A Fireside Chat about Digital Technology in Healthcare

Cleveland Clinic and IBM are partners in the Discovery Accelerator, a joint initiative to develop and apply advanced computing technologies in ways that will profoundly alter the pace of discovery and innovation in healthcare and life sciences.

Coupling Cleveland Clinic’s research and clinical expertise with IBM’s leadership in high performance computing in the cloud, artificial intelligence and quantum computing, the partnership intends to achieve fundamental advances that will improve human health worldwide. The Discovery Accelerator is home to the first private-sector, onsite, IBM-managed quantum computer in the United States, and the first devoted to healthcare research.

Recently, at the inaugural Cleveland Discovery & Innovation Forum, Tom Mihaljevic, MD, CEO and President and Morton L. Mandel CEO Chair of Cleveland Clinic, and IBM Vice Chairman Gary Cohn, sat down for a wide-ranging discussion of topics including the impact of advanced digital technologies on healthcare; cybersecurity risks; responding to workforce shortages; and the state of their organizations’ collaboration.

Their comments have been edited for clarity and brevity. 

Mihaljevic: A couple of years ago we started our collaboration and we've created something that is really a source of excitement. Are you happy with the outcome?

Cohn: We couldn't be happier with where we are. We think we're at the very beginning, though. When you look at the quantum/AI revolution, we think it's an evolution. Cleveland Clinic has been doing research for over a hundred years. IBM's been doing research for over 80 years. We’ve both had amazing accomplishments. You put our two knowledge bases together in one of the most difficult and interesting fields — healthcare — and throw in some of the most sophisticated computing power in the world, with a quantum computer in your facility, and there's enormous opportunity to work together. The thing we've all learned from AI is that it gets smarter every day. We're going to get smarter every day as we go through this program. It would be interesting to hear how you think of the relationship.

Mihaljevic: What we are always looking is for a partner who has a significant commitment to Cleveland Clinic. Often, the problem we encounter with partnerships is that it turns out to be a vendor-customer relationship. With IBM, we have truly found a partner. How do you define a good partnership?

Cohn: We're in a similar position. We're looking for someone can bring something equally to the table. We have the unique ability to bring the quantitative skills, the AI skills. You've got the global database, the knowledge, the scientific expertise. So we need each other. In a good partnership, neither can succeed without the other. I believe the Cleveland Clinic/IBM relationship is an interdependent partnership.

Mihaljevic: Everybody in the world speaks about AI. For some, it is scary. For many, it's inspirational. [OpenAI CEO] Sam Altman said AI is seriously overhyped in the short term and seriously underhyped in the long term. What do you think?

Cohn: I think it's overhyped in the short term but seismic in the long term. I don't want to go too deep into the politics of AI. But when there's a regulatory body that will have influence, people describe something based on the regulatory environment they want. So there are certain people talking about AI as something very scary, like fire and electricity. That's the group that wants it to be highly regulated and wants to regulate themselves onto the island so no one else can get there. Then there are people like us who think that AI is just the next evolution of technology, and we want everyone to have access to it. We think there should be regulation, but no one should be barred from being in the business. You should ultimately regulate the use case. If your [AI-powered] mapping service took you out of the way and it took 22 seconds longer to get to your destination, I don't think the government needs to regulate that. You might've had a song on your Spotify list that you didn't like. I don't think the government needs to regulate that. But if we as IBM and Cleveland Clinic come up with [AI-derived] medical solutions and new medicines, the government probably should be regulating that. So let's regulate the use cases that need regulation and let's let creativity thrive in the world.

Mihaljevic: Speaking about the use cases for AI in healthcare, our strategy can be described in various buckets of AI applications. There's one bucket of applications to empower patients to receive care seamlessly and continuously. Another bucket is AI solutions to make the lives of people who provide care easier. And a third bucket is a suite of applications that helps healthcare executives run our business, which is extremely complex, more efficiently. How do you see this approach? Does it make sense to you? Would you modify it?

Cohn: I think all of those are important use cases. We analyze businesses around the world, and running a hospital is a very complex business with an enormous amount of data input and throughput. AI can help with data processing. The one point I'll make is that I sit on a couple of AI governing bodies and there are always people who are worried about job losses due to AI. I'll ask everyone here to tell me the technology that, over a 10-year cycle, created job loss and not job gain, because I've yet to find that technology. Are you thinking about using AI in the same way that we do as we look at your business?

Mihaljevic: Absolutely. I'll give you a concrete example. Close to one-third of our time when it comes to the practice of medicine is used in activities that have nothing to do with actual patient care. It is mostly either entering or trying to retrieve data from the electronic medical record. If we were to facilitate that with artificial intelligence, it is obviously better for patients. It is also better for providers. It is just an elimination of tasks that are nonproductive and ultimately not satisfying. We have such a tremendous workforce shortage in healthcare that we must create efficiencies — not just for business’ sake, but because if we don't, many people will not receive the care they need. When people ask me what I worry about, I say our ability to continuously provide care for patients in need. And I think technology is here to enable us to do it better than we have in the past.

