Presentation given by chief medical scientist, Dr. Med. Martin Kohn, IBM , Copenhagen May 3, 2013

1. © 2012 International Business Machines Corporation
Putting IBM Watson to
Work In Healthcare
Martin S. Kohn, MD, MS, FACEP, FACPE
Chief Medical Scientist, Care Delivery Systems
IBM Research
marty.kohn@us.ibm.com

2. © 2010 IBM Corporation
IBM Research
Watson Jeopardy!

3. © 2010 IBM Corporation
IBM Research
Health Plans / Payers
Private – BCBS plans, large
national plans, mid-sized regional
plans
Government / National Plans,
Medicare Medicaid
Pharmacies
Pharmacy Benefit Management
Retail Clinics
Drug Developers
Large Pharma, Integrated
Biotech, Research Biotech
Medical Devices
Imaging
Archiving & Retention
Solution Providers
IT Infrastructure and Service
Providers, Application Providers
Patient Education
Healthy Lifestyles
Transaction Services
Claims Processing
Banks / Health Savings
Healthcare Providers
Integrated Delivery Networks,
Large University Medical Centers,
Independent Community Hospitals,
Physician Private Practices
Public Health
Pandemic readiness
Vaccine inventory & distribution
Sanitation & public safety
We approach HCLS as an ecosystem of constituents centered
around the needs of patients and consumers
Patients /
Consumers
Health Clubs
Health & Wellness Programs
Government Agencies
Regulatory & Research
Agencies, FDA, WHO, DHHSS,
CDC, NIH, Health Ministries

4. © 2012 International Business Machines Corporation5
90% of the
world’s data was
created in the
last two years
80% of data in the
world is
unstructured
making decisions
more complex
200% data growth,
in the next two years
fed by 1T connected
devices
1 in 5
diagnoses are
estimated to be
inaccurate or
incomplete
Volume
Variety
Velocity
Veracity
75
new clinical trials start
every day in the US
alone
2X
medical information
is doubling every 4
years
$750B
or 30 cents of every
dollar spent on
healthcare in the US
is wasted
Healthcare is “dying of thirst in an ocean of data”

5. © 2012 International Business Machines Corporation6
Personalized Medicine
Evidence-based Medicine
Why Watson for healthcare?
! Shift from Fee-for-
Service to ACOs
! Focus on Wellness
and Prevention
! Universal coverage
! Costs are 18% of
US GDP
! 34% of $2.3T US
spend is waste
! Costs can vary
up to 10x
! Diagnosis and
treatment errors
! Shortage of MDs
! Demand for remote
medicine
! Medical data
doubles every 5 years
! Detailed patient
biomedical markers
! Targeted therapies
Complexity
Policy
Changes
Costs
Info Overload

6. © 2012 International Business Machines Corporation8
Person Organization
L. Gerstner IBM
J. Welch GE
W. Gates Microsoft
“If leadership is an art
then surely Jack Welch
has proved himself a
master painter during his
tenure at GE.
Welch ran
this?
! Noses that run and feet that smell?
! How can a house burn up as it burns down?
! Does CPD represent a complex comorbidity of lung cancer?
! What mix of zero-coupon, non-callable, A+ munis fit my risk tolerance?
Why is it so hard for computers to understand us?

7. © 2012 International Business Machines Corporation9
Understands
natural language
and human
communication
Adapts and learns
from user
selections and
responses
Generates and
evaluates
evidence-based
hypothesis
…built on a massively parallel
architecture optimized for IBM POWER7
IBM Watson combines transformational technologies
1
2
3

8. © 2012 International Business Machines Corporation10
Watson enables three classes of cognitive services
Decide
• Ingest and analyze domain sources, info models
• Generate evidence based decisions with confidence
• Learn with new outcomes and actions
• e.g. - Next generation Apps " Probabilistic Apps
Ask
• Leverage vast amounts of data
• Ask questions for greater insights
• Natural language inquiries
• e.g. - Next generation Chat
Discover
• Find the rationale for given answers
• Prompt for inputs to yield improved responses
• Inspire considerations of new ideas
• e.g. - Next generation Search " Discovery

