation like traditional devices used to treat patients.

Arthur Caplan, founding director of the Division of Medical Ethics at New York University Langone Medical Center’s Department of Population Health, disagrees. Caplan thinks the technologies should be regulated the same as medical devices, including going through clinical trials.

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