An intelligent assistant for patient health care

The Patient Advocate is designed to be an intelligent assistant for patient-centered health care. Residing on a home computer or special-purpose device and operating within an extended health-care information network, the Patient Advocate will extend medical expertise into the outpatient setting. It will have remote access to the patient's medical record, an understanding of the patient's health status and history, and a model of the patient's interest in health-related issues, preferences for modes and contents of interaction, etc. The Patient Advocate is being designed to provide three kinds of functions. First, it will assist the patient in managing continuing ambulatory conditions, for example chronic problems such as diabetes, special normal conditions such as prenatal care, and wellness issues such as diet, exercise, and stress. Second, it will provide healthrelated information by allowing the patient to interact with the on-line health-care information network and scan media resources to suggest information of interest. Third, it will act as a remote triage point for clinical services by coordinating patient-relevant information such as reminding the patient when a visit to the clinic is indicated. We describe a prototype of the Patient Advocate which is designed to support obstetrics patients at risk of gestational diabetes. It is important that the Patient Advocate is platform-independent, runs on widely available hosts, and has access to various Internet resources. Therefore, it is implemented in Java and is Internet accessible. 1. Patient-Centered Care is Needed In recent years, several knowledge-based systems have been introduced to support health care providers (mainly clinicians) with the monitoring of critical care patients and to assist them with diagnostic decisions and therapy planning (Uckun 1994b). These systems range from simple intelligent alarms to sophisticated systems for anesthesia monitoring or ventilator management (e.g., GUARDIAN (Hayes-Roth, et al. 1989), NEOGANESH/GANESH (Dojat and Sayettat 1995), SIMON (Uckun, Dawant, and Lindstrom 1993), and VIE-VENT (Miksch, et al. 1993)). Automated reactive planners are a special kind of computer-based support which support the process of protocolbased care over significant periods of time. Two approaches can be distinguished. First, the prescriptive approach, in which active recommendations are given according to implicit under-lying guidelines,as in GUARDIAN (Hayes-Roth, et al. 1992) for intensive care monitoring, in VIE-VENT (Miksch, et al. 1993; Miksch, et al. 1996) for artificial ventilation management, in ONCOCIN (Tu, et al. 1989) for oncology, in T-HELPER (Musen, et al. 1992) for AIDS management, and in DILEMMA (Herbert, et al. 1995) as a general architecture. Second, the critiquing approach, in which the program critiques the physician’s actions rather than recommend a complete course of action on its own, such as HyperCritic (Van der Lei and Musen 1991) and ATTENDING (Miller 1984). This approach concentrates on the user’s needs and exploits the assumption that the user has considerable domain-specific knowledge (Miller 1986; Silverman 1992). These systems were built for the convenience of health care providers and ignored the consumers of health care, namely, the patients. Patients are treated only as objects of medical care. Health care is one of the most information-rich, but cost-intensive, areas. Preventive care is known to be one of the most effective means of decreasing long-term health care expenses. Poor or lesseducated patients cannot afford the expense for adequate preventive care, early interventions, or durative clinical observations and interventions. Nevertheless, there are opportunities to improve the quality of health care through more frequent and accurate self-monitoring and consultation with patients, through more effective communication between patients and health care providers, and through more active patient participation. A patient-centered approach should concentrate on the individual patient's needs and preferences. A patient-centered system has to make patient-specific and context-specific choices about different styles of presentation, has to provide a user interface according to the patient's needs, expertise, and abilities, has to use patientoriented vocabulary (e.g., different levels of explanation about the past, current, and future states of the patient's health conditions), and has to perform various reasoning processes. These processes range from data acquisition and validation to sophisticated treatment planning and context-sensitive explanations. Additionally, the system should be used at home, but should still connect the patient to several information resources and facilities. In response to these requirements, we have built a patient-oriented system called Patient Advocate, which adapts outpatient care delivery to the individual patient's demands, needs, and preferences. In the following first section we will illustrate the medical scenario and the patient's participation. The second part will describe the general functionality and the overall architecture of the Patient Advocate project. The third section will concentrate on the most important component of the Patient Advocate project, namely, the monitoring and consulting agent. We will describe its guiding principles, its observation and treatment components, and the sharable underlying task-specific ontology to represent timeoriented treatment guidelines. Finally, we will present our current prototype. 2. The Patient-Centered Medical Scenario When patients with serious medical problems interact with the health care system, they must perform a variety of challenging and consequential information-processing activities over a period of time. These activities support the patient's understanding or her/his evolving medical situation, cooperation with physicians in making decisions about diagnostic and treatment options, and compliance with the agreed-upon treatment. In performing these activities, the patient often requires or benefits from interaction with different health care professionals, other patients, or support