Watson in Healthcare & Lifesciences Op weg naar Cognitive Computing

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1 Watson in Healthcare & Lifesciences Op weg naar Cognitive Computing 27 Januari 2014 To wrest from nature the secrets which have perplexed philosophers in all ages, to track to their sources the causes of disease, to correlate the vast stores of knowledge, that they are quickly available for the prevention and cure of disease - these are our ambitions Sir William Osler ( ) Co-founder of the Faculty of Medicine Johns Hopkins University 2014 International Business Machines Corporation 2

2 Introductie spreker Mijn naam: Nicky Hekster Technical Leader Healthcare & LifeSciences IBM Actief in ICT sinds 1987, in HC & LS sinds 2006 Leveranciersvoorzitter IHE Nederland Te vinden op 2014 International Business Machines Corporation 3 Agenda De context van de zorg Watson, wat is er tot nu toe gedaan? Technisch fundament Voorbeelden van Watson Advisors Wanneer is iets Watson waardig? Voorbeelden van de route naar Watson Thomas J. Watson ( ) Discussie over hoe verder 2014 International Business Machines Corporation 4

3 14 februari International Business Machines Corporation Inconsistente kwaliteit en toenemende kosten vragen om verandering Medicatiefouten leiden jaarlijks tot zo'n onnodige opnames Verhoging van doeltreffendheid en doelmatigheid Verbetering van de klinische bedrijfsvoering International Business Machines Corporation De kosten van incidenten in de zorg bedragen jaarlijks 4 miljard euro Geneesmiddelen voor kanker en Alzheimer werken in 75-80% van de gevallen niet Het aantal mensen dat in Nederland per jaar overlijdt aan vermijdbare medische fouten is ca tot 1600 Er gaan jaarlijks miljoenen verloren door administratieve en klinische verspilling, fraude, en misbruik 6