9. © 2012 International Business Machines Corporation11
Baseline 12/06
v0.1 12/07
v0.3 08/08
v0.5 05/09
v0.6 10/09
v0.8 11/10
v0.4 12/08
Watson made incremental progress in precision and confidence
v0.2 05/08
V0.7 04/10
Precision
IBM Watson
Playing in the Winners Cloud

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Informed decision making: search vs. Watson
Decision Maker
Search Engine
Finds Documents Containing Keywords
Delivers Documents Based on Popularity
Has Question
Distills to 2-3 Keywords
Reads Documents, Finds
Answers
Finds & Analyzes Evidence Watson
Understands Question
Produces Possible Answers & Evidence
Delivers Response, Evidence & Confidence
Analyzes Evidence, Computes Confidence
Asks NL Question
Considers Answer & Evidence
Decision Maker

11. © 2012 International Business Machines Corporation13
Medical journal concept annotations
Medications
SymptomsDiseases
Modifiers

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Inquiry
Decomposition
Answer
Scoring
Models
Responses with
Confidence
Inquiry
Evidence
Sources
Models
Models
Models
Models
ModelsPrimary
Search
Candidate
Answer
Generation
Hypothesis
Generation
Hypothesis and Evidence
Scoring
Final Confidence
Merging & Ranking
Synthesis
Answer
Sources
Inquiry/Topic
Analysis
Evidence
Retrieval
Deep
Evidence
Scoring
Learned Models
help combine and
weigh the Evidence
Hypothesis
Generation
Hypothesis and Evidence
Scoring
How Watson works: DeepQA Architecture
1000 s of
Pieces of Evidence
Multiple
Interpretations
of a question
100,000 s Scores from
many Deep Analysis
Algorithms
100 s
sources
100 s Possible
Answers
Balance
& Combine

13. © 2012 International Business Machines Corporation15
Patient’s Story
Data Acquisition
Accurate Problem
Representation
Generation of Hypothesis
Search for & Selection of
Illness Script
Diagnosis
Key Elements of the Clinical Diagnostic Reasoning Process
Dr. Martin S. Kohn | Clinical Decision Support: DeepQA
Knowledge
Context
Experience
Bowen J. N Engl J Med 2006;355:2217-2225

14. © 2013 IBM Corporation
Solution
Use Case: Oncology Diagnosis &
Treatment (ODT)
• Clinical support for patient assessment based on
objective evidence – patient data, medical info,
research, studies, articles, best practices,
guidelines, etc.
• Evidence panel identifying key information used
to support diagnosis, recommendations (e.g.
suggested tests) and treatment options
• Systematic applied learning based on action
taken and outcome derived
• Initial focus on lung, breast, prostate and
colorectal cancers
Goal
• Create individualized cancer
diagnostic and treatment plans
• Enhance clinical confidence with
greater access and
understanding of information
• Speed time to evidence-based
treatment
• Reduce diagnostic and
administrative errors
• Accelerate the dissemination of
practice-changing research
Assisting physicians with the diagnosis
and treatment of cancer
IBM Confidential: References to potential future products are subject to the Important Disclaimer provided later in the presentation
IBM Watson goes to work in healthcare

15. © 2012 International Business Machines Corporation17
Watson’s Reasoning
• “Shallower” reasoning over large volumes of data
• Delivers weighted responses to clinicians to assist in making
a informed evidence based decison
‒ Considers large amounts of data (e.g. EMR, Literature)
‒ Unbiased
‒ Learns
• Hits sweet spot of human judgment (e.g. problems with bias,
Big Data)
• Identifies missing information
• Watson’s interactive process helps clinician vector in on the
appropriate decisions
• Not limited by database structure
17 Dr. Martin S. Kohn | Clinical Decision Support: DeepQA14 Feb. 2012

16. © 2012 International Business Machines Corporation18