Elementary, my dear Doctor Watson.

Many readers will recognize these as the first words ever transmitted by telephone. The Watson on the other end of the line was Thomas A. Watson, Bell’s assistant. Over a century later, we may soon be hearing these words again, this time at the hospital. But this time the Watson on the other end may not be a person but a machine: IBM’s Watson, a state-of-the-art computer system capable of answering questions posed to it in natural human language. No one knows exactly what the arrival of the new Watson will mean for medicine, or for laboratory medicine in particular, but it is clear that change is coming, and coming soon enough to warrant speculation on what to expect. For most people, Watson entered popular consciousness on Valentine’s Day 2011 with its nowlegendary victory over human competitors on the TV game show Jeopardy! (1, 2 ). In a 3-day, nationally televised performance, Watson defeated the show’s 2 greatest champions, Ken Jennings and Brad Rutter, prompting Jennings to quip, “I for one welcome our new computer overlords” (3 ). Watson’s victory did not come out of the blue, however. It was the culmination of a 4-year, multimillion-dollar effort by a 25-member team as part of an IBM project called DeepQA (“question answering”) (3, 4 ). The project’s goal: to build a computer system that can sort through massive amounts of data—terabytes, or hundreds of millions of Web pages, in the case of the Jeopardy! performance (3 )—to answer virtually any question a human might ask, however he or she might ask it, instantly. Because the questions on Jeopardy! can be about anything, because they can involve puns, slang, and other wordplay, and because contestants have only seconds to answer them, winning on the show presented a fitting challenge. But victory was only ever meant to be a proof of principle. The ultimate goal was—and is—to use Watson’s capability to help real-world decision-making in a number of important areas, including medicine. The year since Watson’s big win has seen several announcements relevant to healthcare. Last February, IBM announced a collaboration with Nuance, makers of medical dictation software, with the goal of making it possible to interact with Watson by speaking, as opposed to just via the written word (5 ). In September, IBM announced an agreement with the 34 million– member multiregional health insurer WellPoint to build a commercial system around healthcare applications (6 ). The 2 companies have mentioned several general uses for Watson, including analyzing patient records and sifting through the latest published research. Just this March, IBM announced formation of a 9-person Watson healthcare advisory board, with members drawn from hospital administration as well as practicing MDs to align the Watson project with “industry needs” (7 ). Board member Herbert Chase, MD, a professor at Columbia University Medical School, whose research is in clinical-decision support, has said that Watson can already answer medical questions better than his residents (4 ) (which, given the Jeopardy! performance, is no ding against residents). The Watson team has clearly been busy, and IBM clearly means for Watson to earn more than just Jeopardy! winnings. But what exactly will the new technology do for medicine? The announcements so far have been relatively light on specifics, suggesting that IBM is either not completely sure or not ready to share. It is clear, however, that a “Doctor” Watson will aim to serve at least 2 groups within healthcare: providers (such as doctors, nurses, and trainees) and insurers. In addition, Watson may well be available for consultation to patients directly. As for what it will do, one can expect much the same as what it did on Jeopardy!: provide answers to questions on the basis of large amounts of data—in this case any data set that is too large or complex for a single person to process comprehensively on the spot. A basic application to expect is a more goaloriented way of querying individual patients’ medical records. The typical record contains no more than a few megabytes of text, largely consisting of visit, admit, consult, and progress notes; and radiology, surgical, and pathology reports. Still, “knowing your patient” is a challenge that takes time and training, and not only because current electronic interfaces leave much to be desired (8 ). Watson should be able to help. Does the 1 Department of Pathology and 2 Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. * Address correspondence to the author at: Beth Israel Deaconess Medical Center, 330 Brookline Ave., BIDMC East/CLS, 741 Boston, MA 02215. E-mail [email protected]. Received March 13, 2012; accepted March 19, 2012. Previously published online at DOI: 10.1373/clinchem.2011.180992 Clinical Chemistry 58:6 986–988 (2012) Opinion