4 Zorgdata hoge volumes en enorme variatie Radiologie Cardiologie Pathologie MDL Dermatologie EPD Ongestructureerd Gestructureerd Geleverde PetaBytes MB/2D beeld 500 MB/4D beeld 2004 >2009 Ongeveer 80% van alle opgeslagen zorgdata is ongestructureerd 1 Zorgdataopslagcapacit eit groeit met 35% per jaar 2 30% van de wereldwijde gegevensopslag bestaat uit medische beelden 3 Data jaarlijks uitgewisseld tussen zorginformatiesystemen: In 2010: 283 terabyte, en in 2020: 78 petabyte miljoen verbonden apparaten AIIM website, geaccepteerd percentage 3 IBM Global Technology Outlook for 2005 Recente studie door de Enterprise Strategy Group International Business Machines Corporation tml 7 Medical Transcription Discharge Summary Sample # 2: Cardiology Consultation Transcribed Medical Transcription SampleReports REFERRING PHYSICIAN: John Doe, MD DATE OF ADMISSION: MM/DD/YYYY CONSULTING PHYSICIAN: Jane Doe, MD HISTORY OF PRESENT ILLNESS: This (XX)-year-old lady is seen in consultation for Dr. John DATE OF DISCHARGE: MM/DD/YYYY Doe. She has been under consideration for ventral hernia repair and has a background of aortic valve replacement and known coronary artery disease. The patient was admitted with complaints Ongestructureerde data zijn rommelig of abdominal pain, anorexia, maar and vomiting. She vol underwent van a CT scan of the abdomen and pelvis ADMITTING DIAGNOSIS: Syncope. and this showed the ventral hernia involving the transverse colon, but without strangulation. There was an atrophic right kidney. She had bilateral renal cysts. The hepatic flexure wall was thickened. CHIEF COMPLAINT: relevante Vertigo or dizziness. medische gegevens There was sigmoid diverticulosis without diverticulitis. It has been recommended to her that she undergo repair of the ventral hernia. For this reason, cardiology consult is obtained to assess HISTORY OF PRESENT ILLNESS: This is an (XX)-year-old male with a past medical history of coronary artery disease,cabg done a few whether she can be cared from the cardiac standpoint. PAST CARDIAC HISTORY: Bypass surgery. She underwent echocardiography and cardiac years ago, atrialfibrillation, peripheral arterial disease, peripheral neuropathy, recently retired one year ago secondary to leg pain. The catheterization prior to the operation. Echocardiography showed an ejection fraction of 50%. There patient came to the ER for an episode of vertigo while reaching for some books. The patient was able to reach the books, to support was marked left ventricular hypertrophy with septal wall 1.60 cm and posterior wall 1.55 cm. self, but did not have any syncope. No nausea or vomiting. No chest pain. No shortness of breath. Came to ER and had a CT head, Coronary arteriography showed 90% stenosis in the anterior descending artery, situated distally which was within normal limits. The impression was atrophy with old ischemic changes but no acute intracranial findings. No focal just before the apex of the left ventricle. Only mild to moderate narrowing was seen elsewhere in weakness, headache, vision changes or speech changes. The patient has had similar episodes since one year. Peripheral neuropathy the coronary circulation. since one year and not relieved with multiple medications. The patient also complains of weight loss of 25 pounds in the last 6 CORONARY RISK FACTORS: Her father had an irregular heartbeat and her brother had a fatal months. No Echocardiogram colonoscopy done. Sample Recent history Report: of hematocheziabut believes it was secondary to proctitisand secondary to decreased heart attack. She herself has had high blood pressure for 20 years. She has elevated cholesterol and takes Lipitor. She has had diabetes for 20 years. She is not a cigarette smoker. She does little appetite. No nausea, vomiting, no abdominal pain. physical exercise. DATE OF STUDY: MM/DD/YYYY REVIEW OF SYMPTOMS: CARDIOVASCULAR AND RESPIRATORY: She has no chest pain. She sometimes becomes short of breath if she walks too far. No cough. She has occasional swelling of PROCEDURES DATE PERFORMED: OF INTERPRETATION The patient had OF a chest STUDY: x-ray, which showed cardiomegalywith atherosclerotic heart disease, pleural her feet. Occasionally, she gets mildly lightheaded. Has not lost consciousness. She tends to be thickening and small pleural effusion, a left costophrenicangle which has not changed when compared to prior examination,copd aware of her heartbeat when she is tired. She has no history of heart murmur or rheumatic fever. pattern. The patient also had a head CT which showed atrophy with old ischemic changes. No acute intracranial findings. GASTROINTESTINAL: Recent GI symptoms as noted above, but she does not usually have such Echocardiogram was obtained for assessment of left ventricular problems. She has had no hematemesis. She has no history of ulcer or jaundice. She sometimes function. The patient has been admitted with diagnosis of has loose stools. No constipation and no blood in the stool. GENITOURINARY: She tends to have Cardiology Consultation Transcribed Medical Transcription SampleReports urinary frequency. She gets up once at night to pass urine. No dysuria, incontinence. She has had CONSULTS OBTAINED: syncope. Overall, A rehab consult the study was was done. suboptimal DATE due to OF poor CONSULTATION: sonic window. MM/DD/YYYY previous urinary infections. No stones noted. NEUROLOGIC: She has occasional headaches. No REFERRING PHYSICIAN: John Doe, MD seizures. No trouble with vision, hearing, or speech. No limb weakness. MUSCULOSKELETAL: She CONSULTING PHYSICIAN: Jane Doe, MD FINDINGS: tends to have joint and muscle pains and has a history of gout. HEMATOLOGIC: No anemia, REASON FOR CONSULTATION: Surgical evaluation for coronary artery disease. PAST MEDICAL/SURGICAL HISTORY: Positive for atrialfibrillation. The patient had AVR 6 years ago. Peripheral arterial disease with abnormal bleeding, or previous blood transfusion. GYNECOLOGIC: No gynecologic or breast HISTORY OF PRESENT ILLNESS: The patient is a (XX)-year-old female who has a known history of coronary artery hypertension, 1. peripheral Aortic root neuropathy, appears normal. atherosclerosis, hemorrhoids, disease. She proctitis, underwent CABG, previous and PTCA cholecystectomy. and stenting procedures in December and most recently problems. in August. Since that time, she has been relatively stable with medical management. However, in the past several weeks, PAST she started MEDICAL to notice HISTORY: some She has had shoulder and hand injuries and has had carpal tunnel 2. Left atrium is mildly dilated. No gross intraluminalpathology exertional dyspnea with chest is pain. For the most part, the pain subsides with rest. For this reason, surgery. she She was re-evaluated has been diabetic and has been on insulin. She has chronic renal insufficiency with with a cardiac catheterization. This demonstrated 3-vessel coronary artery disease with a 70% creatinine lesion to the around right coronary 2.2. She has had hypothyroidism. She has had morbid obesity. She has chronic FAMILY HISTORY: recognized, Positive although for atherosclerosis, subtle abnormalities hypertension, artery; could autoimmune this not was be a proximal diseases excluded. lesion. in the Right The family. left main had a 70% stenosis. The circumflex also had a 99% stenosis. Overall left obstructive sleep apnea and uses BiPAP. She has had hysterectomy and oophorectomy in the past. ventricular function was mildly reduced with an ejection fraction of about 45%. The left ventriculogram did note some apical atrium is of normal dimension. hypokinesis. In view of these findings, surgical consultation was requested and the patient was Otherwise seen and evaluated as noted by above. Dr. 3. There is echo dropout of the interatrialseptum. Doe. Atrialseptaldefects MEDICATIONS: Prior to hospital, she was taking glipizide XL 2.5 mg daily, metoprolol 50 mg PAST MEDICAL HISTORY: SOCIAL HISTORY: could Never not be smoked. excluded. Alcohol socially. No drugs. b.i.d., Cipro 250 mg b.i.d., atorvastatin 40 mg daily, Synthroid 75 mcg daily, aspirin 81 mg daily, 1. Coronary artery disease as