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Can a Virtual Coach Activate Patients? A Proof of Concept Study

This research demonstrates affected person acceptance of a digital health coach whereas ready for the doctor to enter the first care examination room.

Sheri D. Pruitt, PhD, and Dannielle E. Richardson


Objectives: Virtual assistants shaped by way of the union of synthetic intelligence (AI) and pure language understanding (NLU) applied sciences (eg, Siri) are routine in our every day lives. The function of this research was to check sufferers’ acceptance of a digital health coach (VHC) who emulates medical employees to activate the affected person to interact in a dialog with their doctor about wholesome life.

Study Design: Descriptive survey research. 

Methods: Eighty-nine main care sufferers agreed to check “new technology” whereas ready within the examination room for his or her doctor. Patients used a handheld pill pc to work together with an animated VHC who requested questions on widespread health considerations, together with weight, smoking, consuming, stress, or treatment adherence. During the temporary intervention, the VHC suggested the affected person to have a dialog with the doctor concerning the recognized way of life concern.

Results: Patients have been snug with the know-how and stated it positively impacted their emotions concerning the group. They talked to the VHC, rated the know-how as straightforward to make use of, and felt that they might use it once more and that different sufferers would take pleasure in it. Many sufferers tried to speak to the VHC concerning the particular purpose for his or her go to. 

Conclusions: VHCs utilizing AI and NLU applied sciences are acceptable and useable, they usually positively influence sufferers throughout examination room “downtime.” The know-how simply integrates into the clinic workflow and doesn’t prolong the size of the go to. Although sufferers have been prepared to speak with the VHC, in lots of instances, they confused the VHC’s line of questioning about basic way of life considerations with the aim of their go to.

The American Journal of Accountable Care. 2016;four(four):41-45

Patient “activation” is a acknowledged idea that describes a individual’s information, confidence, and expertise to handle his or her personal health and healthcare; thus, sufferers who’re activated of their health and healthcare usually have higher outcomes and decrease prices.1 Yet, 75% of sufferers usually are not adequately knowledgeable or assured, nor have they got the required expertise to handle their health. In specific, wholesome way of life behaviors are problematic for many sufferers. Those with decrease activation not often take part in behaviors that require lively self-management, akin to train, consuming a nutritious diet, and managing stress.2

Interventions to extend sufferers’ activation of their health have targeted on the event of expertise and recommendation tailor-made to the affected person’s degree of activation. For instance, coaching sufferers to ask their docs questions and giving them help to take action has been proven to extend each activation ranges and participation in healthcare.three,four Observations of affected person–doctor encounters recommend solely 10% of the first care go to is dedicated to way of life subjects and, additional, that these 2 minutes principally entail the doctor mentioning a way of life concern. Such restricted and ineffective interactions have prompted calls for extra communication coaching for main care suppliers to assist them interact sufferers in way of life issues in a time-efficient and efficient method.5

A digital health coach (VHC) presents a answer to the issue of affected person activation and affected person–doctor discussions of way of life issues. Current know-how allows the design of an animated VHC who can perceive on a regular basis language and reply to sufferers in a conversational method. Patients are accepting of digital brokers and, apparently, some disclose extra to a pc interviewer than to its human counterpart.6-Eight Standardized behavioral change and motivational interventions may be constructed into VHC interactions.9,10 The means to standardize conversations permits difficult and time-consuming interactions to be temporary, constant in high quality, and scalable. VHCs might finally value lower than actual suppliers in particular contexts.11 Thus, they’re a beautiful various to coaching physicians to be proficient in efficient way of life discussions through the use of motivational interviewing methods, which has confirmed to be difficult at greatest.12,13

The function of the present research was to check the feasibility of a know-how innovation within the main care setting, constructing on an earlier unpublished research of a prototype. We needed to find out sufferers’ acceptance of a VHC—with synthetic intelligence (AI), pure language understanding (NLU), and animated capabilities—by partaking in a verbal interplay with the coach whereas ready within the examination room for the physician. The VHC is meant to emotionally join with, encourage, and help sufferers in preparation for a dialog with their physician about a way of life concern that the affected person identifies as regarding.


Setting and Procedures

Physicians and their medical assistants (MAs) from women’s health and grownup drugs clinics participated within the research. MAs gave sufferers a handheld pill and offered the instruction, “We are testing new technology and need your help.” There was a prominently displayed “start” button. The Northern California Kaiser Permanente Institutional Review Board allowed a waiver to a signed consent doc.

