Cognitive Technology

Cognitive technology will be the differentiator of the digital age. By comparison, if you look back in time to around 4000 bc to 1700 ad at what is sometimes viewed as the first socioeconomic age, the so-called Agrarian or Agricultural Age, the differentiator was the reorganization of work. Before that time, men spent days and weeks away from home hunting for food in the form of animals. Women and children stayed close by the home gathering nuts and berries to eat.Transformation was achieved, in part during the Agrarian Age, when people realized that efficiencies could be gained by bringing animals close to home, fencing them in, and raising the animals for a ready source of food. Similarly, people during that age noted that taking the seeds of berries and nuts and planting them close to home would also gain efficiency and a ready supply of these food types. People transformed work roles from hunters and gatherers to ranchers and farmers, but the work remained largely physical.Next came the age many of us are familiar with, the Industrial Age around 1700 ad to 1960 ad, when great progress was made by overcoming the obstacles of physical work made possible by the use of machines, the new differentiator. No longer did humans manually plow a field to grow crops. Significant efficiency was gained with the invention of the tractor, setting the stage for large-scale agricultural production and ultimately food surpluses. From sewing machines to phones, automobiles, and more, machines made work easier and leisure time increasingly possible.Now we are in the Digital Age, where great progress will be made by overcoming the obstacles of mental (cognitive) work, thanks to computers. It may be hard to readily appreciate this progress when too much of technology to date has added to mental work and sometimes even to physical work. Examples include false alarms on patient monitoring and infusion systems, manual data entry, and nonintuitive work to learn how to use electronic health records. This Technology Today column discusses the role of cognitive technology as the current differentiator, overcoming the obstacles of mental work with the promise of improving clinical and financial outcomes in health care.An examination of the speed and number of health care discoveries helps illuminate the need for cognitive technology. As illustrated in the Figure, the time from medical discoveries to dissemination in clinical practice has progressively decreased for the past 2500 years. As can be seen, dissemination time is on a linear trajectory to reach a point where knowledge discovery becomes instantaneous with widespread implementation in clinical practice.1Looking at the upper left-hand corner of the graph (see Figure), one can see where angina (or what would one day be called angina) was first documented and how it took 2300 years to be commonly taught in medical schools. Looking at the bottom half of the Figure, note that the trend from discovery to dissemination continues to be linear such that the gap between discovery and implementation is narrowing more and more. Important to note in the lower right-hand corner of the Figure is the point in year 2025 when the transition from medical discovery to widespread dissemination is expected to be essentially instantaneous.Further compounding the scenario of discovery to dissemination is the increasing number of medical discoveries to be disseminated. Between 2005 and 2015, 2000 to 4000 completed references were added to MEDLINE each day, with more than 750 000 citations added in 2014.2 It is not uncommon for several relevant studies to guide clinical decision making, studies that often vary in their design, method, population, and intervention.3 Once clinical decisions are made, ongoing reconciliation is then required as changes to the body of knowledge occur with time.Instantaneous and voluminous translation of medical discoveries essentially eliminates typical methods of learning about new discoveries such as conferences, journals, and books.1 The new instantaneous dissemination pathway will be largely digital and direct. Accomplishing this dissemination requires a digital solution known as cognitive technology.Cognitive technology is a category of technologies that enables humans to extend and magnify their current knowledge and cognition. In simple terms, cognitive technologies support human thinking, that is, knowledge-oriented tasks. For example, one type of cognitive technology involves filtering and extracting relevant information from the increasing volumes of published information mentioned earlier.An example of cognitive technology used to analyze evidence involves IBM Watson at Memorial Sloan Kettering Cancer Center (MSKCC).4 Watson was brought into MSKCC in 2012 to help individualize care by rapidly processing current guidelines and research as well as genetic data and patients’ medical records and then suggesting diagnoses and treatments for consideration to clinicians. Originally brought in for patients with lung and breast cancers, the use of Watson has since been expanded to cover other cancers, and it is now being deployed in other organizations.Although cognitive technology can sometimes outperform knowledge-oriented tasks of humans, it is important to understand that, for now, it can only augment human thinking, not replace it. By offloading some cognitive functions to computers, the mental performance of humans can be augmented or expanded. This offloading allows clinicians the ability to perform beyond the capacity of their own brain power.5Supporting cognitive technology is the rapidly evolving field of cognitive informatics. For nurse informaticists, the focus is on the cognitive aspects of nursing such as critical thinking, decision making, and problem solving and how those can be augmented through the use of technology.6 More than 100 cognitive task analysis methods are available for nurse informaticists to use to capture accurate and comprehensive descriptions of nurses’ cognitive processes, enabling them to support the sound design and effective use of cognitive technologies.Technology has the potential to dramatically change nurses’ contribution to health care. As we look at technology today, we must ask ourselves the question very aptly posed by Ober and Applegate,7 “Are we the tools of our tools?” Does benefit exceed work as we manually input tremendous amounts of data into our electronic health records 24/7? Are we gaining more by individually reading and cognitively assimilating as much as we can from the continually increasing number of publications in electronic libraries? The reality is that we are rapidly exceeding our capacity as humans to access, store, and analyze all the data and information we need to provide optimal patient care. Just as we can see farther with telescopes and travel more rapidly with airplanes, we will be able to think more broadly, more deeply, more quickly, and more accurately with cognitive technology.