described above with previous PTCA and stenting procedures. and Lantus 36 units daily. Currently, she is taking Lipitor 40 mg daily, Lantus 10 units at bedtime, 4. Right and left ventricles are normal in internal 2. Dyslipidemia. dimension. Overall left Synthroid 75 mcg daily, metoprolol 50 mg b.i.d., and Zosyn 2.25 grams q.6h. 3. Hypertension. ventricular systolic function appears to be 4. normal. Status post Eyeball breast lumpectomy ejection for cancer with followup radiation therapy to the chest. SOCIAL HISTORY: She does not drink alcohol. ALLERGIES: NO KNOWN DRUG ALLERGIES. ALLERGIES: None. PHYSICAL EXAMINATION: fraction is around 55%. Again, due to poor sonic window, wall motion Medicatie, MEDICATIONS: Aspirin 81 mg daily, Plavix 75 mg daily, Altace 2.5 mg daily, metoprolol 50 mg GENERAL b.i.d. and APPEARANCE: Lipitor 10 mg She is not currently dyspneic, in no distress. She is alert, oriented, and abnormalities in the distribution of lateral q.h.s. and apical wall could not be pleasant. SOCIAL HISTORY: She quit smoking approximately 8 months ago. Prior to that time, she had about a 35- to 40-packyear history. She does not abuse alcohol. REVIEW OF excluded. SYMPTOMS: Weight loss of 25 pounds within the last 6 months, shortness of breath, constipation, bleeding from HEENT: Pupils are normal and react normally. No icterus. Mucous membranes well colored. hemorrhoids, 5. increased Aortic valve frequency is sclerotic of urination, with normal muscle aches, excursion. FAMILY dizziness MEDICAL Color and flow faintness, HISTORY: imaging focal Mother and weakness died prematurely and numbness of breast cancer. both legs, Her father knees died prematurely NECK: Supple. of gastric No lymphadenopathy. Jugular venous pressure not elevated. Carotids equal. aandoeningen, carcinoma. HEART: The heart rate is 82 per minute and regular and the blood pressure 132/78. The cardiac and feet. Doppler study demonstrates trace aortic regurgitation. REVIEW OF SYMPTOMS: There is no history of any CVAs, TIAs or seizures. No chronic headaches. impulse No has asthma, a normal TB, quality. There is a grade 3/6 ejection systolic murmur heard medial to the hemoptysis productive cough. There is no congenital heart abnormality or rheumatic fever 6. Mitral valve leaflets are also sclerotic with normal excursion. Color apex history. and She at has the no aortic area, with well heard radiation to the neck vessels. palpitations. She notes no nausea, vomiting, constipation, diarrhea, but immediately prior to admission, she did develop CHEST: Chest is clear to percussion and auscultation. Normal respiratory effort. flow imaging and Doppler study demonstrates some diffuse trace abdominal to mild degreeof discomfort. She says that since then, this has resolved. No diabetes or thyroid problem. There is PHYSICAL EXAMINATION: VITAL SIGNS: Blood pressure 188/74, pulse 62, respirations 18 symptomen, no depression or psychiatric problems. and There saturation is no musculoskeletal of 98% on room disorders air. General or history of gout. ABDOMEN: There are no Soft hematologic and nontender. The presence of a large ventral hernia is noted. Appearance: mitral The patient regurgitation. is a pleasant man, comfortable. HEENT: problems Conjunctivae or blood dyscrasias. are normal. No bleeding PERRLA. tendencies. EOMI. Again, NECK: she No had a history of breast cancer EXTREMITIES: and underwent There is no edema. Posterior tibial pulses were felt bilaterally, but I did not feel the lumpectomy procedures for this with followup radiation therapy. She has been followed in the masses. Trachea 7. Tricuspid is central. valve No thyromegaly. is delicate and LUNGS: opens Clear normally. to auscultation Pulmonicvalve and percussion is not bilaterally. HEART: Irregular dorsalis past 10 years pedis. and mammography shows no evidence of any recurrent problems. There is no recent fevers, malaise, changes in appetite or SKIN: No rash or significant lesions are noted. rhythm. ABDOMEN: clearly seen. Soft, nontender, No evidence and of nondistended. pericardial effusion. Bowel changes sounds in weight. are positive. GENITOURINARY: labwaarden, Prostate is hypertrophic with LABORATORY sociale AND DIAGNOSTIC DATA: Electrolytes are normal. BUN and creatinine 18/2.2. smooth margin. EXTREMITIES: Upper and lower limbs bilaterally PHYSICAL normal. EXAMINATION: SKIN: Normal. Her blood NEUROLOGIC: pressure is 120/70, Cranial pulse nerves is 80. are She grossly is in a sinus rhythm on the EKG monitor. Respirations are 18 and unlabored. Temperature 98.2 degrees Fahrenheit. She weighs Blood 160 sugar pounds, 150. she White is 5 feet count is 7.6, hemoglobin 11.7 with hematocrit 34.9, platelets 187,000. within normal CONCLUSIONS: limits. No nystagmus. DTRsare normal. Good 4 inches. sensation. In general, The patient this was is an alert, elderly-appearing, awake, and pleasant oriented female x3. Mild who confusion. currently is not in acute LFTswere distress. normal. Skin color Hemoglobin and A1c 7.7. TSH Troponin I was normal on three occasions. turgor are good. Pupils were equal and reactive light. Conjunctivae clear. Throat is benign. Chest Mucosa x-ray was moist showed and an enlarged heart with postoperative changes, but no evidence of acute noncyanotic. Neck veins not distended historie, at 90 degrees. Carotids had 2+ upstrokes familie bilaterally without bruits. No pathology. EKG shows probable left atrial enlargement. Low voltage QRS, probable inferior wall lymphadenopathy was appreciated. Chest had a normal AP diameter. The lungs were clear in the apices and bases, no 1. Poor quality study. LABORATORY DATA AND RADIOLOGICAL RESULTS: WBC 8.6, wheezing hemoglobin or egophony 13.4, appreciated. hematocrit39.8, The heart platelets had a normal 207,000, S1, MCV S2. No 91.6, murmurs, clicks or gallops. myocardial The abdomen infarction was and soft, anterior wall infarction, age undetermined. neutrophilpercentage 2. Eyeball of ejection 72.6%. Sodium fraction 133, is 55%. ASSESSMENT: potassium 4.7, nontender, chloride nondistended Blood urea Good nitrogen bowel sounds of 18 present. and creatinineof No hepatosplenomegaly 1.1. PT 17.4, was INR appreciated. No pulsatile masses were felt. No abdominal bruits were heard. Her pulses are 2+ and equal bilaterally in the upper and 1.6, PTT Trace to mild degree of mitral regurgitation. 1. lower Aortic extremities. valve replacement No with bioprosthetic valve. Residual systolic murmur. clubbing is appreciated. She is oriented x3. Demonstrated a good amount of strength in the upper 2. Arteriosclerotic and lower geschiedenis, heart disease with severe stenosis in anterior descending artery, but this is 4. Trace aortic regurgitation. extremities. Face was symmetrical. She had a normal gait. situated distally and subtends only a small mass of myocardium. IMPRESSION: This is a (XX)-year-old female with significant multivessel coronary artery disease. The patient also has a left main lesion. She has undergone several PTCA and stenting procedures within the last year 3. to Well year and preserved a half. At left this ventricular systolic function. The EKG appearance of previous myocardial The patient had a chest x-ray, which showed cardiomegalywith point, atherosclerotic order to reduce heart the risk disease, of any possible pleural thickening ischemia in the and future, small surgical pleural myocardial revascularization infarction is probably is serious, indicating multiple other medical problems as listed above effusion, a left 2014 costophrenicangle International which Business has not changed Machines when recommended. compared Corporation to prior examination,copd pattern. The patient also had a and also documented in the chart. 8 PLAN: We will plan to proceed with surgical myocardial revascularization. The risks and benefits of this procedure were head CT, which showed atrophy with old ischemic changes. explained No acute to intracranial the patient. All findings. questions pertaining to this procedure were answered. RECOMMENDATIONS: It appears that she does not wish to proceed with the surgery at this time, and if such surgery is not

