B.Buchanan New Challenge for AI in...
Transcript of B.Buchanan New Challenge for AI in...
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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