In 2011, IBM's Watson computer system used artificial intelligence to beat challengers on the TV quiz show "Jeopardy."
Now, physicians at the U.S. Department of Veterans Affairs are putting Watson to a different test: using the system to help them treat veterans with post traumatic stress disorder.
The VA has launched a two-year pilot program to study new ways of searching electronic medical records and medical literature. The pilot, which will rely on simulations but use actual patient records, is intended to evaluate how the IBM technology can speed up clinical decisions. IBM is trying to transform the game-playing system into a commercially viable technology, and the VA is exploring whether doctors at all VA medical centers and clinics should eventually be linked to it.
In the past 31/2 years, a trauma recovery program run by the VA Maryland Health Care System has treated about 3,000 veterans for PTSD at medical centers in Baltimore and Perry Point and six community-based outpatient clinics around the state. The program also operates a 10-bed PTSD residential rehabilitation treatment program that lasts from six to eight weeks at the Baltimore VA hospital.
The VA estimates that about 20 percent of veterans who served in Iraq or Afghanistan suffer from PTSD. The disorder affects 12 percent of Gulf War veterans and 15 percent of Vietnam War veterans, according to the VA's National Center for PTSD. Treatment can include prolonged exposure therapy, which involves re-experiencing or remembering the trauma in a controlled setting, cognitive processing therapy and medications.
Current treatments have proved highly effective for the disorder, said Dr. Aaron Jacoby, chief psychologist for the Mental Health Clinical Center at the VA Maryland Health Care System in Baltimore. But technology, he said, can enhance that treatment.
Tens of thousands of veterans have downloaded the PTSD coach mobile application, developed in 2011 by the National Center for PTSD and the Department of Defense's National Center for Telehealth & Technology. Veterans can use the smartphone app to track symptoms or get reminders of coping skills.
"We're using technology in the VA to augment what we know works well," said Jacoby, who is not involved in the Watson pilot program. "We welcome all technological advances."
Watson, which IBM says processes information more like a human than like a computer, can answer complex questions quickly and accurately in natural language. IBM says its ability to understand natural language, learn as it goes and form hypotheses makes it a good fit for the medical field, where it can sift through millions of pages of literature and patient information and provide answers in seconds.
"When we created Watson, it was to represent a new era of computing, which we call cognitive computing," said Anne Altman, general manager of the IBM division that serves the federal government, the corporation's largest client. "It's the next generation of computing. …It learns" through new information and prior interactions.
"It's a great sign that the [VA] is embracing new technology to address very difficult and challenging tasks for physicians," she said.
People who develop PTSD typically are unable to recover from a trauma and move on with their lives. While more prevalent among veterans who've endured combat, Jacoby said, PTSD can be triggered by sexual assault, a car accident or a natural disaster — "anything an individual does not expect, and has difficulty forgetting."
Symptoms can include a heightened sense of awareness of surroundings, nightmares, flashbacks and difficulty concentrating. The condition can impair social interaction and work performance and lead to isolation, Jacoby said. Some returning veterans who have experienced firefights at night, for instance, have difficulty driving in the dark.
The VA decided to focus the trial period on PTSD because the treatment is complex, said Jim Demetriades, director of human factors engineering for the VA.
PTSD "poses very difficult clinical demands," Demetriades said. "This is a pretty good stress test for a clinical reasoning system. If it can perform well in this area of clinical disorders, we think it will perform even more strongly in a vast number of other areas."
Watson should be able to help VA doctors make sense of voluminous medical data, which doubles every three years, while keeping tabs on patients' electronic medical records.
"We're hoping to discover what some other potential applications might be as well," Demetriades said.
Carolyn M. Clancy, the interim undersecretary for health for the VA, said using Watson could allow clinicians to spend more time "listening and interacting with the veteran."
IBM believes that its technology will shave months off the time physicians spend testing hypotheses, allowing them to reach more precise conclusions in just days or even a few hours, and that it can work across multiple health care systems.
The VA joins hundreds of other Watson clients, IBM says, including Memorial Sloan Kettering Cancer Center in New York and the Cleveland Clinic.
Altman described the VA pilot, run by doctors and staff at a VA data center in Austin, Texas, as Watson's time in school.
Watson "develops a core of knowledge, and this takes a little bit of time," she said. "Watson will be ingesting hundreds of thousands of documents — veterans' health documents, medical records, research papers, medical literature — and it will be able to analyze all of this and the reams and reams of data.
"Doctors today just can't keep up with it."