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How could Cochlear use GPT technology?

Writer's picture: Rudy NauschRudy Nausch

This high-level proposal is a direct response to the current advancements in artificial Intelligence technology, specifically Generative Pre-Trained models, and will outline the opportunities, risks and considerations for evaluation.


DISCLAIMER: At the time of writing I am an employee of Cochlear LTD. All information used in this, and related, articles are based on publicly available sources. At no point was privileged or internal information used in any way. This was done as a part of a master's degree assignment.


Overview of analysis & proposal methodology


The methodology for this proposal will follow the formal Technology and Innovation Management (TM) framework. As a discipline, TM has a 50-year history of research and use which offers universally accepted conceptual models to understand and communicate technology innovation management.


The framework emphasises the dynamic nature (Dynamic capabilities theory) of the knowledge flows that must occur between the commercial and technological functions in an organisation, linking the strategy, innovation, and operational processes. (Çetindamar, et al, 2016)



Opportunity Statement of new technology


Machine Learning and Artificial Intelligence have been in development for several decades, however, over the last few years incredible progress in these fields has captured the world’s zeitgeist.


Specifically Large Language Models (LLMs) have reached a stage of practical maturity, in the form of Generative Pre-Trained (GPT) Models, that has allowed them to pass the following exams in the last month (as of February 10th, 2023):

  • University of Pennsylvania - Wharton MBA

  • US Medical License

  • Chartered Financial Analyst (CFA)

  • Stanford Medical School final for Clinical Reasoning

  • The University of Minnesota Law final

What makes these achievements most notable is that these were done without any specific or specialised training for these exams, or subjects.

The GPT model was trained on 175 billion tokens of data (~100 billion words) and was able to apply this, without any further changes to the model, to these exams. Also worth noting is that the training data includes these languages: (Kublik, Saboo. 2022).

  • English (primary)

  • Spanish

  • French

  • Chinese

  • Russian

  • Portuguese

  • Python

  • JavaScript

  • C++

  • C#

  • Java

  • Ruby

  • PHP

  • Go

To be clear, LLMs are not capable of reasoning as they are statistically probabilistic models to predict the next word in likely order.

However, the emergent capabilities of these large models are sufficiently close to human reasoning to perform several real-world functions at a relatively advanced human level.

It would be reasonable to assume that this technology is currently in the early stage of the growth S-curve and that we are about to experience a significant technological paradigm shift. (Chen, et al. 2012)



Analyse the organisation.


As the market leader in the implanted assisted hearing market, Cochlear has very clear and industry-leading organisational core competencies:

1. Cochlear & Baha Device manufacture

2. Support eco-system around devices – with Clinics, Hospitals, and Audiologists.

3. Sales eco-system around devices – Relationships with medical and governmental bodies across the globe.

4. Medical device research and academic collaboration – Collaborations with several universities and commercially aligned entities, sponsorships of academic entities and scholarships for audiologists.


Prioritisation by Business strategic objectives

By reviewing the Business’s strategic objectives, we can determine the appropriate technology to investigate further. (Cochlear Limited, 2022)

1. Retain Market Leadership.

2. Grow the hearing implant market.

3. Deliver consistent revenue and earnings growth.


Prioritisation by Risk objectives

By understanding the Business’s risks, we can position the appropriate technology. (Cochlear Limited, 2022)

1. Pandemics

2. Product innovation and competition

3. Misappropriation of know-how and intellectual property infringement

4. Medical Device regulations

5. Product Quality

6. Market Access

7. Credit and Currency

8. Interruption to product supply

9. Privacy and Information security

10. Talent management

11. Geo-political risk


Current Status of TM Capabilities in Cochlear

With ~60% market share globally of the Cochlear and Baha (Bone anchored) markets, our technology, products and services are world-class and industry-leading.


Using the TM framework, we will ask and examine:

1. How do we exploit our technology assets?

2. How do we identify future technology that will have an impact on our business?

3. How do we select technology for business benefit?

4. How should we acquire new technology?

5. How can we protect our technology assets?

6. How can we learn from our experience to improve our ability to develop and exploit the value of technology?

TM Activity

Status

Acquisition

Relates to any need for technology acquisition

  • Industry-leading, matured technology manufactured in-house.

  • Recently purchased Oticon for both technology and customer share

  • Focused R&D Portfolio of development product pipelines.

