B.Buchanan NewChallengeforAIinHealthcare

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BruceG.BuchananUniversityProfessorofComputerScienceEmeritus(FormerlyalsoProfessorofPhilosophy,Medicine,andIntelligentSystems)

UniversityofPittsburgh2/21/12 1B.Buchanan

MAINPOINTSOFTHISTALK

I.  SmallappsonmobiledevicesareexploitingpriorresearchinAIandtheplethoraofinformationontheever‐expandingweb.

II.  Followthemoneytofindopportunities

III.AnewchallengeforAIishelpingpeopleavoidboththevolumeofrelevantinformationandthenumberofrelevantapps.

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$10mX‐Prize

  The$10millionbountywillgotothefirstteamthatcancreate“amobileplatformthatmostaccuratelydiagnosesasetof15diseasesacross30[patients]inthreedays”

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Old Style Medical Decision Making Program

Centralizing:ElectronicHealthRecords  Nearly40percentofAmericanprimarycaredoctorsand

about25percentofhospitalsuseelectronicpatientrecords.

  SuppliersofhealthdatasystemsincludeEpic,Alscripts,Meditech,CernerandunitsofdiversifiedgiantslikeI.B.M.,McKesson,SiemensandGEHealthcare.

  “Allofthosecompanies’varyingsystemshaveraisedconcernsaboutusability,especiallywhendifferentsystemsmustshareinformation.Somewonderifthegovernmentshouldplayabiggerroleincreatinguniformtechnicalstandardsanddesignsacrosssystems.”

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I.What’sDifferentNow?•Interconnectedness

SocialComputingCrowdsourcing“InternetofThings”

•MobileDevicesUbiquityVoice+Vision

•VolumeofAccessibleDataReminding/AlertingSystemsNLP‐‐Semantics+StatisticsDataMining

•MatureAITechnology NaturalLanguage VisionSpeech 2/21/12 5B.Buchanan

SomeNewApps

Reference:FromPCtoPhone  MicromedexoffersiPhoneandiPadappsforitsdrugreferenceguideandmedicationinteractionchecker.

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Looks like a book

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Reference:FromPCtoPhone

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MedscapefromWebMD

SocialNetworking

  Sermo‐‐freeapp“allowsphysicianstoshareclinicalimages,askquestions,anddiscussandshareideasonclinicalcases,healthpolicy,practicemanagement,andmore.”

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Crowdsourcing

  FoldItbySethCooperetal.,UniversityofWashingtonagamedesignedtotackletheproblemofproteinfolding.

  “Folditshowedthatitispossibletoeffectively“crowdsource”humanproblemsolvingtosolveveryhardscientificproblems.”

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Foldit

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Today,theInternet‐‐tomorrow,theInternetofThings?  Anythingwithintelligence(includingmachines,roads

andbuildings)willhaveanonlinepresence,generatingdatathatcouldbeputtousescurrentlyunimagined.

  Inhealthcarethereshouldbe1.5milliondevicesattheendoftheyear,withagrowthrateof20%to25%.‐‐usuallywornbyapatienttomonitorachroniccondition,suchasadevicethatadvisesaheartdiseasepatientwhentotakemedicine

[ComputerWorld,Nov.9,2011]

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DataCollection“Oneexperimentaldevicefitssnuglyaroundananimalheart,collectinginformationandstimulatingtheheartmuscleswithelectriccurrentlikeanearlyinvisiblepacemaker.Othercircuitscanbeattachedtothebrainorskinlikeatemporarytattoo.”

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AdvancesinVision

  MIMMobile–“aremotediagnosticimagingtoolforthe

iPad,iPhone,andiPodtouch.”

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MobileDevices:Ubiquity

“Fouroutoffivepracticingphysiciansusesmartphones,computertablets,variousmobiledevices,andnumerousappsintheircustomarymedicalpractices” [InformationWeekOctober21,2011]

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ApplesellsmoreiPhonesperday(402k)thanpeoplebornintheWorldperday(300k)[http://cnet.co/zNhPzb]

Interconnection:Alerting

  PatientmonitorsareconnectedtoanetworkandeveryalarmtheyproduceiscapturedbyAlertLink.Asmallpercentageofthosealarmsareconsideredlifecriticalandcanbeforwardedtoacaregiver’smobiledevice,suchasaphone.

