Silkfire Watson: What if Watson lived in Amazon’s cloud?

This is going to be waaaay crazy and out-there, except my antennas are twitching that it might be reality within 18 months.

Don’t ask me where I got that date; my antennas told me. Serendipitously I read two articles tonight. (I love Thanksgiving weekend.) I’ve probably got the details wrong, but consider three technologies:

• Amazon’s new “Kindle Fire” tablet
• Amazon’s new “Silk” browser
• IBM’s Watson.

1. Kindle “Fire”

In case you missed it, there’s been enormous talk about Amazon’s latest Kindle product, the Fire. It bears little resemblance to previous “books only” Kindles – it’s a media-streaming tablet. To understand what a big difference this is, see the new Wired interview with Jeff Bezos, CEO of Amazon.

Note: all is not great – I’m a strong believer in David Pogue’s reviews at the New York Times, and he says this first version of Fire is ugly-bad:

You feel [the cheap] price tag with every swipe of your finger. Animations are sluggish and jerky — even the page turns that you’d think would be the pride of the Kindle team. Taps sometimes don’t register. There are no progress or “wait” indicators, so you frequently don’t know if the machine has even registered your touch commands. The momentum of the animations hasn’t been calculated right, so the whole thing feels ornery.

But he ends with this: “Then again, Amazon tends to keep chipping away at the clunkiness of its 1.0 creations until it sculptures a hit.” For instance, today’s conventional Kindles are far slicker book machines than the original; they’re beautiful.

So for this fantasy about healthcare in a year or two, think about Fire in a year or two.

2. Fire’s new “Silk” browser and cloud computing

I love my laptops, but I long for power in the palm of my hand. And I un-long for my the cost of my 3G and 4G data plans, a separate one for every device. In short, I want all the speed I can eat, via wifi.

But websites that are designed for hard-wired computers aren’t optimized for slower connections. The Wired interview explains what Amazon is doing to re-architect how data gets to your browser:

One of the things that makes mobile web browsing slow is the fact that the average website pulls content from 13 different places on the Internet. On a mobile device, even with a good Wi-Fi connection, each round trip is typically 100 milliseconds or more …

We’ve broken apart this process. If you can be clever enough to move the computation onto our cloud platform, you get these huge computational resources. Our cloud services are really fast. What takes 100 milliseconds on Wi-Fi takes less than 5 milliseconds on Amazon’s Elastic Compute Cloud.

The interviewer, Steven Levy, points to how this may shift power fundamentally – especially how much power you need in your palm:

It’s a hack that aims to make web pages download much faster. But it also has grand ramifications: It points to an era in which the device is so secondary that even computation takes place in the cloud.

Mixed emotions here:

• “Computation takes place in the cloud”: that has one level of impact if you’re talking about tablets, but it has quite another level if you think about smartphones (iPhone, Android) or even “app-phones” (e.g. Blackberry) and cheap plain-old cell phones. The lesser devices have less power. What if they can access power anyway? Even the most disadvantaged people?
• But Levy, what are you smoking in that Fire? Tests by Anandtech.com show no improvement at all with that feature enabled, and Pogue’s test of three sites says “The iPad took about half as long each time.”

But let’s say that too gets resolved in 1-2 years, and  just think about this architecture – a potentially potent streaming tablet, connected to a cloud platform that does a ton of the computing for you, and delivers slick answers to your hand.

Now, what if we connect that to a wicked-smart health information platform? Hm, where would we find that?

3. IBM’s Watson

Nine months ago IBM’s “Watson” supercomputer played the Jeopardy quiz show against the two best Jeopardy champions ever, and stomped the snot out of them (NY Times). One of the champions was Ken Jennings, who had won 74 consecutive matches. Watson beat him by $77,147 to $24,000. The second-best champion ever, Brad Rutter, earned $21,600.

At the time, my antennas instantly told me to write a post titled “Watson, I need you“:

Did you know the first “phone call” was a cry for medical help? Alexander Graham Bell had spilled acid on himself, and hollered to his assistant, “Watson, come here. I need you.” In a remote room, Watson was astounded to hear the first sound come from the primitive speaker.