  • Collaborations with several universities and commercially aligned entities,

  • Sponsorships of academic entities and scholarships for audiologists.

  • Components are simple and devices are assembled in-house, with minimal dynamic transaction costs.

Exploitation

Relates to market penetration, technology robustness and technology comparative advantages.

  • Commercialisation of technology is highly matured, with excellent speed to market throughput from the R&D portfolio

  • Highly mature marketing function which has a global presence

  • Deep penetration of the primary market group (Children) with growth in the secondary market (Adults & Seniors)

  • Devices demonstrate:

  • Reliability – product robustness is very high, based on device breakdown metrics.

  • Maintainability – surgical units are incapable of breaking down, and replacement of sound processes can be done within 24 hours in almost all cases.

  • Availability – operational usage of devices is ~100%

  • Technological capabilities are ahead of most peers, and at similar levels for any new technological breakthroughs.

Identification

Relates to the identification of technological opportunities and threats

  • Advanced Bionics is a subsidiary of Sonova, a Swiss-based group that holds ~20% of the total hearing aid market. Their holding company also has subsidiaries in several audio-related markets, most notable Sennheiser consumer electronics and Phonak, an integrated wireless communications company. AB’s product offering is very similar to Cochlears in all aspects; however, they are heavier (~25% heavier across the range), require an intermediary device for wireless streaming, and do not have Remote Assistance; however, has a Roger Pen option & Contralateral Routing of Signal, both of which Cochlear products do not. (Villegas, C. 2018)

  • MED-EL (Medical Electronics) is a privately held Austrian company that is almost precisely aligned with Cochlears' market focus. Their focus and innovative research agenda are significant, specifically Hearo – a surgical robot designed to assist with cochlear implantation, Dexel – a device that emits healing improvement drugs post-implantation, and TICI – a fully contained CI that has no Above the Ear or Behind the Ear component. In terms of products' point of difference, the Med-El devices do not offer Remote assistant or any hearing aid collaborations. They also have an auditory brainstem implant product.

  • Demant A/S is a Danish-based company that is the dominant market leader in Hearing Aids; however, they do not directly compete with Cochlear in the CI market anymore as Cochlear purchased Oticon in December of 2022.

  • Zhejiang Nurotron Biotechnology is a privately held China-based competitor and has a relatively insignificant impact on the market presently, with lagging technology capabilities.

Learning

Relates to technological change impacts and the ability to apply continuous improvement

  • Medical regulatory burden for documentation creates an excellent and very thorough library of technical, process and organisational artefacts.

  • The change management function is relatively new; however, it is growing and increasingly facilitates quicker technological learning.

  • Technical education team is mature and has software and process tooling in line with global leaders.

  • Frequent use of leading consultancies to keep ahead of technology innovations across all technology functions.

Protection

Relates to IP and technology protections in place, and mechanisms.

  • Technology Assets are patented and copyrighted rigorously during the development stages by the legal department.

  • The Intellectual Property portfolio is managed by the executive and corporate teams and is one of our leading market value metrics

  • Knowledge workers are given industry-leading remuneration packages, including work-life balance opportunities and bonus incentivisation.

Selection

Relates to knowledge and implementation of new technological capabilities and innovations

  • Continuous review of available technologies, and observation of innovation within the industry facilitate strong technological forecasting ability.


Identification - Potential Use cases of LLMs


Due to GPT models' versatility across tasks that it has not specifically been trained for, there are many potential uses. Listed below are the specific use cases identified that would be most applicable to Cochlears current operations, segmented by enterprise domain. (Kublik, Saboo. 2022).


Some of the systems listed below are compound Machine Learning models, utilising bolt-on LLM technology. (Harvard Business Review. 2021)


Marketing

Marketing content generation, translation, and assistance


Customer Domain – Recipients and Candidates

Customer Service GPT (Connected Care)

  • Frontline website and apps chat

  • Audiological and device assistance for recipients

  • Customer sentiment analysis, keyword extraction, and trend analysis

  • Organize & summarize product feedback from users (support tickets, surveys, analytics) into actionable insights for future product development, and improved service delivery


Customer Domain - Professionals

Professional Audiological GPT

  • Training of audiologists

  • Device reference for clinics and clinicians

  • Medical reference for all professional users


Enterprise efficiency

Enterprise Internal GPT

  • Enterprise search,

  • Internal training support,

  • Medical and Device reference assistance,

  • Technical assistance,

  • Medical texts & Research summarisation,

  • Summarisation for decision-making


HR Assistance GPT – support, internal sentiment analysis, keyword extraction, and trend analysis