5 Zorg op het lijf geschreven - realiteit vereist betere toegang tot en analyse van relevante patiëntinformatie en klinische kennis Goed Meer kunst dan wetenschap Meer wetenschap dan kunst Zorginformatie verdubbelt elke 5 jaar Toegang tot relevante patiëntinformatie Waarde Gepersonaliseerd (Gebaseerd op mensen zoals ik) Voorspellend en Evidence-based (Gebaseerd op patiëntencohorts) 80% van de artsen hebben hoogstens 5 uur/maand om hun Intuïtief vakliteratuur en volgens klinische consensus bij te (Op basis van partiële toegang tot beschikbare patiëntinformatie en klinische kennis) houden Proefondervindelijk (Gebaseerd op expertise en ervaring) Matig 1 op de 5 diagnosen Toegang tot klinische is niet Matig kennis accuraat of Goed (e.g. Diagnostische hulpmiddelen, kennis van de oorzaken van ziekten, empirisch bewijs of vergelijkende effectiviteit) onvolledig Bron: IBM Global Business Services and IBM Institute for Business Value 2014 International Business Machines Corporation 9 Waar is de holistische kijk op de patiënt? Symptomen Koorts, duizeligheid, buikpijn, rugpijn, hoest,... Familiehistorie Diabetes, borstanker, hartproblemen, erfelijke ziekten,... Patiënthistorie Hoge bloeddruk, verhoogd cholesterolgehalte, verminderde schildklierwerking, chronische blaasontsteking, roken, alleenwonend,... Klinische historie Bloeddruk, hartslag, temperatuur, pijnscores, labuitslagen,... Medicatiehistorie Pravastatine, betablokkers, lasix, aspirine, chemotherapie, antiemetica, International Business Machines Corporation 10