This week, the amazing victory by IBM’s Watson immediately made me think, “What could this thing do in healthcare?? If it stomped the fastest fact-retrieval minds we’ve ever found, what could it do in medicine?”

I want it. It reads constantly, remembers everything it’s read, and understands what it means. Imagine how useful it could be for physicians … and for members of my ACOR kidney cancer community.

I was going to speculate about applications: Watson might say “I see you mentioned Sutent. Last week at a conference in Bulgaria a doctor mentioned a new finding, during the live-streamed Q&A in session B42.” or “There’s a discussion in process in Inspire.com’s Women Heart community, with a reliability rating of 87.3…” (I made up “reliability rating.”)

At the time, circumstances came up and I never wrote the post, but I wondered if it had occurred to IBM. Ha: I should have known: with $2,000,000,000 a year of healthcare spending worldwide, IBM was already on it. Just eight weeks later they announced it, and five months after that (Sept. 12) they announced a major Watson deal with Wellpoint, corporate parent of Blue Cross:

For physicians, incorporating hundreds of thousands of articles into practice and applying them to patient care is a significant challenge. Watson can sift through an equivalent of about 1 million books or roughly 200 million pages of data, and analyze this information and provide precise responses in less than three seconds.

The announcement added this thought:

Watson may help physicians identify treatment options that balance the interactions of various drugs and narrow among a large group of treatment choices, enabling physicians to quickly select the more effective treatment plans for their patients. It is also expected to streamline communication between a patient’s physician and their health plan, helping to improve efficiency in clinical review of complex cases.

Help physicians identify treatment options? Um, it might help the rest of us, too. Especially those of us who are having a hard time affording a doctor visit.

Then this, which may not be welcome by certain providers in your area, but very welcome by others:

It could even be used to direct patients to the physician in their area with the best success in treating a particular illness.

I could go on at length, but you get the picture: a wicked fast system that understands human questions, continuously updates itself and delivers answers… and isn’t controlled by the medical establishment. Extremely disruptive, because it goes around existing vendors (providers) and delivers valuable facts directly to the buyer.

Who are the buyers who’d like that information?  Depends on the patient:

• the insurance company, or
• government insurers (everything from Medicare to county health agencies), or
• self-insured employers (who have given up on insurance), or
• self-pay patients. (That’s me, for all practical purposes: I’m on $10,000 deductible insurance.)

How big a deal would that disruption be? Recently at an event in the Midwest, I heard an MD panelist at the region’s dominant hospital respond to talk of shared decision making by booming, “WE will tell you the best treatment! WE will tell you who the best surgeon is! WE are the experts! Don’t get that from some… blog!” He almost spat the word out.

I wonder how he’ll do in Q&A versus Watson. Because it seems that day is coming.

1+2+3: Silkfire Watson

Now imagine something with Watson’s power, thinking out there in the cloud somewhere, with enormous amounts of information about outcomes. Immediate and long-term outcomes.

Imagine it with an architecture like the Silk browser and Amazon’s “thinking cloud” (my term, not theirs). So all that power (and knowledge) gets delivered to however much power you have in your hand (Fire or other), or in your desktop computer, or whatever.

Or to a kiosk in a public health clinic. Health information accessible to everyone.

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I imagine a mashup of Watson with the Amazon Computing Cloud is crazy, but consider the concept.  I don’t know if any of it’s going to happen, and I certainly don’t know if it would involve Silk and Fire. Plus, arguably Microsoft’s own cloud computing is better positioned, because MS’s HealthVault has such a good footprint in healthcare.  I don’t have a clue.

But on the other hand, I wouldn’t be surprised if IBM’s on the verge of announcing it, same as they voiced my February fantasies within eight weeks. We’ll see.

But really – just think what it would be like if you and your doctors could get the best information, without depending solely on the doctor’s capacity for reading.