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 it tracking the eradication of polio in Botswana or managing a child’s diabetes in 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 L. Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age”.

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  3. DeterminedMD says:

    Careful what you wish for. Playing a game of trivia is not an analogy to problem solving people’s medical issues. But, simplification and quick fix is the mantra of tech heads, you all just act so shocked and dismayed when things aren’t so hunky doory WHEN the technology fails.

    By the way, this site update is not an improvement to me. Probably some will be happy to hear I am thinking of not participating any more.

  4. pcp says:

    I have diagnosed many sick patients, and I have been on Jeopardy, and anyone who thinks the the mental skills involved in the two activities are similar has NO idea what they are talking about.

    Using this updated site, however, is VERY simliar to using an EMR.

  5. MD as HELL says:

    Medical care will still require someBODY to choose a course of action. I often use a computer to look up an item. But putting all of a case into a computer in real time where time is of the essence will never happen.

    I doubt anyone will ever believe a computer cares.

    I doubt a computer can ever think outside of the box.

    Does anyone want a computer to be put in place of a jury? So many subtleties of communication cannot ever go into a computer.

  6. twa says:

    Did you even read this piece? Or did you just see the word “computer” and respond with your standard “I hate EHR’s” rants.

    Ironic that you also complain about the new site. Change really sucks.

    Luddite much?

  7. My first comment on the new site. I’ll start by saying what new EMR users are told after an upgrade – you will get used to this. In a few weeks you would have forgotten the old site and this one will feel as natural as the old. Just be patient and give it a chance….. :-)

    As to Watson, it won’t change medicine any time soon, but try to think ahead….50 years…. 100 years….. Perhaps medicine will become so powerful that caring will be less frequently needed. Am I delusional?

  8. First, I’m a big fan of technology. As a practicing primary care doctor with one of the world’s most comprehensive and advanced electronic health record I’m living the future. However, it’s naive to think Watson or future iterations in the foreseeable future will be as good as the op-ed piece from USA Today author had suggested. Computers can’t “read” emotional context and they take natural language literally as the truth.

    As this author notes, technology can help support doctors and patients connect more easily as well as access information more precisely much like electronic systems help pilots in aviation.

    Perfect computers cannot replace doctors because people are inherently not perfect and can mislead and lie unwittingly which can change a diagnosis and treatment. http://www.thehealthcareblog.com/the_health_care_blog/2011/01/patients-lie.html and http://www.kevinmd.com/blog/2011/02/anchoring-leads-misdiagnosis.html.

    Yes, human doctors are flawed and have cognitive shortcomings and yet that is exactly why people will continue to see us and computers will always be around to assist, but unable to replace doctors.

  9. DeterminedMD says:

    “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.” ”

    So the author has these 2 paragraphs in this article and goes on to talk how this is the wave of the future. My response to twa and the equally extremist opposites to luddites is this: WTF did I misread here? You think silicon and other noncarbon elements have replaced carbon based life form interactions? Check out Jennings’ article in the New York Daily News today, all you computer geeks can find the link ’cause your keyboards are your fifth appendage!

    Yeah, you get used to change. Sometimes change just for the sake of change is not a responsible choice. If it benefits the masses, then I am the odd person out. But, this site does not flow the way it did in the past.

    Some of us do not eat, breath, and replicate in front of screens. Oops, forgot I was attempting to talk to noncarbon based life units!

  10. pcp says:

    My concern about the new site is that, Luddite that I am and using three computers in three different locations, 95% of the time I can’t get it to open or let me post.

  11. Telemedicine says:

    Technology has improved and simplified our lives in many aspects. It’s only normal and natural that this innovation and change would also extend into the health care industry. Technology will continue to impact how we give and receive healthcare. But technology will never be able to replace the human touch which is so essential to healing and the infinite capacity of the human mind to create and innovate new procedures and medical devices.

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