6 Ontworpen voor de uitdagingen in taal en betekenis food would get stuck when she was swallowing swallowing difficulty food gets held-up Causation can cause food to move slowly in the esophagus. Terminology Normal QRS Pattern Abnormal QRS Complex Delta-Wave PR Interveral Domain coryza sudden onset of chills cold Chronology Terminology chills Magnitude High Temperature Temperature Fever Chronology Fever after acute symptoms subside Negation productive cough after nonproductive cough productive cough nonproductive cough Chronology Terminology pneumaturia bubbles in the urine Abdomen Pain Urination Pain Causation Dysuria Abdomen Pain exacerbated by exercise between the upper abdomen and the back Kidney Pain Flank Pain Lower Back Pain Location 2014 International Business Machines Corporation 11 Gebruikt de New England Journal of Medicine voor annotaties van medische concepten Aandoening Symptomen Medicatie Modificatoren 2014 International Business Machines Corporation 12

7 Big Data: meer dan de traditionele datatypen Transactionele - en applicatiedata Social Media data Enterprise Content Wetenschappelijke artikelen Medische beelden Klinische rapporten International Business Machines Corporation 13 De Megatrends Cloud Mobile Social Analytics 2014 International Business Machines Corporation 14

8 Big Data meer dan de volume-dimensie! Volume Velocity Variety Veracity Petabytes Exabytes Zetabytes Iotabytes Brontobytes Geobytes Streaming data, milliseconden tot seconden tijd om te antwoorden Gestructureerd, ongestructureerd tekst, multimedia Onzekerheid, inconsistensie, ambiguiteiten 2014 International Business Machines Corporation 15 Watson luidt een nieuw computertijdperk in Tabellerende Systemen Programmeerbare Systemen Cognitieve Systemen Systemen welke: In en op natuurlijke taal reageren Oceanen van gestructureerde en ongestructureerde gegevens verwerken Van elke interactie leren 2014 International Business Machines Corporation 16

9 Voor een computer is taal pas echt lastig! Schaken (Deep Blue, 1997) Een eindige welgedefinieerde afgebakende zoekruimte Beperkt aantal zetten en situaties Gebaseerd op expliciete, eenduidige wiskundige regels Natuurlijke taal Meerduidig, context afhankelijk en impliciet Gebaseerd op menselijk cognitief vermogen Ogenschijnlijk een oneindig aantal manieren om hetzelfde uit te drukken 2014 International Business Machines Corporation 17 Commercialisatie van Watson vereist een aantal substantiële stappen Watson aan het spelen Watson aan het werk 1 Gebruiker 1 Vraag Max. input 2 zinnen Stateless Focus op beste antwoord 1 week hertrainen Bewijs niet aanwezig Alleen tekstinvoer Q&A omgeving Elementaire beveiliging 1000en Gebruikers tegelijkertijd Samengestelde vragen Uitgebreide tekst input Statefull Nadruk op beste suggesties Dynamische invoer van content Volledige traceerbaarheid Tekst, tabellen, plaatjes, Q&A + Case Mgmt. omgeving Privacy & security (e.g. HIPAA, NEN 75xx, ) 2014 International Business Machines Corporation 18

10 De adviseur van de arts Complexe diagnosen Betere en beter afgestemde medicatie Voorkomen van medische missers Evidence Based Medicine (EBD) Natuurlijke taal interface NLP Opstellen van hypothesen Zelf-lerend en adaptief 2014 International Business Machines Corporation 19 Hoe Watson werkt: DeepQA architectuur Learned Models help combine and weigh the Evidence Question Answer Sources Primary Search Candidate Answer Generation 100 s Possible Answers 100 s sources Answer Scoring 1000 s of Pieces of Evidence Evidence Sources Evidence Retrieval Deep Evidence Scoring 100,000 s Scores from many Deep Analysis Algorithms Balance & Combine Models Models Models Models Models Models Question/Topi Multiple c Analysis Interpretations of a question Question Decomposition Hypothesis Generation Hypothesis and Evidence Scoring Synthesis Final Confidence Merging & Ranking Hypothesis Generation Hypothesis and Evidence Scoring Responses with Confidence 2014 International Business Machines Corporation 20

11 De componenten van Watson Decomposition Hypothesis Generation Question & Topic Analysis Hypothesis & Evidence Scoring Synthesis Final Confidence Merging & Ranking Workload Optimized 2014 International Business Machines Corporation 21 Het Watson Platform Specialized Watson Advisor Solution Evidenc e Lexicon s Answers Data Ontologie Training Data s StructuredUnstructure Abbreviationsd Algorithms / NLP Integration Services Tooling Extensions User Experience / Watson Enabled App Evidenc e Lexicon s Domain Accelerators (Healthcare, Financial Services, Contact Center, etc.) Answers Training Data Ontologie s Data Algorithms / NLP Methodology StructuredUnstructure Abbreviationsd Tooling Extensions User Experience Patterns Evidenc e Lexicon s Structure d Answers Data Abbreviation s Ontologie s Tooling Accuracy & Solution Construction Content Creation & Management Training Data Unstructure d General Watson Platform Core Infrastructure, Ops, Lifecycle & System Management User Experience Patterns / Watson Enabled App Toolkit Runtime Algorithms / NLP Methodology Extensability/ Programmability Full Lifecycle Ready Build Teach Run 2014 International Business Machines Corporation 22