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PetabytesofOnlineData=ThousandsofTerabytes,MillionsofGigabytes

AMAZON.COM–59millionactivecustomers;Personalinformation(phonenumberaddress,etc),receipts,wishlists,andvirtuallyanysortofdatathewebsitecanextractfromitsuserswhiletheyareloggedon.Plus250Kbooksonline(fulltext)

GOOGLE.COM91millionsearchesperday(halfofallInternetsearches)33trillionentriesstoredindatabasesperyear

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RecognizingtheValueofLargeAmountsofData:FDAInitiative

  FDAcurrentlyhousesthelargestknownrepositoryofde‐identifiedclinicaldata‐‐safety,efficacy,andperformance+postmarketsafetysurveillancedata.

  allowustoaddressfundamentalscientificquestionsabouthowdifferenttypesofpatientsrespondtotherapy.

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AdvancesinNLP:MedicalDatainText

  “Approximately1.2billionclinicaldocumentsareproducedintheUnitedStateseachyear.Thesedocumentscomprisearound60%ofclinicalinformation…“

HealthStoryProjecthttp://www.healthstory.com/about/about.htm

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Full‐TextMedicalRecordsatPitt:MARS

  History&Physical+DischargeSummaries  LabResults  PharmacyOrders  OperativeReports  OutpatientProgressNotes  Radiology&CardiologyReports  FinancialChargeDetails

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FullTextRecordsatPitt

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NaturalLanguageUnderstanding  De‐IDSystem:MakingFullTextRecordsAnonymous

  [G.Cooper,B.Buchanan,P.Hanbury,M.Saul]  Heuristicsfindanyof18HIPAA‐speecifiedidentifiers  Dictionariesofplacenames  Medicaltermswithpropernamespreserved  Sametagsusedinmultiplereplacementsofsamename

  [EvaluationofaDeidentification(De‐Id)SoftwareEnginetoSharePathologyReportsandClinicalDocumentsforResearchDilipGupta,MD,1MelissaSaul,2andJohnGilbertson,MD1.AmJClinPathol2004;121:176‐186]

  Neg‐Ex:DeterminingNegationsinMedicalText[ChapmanWW,BridewellW,HanburyP,CooperGF,BuchananBG.Asimplealgorithmforidentifyingnegatedfindingsanddiseasesindischargesummaries.JournalofBiomedicalInformatics34(2002)301‐310.]

  IBM’sWatson:StatisticalNLP  HealthMap(UW):ReadingandSummarizingText

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WATSON:CopingwiththeVolumeofInformation

  Startwithcrediblesources(e.g.,textbooks,encyclopedias,peer‐reviewedjnls)

  Associationsoftermswithin200millionpagesofcurrentdocumentswillsuggestcorrectanswers

  Augmentassociationswithsomeknowledgeofgrammar,languageuse(e.g.,metaphors),realworld

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HealthMap:ReadingTextfromGoogleNews+OtherSources

  Diseasealertswithin100milesofSeattle,Washington,UnitedStatesinthepastmonth.

  Gastrointestinal

  Jan16Victoria,BritishColumbia,CanadaDozensremainisolatedinVictoriahotelroomsafterNorovirusoutbreak‐VictoriaTimesColonist… Respiratory

  Jan13CowlitzCounty,Washington,UnitedStatesMorecasesofwhoopingcoughdocumentedinCowlitzCounty‐LongviewDailyNews

  Jan13GrantCounty,Washington,UnitedStatesGrantwhoopingcoughoutbreakdowngraded‐TheNewsTribune.com… 2/21/12 23B.Buchanan

HealthMap:InteractiveView

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II.HowCanSmallAppsMakeaDifference?II‐A.FollowtheMoney

  In2000,healthcarespendingroseto$1.3trilliondollars,oranaverageof$4,637perperson.

