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'Laura' makes digital health coaching personal

As a computer scientist, one wouldn't expect Timothy Bickmore to concern himself with making sure that schizophrenics take their medications or the elderly get enough exercise.

But that's where Laura comes in.

Laura, a computer-generated character, raises and knits her eyebrows, nods her head ever so gently, and almost seems to sigh as she commiserates with a patient over how challenging it is to remember to take pills or get out for a walk. A virtual health coach, she asks questions of patients and responds empathetically and encouragingly to their answers.

Bickmore's creation of Laura puts this Northeastern University professor at the forefront of growing attempts to build technology to help people stick to health regimens and increase the flow of information between health care providers and patients. The health care industry may soon turn to programs like Bickmore's -- which is still in the research phase -- to augment the personalized attention patients get.

With an aging population of baby boomers and not enough health care professionals to meet their needs, virtual coaches like Laura may one day, Bickmore hopes, be able to bridge the gap -- and then some. After all, even if there were enough health care professionals to go around, nurses don't remind people to take their pills every day and few people can afford personal trainers.

The benefits of virtual coaches and other interventions could go far beyond the health of the individual patient, innovators say. By keeping patients on their medication and physically active, virtual coaches and other technological innovations could also reduce hospital admissions and illness, and, as a result, cut health care costs. Studies suggest, for instance, that at least half of schizophrenics at some point fail to take their medication as prescribed.

Researchers are also experimenting with tailored voice messages delivered via phone and with Internet sites, sometimes linked with chat groups, to help people exercise or quit smoking. There's also a new portable pill box, called Med-eMonitor, that not only sounds a chime when it is time to take a pill, but can sense if the patient took the pill out of the box, and it has a screen that can ask the patient questions. The device hooks up to a phone line and sends data to trained health coaches who can send patients messages or contact their doctor.

The complexity of today's medical regimens -- which can require patients to take a half-dozen or more pills per day -- makes the high-tech approach particularly relevant.

"The good news is that medicines are cleaner today than they were before and more targeted to certain conditions. But people are also taking increasingly complex cocktails," said Dr. Bruce Kehr, a doctor and CEO of Informedix, of Rockville, Md., which makes the Med-eMonitor. Roughly 10 percent of all hospital admissions are because of noncompliance with medicine, he said.

Early evidence suggests such high-tech health monitors are effective.

In one study, published last week in the Archives of Internal Medicine, a Web-based exercise intervention programs for sedentary adults showed very strong results.

"People in our study went from doing nothing to doing 120 minutes of exercise per week and maintaining that for a year," said Brown Medical School psychiatry professor Bess Marcus, the study's lead author and director of the Centers for Behavioral and Preventive Medicine at The Miriam Hospital in Providence, where the research was conducted.

Laura has been the subject of a variety of completed and ongoing studies. In one study carried out at Boston University, elderly people -- most of whom had little or no experience with computers -- were given a computer tablet with a touch screen and a pedometer to measure how far they walked. They were instructed to check in with Laura every night for 10 minutes, to answer a few questions. The group upped their walking by 100 percent.

"The control group was given the standard care intervention," Bickmore said. "They were given a pedometer, a brochure, and a pat on the back. The control group didn't increase their walking over the two months."

Another program in which Laura tries to help schizophrenics adhere to their medication is currently under trial at the University of Pittsburgh. This study is funded by pharmaceutical firm Eli Lily.

In some cases, Bickmore says, research has shown that patients actually prefer dealing with a computer than a real, live health care professional. Patients often feel less intimidated asking questions of or taking the time of a computer than a nurse.

He said research has also shown that "people are more honest with computers about socially undesirable behaviors, like drug and alcohol use."

Bickmore's interest in Laura as a computer scientist -- and former MIT Media Lab doctoral student -- is to look "at social and relation-building cues that are used to build trust and rapport over time. These two factors are a significant determinant of health care outcomes," he said. "The more you trust your health care provider the more likely you are to follow what they say and the better the health outcomes."

Both Marcus and Bickmore insist that the gold standard in health care is human-to-human contact and that they aren't trying to replace it. But because of limitations in the current health care system and disparities in access to care, they say, interventions like theirs can have positive outcomes.

"Critics outside the system say 'Can't you get a nurse to spend five more minutes with people?' or 'Why don't you hire more nurses?' Well that's a huge problem, and it's not one I can solve," Bickmore said. "The problem I know how to solve is to try and build technology that can spend time with patients to improve their behavior."

To see Laura in action, go to: ccs.neu.edu/home/bickmore/FitTrack1.mov

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