and the Future of Medical Practice. Who
Owns the Data and Who Uses It?
Down the road, the IBM supercomputer
could become a tool for comparative effectiveness research.
Blog, April 30, 2012
Pierre Simon de Laplace (1749-1827), Ouevres, Volume VIII, Theorie Analytique des Probabilities (1812-1820)
Given for one instant an intelligence which could comprend all the forces by which nature is animated and the respective positions of the being which compose it, if morever this intelligence were vast enugh to submit this data to analysis to it nothing would be uncertain, and the future as the past would be present in its pages.
2012 - As a rule, I am skeptical about
the use of the computer as the be-all and end-all as a principle means of transforming and improving health care.
based on my personal experience, the computer has a potentially powerful role
in health care. Back in the early days
of the Internet, the late 70s and early 80s,
with the help of University of Minnesota physics professor, I developed a differential diagnosis program
called UNIPORT and a program for estimating the state of a person’s health
called The Health Quotient . Using
UNIPORT, our clinical laboratory sent out 6 million differential diagnosis
reports, with the proper diagnosis listed 80% of the time in the top 5
diagnostic possibilities .
national laboratory bought our laboratory in 1985, the national firm
discontinued the two programs, presumably because of expense and potential
medical liability claims.
I saw then and I see now, given a patient’s symptoms, chief complaints, gender, age, other demographic data, lab tests, and medical history, based on
clinical algorithms, one could list a
patient’s correct diagnosis, proper treatment, and state of health more than 90% of the time.
WellPoint, using IBM’s supercomputer,
Watson, share that belief. The how-to,
what to-do, and when to-do, is being worked upon. The idea is pretty straightforward – to provide
a list of likely diagnoses and treatments,
given the patient’s symptoms and other data.
reservations about data-dominated care: Will
the lists be kept forever in government or health plan databases?
Will the lists be used to judge , to pay for, to reward or as fodder to punish physician performance? Will the lists be a basis for telling doctors
what tests to do and not to do.
Elizabeth Bingham, WellPoint’s VP for Health IT studies, says her firm
is being used to consider what tests to authorize.
There is an
Orwellian danger here – that Big Brother knows best. My main concern is this: Who owns the patient
and doctor data? The government? The
health plan? The patient? The doctor?
There is simply no question in my mind that, given enough data, both
factual and historically,
precisely predict diagnoses, a patient’s comparative health, and courses of
treatment and prevention. But to whose
benefit? And for what purpose? And is
there a possibility of a massive intervention into personal privacy?
Tweet: IBM and WellPoint, using IBM’s supercomputer,
Watson, are working towards providing lists of diagnoses and treatments based
on patient symptoms.
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