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Conversational IT for Better, Safer, Pediatric Care William G. Adams, MD Associate Professor of Pediatrics Director of Child Health Informatics Boston.

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Presentation on theme: "Conversational IT for Better, Safer, Pediatric Care William G. Adams, MD Associate Professor of Pediatrics Director of Child Health Informatics Boston."— Presentation transcript:

1 Conversational IT for Better, Safer, Pediatric Care William G. Adams, MD Associate Professor of Pediatrics Director of Child Health Informatics Boston Medical Center/Boston University School of Medicine badams@bu.edu

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3 A Critical Role for Patient- Centered HIT Limits of clinician-centered HIT Pressing need to: –Respond to individuals –Engage patients outside clinical settings –Provide access to personal medical information –Empower patients to be active participants in decisions and daily management –Consider unique constraints for child- centered systems

4 Conversational IT Speech-based Bidirectional Informative Adaptive Intelligent

5 Why Telephony ? Conversational Ubiquitous Directed Scalable Outbound

6 Three Child-centered Conversational Systems TLC-Asthma Healthy Eating and Activity Today (HEAT) Personal Health Partner (PHP)

7 TLC-Asthma: An Integrated Information System for Child-centered Monitoring and Case Management

8 Four age-specific child scripts (Grades K-1, 2-3, 4-6, 7+) 6 rotating modules Separate scripts for parents Modules –monitor and teach –alert nurse case manager TLC-Asthma Scripts

9 TLC-Asthma Alert Summary* Child # (%) Parent # (%) Child seriously ill23(4)3(1) Persistent asthma symptoms167(31)100(22) Missed school due to asthma21(4)- Medication change54(10)61(13) Needs refill25(5) Medication knowledge deficiency66(12)50(11) Rx does not match symptoms34(6)54(12) Excessive reliever med. use95(18)91(20) Persistent trigger exposure-9(2) Peak flow monitoring problem33(6)55(12) No action plan3(1) Other13(2)6(1) * 6 month intervention, 79 intervention families

10 TLC-Asthma – Results No difference in ER visits, hospitalizations, or spirometry 36% decrease in daytime symptom- days 25% increase in symptom-free days 67% fewer missed school days Increased effect in heavier users Preliminary, unpublished findings

11 The Healthy Eating and Activity Today (HEAT) Program: Telephony-based Self Care for Overweight Children

12 HEAT Two evidence-based programs –Traffic Light Diet (TLC, Epstein et al) –Student Media Awareness to Reduce Television (SMART, Robinson et al) 9-12 yr old children in early stages of overweight ( BMI < 5 above 95 %’ile) Child’s parent participates with child PCP supports family’s efforts

13 Theoretical Foundation for HEAT Content ComponentTheory/goal Greeting and positive praise or encouragement for sticking with the program Reinforcement to build adherence to the program Follow-up on challenge / goal set in the previous call Contingency management, rewards Educational topic related to weight management strategies Building behavioral capability Assessment related to the topic of the call Self-monitoring / self-awareness Challenge / goal setting related either to the previous challenge or to the topic of the day Building self-efficacy / goal setting Implementation intention Summary statement / closing to wrap up what was discussed

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15 The Personal Health Partner (PHP) Pre-visit conversation with parent Pediatric primary care and medication safety RCT (assigned at time of call): –Usual Care –Assessment (w/ EHR Integration) –Assessment, Counseling, and Activation

16 PHP System Architecture Anywhere Communication Gateway Server (Envox) vXML Application Server (Tomcat) Database (SQL Server) Speech Recognition (ASR) and Text-to- Speech (TTS) (Loquendo) Network Clinician Primary Care Center Parent EHR (Logician) vXML Script Development Software (Envox)

17 Hypotheses PHP use will be associated with more comprehensive visits PHP counseling will improve parental: Knowledge Behavior Activation PHP will improve efficiency by pre- populating RHCM form in EHR

18 PHP Study Design

19 PHP Assessment Samples TopicTriggerActivation Parental SmokingCaller is smokerCall local/national quit line Child DevelopmentFailed ScreeningDiscuss concerns with PCP, offer EI phone number Maternal DepressionPositive screen (PHQ2), no current treatment Call/find parent PCP, discuss feelings with pediatrician TB RiskAt risk, due for screeningRemind clinician to do PPD Medication Reconciliation Inactive or undocumented med in EHR Med List NA (physician notified via EHR) Medication UseOn prescription medsBring medication to visit Dosing errorsDiscuss dosing with clinician Asthma reliever used as controller Bring medication to visit and discuss use with clinician

20 Demonstration

21 PHP: Year 1 Activities Script development (questions, triggers, counseling, activation) New script data model and tools EHR data and user interfaces Focus group planning

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