12 Watson Referentie Architectuur Solution Watson for Healthcare Watson for Financial Services Watson for Contact Center Watson for Industry User Experience / User Interface Product NOW NOW NOW Future Watson Decision Advisor Watson Engagement Advisor Watson Diagnose & Treatment Advisor Watson xxx Advisor Watson future Advisor ASK Services DISCOVER Services DECISION Services Technology NLP & Machine Learning Data Analytics Cloud Mobile Workload Optimized Systems Foundation Content Tooling Methods Algorithms APIs 2014 International Business Machines Corporation Annonceringen van Watson Eerste twee commerciële producten 8 februari 2013 Eerste twee zorgproducten geannonceerd i.s.m. WellPoint en MSK, Watson Decision Advisor, Research & Insight Advisor Watson Ecosystem 14 november 2013 Watson Ecosystem Developer Cloud, Content Store, APIs T.b.v. innovatie en het cultiveren van nieuwe mogelijkheden Januari 2013 April Juli Oktober December 2013 Watson Engagement Advisor 21 mei 2013 Watson Engagement Advisor geannonceerd Cross-industry en crossgeography Watson Healthcare Update 18 oktober 2013 MD Anderson lanceert de Watson Diagnosis & Treatment Advisor Watson wordt gebruikt om een brug te slaan tussen klinische praktijk en medisch onderzoek 2014 International Business Machines Corporation 24

13 Watson Engagement Advisor Helpt organisaties de diensten naar hun klanten te verbeteren. Betrekt klanten via een dialoog bij zoeken naar informatie en het nemen van beslissingen. Call centers Banken Verzekeraars International Business Machines Corporation 25 IBM Oncology Diagnosis & Treatment Advisor Laat zien hoe Watson een oncoloog kan assisteren bij: Correlatie van verspreide data, zoals patiëntendossiers, professionele samenvattingen, testresultaten, pathologie rapporten, etc. Identificatie van ontbrekende gegevens en aanbeveling om aanvullende onderzoeken te doen. Suggereren van patiëntgepersonaliseerde, gewogen, evidence-based behandelopties 2014 International Business Machines Corporation 26

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16 Creating a Corpus of Knowledge for Cancer Care Ingestion of NCCN guidelines for breast cancer and lung cancer: Roughly 500,000 unique combinations of breast cancer patient attributes. Roughly 50,000 unique combinations of lung cancer patient attributes. Over 600,000 pieces of evidence ingested, from 42 different publications/publishers, including: The Breast Journal, National Comprehensive Cancer Network (Clinical Practice Guidelines, Drug and Biologics compendium, et al.), American Journal Of Hematology, Annals Of Neurology, CA: A Cancer Journal For Clinicians, Cancer Journal, Cochrane, EBSCO, Hematological Oncology, Hepatology, International Journal Of Cancer, Journal Of Gene Medicine, Journal of Clinical Oncology, Journal of Oncology Practice, Massachusetts Medical Society Journal Watch, Massachusetts Medical Society New England Journal Of Medicine, Merck, Nephrology, UptoDate, Clinical Lung Cancer, Current Problems in Cancer, Cancer Treatment Reviews, Elsevier's Monographs in Cancer (multiple), Clinical Breast Cancer, European Journal of Cancer, Lung Cancer (the journal) International Business Machines Corporation IBM Confidential 31 Nieuw in 2014 IBM Watson Business Unit - HQ in New York Commercialisatie van cognitieve producten en diensten Investering van $1 miljard over een aantal jaren 2000 professionals, $100 miljoen equity investment Nieuwe Watson producten Marketing research Visualisatie sp corp flexibi #users Size speed corpus flexibility #users size speed corpus flexibility #users s 2880 cores Single Power 750, 240% faster Watson cloud service Single user system 1000s of users Millions of users 2-3 sentences input 20 pages of input Dialog chaining 2014 International Business Machines Corporation 5+ days to retrain < Day to ingest and train Few hours Wikipedia, general corpus Medical corpus Broad industry corpus 32

17 Watson Hoofdkantoor 51 Astor Place, Manhattan (Silicon Alley) Incubator voor innovatie Client Solutions Center Interactieve hands-on Design Lab Workshops en Seminars 2014 International Business Machines Corporation 33 Watson Analytics Maakt via natuurlijke taal data selecties, semantische en mathematische analyse op de achtergrond Om nieuwe patronen snel te herkennen via een eenvoudig NLP en visueel interface betere beslissingen snel te nemen Focus op Sales & Marketing Cloud-based model International Business Machines Corporation 34

