Should IBM’s Watson supercomputer play a role in health care decisions?

Kathryn Hawkins

Who do you want to make the most important decisions about your health care: a doctor or a computer?

If you’re a customer of WellPoint Inc., the largest health insurance plan in the Blue Cross and Blue Shield network, you may not have a choice. WellPoint recently teamed up with IBM to make use of the tech giant’s Watson supercomputer technology.

Watson is best known for beating Ken Jennings on the “Jeopardy!” game show, but the artificial intelligence machine has a wide range of applications. For instance, IBM is developing health care software built on Watson’s proprietary technology. IBM and WellPoint envision the software benefiting patients with conditions like cancer, diabetes and heart disease.

As IBM explains it, “Watson’s ability to analyze the meaning and context of human language, and quickly process vast amounts of information to suggest options targeted to a patient’s circumstances, can assist decision-makers, such as physicians and nurses, in identifying the most likely diagnosis and treatment options for their patients.”

IBM’s Watson supercomputer beat “Jeopardy!” superstar Ken Jennings. Can it help beat cancer and heart disease as well?

Watson and WellPoint

WellPoint plans to use the software to help diagnose and treat the more than 34 million members of its health insurance plans in 14 states, including California, Georgia, New York and Ohio. The software will sort instantly through patient records, WellPoint’s database of treatment histories, and IBM’s collection of medical journals and textbooks to determine the best medical steps in each case. Recommendations will be ranked according to the technology’s confidence in each decision.

WellPoint is set to launch the Watson-inspired software in early 2012 through pilot tests in several regions.

“We expect Watson will be an invaluable resource for physicians, and could dramatically enhance the quality and effectiveness of the medical care they deliver,” says Tony Felts, a spokesman for Anthem Blue Cross and Blue Shield, a WellPoint brand. “By combining IBM Watson with WellPoint’s extensive, unique and deep data, we can equip physician partners with the information that will allow them to make more informed decisions for their patients, at the point of care.”

The first health care services provider to employ the Watson technology is the Seton Healthcare Family in Texas. Seton is a network of 31 health care facilities in the Austin, Texas, area; its use of the technology is separate from the WellPoint deal.

In a post on an IBM blog, Dr. David Ramirez, medical director at Seton, calls the IBM software a “game changer.”

One of Seton’s goals in using the software is to cut down on repeat hospital stays for patients who’ve suffered heart failure — hospital stays that cost more than $35 billion a year in the United States. Ramirez notes that heart failure affects about 5 million Americans annually, with 500,000 new cases diagnosed each year. More than half of heart-failure patients are hospitalized again within six months of treatment, he says.

“Our goal is to advance diagnosis and treatment by extracting medical facts and understanding relationships that are often buried in large volumes of clinical and operational data,” Ramirez says.

High-tech benefits

The sophisticated software can supply detail data regarding treatment options, but should the computer’s conclusions possibly take priority over a doctor’s?

Colin Hill, founder and CEO of health care data analytics company GNS Healthcare, says that relying on advanced technology to help determine treatment plans can be an advantage for patients.

Supercomputers like Watson are able to analyze data for millions of patients, and have the capacity to determine which treatment plans have historically led to better results for patients with certain conditions, he says.

“By contrast,” Hill says, “doctors use intuition and hunches that are not scalable and that — particularly with respect to complex cases where patients suffer from several diseases and are on several medications — may actually result in poorer patient outcomes.”

Hill believes that if the technology is used wisely — “to enable doctors, rather than to completely supplant their judgment” — it can lower health care costs and provide better treatment.

Too much technology?

Not everyone believes that such technology will benefit patients.

“Things in the insurance world go awry when insurers try to use computers to put a price tag on people’s injuries or determine what medical treatment is appropriate,” says Amy Bach, executive director of insurance consumer advocacy group United Policyholders.

For instance, health insurance giant UnitedHealth Group’s Ingenix system automatically determines policyholders’ reimbursement rates based on computerized data. In 2008, the State of New York sued UnitedHealth, claiming that Ingenix’s claims decisions had left policyholders “under-reimbursed to the tune of at least hundreds of millions of dollars,” New York Attorney General Andrew Cuomo said. UnitedHealth reached a $50 million settlement with Cuomo’s office in 2009 but denied any wrongdoing.

When health insurance claims are denied, both patients and physicians suffer: Patients often must pay for expensive health services out of pocket, while doctors are paid reduced rates or must chase down payments from patients.

That may be just what the insurance companies want. According to Miller-McCune magazine, companies like IBM, McKesson, Bloodhound Technologies and TC3 Health say their claims-review software can reduce health insurance payouts by 3 percent to 7 percent.

A doctor’s best friend?

Still, Bach believes that sophisticated software like IBM’s can be a plus in the medical world — if used properly.

“A computer can track expenditures for procedures and drugs to make sure that costs are in line,” she says. “If it’s just a matter of tracking costs for procedures, that can be a good thing in eliminating fraud and over-billing.”

However, Bach doesn’t think this software has any place in determining a particular patient’s course of treatment. “Computers should not be making medical decisions, that is for darn sure,” she says.

According to WellPoint spokesman Felts, they won’t be. Watson is an assistant, not a replacement, he says.

“Watson will not dictate treatment or diagnosis, but rather suggest evidence in support of certain treatment and diagnosis options to the doctor,” Felts says. “Ultimately, the doctor or other licensed medical professional will use his or her own experience to discuss treatment options with the patient.”

If the Watson technology is used ethically, it could be a doctor’s best friend.

“With the demands on medical professionals today, and the complexity of disease management, this type of technology could greatly assist physicians and provide them with a new level of confidence in their decision-making,” Felts says.