DevOps and Coding GPT - technical assistance, automation and technical artefacts support and generation


Prioritisation decision matrix

LLM technology use-case

Strategic Objectives Alignment

Risk Objectives

Alignment

​Total Value (Sum of Alignments)

Marketing

1,2,3

2,5,6

6

Customer Service GPT

1,2,3

2,4,5,9,10

11

Professional Audiological GPT

1,2,3

2,3,4,5,10

11

Enterprise Internal GPT

3

1,2,4,5,9,10

7

HR Assistance GPT

3

4,5,9,10

5

DevOps and Coding GPT

3

1,2,4,5,9

5


The Customer Domain is the priority based on both strategic and risk alignment, with the current service touch points processes summarised below.


Current State


Customer Domain Functions

Responding to customer inquiries: answering customer questions and resolving any issues or concerns they may have.

Order processing: taking customer orders, processing payments, and ensuring that orders are fulfilled in a timely and accurate manner.

Technical support: helping customers with technical issues, such as troubleshooting problems with products or services.

Complaint resolution: receiving and resolving customer complaints, often through a process of investigation, negotiation, and dispute resolution.

Account management: managing customer accounts, including handling account changes, billing inquiries, and payments.

Sales and marketing: promoting products and services to potential customers and helping to close sales.

Escalation management: handling complex customer issues that require a higher level of expertise or attention and ensuring that these issues are resolved in a timely and satisfactory manner.

Feedback and suggestion management: collecting and analysing customer feedback and suggestions and using this information to improve products and services.

Quality assurance: monitoring and evaluating the quality of customer service to ensure that it meets established standards and expectations.

Reporting and analysis: generating reports on customer service metrics and analysing data to identify areas for improvement.


Technology Audit of selected technological domains for LLMs


Gap analysis

Current Process & Technology

Capability gap improvement opportunities

Web and app

The Customer Service department facilitates contact through email, and phone centres. The information is captured in a Customer Relationship Management tool Salesforce.

  • Single point of contact through GPT allowing comprehensive 360-degree customer management

  • Improved speed and quality of responses

  • Reduced cost of call centres and customer service overheads

  • The Customer Service department enters issues into issue-tracking software, and/or escalates issues to relevant product teams for further collation of audiologist or device subject matter expert advice.

  • Direct contact with associates or affiliates

  • Fully automatable functionality that can be delivered with little to no human oversight.

  • Data collected via Salesforce or other touch point attribution systems manually, then sent to Analysts and BI teams.

  • Fully automatable functionality

  • Manual collection and analysis, Salesforce metrics

  • Significant speed of insight and analysis improvements

  • Fully automatable functionality

Training

In-person, when and where available

  • Fully automatable service that can be delivered with little to no human oversight.

Access to the Cochlear Professional portal which allows access to the knowledge base and technical escalation.

  • Significantly improved service and speed of knowledge base use

Access to the Cochlear Professional network which allows access to the knowledge base and escalation via the portal or direct contact

  • Significantly improved service and speed of knowledge base use


Identification - Value Analysis

Value analysis is a process used to evaluate the benefits and costs of a technology to determine its overall value to a business. This process helps to make informed decisions about technology investments and ensure we are getting the maximum return on investment. (Phaal, et al. 2011)


Using GPT technology for the customer domain has the following advantages and disadvantages.


Advantages

  • Increased efficiency: provide quick and accurate responses to customer queries, reducing response times and increasing overall efficiency.

  • Improved accuracy: By fine-tuning GPTs for specific use cases, high levels of accuracy in understanding customer inquiries and providing appropriate responses can be achieved.

  • Cost savings: reduce labour costs associated with having human agents handle customer inquiries.

  • 24/7 availability: beneficial with a global customer base or for customers who require support outside of traditional business hours.

  • Enhanced customer experience: provide customers with more personalized and engaging experiences, improving overall customer satisfaction and loyalty.

Disadvantages

  • Limited empathy: Unlike human agents, GPT technology lacks the ability to provide emotional support and empathy to customers, which can impact the quality of the customer experience.

  • Limited understanding: GPT technology may not be able to fully understand the nuances of certain customer inquiries or may provide incorrect responses, leading to customer frustration.