SomeDocumentedCosts

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Costs:Physicians’Time

  15‐17%oftheirtimeindirectpatientcare.  64‐67%oftheirtimeinindirectpatientcare(dividedbetweenreviewingresults,performingdocumentation,andengagingincommunication)

  Reviewingresultsandcarryingoutdocumentationareclearlyinformation‐focusedinnature,whichmeansthatphysiciansspendabout35‐40%oftheirtimeengagedwithinformation

[BillHershhttp://informaticsprofessor.blogspot.com/2012/02/is‐medicine‐information‐science.html]

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COSTS:WasteintheSystem

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[“HealthCare’sWastedDollars”http://money.cnn.comAug.10,2009]

COSTS:HospitalERVisit(2008,MEPS)

  AverageexpensesforavisittotheEmergencyRoomwere$1265in2008

‐Ages45to64 $1681‐Ages65andup $1554‐Childrenunderage18 $351‐$412

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COSTS:ClaimsProcessing

  Inefficientclaimsprocessingcostsasmuchas$210billionannually‐"Wespendalotoftimeandmoneytryingtogetpaidbyinsurers,"saidDr.TerryMcGenney,aKansasCity,Mo.‐basedfamilyphysician.‐"Everyinsurancecompanyhasitsownforms,"McGenneysaid."Somepracticesspend40%oftheirrevenuefillingoutpaperworkthathasnothingtodowithpatientcare.Somuchofthiscouldbeautomated."

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Costs:Non‐Compliance

  10‐25%ofhospital&nursinghomeadmissions,resultingin340deathsperday

  20%ofunintentionalpregnanciesintheUSatacostof$2.6billion

  3timesasmanydoctorvisits&$2000peryearinadditionalcostscomparedtopatientswhofollowtheirtreatmentplan

  33‐69%ofallmedication‐relatedhospitaladmissionsintheUSatacostof$100billion

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COSTS:MedicalErrors

  98,000Deaths,$29billionincosts  Solution=ComputerizedMedicalRecords  SystemsInvestmentof$115billionover15yearscanproduceyearlysavingsof$81billionfromefficiencyanderroravoidance

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COSTS:ICUSTAY

  MeanlengthofstayinICU(2002)=8.5‐14.4days(withoutorwithmechanicalventilation)

  Coston3rdandsubsequentdays(2002)=$3184‐$3968(withoutorwithmechanicalventilation),

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HOWCANSMALLAPPSMAKEADIFFERENCE?

  Findasmall,well‐definedproblem  Createanicheappthatsavestimeormoney  MultiplyitsusesacrosstheU.S.

  THENMultiplythenumberofapps

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II‐B.SomeHypotheticalExamples

THEMULTIPLIERS

  #Hospitals(U.S.) ~12,000  #Clinics,Ctrs,etc. ~36,000  #Physicians&Surgeons >972,000(2009)  #StaffedBeds ~1m  #Hosp.Admissions >37m  #E.D.Visits (2008) >123m   HospitalCharges >$725b

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EXAMPLE:ClericalTime

  Smallappthatsaves5min.ofclericaltimeoneveryadmission–usedinhalfthehospitals

  At$24perhour,5min.=$2  $2x0.5x37madmissions=$37mannually

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EXAMPLE:PATIENTEDUCATION‐‐WhentoVisitanE.D.

  SmallappthatletspatientsavoidatriptoanE.D.1%ofthetime,reducing#visitsfrom123mvisitsfor300mpeopleto122mannually.

  Assume$569pervisit(mediancostin2008)  $569x1m=$700msavings

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EXAMPLE:PATIENTEDUCATION–ComplianceonMeds

•Recordschedule&doses–withreminders•Explainpackageinsertinformation–common,harmlesssideeffectsvsseriousones

Saveafractionof$100billion(fromthe33‐69%ofallmedication‐relatedhospitaladmissionsintheUS)

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EXAMPLE:ClaimsProcessing($210b/yr)

  Smallsetofappsthatfilloutforms(oneperform)

  Save5min.performx6formsperday  =30min./dayx900Kphysicians&surgeons

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Example:TranscriptionTime

  “AllscriptsBroadensSpeechRecognitionChoicesInEHRs:EHRvendornowwillofferbothM*ModalandDragon'ssoftwaretoitscustomers.”[ByNicoleLewisInformationWeek,February01,2012]

  1minute/noteX$1/min.Xmillionsofnotes

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EXAMPLE:AdverseDrugEvents

  Over770,000peopleareinjuredordieeachyearinhospitalsfromadversedrugevents(ADEs)

  Costsestimatedat$1.56to$5.6billionannually.4‐7.  PatientswhoexperiencedADEswerehospitalizedan

averageof8to12dayslongerthanpatientswhodidnotsufferADEs,andtheirhospitalizationcost$16,000to$24,000more.

  “Anywherefrom28percentto95percentofADEscanbepreventedbyreducingmedicationerrorsthroughcomputerizedmonitoringsystems.”

