Adaptive Systems in Healthcare

1. Adaptive Systems in Healthcare Velma L. Payne October 5, 2005

2. Papers Reviewed • Core paper “Adaptive Systems in Healthcare” • A. Cawsey, F. Grasso, C. Paris • The HOMEY Project: a telemedicine service for hypertensive patients • T. Giorgino, S. Quaglini, C. Rognoni, J. Baccheschi • Dialogue Systems for Health Communication ,ed AAAI Press ,pages 32 - 35 ,(2004) • http://www.csc.liv.ac.uk/~floriana/UM05-eHealth/Giorgino.pdf

3. Papers Reviewed • Adaptive Medical Workflow Management for a Context-Dependent Home Healthcare Assistance Service • L. Ardissono, A. Di Leva, G. Petrone, M. Segnan, M. Sonnessa • Proceedings of the CWS-05; International Workshop on Context for Web Services • http://www.di.unito.it/~liliana/EC/CWS05.pdf

4. Agenda • Goals of Patient Information • Considerations for Adaptive Information Systems • User Model Requirements • Adaptation Techniques • System Evaluation • System Implementation • Applications of Adaptive Healthcare • Conclusion

5. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Goals of Patient Information • Inform Patient • Of their condition • Of treatments, drugs, side effects • Enable Decision Making • Persuade Patient to be Compliant • To follow course of action (improve diet, exercise, quit smoking) • Reduce Stress and Anxiety • Enhance Patient Care

6. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Considerations for Adaptive Information Systems • Each patient has different … • Information Needs • Emotional Needs / Stability • Cognitive Ability - ability to comprehend • Stress Loads

7. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Considerations for Adaptive Information Systems cont… • Patients musttrustsource of information • Patients need to be incontrol • They need to control the information the system keeps about them and their condition • Systems must maintain patientprivacy • Systems must keep patient Information secure

8. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion User Model RequirementsWhat needs to be captured in order to provide tailored medical information to a patient? • Patient Data– age, sex, diagnosis, past and current treatments, specialists that have been seen, etc. • Mental and EmotionalState * • Acceptanceof Their Disease * • Ability to MakeDecisions * • Ability toPerformComplex Tasks * • MotivationLevel / Willingness to Change * * How do you evaluate these ?

9. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion User Model Requirements cont… • Literacy Level • Monitor patient’s state • Update user model with state changes The author designates the last two items are “research challenges” and does not expound upon how a system should accomplish them

10. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Adaptation Techniques • Natural Language Generation (NLG) • NLG techniques are concerned with the automatic production of appropriate textual documents from structured data sources • Two Stages of NLG • Content Planning - planning what to say • Information Presentation - deciding how to express information

11. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion NLG - Content Planning • Input • Domain information from a database or knowledge base • User Model Data • Process • Selects information based on user data & data available in Database or Knowledge Base • Output • Sequence of primitive messages

12. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion NLG - Information Presentation • Ask / Consider the Following • Should each fact constitute one sentence or should they be conjoined? • Should facts be announced bluntly or indirectly? • Should facts be presented formally or informally? • What words should be used?

13. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Adaptation Techniques • Autonomous Agents (Ardissono paper) • Autonomous Agents are software entities that are capable of independent actions in dynamic, unpredictable environments • Autonomous Agent research has developed advanced action execution techniques that support sophisticated selection of actions to perform in order to achieve goals, taking contextual conditions into account

14. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Autonomous Agents • Belief Desire Intention (BDI) Agents • Deliberative agents acting in an environment to achieve goals in a context dependent manner • Capabilities of a BDI Agent are called Actions • BDI Agent has an Action Library specifying all the actions it can perform • Each action is aimed at achieving a Goal • Each goal is characterized by it’s Applicability Conditions • Each action has a Body describing the sequence of steps to be executed

15. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Autonomous Agents A1: Book Blood Test Goal: Get Blood Test Appointment • Book Blood Test 1: • Goal: Get blood test appointment • Appl Condition: Moveable patient • Body: • Fix appointment with lab; • Notify patient about place and time of appointment • Book Blood Test 2: • Goal:Get blood test appointment • Appl Condition: Non-moveable patient • Body: • Fix appointment with lab; • Request nurse at home; • Notify patient about the arrival of nurse; • Notify nurse about lab test;

16. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion System Evaluation • Need to consider • What is the claim or hypotheses ? • What techniques can be used to prove or disprove the validity of the hypotheses ?

17. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion System Evaluation cont… • Questionnaires • Is system preferred over other systems • Does system provide relevant information • Increased patient understanding • Reduction of anxiety • Higher level of compliance

18. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion System Evaluation cont… • Randomized Clinical Trial (RCT) • Patients are randomly assigned to an intervention (personalized / non-personalized system) • Patients participate in the study • Results are collected and measured statistically • Conclusions are determined

19. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion System Evaluation cont… The author recognizes … • RCT is the “gold standard” for evaluation within the medical domain • It is difficult for computer scientists to utilize this method of evaluation for information systems • Other means of evaluation of information systems are needed for information system evaluation … but the author did not provide any insight on this issue

20. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion System Implementation • How to implement an adaptive information system into the medical community was raised, but not answered, by the author

21. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion System Implementation cont… My Thoughts • Gain support from a entity in the medical profession that is open to the use of computer systems • Integrate such an entity in the project from the “get go” • Ensure the entity recognizes they are a valuable contributor to the project • Ensure the entity recognizes the system will enhance their business and reduce costs • Assist the entity in the introduction and tracking of the system to the patient

22. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications - Piglet • Concerned with creating personalized materials for patients undergoing treatment for diabetes and cancer • Provided patients with on-line access to their medical record • Provided hyperlinks to explanatory information about their condition and treatment • These explanatory pages were generated dynamically from a knowledge base of medical information and patient record

23. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications - Piglit

24. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications - Piglit • Adaptive Techniques • Natural Language Generation • Evaluation • Randomized Control Trial – 525 patients (part with personalized info / part with general information system) • Questionnaires – patient views of system and anxiety level before and after intervention • Results • Patients receiving personalized information felt they learned relevant information

25. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications – HOMEY • Personalized Home Monitoring to Support Continuity of Care • System Goals • Ensure chronic patients with hypertension and diabetes comply to the therapeutic and lifestyle regimes • Improve information flow between patients and medical staff

26. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications – HOMEY • Allows patients to communicate their test values to the medical staff • System updates patient’s records • System prompts / questions / makes recommendations to patients on their lifestyle • Medical staff reads patient’s updates and provides recommendations

27. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications – HOMEY • Adaptive Techniques / System Design • Natural Language Dialog Technology / Intelligent Dialogue Technology - provides “real time dialog” rather than “canned scripts • Creates dynamic html pages and voiceXML sentence fragments • System remembers past conversations / asks about specifics of these. For example, system could day “You wanted to quit smoking, have you began to reduce your smoking habits yet?”

28. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications – HOMEY • Sample Dialogue • System: What is your heart rate? • Patient: What do you mean? • System: How many times a minute does your heart beat? • Patient: My heart rate is 67, my BP is 90 over 120 • System: Are you still swimming twice a week? • Patient: Yes • System: Are you still smoking? • Patient: Yes, 5 cigarettes per day • System: You should stop smoking

29. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications – HOMEY • Evaluation • Study performed in two Italian hospitals hypertension units / Two different studies • Randomized Control Trial – 300 patients • Blood Pressure Measurement – before and after system use • Results • Patients using system had greater systolic pressure decrease

30. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications – Home Healthcare Assistance Service • Goals • Allow patients to spend time in a familiar environment • Efficiently manage home health-care assistance • Reduce hospital expenses • Methods • Provide a virtual connection between patient and hospital • Virtual connection monitors activities, requests services and manages medical protocols that the patient under-goes

31. User Physician, Nurse, Patient, Relative Guideline Guideline Manager Activity Execution Manager Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications – Home Healthcare Assistance Service • If multiple guidelines apply to a patient, they are carried out as parallel work-flows, each managed by the Guideline Manager • The active guidelines have to be coordinated in order to prevent scheduling conflicts • Updates to the patient’s clinical record are synchronized with patient data, pending appointments and tasks the patient should perform

32. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Applications – Home Healthcare Assistance Service • Authors did not provide any information on the evaluation of the system • The paper only described the development of the framework

33. Goals Considerations User Model Techniques System Evaluation System Implementation Applications Conclusion Conclusion • Adaptive systems definitely have a place in the Healthcare Industry • The development of such systems can be complex • Integrating such systems into the industry remains a challenge which must be overcome

34. Thank You