Boston Globe Reports on Professor Tim Bickmore's Reasearch
Prof. Bickmore's research on health counseling agents was featured in an article in the Health & Science section of the May 21 issue of the Boston Globe. The article outlines work by Bickmore and others on the development of automated systems to improve adherence to health behavior regimens such as exercise programs, diets and medication taking.
'Laura' makes digital health coaching personal
By Catherine Elton, Globe Correspondent
May 21, 2007
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: http://www.ccs.neu.edu/home/bickmore/FitTrack1.mov