A recent clinical trial of the technology found that Elizabeth also appears to have a beneficial effect on care. A month after discharge, people who interacted with the virtual nurse were more likely to know their diagnosis and to make a follow-up appointment with their primary-care doctor. The results of the study are currently under review for publication.
Timothy Bickmore (seen here with his virtual nurse system) will use a new grant to develop agents that help cancer patients. Photo by Lauren McFalls
To develop the computer-controlled avatars, researchers first recorded interactions between patients and nurses. They then tried to emulate the nurses' nonverbal communication by endowing the virtual character with hand gestures and facial expressions. (The resulting animation is, however, much simpler than today's sophisticated video games.)
Researchers also add small talk, asking users about local sports teams and the weather, which real nurses and coaches often do to put patients at ease. The verbal interactions are fairly basic; the nurse or trainer has a set repertoire of questions, and users choose from a selection of possible answers. For anything beyond that repertoire, the virtual agent will refer the patient to a human health-care provider.
"We already know we don't have enough health-care providers to go around, and it's only getting worse," says Kvedar. "About 60 percent of the cost of delivering health care comes from human resources, so even if you can train more people, it's not an ideal way to improve costs."
Kvedar worked with Bickmore on a second, home-based trial, in which a virtual coach called Karen encouraged overweight sedentary adults to exercise. Users checked in with Karen three times a week, and she gave them recommendations and listened to their problems. Over 12 weeks, those who talked to the coach were significantly more active than those who simply had an accelerometer to record how much they walked.
Bickmore's team is now working on a virtual nurse that would reside in the hospital room. Patients can talk to it about their hospital experience, report pain levels, and ask questions. The researchers are also integrating sensors into the system, to record when the patient is sleeping, for example, or to track when different doctors enter the room.
In a pilot study, patients had an average of 17 conversations with the nurse per day. "When we interviewed them afterward, we found that the agent seemed to be effective at addressing the loneliness you often feel if you're at the hospital by yourself," says Bickmore.
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