Cohn: Our objective, working with you, is to find new and better treatments for things that today we don't know how to cure.

Mihaljevic: Yes. Our ability to analyze large data more effectively, leading to new cures, is really important. But what is really, really important is our ability to provide a common standard of care to all people in need. The 10 best healthcare systems in the United States provide care for only about 10% of all Americans. That means 90% of Americans do not have access to the best of what U.S. healthcare has to offer. That's the problem we need to solve today.

Cohn: To reach those other patient populations, you would use a variety of mechanisms.

Mihaljevic: Correct.

Cohn: A lot of that may be with telehealth. I'm always concerned about the cybersecurity side of the issue. That's got to be a concern of yours, too — as we reach out to more and more patients, how do we protect the integrity of the data, especially in your highly regulated industry.

Mihaljevic: Yes, it's hugely concerning. Cybersecurity in healthcare is, in our assessment, the greatest risk variability to providing care. We need to protect ourselves. And the majority of U.S. healthcare is composed of 100- to 200-bed hospitals that operate on maybe a 1% margin and usually have a very lean IT staff. What is your assessment of the degree of vulnerability when it comes to cybersecurity?

Cohn: The industry as a whole is very vulnerable. You've got the hospital layer, but you're also digitally interfacing with pharmacies and third-party payers. If a hacker were going to try to cause havoc for consumers, it would probably be that layer between the healthcare provider and the pharmacy. If people couldn't get their medications, it would be chaotic. The interwoven nature of the healthcare system creates multiple vulnerabilities. Any one of those could be a point of attack.

Mihaljevic: Yes. When we speak about the technological enhancement of healthcare, a part of that is the workforce we have to develop to implement and manage it. We’ve been working together on workforce development ever since we started our collaboration. Where does IBM stand on that topic? Does the workforce shortage affect you as well?

Cohn: Absolutely. It affects everyone in this country and globally. You said before, and I'll reiterate, that as we replace many jobs at the bottom of the cycle [with technology], we need to retool those people into higher value-added jobs. It's good for the people; it's good for us. We've pledged to train 30 million people around the world in AI/quantum by 2030. We need these people. Not all of them will end up at IBM. Some will end up at our competitors. But as a world, we need to train people in how quantum works, how AI works. We're bringing in high school interns, college interns, people at every level. Not necessarily people with four-year degrees. We're willing to train anyone who wants to be trained in this area. With the labor shortage we've got in the world today and the expanding economy, where we run less than 4% unemployment, we have to spend the time training people.

Mihaljevic: There's absolutely no way around it. There are several ways we're trying to solve the problem. One is to redesign how we provide care so it can be done with different teams. The other is skills-based hiring. We have revised hundreds, if not thousands, of our job descriptions that used to require a degree. We found that we have many people inside and outside our organization who don’t have a degree but have the appropriate skills, aptitude and willingness to learn. That opens a lot of opportunities for folks in particular in our immediate community. Cleveland Clinic is leading the United States when it comes to the skills-based hiring movement in healthcare. We're very proud of it.

Cohn: I know historically that the shortage of nurses in this country has been one of the factors that impedes growth in healthcare. As an incentive, don’t you reimburse registered nurses for tuition?

Mihaljevic: There are a tremendous number of programs to subsidize further education for people who join Cleveland Clinic. Those help us attract the best and brightest and are an extremely effective retention tool. But even with that, we struggle with work shortages, especially in nursing, as you mentioned. A delegation from the Philippines recently visited with us. Their country educates probably the most nurses per capita of any country in the world, and yet the biggest problem in healthcare in the Philippines is the nursing shortage. So that issue will be with us for a long time. The technological solutions we've been talking about are geared toward enabling our colleagues in nursing to practice at the top of their license. We’ve been discussing how can we redesign the processes of care so that all of our qualified caregivers can work at the top of their license.

Cohn: Changing the efficient frontier changes the margins. Everything changes. And AI is probably the only tool you can use to do that.

Mihaljevic: That is true. We have been very encouraged by several use cases where we've already applied AI in clinical workflows. For example, using AI for early detection of sepsis, which is one of the leading causes of death in the hospital setting. We have been able to be much more efficient in identifying patients who suffer from it and taking care of them effectively. We are looking forward to many more AI-aided solutions in the future. We are also very proud of having the first quantum computer devoted to healthcare and life sciences research. It's attracted a tremendous amount of funding and research projects. As you know, we are significantly increasing the size of our research space and are adding sophisticated computational methods to accelerate discovery. It’s a phenomenal opportunity for both of our organizations. We’re grateful for the collaboration.

Cohn: We're equally excited about what’s going on with quantum computing at Cleveland Clinic. The opportunities for the future of healthcare are extraordinary.