IBM's Watson Gains Commercial Acceptance in US

Abraham Schwarzberg, MD

Watson for Oncology (WFO), the IBM “cognitive” computer tool for helping with clinical decisions, is making its debut this month at Jupiter Medical Center in Florida as a regular member of the armamentarium for fighting cancer, as opposed to being a prospective product on trial. This is a first for IBM in the United States. WFO has been commercially available since the end of 2014 and has been used at locations in India, China, Korea and Thailand. In studies, oncologists have been impressed with WFO’s ability to support their decision making with deep draws on curated clinical studies and textbook learning.

Jupiter, a hospital of roughly 330 beds, is moving aggressively into cancer care. In February it announced the groundbreaking for the 75,000-square-foot Anderson Family Cancer Institute, which will combine research and treatment and bring all of the hospital’s oncological services under one roof, complete with a 2-story fish tank.

As a tool for supporting clinical decisions, WFO can take information from the electronic health record, read physicians’ notes, search a database of medical literature, and provide a prioritized list of treatment options. If patient information is insufficient, it will prompt the physician to provide more data. Two IBM services being developed in conjunction with WFO are genetic test interpretation and clinical trial matching.

At Jupiter, WFO is expected to contribute to the efficiency of decision making in the examination room, Abraham Schwarzberg, MD, chief of oncology, said. WFO is accessible on a simple tablet device and can build a doctor’s confidence in the decisions being made, both in the clinical and legal sense. “We want a tool that interacts with physicians on the front end as they are prospectively going into making decisions,” Schwarzberg said.

He said that WFO essentially provides a nonhuman “second opinion” in the examination room, which also may improve patient confidence. “If a patient wants to know that a few doctors have through their case, it can help facilitate those opinions without them having to leave the exam room.”

IBM is making no claims about the potential for reduced errors in medical decisions. “It’s too early to know if WFO will help doctors reduce errors or improve outcomes, but we certainly hope that it will, and we believe it will help doctors be more efficient so that they can spend more time caring for their patients, rather than sifting through data,” said Andrew Norden, MD, deputy chief health officer, IBM Watson Health.

As for whether WFO will make practices more efficient, IBM touts the speed of the program’s ability to scan information and provide doctors with answers. In addition, Norden said that “The shift toward value-based care requires more effective use of data and evidence, and we think WFO will enable that.”

IBM promotes its clinical trial selection tool as being able to work from both ends of the process. First, it helps to improve the quality and volume of patient selection, so that trials are more likely to succeed by recruiting ideal candidates and a sufficient number of patients. Second, it enables doctors to search through open trials quickly to find opportunities for their patients. IBM’s genetics program is promoted as being able to take a patient’s gene assay and help find suitable treatments based on identified gene mutations.

In a recent study in Manipal Hospitals in Bengaluru, India, WFO’s capabilities were tested against tumor board recommendations in a review of 638 breast cancer cases. Over 90% of WFO standard treatment and “for consideration” recommendations were in accord with those of the tumor board. The breakdown was 80% concordance in nonmetastatic disease and 45% concordance in metastatic cases. In triple-negative breast cancer, concordance was 68%; and in HER2/neu—negative cases, 35%. A Manipal spokesman said HER2/neu–negative cases are more complicated and increase the potential for divergent opinions.

IBM declined to disclose what it would cost to have WFO in a community practice. The company said it considers WFO acceptable for independent oncology clinics as well as large institutions. The program is currently available as an employee benefit to IBM workers and their families. Outside of oncology, Norden said, IBM is developing similar “cognitive solutions” in diabetes, medical imaging, population health.

Somashekhar SP. Double blinded validation study to assess performance of IBM artificial intelligence platform Watson for oncology in comparison with Manipal multidisciplinary tumor board—first study of 638 breast cancer cases. Presented at: San Antonio Breast Cancer Symposium, Friday, Dec. 9, 2016; San Antonio, TX. Abstract S6-07.