The VHC oriented the affected person to the aim of the pill app and offered directions for the microphone. As the VHC “spoke,” the pill’s display concurrently displayed the VHC and the textual content of the VHC’s phrases on the display to permit sufferers to learn the dialog. The affected person was requested to pick a common health concern (eg, weight, smoking, consuming, stress, taking drugs, or none of the above) and reply to a collection of questions, interspersed with empathic and supportive statements, all with the aim of encouraging the affected person to convey up the regarding health matter as quickly because the physician entered the room. The VHC used motivational inquiries to prime the affected person for the dialog.14 At the top, there was a “learn more” button for studying supplies related to the life-style matter the affected person chosen. Upon entry, the doctor requested, “What did you discuss with the health coach?”

Patients accomplished surveys disseminated by the authors and temporary interviews on the finish of their go to. Physicians have been surveyed by way of e-mail.


The VHC (an AI-based cognitive software program answer) was created by a contracted vendor, and it spoke English and Spanish. It was constructed on the Alme platform, which mixes a healthcare area mannequin and NLU with an avatar to drive interactive conversations. Samsung tablets have been related to a safe, company wi-fi community.

Outcomes, Measurements, and Analysis

Data have been captured by way of the pill app, together with verbal interactions, the life-style concern chosen, and the mode of communication (speaking, typing, and tapping an icon). Surveys used a 1-to-7 Likert scale to measure elements of the expertise, and sufferers additionally offered verbal suggestions. Means and commonplace deviations have been calculated for survey responses, and the consumer expertise knowledge have been additionally described.


Eighty-nine affected person–VHC conversations have been captured. One affected person refused to take part, and 63 sufferers (12 male, 48 feminine) have been out there for surveys and interviews. Thirty-four sufferers have been from women’s health clinics and 29 have been from grownup drugs clinics. The common age of males was 56 years (vary = 33-82 years), and the typical age of females was 41 years (vary = 18-84 years). Eight physicians participated.

Patients talked out loud to the VHC in 82% of the interactions and typed responses 6.6% of the time. When an icon was obtainable, sufferers “tapped” on it 74% of the time versus voicing their way of life concern audibly. Most sufferers rated the know-how as straightforward to make use of, felt different sufferers would take pleasure in utilizing it, and have been prepared to make use of it once more, whereas the modal response was “neutral” about their very own enjoyment. Many reported the constructive impression of the know-how on their emotions towards the healthcare group. Patients’ survey knowledge are introduced in Table 1.

Patients stated they felt inspired by the VHC to speak with their physician, and 51% of them reported they engaged in a dialog with their doctor concerning the health matter they chose on the pill. Twenty-six % reported that they had not talked with the doctor about this matter beforehand. “None of the above” was probably the most incessantly (66.three%) chosen way of life concern. Of that 66.three%, 24 sufferers particularly said, “I’m healthy,” 26 vocalized a particular purpose for his or her go to, and 9 of the verbal responses of sufferers have been unintelligible. Weight was probably the most frequent concern (18%), adopted by stress (7%), treatment adherence (6%), consuming (2%), and smoking (1%).

The verbal feedback relating to suggestions on the VHC included it was “fun,” “interesting,” “very cool,” “impressive,” in addition to “It was great to have something to do while waiting” and “I love this about this organization.” A quantity of different feedback have been just like “It would be great if it related to the reason I’m here.” Comments particular to the VHC included, “weird movements,” “robotic voice,” and 1 affected person said, “I didn’t like it.”

Sixty-seven % of the affected person–VHC conversations have been accomplished, which means sufferers reached the ultimate display. There have been Internet stability issues in some instances, and know-how malfunctions in others; for some, the doctor entered the room earlier than the affected person–VHC change was accomplished.

There was a vital adverse correlation between age and luxury with utilizing “touch screens” (r = –zero.51; P <.00003; R² = zero.26). No relationship was detected between the variables of age and luxury utilizing voice recognition know-how. Physicians reported minimal influence of the know-how on the period of the go to, they usually have been, on common, impartial concerning the usefulness of the VHC. Table 2 shows the doctor scores.


The function of this feasibility research was 2-fold: first, to find out sufferers’ acceptance of a VHC whereas ready for his or her doctor, and second, to determine whether or not sufferers would interact in a dialog with their doctor about a way of life concern recognized by way of the digital interplay. We consider that is the primary report of utilizing AI/NLU applied sciences with sufferers within the main care setting and contemplate the findings worthy of additional investigation.

Patient Experience

Patient responses to the know-how exceeded expectations. Regardless of age, sufferers have been prepared to make use of a VHC whereas within the examination room and to talk aloud to it. As in earlier reviews, sufferers have been constructive concerning the know-how.7,15 Patients additionally felt inspired by the VHC to interact in a dialog with their doctor. Interestingly, though sufferers assume others will benefit from the VHC, their very own enjoyment scores have been “neutral.”

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