Be Ready for Watson with IBM Content and Predictive Analytics 1
Michelle Blackmer Title: Be Ready for Watson with IBM Content and Predictive Analytics IBM Content and Predictive Analytics (ICPA), IBM's first Ready for Watson solution offering, enables subject matter experts and other knowledge workers to explore information in order to analyze the past, understand the present and predict the future. This solution pairs IBM Content Analytics and IBM SPSS Predictive Analytics to reveal new and actionable insights in structured and unstructured content; unstructured content accounts for 80% of an organizations data. As a result, organizations can find more effective ways to improve customer satisfaction, inform decision making and increase operational efficiencies. Attendees will learn how Seton Healthcare is leveraging ICPA to reduce inconvenient and costly congestive heart failure readmissions.
Session Agenda Introduction to Watson and IBM Content and Predictive Analytics for Healthcare (ICPA) Using ICPA to Prevent CHF Readmissions Seton Healthcare Family Case Study 3
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2011 IBM Corporation Inconsistent quality and increasing costs require healthcare transformation in key areas 5 * New England Journal of Medicine Rehospitalization Among Patients in the Medicare Fee-for-Service Program, April 2009 ** http://www.healthleadersmedia.com/content/COM-263665/3-Readmissions-to-Reduce-Now The need for better clinical outcomes One in five patients suffer from preventable readmissions represents $17.4 billion of the current $102.6 billion Medicare budget* 1.5 million patients in the U.S. harmed annually by errors in the way medications are prescribed, delivered and taken The need for better operational outcomes In 2012, Hospitals will be penalized for high readmission rates - Medicare discharge payments starting will be reduced in key areas** $475 billion: Estimated annual US healthcare spending on administrative and clinical waste, fraud, abuse and other waste
2011 IBM Corporation With this change comes an opportunity to exploit the explosion of information 6 yet some health organizations operate with blind spots and information is not actionable Volume of information Lack of Insight 1 in 3 managers frequently make critical decisions without the information they need Variety of information Inefficient Access 1 in 2 dont have access to the information across their organization needed to do their jobs notably unstructured information including paper Velocity of decision making Inability to Predict 3 in 4 business leaders say more predictive information would drive better decisions 15 petabytes Amount of new information created each day - eight times more than the information in all US libraries 1 Health data growing 35% per year* * Recent study by Enterprise Strategy Group
2011 IBM Corporation 7 Remember to Answer in the Form of a Question
2011 IBM Corporation explorer India In May 1898 India In May celebrated anniversary in Portugal In May, Gary arrived in India after he celebrated his anniversary in Portugal Portugal 400th anniversary celebrated Gary 8 In May 1898 Portugal celebrated the 400th anniversary of this explorers arrival in India This evidence suggests Gary is the answer BUT the system must learn that keyword matching may be weak relative to other types of evidence arrived in arrival in Legend Keyword Hit Reference Text Answer Weak evidence Red Text Why is Jeopardy! so difficult? Answering complex natural language questions requires more than keyword evidence
2011 IBM Corporation 27th May 1498 Vasco da Gama landed in arrival in explorer India Para- phrases Geo- KB Date Match 9 Stronger evidence can be much harder to find and score and the evidence is still not 100% certain Search far and wide Explore many hypotheses Find judge evidence Many inference algorithms On the 27th of May 1498, Vasco da Gama landed in Kappad Beach 400th anniversary Portugal May 1898 celebrated In May 1898 Portugal celebrated the 400th anniversary of this explorers arrival in India. Kappad Beach Legend Temporal Reasoning Reference Text Answer Statistical Paraphrasing GeoSpatial Reasoning Watson Leverages Multiple Algorithms to Gather Deeper Evidence
2011 IBM Corporation How are you measuring and reducing preventative readmissions? How are you providing clinicians with targeted diagnostic assistance? Which patients are following discharge instructions? How are you leveraging unstructured data to prevent and detect fraud? How are you using data to predict intervention program candidates? Would revealing insights trapped in unstructured information facilitate more informed decision making?... but the biggest blind spot still remains Physician notes and discharge summaries Patient history, symptoms and non-symptoms Pathology reports Tweets, text messages and online forums Satisfaction surveys Claims and case management data Forms based data and comments Emails and correspondence Trusted reference journals including portals Paper based records and documents 10 * AIIM website, accepted industry percentage Over 80% of stored health information is unstructured* Does unlocking the unstructured data help accelerate your transformation?
