The Dr. Watson dilemma

Watson, originally called DeepQA when developed by IBM, can rapidly browse through a vast store of information. Like Johnny Five, the speed-reading robot in the 1980s comedy "Short Circuit," Watson works fast, and can page through about 200 million pages of data in three seconds, according to a presentation Nuance gave at the Radiological Society of North America's annual meeting last fall.


Using all the data at its electronic fingertips, plus its hypothesis-testing programming that helps it puzzle out a user's "intent," Watson can then provide answers to specific questions. Famously, this was done answering trivia on the TV show "Jeopardy." But almost immediately, people began wondering if there were medical applications for it.

It turns out Nuance has been working with IBM (again, the company is cagey about specifics), doing research on using a Watson-like technology in medicine. Petro said when they originally approached IBM about using Watson, the first idea bandied about was essentially "Dr. Watson": having the software answer specific questions related to specific diagnoses. But Petro said they decided it could be an "unnatural interaction" for physicians, and that it could "tread too closely on what is ultimately their clinical decision-making." What doctors want, Petro suggests, is a consultative process, where they work with the software to get deeper and deeper levels of information about medical topics, such as common treatments for psoriasis.

"We call it spiraling," he said. "You can imagine spiraling down and converging on a single body of information to provide final answers to support the conclusion the physician has made."

As a test, Nuance said it's working on getting the technology proficient at a type of "medical Jeopardy" known as Doctor's Dilemma. Developed by the American College of Physicians, it provides a set of standard questions in medicine, like what is the most common vector of rabies in the United States (hint: it's a mammal with wings).

"[Doctor's Dilemma] involves all the critical pieces of getting the system to work, in terms of accessing a different variety of repositories, so we are internally benchmarking [the technology's proficiency] on a day-to-day basis," Petro says.

Right database, radiology

Feeding this technology the correct information is key, which is why Nuance said IBM is focusing on oncology, where there's a well-defined body of information the technology can rely on. Nuance said it's interested in setting up a repeatable, reliable process to refresh content to keep the technology up-to-date.

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