  • Inflexibility: GPT technology is limited by the data it was trained on and may not be able to adapt to new or unique customer inquiries without additional training and fine-tuning.

  • Technical limitations: GPT technology can be expensive to implement and maintain, and may require specialized technical expertise to operate effectively.


Ethical considerations

  1. Bias – ML Models retain the inherent biases of society and can manifest in operation.

  2. Confabulation – AI “Hallucinations” are the result of probabilistic uncertainties captured in the model’s training.

  3. Saliency - the black box nature of AI can be difficult to position in a heavily regulated market such as Medical Devices

System proposal to close gaps.

Conceptual design of Target Architecture for the first and second releases.

R1 = Stand-alone GPT support for Customer Services Function

R2 = Customer Service function regulating (HFRL) GPT front-line servicing


Release 1


Release 2


Human Feedback Reinforcement Learning (HFRL)

HFRL is a type of machine learning that uses human input to guide the learning process of an AI system. The AI system receives feedback from human operators in the form of rewards or punishments, which are used to adjust the system's behaviour. Human operators provide more nuanced and context-specific feedback on the system's behaviour and are safeguards against Bias and Confabulation, which we covered earlier. The GPT system may receive positive reinforcement when it provides helpful and accurate responses to customer inquiries and negative reinforcement when it provides incorrect or unhelpful responses.


Over time, the GPT system will learn from this feedback and improve its performance, providing a better customer experience.


Value Curve of Service Offerings*


The Value-Curve of our perceived service offerings versus competitors shows that there are several improvement opportunities that implementing GPT technology will help improve.

*Dummy data


Opportunity Cost and Benefit analysis

Opportunity cost refers to the cost of an alternative that must be forgone in order to pursue this technological implementation. It represents the value of the best alternative use of resources and time.


Cost of doing nothing:

- Competitors may implement first.

- Cost of future implementation and catch up maybe significant.


The potential benefit of implementation:

- Higher professional customer satisfaction

- Higher recipient customer satisfaction

- Significant cost savings

- Faster and better device support

- Faster insights and value realisation

- Well positioned for future advances in GPT technology


Forecast the Technology and environment.

In the next few years, the adoption of GPT technology in the medical device industry is expected to experience significant growth.


From streamlining supply chain management to improving product development and regulatory compliance, the potential applications of GPT in the medical device industry are numerous. As the technology continues to evolve, it is likely that more and more companies in this industry will adopt GPT to gain a competitive advantage and meet the ever-increasing demands of the healthcare sector.


This trend is expected to lead to an acceleration in the pace of innovation in the medical device industry, with companies leveraging GPT to develop new products, improve existing ones, and provide better care to patients


Analyse and forecast the Market User

As industries and society embrace GPT technology there will be an expectation from customers for the speedy, in-depth and personalised customer experience that this technology will increasingly become better at.


Acquisition of technology

Technology or Activity

Buy (License)

Make

Collborate

GPT model

Licensing models for GPTs are increasingly available and cheaper as time progresses.

Expensive and requires unique SMEs outside of Cochlears’ core competencies. Training costs would be in the millions of dollars for each fully trained model.

Possible to do, however, the cost of development and maintenance may be significant

Integration

Would be provided as part of the AI as a Service (AIaaS) / Platform as a service model (PaaS)

Expensive and requires unique SMEs outside of Cochlears’ core competencies

Achievable and cost-effective as Python skills are not prohibitively expensive. Skills exist in-house and would need up-scaling.

Support

Would be provided as part of the AI as a Service (AIaaS) / Platform as a service model (PaaS)

Expensive and requires unique SMEs outside of Cochlears’ core competencies

Achievable, however certain aspects of deeper technical support may be expensive.

Customisation

May be challenging depending on the vendor’s service model.

Full customisation is needed and will require support.

Achievable, not as expensive as making the toolset but more expensive than licensing.




Implementation - Portfolio Management

The needs of the program of work will need to be balanced against the existing Technology Portfolio, should we move forward. The rank prioritisation will dictate timelines and scope will indicate the budget.


Resources

1. Technical personnel with knowledge of GPT models and tools

2. Technical personnel with knowledge of tool integration

3. Hardware and software resources to implement the GPT model, tools, and integrations.

4. Access to any necessary external services.

a. Contactors

b. SME’s


Implementation Road Map and Stage Gates

Proposal by Releases to mitigate any potential issues and provide as safe as is possible implementation.