2011 IBM Corporation Medical Transcription Discharge Summary Sample # 2: DATE OF ADMISSION: MM/DD/YYYY DATE OF DISCHARGE: MM/DD/YYYY ADMITTING DIAGNOSIS: Syncope. CHIEF COMPLAINT: Vertigo or dizziness. HISTORY OF PRESENT ILLNESS: This is an (XX)-year-old male with a past medical history of coronary artery disease, CABG done a few years ago, atrial fibrillation, peripheral arterial disease, peripheral neuropathy, recently retired one year ago secondary to leg pain. The patient came to the ER for an episode of vertigo while reaching for some books. The patient was able to reach the books, to support self, but did not have any syncope. No nausea or vomiting. No chest pain. No shortness of breath. Came to ER and had a CT head, which was within normal limits. The impression was atrophy with old ischemic changes but no acute intracranial findings. No focal weakness, headache, vision changes or speech changes. The patient has had similar episodes since one year. Peripheral neuropathy since one year and not relieved with multiple medications. The patient also complains of weight loss of 25 pounds in the last 6 months. No colonoscopy done. Recent history of hematochezia but believes it was secondary to proctitis and secondary to decreased appetite. No nausea, vomiting, no abdominal pain. PROCEDURES PERFORMED: The patient had a chest x-ray, which showed cardiomegaly with atherosclerotic heart disease, pleural thickening and small pleural effusion, a left costophrenic angle which has not changed when compared to prior examination, COPD pattern. The patient also had a head CT which showed atrophy with old ischemic changes. No acute intracranial findings. CONSULTS OBTAINED: A rehab consult was done. PAST MEDICAL/SURGICAL HISTORY: Positive for atrial fibrillation. The patient had AVR 6 years ago. Peripheral arterial disease with hypertension, peripheral neuropathy, atherosclerosis, hemorrhoids, proctitis, CABG, and cholecystectomy. FAMILY HISTORY: Positive for atherosclerosis, hypertension, autoimmune diseases in the family. SOCIAL HISTORY: Never smoked. Alcohol socially. No drugs. ALLERGIES: NO KNOWN DRUG ALLERGIES. REVIEW OF SYMPTOMS: Weight loss of 25 pounds within the last 6 months, shortness of breath, constipation, bleeding from hemorrhoids, increased frequency of urination, muscle aches, dizziness and faintness, focal weakness and numbness in both legs, knees and feet. PHYSICAL EXAMINATION: VITAL SIGNS: Blood pressure 188/74, pulse 62, respirations 18 and saturation of 98% on room air. General Appearance: The patient is a pleasant man, comfortable. HEENT: Conjunctivae are normal. PERRLA. EOMI. NECK: No masses. Trachea is central. No thyromegaly. LUNGS: Clear to auscultation and percussion bilaterally. HEART: Irregular rhythm. ABDOMEN: Soft, nontender, and nondistended. Bowel sounds are positive. GENITOURINARY: Prostate is hypertrophic with smooth margin. EXTREMITIES: Upper and lower limbs bilaterally normal. SKIN: Normal. NEUROLOGIC: Cranial nerves are grossly within normal limits. No nystagmus. DTRs are normal. Good sensation. The patient is alert, awake, and oriented x3. Mild confusion. LABORATORY DATA AND RADIOLOGICAL RESULTS: WBC 8.6, hemoglobin 13.4, hematocrit 39.8, platelets 207,000, MCV 91.6, neutrophil percentage of 72.6%. Sodium 133, potassium 4.7, chloride 104. Blood urea nitrogen of 18 and creatinine of 1.1. PT 17.4, INR 1.6, PTT 33. The patient had a chest x-ray, which showed cardiomegaly with atherosclerotic heart disease, pleural thickening and small pleural effusion, a left costophrenic angle which has not changed when compared to prior examination, COPD pattern. The patient also had a head CT, which showed atrophy with old ischemic changes. No acute intracranial findings. HOSPITAL COURSE AND TREATMENT: This is an (XX)-year-old male with syncope. 