Cover Story
Real World Examples of Artificial Intelligence
Everything you know about computers is about to change.
By Mark Hays
MELINDA WILSON LIMPED INTO THE crowded waiting room with her mother. A nagging pain appeared in her left leg a few weeks ago, and it hasn’t gone away. This is her second visit, and Dr. Balsamo is worried; there’s something unusual about Melinda’s case, more than another bruise on the playground–but he can’t put his finger on it.Dr. Balsamo stops at the computer to check Melinda’s lab work. An image on the screen looks at him for a moment, then waves, “Good morning, Dr. B,” said the machine, “I have some interesting information for you regarding Melinda Wilson, the four-year-old girl you’re going to see this morning.” Dr. Balsamo is surprised; the talking computer often startles his patients, but he’s used to it. It’s the news about Melinda he didn’t expect. “Computer, tell me what you found.”
“I searched the Internet, and it appears that Melinda’s symptoms relate to a rare condition–Legg-Calve-Perthes (LCP) disease. I also found a recent study linking LCP to second-hand smoke in the home.” The computer paused for a second, “Would you like to see the report?” Dr. Balsamo began to smile. Melinda’s father is a two-pack-a-day smoker, and his wife has been trying to get him to quit. “Yes,” he said, “Show me that report.”
Computers That Talk, Listen and Think?
“Computer, tell me what you found?” Does this sound like a scene from Star Trek or Babylon 5? No keyboards or complicated menus? Not in your lifetime?
Think again. The assumptions you hold today about computers will be challenged by radical change. Smart systems like the one in Melinda’s story are being built and tested today, with the ability to see, hear and talk. The first will be installed in hospitals and clinics within 12 months.
The Plain Truth: Things are a Mess
This bright future is a long way from where we are today. Despite fast new Pentium processors, the Internet explosion, Windows NT and Java, most physicians and nurses use computers only when they’re forced to. Existing systems are often complicated, slow and unfriendly. Many caregivers say that it’s easier to enter patient information on paper charts, and–let’s admit it–they’re right. Even when patient information is stored in a database, many physicians ask for a paper print-out and rarely look at a computer screen.
The basic problem is no mystery: today’s computer is too difficult to use. Even industry leaders Microsoft, Apple and IBM agree. At a Microsoft-sponsored conference last September, Bill Gates noted, “Certainly the PC is not easy enough to use … you’re going to [need] a seeing and listening interface.”
Donald Norman at Apple Computer (vice president of advanced technology) came to the same conclusion in 1996, saying, “The current state of desktop computers is a mess. Computers are much too complex, much too complicated… Many people spend a considerable amount of time every day managing their computers instead of doing their jobs–even experts, maybe especially experts.” (Internet World, May, 1996)
This is a deep-rooted problem. Hospitals and clinics have 20 years of complicated technology that needs to be taken to the garage and overhauled, from legacy mainframes up to the current batch of GUI applications. Some systems are much better than others, but none measure up to the real needs of health care providers.
Now there’s hope on the horizon–with smart technology.
New Smart Solutions
Researchers have been working on the fundamentals for more than 40 years, and this effort is finally bearing visible fruit. Running under a number of names such as artificial intelligence (AI), intelligent agents, social interfaces and decision support, smart technology can solve many problems. Let’s look at five solutions with the greatest impact for health care:
1. Smart desktops: will recognize you, understand what you say and speak to you.
2. Portable systems: will put the “smart desktop” in your pocket.
3. Smart clinical assistants: will help caregivers analyze patient data.
4. Smart data mining: will help you make sense of all that information.
5. Smart security: will protect electronic patient records.
Smart Desktops
The most important solution starts with the care provider. “Smart desktops” are being designed to create a new “social” interface, with voice recognition that will allow the user to talk instead of type. Voice recognition has become the “Holy Grail” for everyone who hates a keyboard–and if you walk into the local CompUSA, you’ll see how close we are to the goal. New products from IBM and Dragon Systems are inexpensive and deliver phenomenal results (see related article on pages 40-41).
A key barrier was crossed in the last six months with continuous speech recognition. This allows you to simply talk to the computer, instead of “talk … to … the … computer.” With a little training, many people find they can “talk” a sentence as fast as a good typist.
Voice synthesis is also available off-the-shelf, and quality has improved significantly. This step is more important than you might expect; with a good voice that people will listen to, the computer has the ability to alert a physician who’s not looking at the screen, and simply speak important information.