R1 = Stand-alone GPT support for Customer Services Function

R2 = Customer Service function regulating GPT front-line servicing


1. Preparation: Establish the plan for the technological and operational implementation of the LLM GPT model.


2. Requirements: Determine the necessary technical requirements and resources to implement the model against Stage Gate One requirement. Cost out Licensing vs Collaboration approaches.


3. Selection: Select the GPT model and tools that best suit the organization's needs.


Stage-Gate One – Stakeholder reviews of the vendor demo system.

- Edge-cases

- Robustness

- Bias

- Saliency

- Confabulation

- Regulatory compliance

- Disaster processes


4. Governance, Quality and Operational Model design finalisation: all processes, quality and governance considerations will require significant workshops and collaboration across several functions. This should be led by the IT Architecture team.


5. Training: Train the team on how to use the GPT model and associated tools.


6. Implementation: Install and configure the GPT model and tools.


7. Testing: Test the GPT model and tools to ensure they are working correctly.


Stage-Gate Two – Technical and Operational field-testing validation.

Roll out of the system in one geographical domain, to run in parallel with existing systems. Hyper-care model to facilitate HFRL and any hotfixes as required.


8. Deployment and Change Management: Deploy the GPT model and tools to the remaining geographies in a methodical manner, with extensive change management support.

9. Continuous Improvement / Continuous Deployment (CI/CD) and Kaizen: As the technology teams are rolling off the main development roadmap, we will create support and CI/CD teams to continually improve the functionality. Human Feedback Reinforcement Learning (HFRL) – feedback and analysis of requests and outputs by customer service, medical and device experts will also assist to facilitate continuous improvement of the system.


Key Performance Indicators (KPIs)

How we will measure the success of the technological implementation:

  • Benchmarking against current processes (will require a Time Analysis study) baselines.

  • Cost savings annualised against existing spend for identified Customer Domain functions

  • Comparisons against best-in-class, cross-industry, implementations of this technology in the customer domain

  • Total Quality Management (TQM) – questionnaires and surveys

Protection

Depending on the final acquisition model we will implement a legal IP review process.

  • Identifying and measuring technology assets (internal and external)

  • How best to manage knowledge workers and their IP

  • IP portfolio management


References

3 Areas Where AI Will Boost Your Competitive Advantage. (2021). Harvard Business Review. https://hbr.org/2021/12/3-areas-where-ai-will-boost-your-competitive-advantage

Bennink. (2020). Understanding and Managing Responsible Innovation. Philosophy of Management, 19(3), 317–348. https://link-springer-

Çetindamar, Phaal, R., & Probert, D. (2016). Technology management activities and tools (2nd ed.). Macmillan Education.

Cochlear LTD. (2022). Cochlear Annual Report 2022. Corporation Listings. https://www.listcorp.com/asx/coh/cochlear-limited/news/2022-annual-report-2749627.html

Chen, C.-J., Huang, Y.-F. and Lin, B.-W. (2012) ‘How Firms Innovate through R&D Internationalization? An S-curve Hypothesis’, Research Policy, 41(9), 1544–1554.

Kublik, & Saboo, S. (2022). GPT-3 : building innovative NLP products using large language models. O’Reilly Media, Inc.

Phaal, R., O’Sullivan, E., Routley, M., Ford, S. and Probert, D. (2011) ‘A Framework for Mapping Industrial Emergence,’ Technological Forecasting and Social Change

Tamkin, A. (2021, February 4). Understanding the Capabilities, Limitations, and Societal Impact of Large Language Models. arXiv.org. https://arxiv.org/abs/2102.02503

Technology Organisations, management and innovation. (2020, April). The Open University. https://www.open.edu/openlearn/nature-environment/organisations-environmental-management-and-innovation/content-section-1.7

Villegas, C. (2018a, April 6). Roger Pen/ Roger EasyPen (For Cochlear Implants). Arizona Hearing Center. https://www.azhear.com/roger-pen-roger-easypen-for-cochlear-implants/


Villegas, C. (2018b, April 12). Streaming Technology (For Cochlear Implants). Arizona Hearing Center. https://www.azhear.com/streaming-technology-for-cochlear-implants/

Witzel, L. (2023, February 1). ChatGPT and DevOps: Practical Uses for Disruptive AI | The TIBCO Blog. The TIBCO Blog. https://www.tibco.com/blog/2023/01/12/chatgpt-and-devops-practical-uses-for-disruptive-ai/

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