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ADE’s(contd.)  In1992,567ADEscostLDSHospital$1.1millionindirectexpenses

(notincludingliabilitycostsorthecostofinjuriestopatients).If50percentoftheseADEshadbeenprevented,LDSHospitalwouldhavesaved$500,000ayear.1

  BrighamandWomen'sHospitalwouldhavesaved$480,000annuallyifthe17percentdecreaseinADEshadbeenappliedhospital‐wide;thisfiguredoesnotincludethecoststopatientsofinjuries,malpracticecosts,ortheexpenseofadditionalworkrequiredtocorrectmedicationerrorsandtreatpatientswhosufferfromADEs.23

  DoctorsatWishardMemorialHospitalwhousedcomputerorder‐writingworkstationshad13percentlowerinpatientcharges(about$900perhospitalization)thanthosewhousedpaperforms.25

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Example:AvoidingErrorswithRemindingSystems  WellPointInc.,whichoperatesBlueCrossBlueShieldplansin14states,willuseWatson’svasthealthcaredatabaseandquickcalculatingpowertoguidetreatmentdecisionsforits34.2millionmembers.

  Initsnewjob,Watsonwillswiftlycomparepatients’electronicrecordstoamammothlibraryoftextbooksandmedicaljournals,andWellPoint’shistoryoftreatmentstogeneratealistofoptionsandtherationalebehindthem.”

  [ABCNews,Sept.12,2011]

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III.ChallengeforAI

  RecommendtheApps  Reviews&Recommendations(text+ratings)  SpecificMedicalContext  SpecificFeatures

  LearntoDistinguishtheBest  ForEachMedicalContext

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✔

✔

CHALLENGE:TOOMANYAPPS  e.g.,“FindingGoodAppsforChildrenWithAutism”

400‐700,dependingonthelist

  “…it’sdauntingtoknowwheretobeginwhensortingthroughthethousandsofprogramsavailable.“Therearesomanyapps,andnotallofthemaregreat,”…Tothatend,severalgoodWebsiteshavebeencreatedtoreviewspecial‐needsapps.”

  [NYTimes,Nov.29,2011]

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560KApps:[Medical=10,482or1.9%][Healthcare&Fitness=13,604or2.4%]

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CHALLENGE:RATEOFNEWAPPS

  TotalAppsintheAppStoreCurrentlyAvailableforDownload=560,990

  NumberofActivePublishersintheUSAppStore=

134,074  CountofApplicationSubmissionsJanuary,2012ThisMonth(Games):3,598 (116/day)ThisMonth(Non‐Games): 19,430(627/day)ThisMonth(Total): 23,028(743/day)

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NewsFinder:SortingtheWheatfromtheChaff

  Goal=alertsubscribersto“interesting”articlesaboutAIfromcrediblesourcesinthelastweek

  Problemswithkeywordsearching  (a)Toomanyhits(e.g.>8000mentioning‘artificialintelligence’or‘robot’or‘datamining’fromGoogleNews ‐Manyduplicates(e.g.,storiesaboutWatson) ‐Manylocalstories(e.g.,highschoolrobotteams)

  (b)Nosenseofwhyastoryisinteresting  (c)NosenseofthebreadthofAI(e.g.,ethics,history,…)

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NewsFinder  Train19SVMs(oneforeachtopic;e.g.,agents,ethics,history,machinelearning)–KeepLearning!

  Remove583Stopwords;Representasvector(~180words)

  Assigntopicnamesto~170articlesfoundonlineat37sources(+GoogleNews)eachweek  Removeuntaggedstories  Mustnotcontainanyof458“BadWords”  Mustcontainatleast2(of107)“Whitelist”term  Removeverysimilarstories(>cosinesimilaritythresh.)

  Select12orfewerofthemostrelevantstories

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NewsFinderExtensions

  QUESTION:CanNewsFinderbemodifiedtofindinterestingstoriesinmedicalinformatics?   NewWhitelist;  Newsetoftopiccategories  Newsetofpreferredsources

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FUTURE:Usesameproceduretoreadreviewsandselectbestapps

Conclusion:FindingrelevantinformationishalfthebattleThenexthalfincludes

  Selectingthemostrelevantinformationforaspecificcontext

  Selectingthebestappsforthespecificcontext

  Integratingtheresultsfromrunningseveralapps

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FINI

Thankyou.

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