On the screen, we’re moving away from complicated menus and toward a much friendlier “interactive” interface. The most advanced work is currently being done in an area you might not consider–computer games. Think about this for a second: a sophisticated computer game presents very complex information, very quickly, with minimal training, in a way that makes people want to come back for more. If your clinical information system could do the same thing in a slightly different way, physicians would love to use it.
All of this technology is available today, and there are new products on the test bench that are even better. Now it’s up to the health information system (HIS) vendors. It’s very possible to build the smart system that had a conversation with Dr. Balsamo. Smarter, more innovative vendors are building systems that integrate these technologies to create a complete smart solution. This is a fundamental change that will turn computing as we know it today completely on its ear.
New Portables Put “Smart” in Your Pocket
New hardware is available that will take the smart desktop and put it into your pocket. This is a very important step for health care; if we have a smart computer system, we’ll need it at the point of care. To achieve this, six key barriers had to be overcome:
* Size: it must fit in a pocket;
* Batteries: it must last for an entire shift, at a minimum;
* Links: it must connect to the central HIS system, to push/pull data;
* Rugged: it must survive repeated drops to a hard floor;
* Cost: it can’t be priced more than $1,000 per unit; and
* Power: it must be smart and easy to use.
The second generation of Windows CE hand-helds will knock down all of these obstacles. You’ll be able to carry much of the power of a smart desktop in your pocket, to the point of care, with the ability to connect to your existing HIS systems, at a price your facility can afford. This single step will revolutionize the use of computing in health care.
Smart Clinical Assistants
In clinical applications, smart technology is already widely used in many areas, including cardiology (diagnosis of coronary artery disease), high risk surgery (to predict outcomes), pharmacology (to suggest the best dosage), oncology (to pick the most effective treatment) and OB/Gyn (to automatically analyze cervical cells).
More than a thousand studies are documented in medical literature, showing widespread implementation of neural networks, genetic algorithms and fuzzy logic. This reflects the basic power of smart technology, and the way it can be applied to solve a diverse range of clinical problems.
Expect to see an increasing number of smart clinical systems move out of the lab and into products. A number have already been released with full Food and Drug Administration (FDA) approval, including a well-publicized solution for automated analysis of Pap smears.
Smart Data Mining
One of the most exciting applications of intelligent technology is the tedious analysis of mountains of health care data. Computers are endlessly patient and thorough, and smart systems have the ability to glean through an endless stream of information to mine the “gems” that will improve care.
Smart systems are much more powerful than standard statistical tools, with the ability to analyze a wide array of disparate and “messy” patient information–overcoming obstacles that would block a statistical algorithm. This ability to take a look at the entire world of clinical data makes AI technology particularly valuable. An intelligent data mining engine will often find unexpected relationships between variables that were unnoticed by physicians and caregivers. A smart engine is also very efficient and will find solutions quickly, without a long series of repetitions and fine-tuning.
For forward-thinking care providers and payers, this is a financial gold mine. As we run out of more obvious techniques for cost reduction, the devil is increasingly hidden in the details. Smart data mining technology can uncover keys that will improve the quality of care and reduce expenses–the best of both worlds.
Other industries have made much more aggressive use of AI to solve similar data mining problems, particularly the large investment houses on Wall Street. Health care should take a much closer look at this important technology.
Smart Security
Smart systems can also solve the rapidly growing problem of security for sensitive patient information, as more and more patient data goes online. Biometric systems can automatically analyze unique physical characteristics; authorized users can be identified by fingerprint, for example. This eliminates weak and error-prone passwords that annoy users and provide minimal protection.
The significance of this problem cannot be overstated. Most health care providers are blissfully unaware of the growing risks they face with increased computerization of patient data. Unlike financial systems, which are heavily defended but frequently broken into, the damage caused by the release of sensitive patient data cannot be repaired. There is no way to restore the privacy of your patients or recapture information after it’s released. As a result, the potential liability for each incident is much higher.
Smart security also provides important benefits to the user. If a computer can recognize you, it can give you personal attention. For a physician this means quick access to your patient records–automatically. You’ll be able to see test results and patient data in the way that best fits your practice and your preferences for maximum productivity. Say goodbye to one-size-fits-all menus. Sophisticated HIS vendors are beginning to build these user-specific functions into their products, using smart technology.
The Future is Here
It’s taken years to reach this point, but the revolution is finally at our doorstep. “Computer, show me that report” will become the ordinary, and we’ll marvel when we look back at the hopelessly complex systems we’re using today.
Mark Hays is the senior vice president for product development and the chief technology officer for Health+Cast, LLC, in Boise, ID. He can be reached via e-mail at [email protected].
