Monday, April 30, 2012

The Computer 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.
The KHN Blog, April 30, 2012

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.

Pierre Simon de Laplace (1749-1827),  Ouevres, Volume VIII, Theorie Analytique des Probabilities (1812-1820)
April 30, 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.
That said, 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 .   

When a national laboratory bought our laboratory in 1985, the national firm discontinued the two programs, presumably because of expense and potential medical liability claims.
Nevertheless, 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.
IBM and 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.
I have 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,
 one can 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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