Building Archimedes - a Q&A with 'Dr. Data' - ' Archimedes in Other Fields '

Archimedes in Other Fields

In what other fields besides medicine could someone apply a model like Archimedes?

It is ironic that, despite the facts that it deals with life and death and that it is a $1.5 trillion industry, healthcare is far behind other fields in using models like this. Goodyear does not design the tread of a new tire by making a hundred different versions and trying each one out on a road; they do it on a computer. Airplane wings are designed in models. The stresses on skyscrapers are analyzed in models. We are trying to bring that same kind of capability into medicine.

Why has it been done in other fields but not medicine?

I believe there are two main reasons. One is that the other places where mathematical modeling has been successful have tended to involve physical systems, where physical laws are applicable. In medicine, we are dealing with natural biological phenomena and human behaviors. There is much more variability and uncertainty. But with Archimedes we have shown that that barrier can be passed. The other reason is that healthcare is the domain of physicians, and the practice of medicine is based much more on qualitative reasoning than on quantitative reasoning. Once again, I can say that without intending any insult, because I trained in medicine before getting my doctorate in applied math, and I come from four generations of physicians. As physicians, we talk about the "art" of medicine and clinical "judgment." For many if not most physicians, numbers and models are not to be trusted. That is now a big barrier, and will continue to be. But as costs continue to increase, and as more and more articles are published – by physicians themselves – showing that physicians vary enormously in their beliefs and practices, with unacceptably high rates of the practices being deemed inappropriate by their own criteria, then I believe this will change. If physicians do not do it themselves, then the public will eventually demand it.

If I were trying to pitch this to a CIO I would begin by admitting that I do not pretend to know their business. But if pushed further I would start with the two main ways that (I believe) information is currently used in an organization. One is to gather and store information about the operation of the organization and the state of its products (e.g., inventories). In healthcare this would involve collecting data on such things as resources, utilization and costs. As healthcare organizations begin to develop automated medical records, they would also be included in this category. The second main use of information systems is to send messages out, in order to make desired things happen. This includes communications between various departments, getting information to the field and so forth. To use a medical analogy, the first use corresponds to the sensory system, collecting information through touch, sound, sight, etc., while the second corresponds to the muscular system, using information to cause certain actions. Archimedes fits in the middle. Its role is to process the incoming information and decide what to do, so that the right signals can be sent out. In the medical analogy, which I will admit is getting stretched, Archimedes is like the brain. It can take information about a population and tell you what is going to happen to it, and how that will change depending on various actions you can take. It can predict what is likely to occur so that you can prepare for it. It can suggest what you should do to make what you want to have happen, happen.

In business, no one would make an important decision without asking for a proposal and a business case. In the clinical [physician] side of healthcare right now, we rarely do that. Our equivalent to a business case is something like: "Our committee of physicians thinks this is the right thing to do." I believe that in five years, when a CEO or head of a department in healthcare is faced with an important decision involving clinical practices, he or she will ask, "What does Archimedes say?"