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

Adaptive Systems in HealthcareAdaptive Systems in Healthcare

Velma L. PayneVelma L. PayneOctober 5, 2005

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

• 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

Papers Reviewed

Agenda

• Goals of Patient InformationGoals of Patient Information

• Considerations for Adaptive Information SystemsConsiderations for Adaptive Information Systems

• User Model RequirementsUser Model Requirements

• Adaptation TechniquesAdaptation Techniques

• System EvaluationSystem Evaluation

• System ImplementationSystem Implementation

• Applications of Adaptive HealthcareApplications of Adaptive Healthcare

• ConclusionConclusion

Goals of Patient InformationGoals 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

GoalsGoalsConsiderationsConsiderationsUser ModelUser ModelTechniquesTechniquesSystem EvaluationSystem EvaluationSystem ImplementationSystem ImplementationApplicationsApplicationsConclusionConclusion

Considerations for Adaptive Considerations for Adaptive Information SystemsInformation Systems

• Each patient has different …Each patient has different …

- Information NeedsInformation Needs

- Emotional Needs / StabilityEmotional Needs / Stability

- Cognitive Ability - ability to comprehendCognitive Ability - ability to comprehend

- Stress LoadsStress Loads


Considerations for Adaptive Considerations for Adaptive Information Systems cont…Information Systems cont…

• Patients mustPatients must trusttrust source of informationsource of information

• Patients need to be inPatients need to be in controlcontrol

- They need to control the information the system They need to control the information the system keeps about them and their conditionkeeps about them and their condition

• Systems must maintain patientSystems must maintain patient privacyprivacy

• Systems must keep patient Information Systems must keep patient Information securesecure


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 Emotional State *

• Acceptance of Their Disease *

• Ability to Make Decisions *

• Ability to Perform Complex Tasks *

• Motivation Level / Willingness to Change *

* How do you evaluate these ?


User Model Requirements cont…

• Literacy Level

• MonitorMonitor patient’s patient’s statestate

• UpdateUpdate user user modelmodel with state changes with state changes

The author designates the last two items are “research The author designates the last two items are “research challenges” and does not expound upon how a system should challenges” and does not expound upon how a system should accomplish themaccomplish them


Adaptation Techniques

• Natural Language Generation (NLG)Natural Language Generation (NLG)- NLG techniques are concerned with the NLG techniques are concerned with the

automatic production of appropriate automatic production of appropriate textual documents from structured data textual documents from structured data sourcessources

• Two Stages of NLGTwo Stages of NLG- Content Planning - planning what to sayContent Planning - planning what to say- Information Presentation - deciding how Information Presentation - deciding how

to express informationto express information


NLG - Content Planning

• InputInput- Domain information from a database or knowledge baseDomain information from a database or knowledge base- User Model DataUser Model Data

• ProcessProcess- Selects information based on user data & data available Selects information based on user data & data available

in Database or Knowledge Basein Database or Knowledge Base

• OutputOutput - Sequence of primitive messagesSequence of primitive messages


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?


• Autonomous Agents Autonomous Agents (Ardissono paper)(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

Adaptation Techniques


Autonomous Agents

• Belief Desire Intention (BDI) AgentsBelief Desire Intention (BDI) Agents

– Deliberative agents acting in an environment to Deliberative agents acting in an environment to achieve goals in a context dependent mannerachieve goals in a context dependent manner

– Capabilities of a BDI Agent are called Capabilities of a BDI Agent are called ActionsActions

– BDI Agent has an BDI Agent has an Action LibraryAction Library specifying all specifying all the actions it can performthe actions it can perform

– Each action is aimed at achieving a Each action is aimed at achieving a GoalGoal

– Each goal is characterized by it’s Each goal is characterized by it’s Applicability Applicability ConditionsConditions

– Each action has a Each action has a BodyBody describing the sequence describing the sequence of steps to be executedof steps to be executed


A1: Book Blood Test Goal: Get Blood Test AppointmentA1: Book Blood Test Goal: Get Blood Test Appointment

Autonomous Agents


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;

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

System Evaluation

• Need to consider

- What is the claim or hypotheses ?What is the claim or hypotheses ?

- What techniques can be used to prove What techniques can be used to prove or disprove the validity of the or disprove the validity of the hypotheses ?hypotheses ?


System Evaluation cont…

• QuestionnairesQuestionnaires

- Is system preferred over other systemsIs system preferred over other systems

- Does system provide relevant informationDoes system provide relevant information

- Increased patient understandingIncreased patient understanding

- Reduction of anxietyReduction of anxiety

- Higher level of complianceHigher level of compliance



• Randomized Clinical Trial (RCT)

- Patients are randomly assigned to an intervention Patients are randomly assigned to an intervention (personalized / non-personalized system) (personalized / non-personalized system)

- Patients participate in the studyPatients participate in the study

- Results are collected and measured statistically Results are collected and measured statistically

- Conclusions are determinedConclusions are determined



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


System Implementation

• How to implement an adaptive information system into the medical community was raised, but not answered, by the author


System Implementation cont… My Thoughts

• Gain support from a entity in the medical profession that is Gain support from a entity in the medical profession that is open to the use of computer systemsopen to the use of computer systems

• Integrate such an entity in the project from the “get go”Integrate such an entity in the project from the “get go”

• Ensure the entity recognizes they are a valuable contributor Ensure the entity recognizes they are a valuable contributor to the projectto the project

• Ensure the entity recognizes the system will enhance their Ensure the entity recognizes the system will enhance their business and reduce costsbusiness and reduce costs

• Assist the entity in the introduction and tracking of Assist the entity in the introduction and tracking of the system to the patientthe system to the patient


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


Applications - Piglit


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


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



• 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



• 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?”



• 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 You should stop smoking



• 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

GoalsGoalsConsiderationsConsiderationsUser ModelUser ModelTechniquesTechniquesSystem EvaluationSystem EvaluationSystem ImplementationSystem ImplementationApplications Applications ConclusionConclusion

Applications – Home Healthcare Assistance Service

• GoalsGoals- Allow patients to spend time in a familiar environmentAllow patients to spend time in a familiar environment

- Efficiently manage home health-care assistanceEfficiently manage home health-care assistance

- Reduce hospital expensesReduce hospital expenses

• MethodsMethods- Provide a virtual connection between patient and hospitalProvide a virtual connection between patient and hospital

- Virtual connection monitors activities, requests services Virtual connection monitors activities, requests services and manages medical protocols that the patient under-and manages medical protocols that the patient under-goesgoes




UserPhysician, Nurse, Patient, Relative

Guideline Manager Guideline

Activity Execution Manager

• 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

• Authors did not provide any information on the evaluation of the system

• The paper only described the development of the framework



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


Thank You

Documents

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