02/05/10

From CNS News (partly)

Doc In A Box

Government Is Funding Technology to Monitor People's Health-Care Behavior by Having Them 'Visit' with Computers

By Marie Magleby

Sequential Multiple Analysis Computer at the Warren Grant Magnuson Clinical Center (National Institutes of Health photo).
(CNSNews.com) - “Health-care professional time is very, very expensive,” says Robert Friedman of Boston Medical Center. “We’re not going to constrain health-care costs by giving patients absolutely unlimited time with doctors or nurses--they’re too expensive.”


In an effort to increase efficiency in the treatment of certain health-care problems, the federal government has provided Friedman with about $22 million in grants since 1995 to develop technology that can save people actual visits to a doctor's office by allowing them to make "virtual" visits in which a computer speaks to them via a digitalized voice over the telephone.

Friedman has called the technology “Virtual Visit.”

“Telephone-Linked Care (TLC) technology has been developed and applied as an alternative to and a supplement for office visits as a means to deliver ambulatory care,” Friedman wrote in an article titled “The Virtual Visit,” in the November-December 1997 issue of The Journal of the American Medical Informatics Association.

Friedman currently has six active grants from the National Institutes of Health.

The TLC computer system works with patients to address common medical conditions such as alcoholism, asthma, depression, diabetes, heart disease, hypertension and spinal-cord disease through a telephone interface with the patient.

TLC can also be used to monitor personal behavior patterns by using computer-generated telephone calls and question-and-answer sessions to ask patients about such things as their fruit and vegetable consumption and their physical activity. The computer can even praise patients for exhibiting positive behavior in the answers they give.

“The goal is to monitor patients who need monitoring daily rather than just when they are seen in the office,” Friedman told CNSNews.com.

According to Friedman, the computer-and-telephone system can increase efficiency in health care.

“The information we have [in TLC] is absolutely accurate, it’s absolutely up-to-date, the systems are inexpensive to deploy,” he says. “So what it means is that we can have, in our programs, much more contact time with patients than they’re ever going to get from doctors and nurses unless there are very, very unusual circumstances.”

After more than 20 years of research, TLC technology is now in its licensing stages. Once it is in place, doctors and patients may use TLC to monitor the patients’ progress between visits.

Although patients are expected to call TLC according to a set schedule, TLC initiates the call when patients do not. Patients are greeted and asked to enter a Personal Identification Number, after which their automated “conversations” with TLC begin.

Because the information from each visit is stored in a database, TLC attempts to tailor the conversations to the personal histories and needs of each patient.

By pressing numbers or speaking into the phone, patients answer closed-ended questions that prompt pre-scripted responses from the computerized voice on the other end of the line. TLC then offers information and counseling depending on the patient’s input.

"During TLC telephone encounters, the system speaks to patients using computer-controlled digitized human speech,” Friedman wrote in “The Virtual Visit.”

“The patients, in turn, communicate with TLC by depressing the keys on their telephone keypad or by speaking into the telephone receiver,” wrote Friedman. “During each conversation, TLC asks the patients clinical questions and comments on their responses; it also can provide information and counseling. Depending on the clinical domain of the particular TLC application and the patients’ responses, a conversation can last between 2 and 15 minutes."

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"Next, place a plastic bag over your telephone handset, drop your trousers and underwear and bend over. You may experience some temporary discomfort..."

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