1. Syncope. This may be secondary to questionable cerebral ischemia/atrial fibrillation/hypotension, so Neurology was kept on board and the patient was scheduled for a carotid Doppler and a 2-D echo. Orthostatics were ordered. Vitamin B12, TSH, free T4 and T3 were ordered along with cortisol level in the morning. FOBT x3 were done and cardiology followup as outpatient. The patient had a carotid Doppler done on the next day and it showed mild irregular plaque disease, right and left internal carotid arteries, approximately 20- 59%. The patient's vitamin B12 level came the next morning and the level was 1180. His folate was 18.7 and his TSH was 1.98, free T4 of 1.38 and T4 level of 7.4, cortisol level of 15.4, which are within normal limits. Dr. Doe, who is the patient's cardiologist, was informed. Dr. Doe was kind enough to see the patient the very next day, and his impression was that the patient has atrial fibrillation, rate controlled, status post AVR, St. Jude, and peripheral neuropathy. Subtherapeutic INR, the patient's relative target INR is 2-3. He suggested PT evaluation and suggested a low dose of SSRI and Dr. Doe was of the opinion that the patient does not need any further cardiac recommendation. CT chest, abdomen, and pelvis were done. CT chest had an impression of coronary artery calcification, aortic valve replacement, cardiomegaly, suspect a very small left pleural effusion, no acute active pulmonary disease. CT abdomen and pelvis showed prior cholecystectomy, diverticulosis of sigmoid colon, two benign-appearing simple cysts involving the right kidney, calcified arteriosclerotic plaque disease of the abdominal aorta and iliac vessels bilaterally. The patient was ruled out of any malignancy whatsoever. 2. Hypertension. The patient at home was on Cardizem ER 90 mg thrice daily, and it was changed initially to Cardizem 90 mg thrice daily, and then with Dr. Doe's request, we changed the Cardizem to 240 mg t.i.d. 3. Atrial fibrillation with subtherapeutic INR. The patient at home was on Digitalis. That was continued. Dr. Doe was of the opinion that the patient himself takes care of the Coumadin, and Dr. Doe was of the opinion that probably that is why the patient is not able to maintain therapeutic INR. In the hospital, the patient's warfarin was increased to 5 mg q.h.s., and at the time of the discharge, he was requested to follow his appointments so that his INR can be maintained. 4. Gout. The patient was on allopurinol. There were no acute issues regarding the gout. 5. Prophylaxis. The patient was on Protonix and TEDs. 6. Social. The patient is FULL CODE. DISCHARGE DIAGNOSIS: Syncope. DISCHARGE DISPOSITION: The patient is discharged to home. DISCHARGE MEDICATIONS: The patient was discharged on the following medications; Cardizem 90 mg p.o. thrice daily, digoxin 0.125 mg p.o. once daily, allopurinol 100 mg two times daily, Coumadin 4 mg p.o. q.h.s., and Remeron 15 mg p.o. q.h.s. DISCHARGE INSTRUCTIONS: Since the patient had generalized deconditioning, the patient was advised home PT, OT and that was arranged for the patient. DISCHARGE DIET: Cardiac diet. DISCHARGE ACTIVITY: Resume activity as tolerated. Echocardiogram Sample Report: DATE OF STUDY: MM/DD/YYYY DATE OF INTERPRETATION OF STUDY: Echocardiogram was obtained for assessment of left ventricular function. The patient has been admitted with diagnosis of syncope. Overall, the study was suboptimal due to poor sonic window. FINDINGS: 1. Aortic root appears normal. 2. Left atrium is mildly dilated. No gross intraluminal pathology is recognized, although subtle abnormalities could not be excluded. Right atrium is of normal dimension. 3. There is echo dropout of the interatrial septum. Atrial septal defects could not be excluded. 4. Right and left ventricles are normal in internal dimension. Overall left ventricular systolic function appears to be normal. Eyeball ejection fraction is around 55%. Again, due to poor sonic window, wall motion abnormalities in the distribution of lateral and apical wall could not be excluded. 5. Aortic valve is sclerotic with normal excursion. Color flow imaging and Doppler study demonstrates trace aortic regurgitation. 6. Mitral valve leaflets are also sclerotic with...