18 Watson Explorer Visualisatie exploratie software om mensen te helpen met het begrijpen van wat er in hun gegevens schuil gaat Vinden, ophalen en afleveren van content ongeacht het formaat of waar het zich bevindt Gestructureerde data, ongestructureerde content, e.d International Business Machines Corporation 35 Hoe met Watson aan de slag te gaan? Workshop Watson of de route naar Watson? IBM Global Business Services (GBS) Watson Assessment Workshop IBM Software Groep IBM Center for Advanced Studies (CAS) Onderzoek i.s.m. VU Infomatica, Amsterdam 2014 International Business Machines Corporation 36

19 Technische Routekaart Ontsluiting databronnen (taal!), content ingestie (e.g. Patiëntregisters) Consolidatie, opschoning en verrijking van de data Visualisatie middelen Content sharing Annotations en Rules Trainen van Watson Connections Predictive tooling 2014 International Business Machines Corporation 37 Wanneer is het nu Watson? 1/2 Natuurlijke taal interactie met evidence based, confidence weighted antwoorden, leren van nieuwe inzichten Cognitief Vertel me wat ik het beste kan doen Cognitief Stochastische optimalistaie Optimalistaie Wat is de beste optie gegeven de variabiliteit? Voorschrijvend Hoe kunnen we de beste uitkomst krijgen? Modelleren Wat zal er gebeuren als? Business Value Simulatie Voorspellen Wat kan er gebeuren? Wat als deze trends aanhouden? Voorspellend Alarmsignalen Welke acties zijn nodig? Analyse Wat is het probleem precies? Ontdekking Hoe veel, hoe vaak, waar? Beschrijvend Rapportage Wat gebeurde er? 2014 International Business Machines Corporation 38

20 Wanneer is het nu Watson? 2/2 Het is Big Data wanneer Het is BI (Cognos) wanneer Het is SPSS wanneer Het is Watson wanneer... Dealing with large complex and dynamic data sets Looking to coordinate structured and unstructured data Interest is in streaming data Looking to find rare events, common patterns, and outliers General focus is on data architecture, extraction, transformation, movement, storage, integration, and governance Need is for reporting, dashboards & scorecards - Business Intelligence Looking to spot and analyze trends, patterns and anomalies In-memory reporting and analysis is required Need is to perform enduser query and analysis Requirements are for planning, budgeting and forecasting resources Desire is to leverage predictive outcomes Data mining is required for deep insights and pattern recognition Interest is in using statistics including logistic regression. Looking to create predictive scores around key attributes Automating decision management processes leveraging predictive analytics and business rules for optimization. Looking to perform question and answer iterations with confidence based responses Need to work with unstructured data, leveraging natural language processing to deal with complexity of human speech. Hypothesis generation and validation is critical to the process Evidence based learning is integral to the solution delivered 2014 International Business Machines Corporation 39 De 5 kernfunctionaliteiten van Watson Analyseert grote volumes van gestructureerde en ongestructureerde data Combineert grote hoeveelheden ongestructureerde met gestructureerde gegevens om samen te worden geanalyseerd Interpesteert en begrijpt vragen gesteld in een natuurlijke taal Begrijpt dubbelzinnige en onduidelijke vragen met behulp van geavanceerde natuurlijke taal algoritmen Genereert en evalueert hypothesen en kwantificeert het vertrouwen in de antwoorden Identificeert veel antwoorden op vragen met bewijs om de rationaal te verklaren Ondersteunt een iteratieve dialoog om de antwoorden te verfijnen Stelt iteratieve en interactieve vragen ter verfijnening verbetering van de resultaten Past zich aan en leert om in het vervolg met nog betere resultaten te komen Leert van aanvullend bewijs, aanvullende vragen en fouten om in de tijd de nauwkeurigheid te verbeteren 2014 International Business Machines Corporation 40

21 IBM Content and Predictive Analytics for Healthcare Extract medical facts and relationships from multiple clinical and operational information sources Analyze and Visualize past, present and future scenarios to create an evidence based corpus of information Enable clinicians, executives and knowledge workers to Interact with information and derive insight in new ways Integrate and leverage other systems to turn insight to action Raw Information IBM Content and Predictive Analytics Analyzed and Visualized Information Dynamic Multimode Interaction Unstructured Data (Nurses notes, discharge notes, etc.) Structured Data (Billing data, EMR, etc.) Content Analytics Natural Language Processing Medical Fact and Relationship Extraction (Annotation) Trend, Pattern, Anomaly, Deviation Analysis Predictive Analytics Predictive Scoring and Probability Analysis Search and Visually Explore (Mine) Monitor, Dashboard and Report * Future optional capability Partners (HLI) Health Integration Framework Specialized Research Data Warehouse and Model Master Data Management Advanced Case Management Business Analytics Question and Answer* Custom Solutions 2014 International Business Machines Corporation 41 Slimmere gezondheidszorg d.m.v. analytics Integratie van virale genomics data met klinische gegevens om de reactie op een anti- HIV therapie te voorspellen. Koppeling van o.a. DNA-expressies en klinische data voor een beter begrip van en sneller onderzoek naar inflammatoire darmziekten. Real-time analytics op streaming data van medische instrumenten ter monitoring van te vroeg geboren baby's in het Toronto Sick Children's Hospital. Verbetering van kennis en diagnostiek en vroegtijdige herkenning t.b.v. zeldzame ziekten. Verbetering van kennis over en plannen van Creëren van een uitgebreide corpus van heropnames rondom Congestief Hartfalen gegevens over Epilepsie, waaruit via predictive (CHF) via het correleren van ongestructureerde analytics betere behandelingen en en gestructureerde data. medicatievoorschriften worden gedistilleerd International Business Machines Corporation 42

