First published 2/15/11 on The Doctor Weighs In
If you want to see the future of health information technology, take a look at the dueling visions of two Thomas Watsons that are on display this month in a game show and a trade show. The juxtaposition unintentionally demonstrates what doctors and patients will be doing together and also what they can do separately.
What I’ll call Game Show Watson is a computer named for IBM founder Thomas J. Watson, Sr. This Watson is appearing on the TV show Jeopardy to play a highly publicized set of matches against two human champions from Feb. 14-16. Although viewers will actually see a black computer screen with a revolving blue globe, Game Show Watson itself, in the tradition of “Big Iron” mainframes, consists of ten refrigerator-sized servers located offstage.
In contrast, the Watson at the trade show is not one computer, but thousands of them, all contained inside the mobile devices that are descendants of the telephone first demonstrated by Alexander Graham Bell and his assistant,Thomas A. Watson. (That Watson was also an inventor is a topic for another time.) The Telephone Watsons, on display for the tens of thousands of attendees at HIMSS11 from Feb. 20-24, are giving rise to a new field known as “mobile health.”
Game Show Watson represents the victory of centralization. Or as author Stephen Baker, in his ebook, Final Jeopardy: Man vs. Machine and the Quest to Know Everything, puts it: “What if there were a machine that could answer virtually any question?”
As medical student Yong Suh wrote in a USA Today op-ed, the potential to transform medicine is obvious: “Performing well on Jeopardy and diagnosing sick patients have similar prerequisites: a broad fund of knowledge, ability to process subtlety and ambiguity in natural language, efficient time management and probabilistic assessment of different possibilities.”
Thomas J. Watson, Jr. (like his father an IBM CEO) put it slightly differently way back in 1965: “The widespread use [of computers]…in hospitals and physicians’ offices will instantaneously give a doctor or a nurse a patient’s entire medical history, eliminating both guesswork and bad recollection, and sometimes making a difference between life and death.”
And a mere 45 years later, the federal government passed legislation to get doctors to do just that! The electronic health record, with or without decision support, is centralization’s most impressive victory.
Telephone Watsons, on the other hand, show the power of decentralization, whether in smartphones or their cousins, smart tablets. There is an explosion of applications focused on taking the computing power that once needed machines the size of refrigerators and putting that power into the hands of patients to improve their own health.
With 3.5 billion mobile phones in use around the world, mobile health applications are already transforming the delivery of health care, be ittracking the eradication of polio in Botswana or managing a child’s diabetesin Boston. The potential payoff for innovators has attracted big companies like Cisco, smaller niche players and affluent private investors, like pharmaceutical executive and billionaire physician Patrick Soon-Shiang.
While there are a burgeoning number of mobile applications geared towards physicians, the real transformation of health care lies not in better doctoring but in better partnering between doctors and patients. As my colleague and friend Jane Sarasohn-Kohn writes: “Mobile = social. That’s the value-add for health. The wisdom of crowds translates to wisdom of patients, wisdom of doctors, wisdom of caregivers, all on-the-move, 24/7. The more these share with each other, and across their roles, the greater the knowledge accrues….”
In other words, however Game Show Watson fares on Jeopardy, partnering with patients as they turn into Telephone Watsons — not just being more smart about telling patients what to do — will remain central to improving health as well as health care. As Dr. John Watson, famous companion of Sherlock Holmes might put it, that truth is elementary.
Michael Millenson i