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Ninety percent of the data that currently exists in the world is less than two years old, which means everything is new. For the majority of physicians, what they read, is two or three journals that they subscribe to or think are most relevant to their practice. In 2010 the National Library of Medicine cataloged 700,000 new articles. There is information there that would be helpful to you that you never will read, see, learn, or memorize.

We need support such as Watson and other analytical tools because the amount of information that is out there, it overwhelms us. We can't even conceive of it let alone use it. So Watson is a computer system that reads and understands English, which is a major advance. There are lots of tools that can recognize certain words or patterns of words, but Watson actually understands the meaning of an English statement or an English document.

Any clinician patient-relationship is a key to the future of health care. Disrupting that would be distinctly disadvantageous. Patients really aren't interested in having tools make decisions for them but providing them advice or ideas, along with their clinician, to help both of them make a better decision.

So that's what Watson does, it understands the nature of the question to be addressed then does all this reading and says, "'These are the important concepts, I think, for you to consider in making your decisions."' That's the key part, it helps you decide by giving you information that you can use with your skills and expertise to make it more likely to have an evidence-supported decision.

So that's where these algorithms come in. Recognizing that in this complex data, there are patterns and clues and signs that we can use to make better decisions that we can't process ourselves. At the heart of Watson is hundreds and hundreds of such algorithms.

In organizations such as the University of Utah are developing this algorithmic approach because we know that if we are going to use that data effectively we have to develop the mathematical and computer tools that collect and process that information for us and present it to us in a way that we can use when the mass amount of data is something we can't use.

As we really face this changing future, it's time for us to look deep inside and ask ourselves some fundamental questions about how we carry out our work. We have to hold close to our heart the core values and core purposes that are the essence of what we do in academic medicine, training the next generation of caregivers, carrying out the important biomedical and population research, caring for populations and individuals.

But how we do it can all change, and I think we have to start asking ourselves, how do we recognize and reward our researchers? Are we recognizing and rewarding the right things? We've had a tendency to focus on the RO1 or the independent scientist at the expense really of team science, or we acknowledge certain kinds of discovery as being more important than the science of integration or application.

In the education community, there are a number of questions. We use a four year time period to finish medical school. What are the skills that you need? Time should be a dependent variable, not the independent variable that determines how long medical school is.

We need to ask ourselves about cross training and residencies and across all the health professions. And then we have a lot of questions about how we deliver health care. We have traditions and structures. We tend to focus on inpatient care, but not as much on the continuum outpatient, skilled nursing, mental health, rehab. We really need to think more broadly about it.

So it's a time of reflection, of asking ourselves, why do we do things the way we do them, and if we did them differently could we do it better and as society is telling us, do it a lot cheaper? The challenge is, of course, that making change is difficult, it's painful. People often feel a sense of loss because they liked the way things are, but I think leaders have to step up and do it. Otherwise, somebody once said, "Lead, follow, or get out of the parade," and this is the time for leaders to step up and really be leaders.