22 Seton - wat werd er gevonden? De gegevens waarvan men dacht dat ze nuttig waren, waren dat niet! 113 kandidaat-predictoren uit gestructureerde en ongestructureerde data bronnen Gestructureerde gegevens waren minder betrouwbaar Nieuwe onverwacht indicatoren kwamen naar boven drijven 18 accurate indicatoren of predictors Predictor Analysis % Encounters Structured Data % Encounters Unstructured Data Ejection Fraction (LVEF) 2% 74% Smoking Indicator 35% (65% Accurate) 81% (95% Accurate) Living Arrangements <1% 73% (100% Accurate) Drug and Alcohol Abuse 16% 81% Assisted Living 0% 13% 2014 International Business Machines Corporation 43 Seton - top 18 indicatoren LVEF en Roken zijn significante indicatoren van CHF maar niet van heropnamen. Assisted Living en Overmatig Drugs en Alcohol Gebruik bleken de belngrijkste predictors (alleen aangetroffen in ongestructureerde data) Vele predictoren werden in historische en observationele aantekeningen gevonden 18. Jugular Venous Distention Indicator 17. Paid by Medicaid Indicator Immunity Disorder Disease Indicator Cardiac Rehab Admit Diagnosis with CHF Indicator Lack of Emotion Support Indicator Self COPD Moderate Limit Health History Indicator With Genitourinary System and Endocrine Disorders Heart Failure History High BNP Indicator Low Hemoglobin Indicator 5 8. Low Sodium Level Indicator Assisted Living (from ICA Extract) 2 6. High Cholesterol History Presence of Blood Diseases in Diagnosis History High Blood Pressure Health History Projected Odds Ra o 3. Self Alcohol / Drug Use Indicator (Cerner + ICA) Heart Attack History Heart Disease History 2014 International Business Machines Corporation 44 Ranking of Strength of Model Variable

23 Regio Montpellier: reumatoïde polyartritis Chronische ziekte aantasting van het autoimmuun systeem, ontsteking van het synoviaal vlies Invaliderende misvorming van gewrichten vnl. handen en voeten Zeer belangrijk dat de behandeling aangepast wordt aan de patiënt, want polyartritis uit zich niet bij iedereen op dezelfde manier De ziekte kent hoge en lage fasen Erosieve en niet-erosieve vormen Een goede vroege behandeling kan leiden tot een lange lage fase IBM La Gaude Global Healthcare Center of Excellence gebruikte ICPA Annotaties van Franse medische termen Ontwikkelen van een prototype Het vinden van de risico predictoren bij het eerste bezoek van de patiënt 2014 International Business Machines Corporation 45 Architectuur Data Warehouse Longitudinal patient record Extraction, integration Share knowledge IBM Cognos BI - Sharing reports - Operational dashboards Structured & Unstructured datasources Metadata Predictive data Medical & operational optimisation actions IBM Content Analytics - Natural language processing jobs - Data mining IBM SPSS Modeler - Building a predictive model - Scoring jobs Identification of facts, correlations Scoring based on historical data 2014 International Business Machines Corporation 46

24 Watson pilot project in het UMCG Onderzoek naar hoofd-hals kanker Zoeken in gestructureerde en ongestructureerde data naar correlaties tussen hoofd-hals kanker en andere aandoeningen (comorbiditeit) Opstellen van een business case voor gebruik in de praktijk van dit soort technieken Content invoer, annotaties en rules Cohort van 600 geanonimiseerde patiënten ( ) Ontslagbrieven, verwijsbrieven, medicatiedossiers, etc. DHD medische termen Behandelingen, diagnose methodieken, protocollen, e.d. Technologie: IBM Content en Text Analytics 2014 International Business Machines Corporation 47 Met dank voor uw aandacht 2014 International Business Machines Corporation 48

25 2014 International Business Machines Corporation 49 The Singularity is near When humans transcend technology De Wet van de Versnellende Meeropbrengst voorspelt een exponentiële toename in technologie computers, genetica, nanotechnologie, robotica, kunstmatige intelligentie. Dit leidt tot een technologische singulariteit in 2045 Versnelling gaat harder dan de mens kan bevatten. De mens zijn lichaam en geest uitbreiden met genetische veranderingen, nanotechnologie, en AI International Business Machines Corporation 50