Virtual healthcare system makes house calls

Voice-activated systems extend healthcare to patients' homes

Using speech recognition and IVR technologies, Boston Medical Center is deploying automated applications that screen patients over the phone for healthcare issues.

Four months go by, on average, between scheduled checkups for patients with chronic diseases such as diabetes, obesity and hypertension. A lot can happen between visits, and researchers at Boston Medical Center are pioneering ways to stay virtually connected with patients so that any healthcare issues can be addressed without delay.

The goal is to provide guidance and information when patients need it, during their daily lives and not just during scheduled doctor visits, says Robert Friedman, a physician and head of a team at Boston Medical Center that's developing telephone-based systems for delivering virtual care.

Virtual visits

"What we're trying to do is catch problems earlier and then facilitate physicians and other health professionals to do something earlier," says Friedman, who is chief of the Medical Information Systems Unit at Boston Medical Center. "We're also educating people how to take care of themselves, encouraging them, monitoring what they do, and counseling them. There's a psychological and behavioral intervention component to it, too."

Using speech recognition and interactive voice response (IVR) technologies, Friedman and his team have developed automated applications that screen patients by emulating what a healthcare professional might do.

Patients dial the systems from their homes, or the systems make outbound calls (particularly if someone misses a virtual appointment). They're prompted to input information, such as their blood pressure or weight, using speech or keypads. They're also asked questions such as whether they are exercising, sticking to a diet and taking medication regularly. The system analyzes the data and provides patients with feedback and coaching, using digitized human speech or text-to-speech generators. It also alerts appropriate parties if there are signs of trouble or indications that someone's healthcare regimen needs to be modified.

"It's in real time, so someone is on the phone, taking their blood pressure or answering a question, and that's being reported to physicians or clinicians electronically," Friedman says.

Most recently Boston Medical Center went live with a system that targets people at risk of substance abuse problems. Developed for the Massachusetts Department of Health, the application takes data from medical practices and uses it to screen primary care patients for undiagnosed substance abuse problems.

The system is capable of reaching thousands of people every week -- which would be prohibitively expensive for healthcare providers to do in-person. "Early detection is critical for people in the beginning phases of addiction. With the voice-activated system, we can get to them right away," says Amy Rubin, a clinical psychologist and member of the Boston Medical Center development team.

New delivery models

The idea of using telephone systems to deliver healthcare to people in their homes is not new. Friedman, for instance, has spent 25 years working on increasingly advanced systems for delivering virtual care.

What's most different between Friedman's early applications and those he’s creating today is the use of a commercial platform for developing, deploying and managing applications.

Boston Medical Center uses the Envox Communications Development Platform 7, which combines a programming environment for developing applications with a VoiceXML gateway and run-time environment. Management and administration tools round out the platform.

On the telephony front, the Envox system performs tasks such as answering and placing calls, playing menus, executing options, and monitoring or recording calls. It's tied to a Nuance platform for speech recognition, and it's also integrated with some of the medical center's patient systems. The software-based Envox 7 platform can be deployed on standard Windows servers, and it adheres to standards including SIP, H.323, CCXML and VoiceXML

For Friedman, shifting from proprietary, home-grown systems to a standards-based platform has enabled him and his team to build and deploy applications more quickly. "We built the first IVR system we used," Friedman recalls. "But trying to build your own IVR system, maintain it and improve it is a whole business in itself."

Looking ahead, he sees a time when virtual care options become an integral part of healthcare. But first advocates need to resolve the fact that virtual care isn't a traditional healthcare service and it doesn't yet have a place in most insurers' business models.

"The biggest impediment has not been resistance from patients or resistance from health professionals," Friedman says. "The real problem is more systematic, to do with how healthcare is delivered and paid for."

Progress is being made, however. Boston Medical Center today is overseeing virtual healthcare projects around the world, including in Sweden, China and Australia. "This type of model will be a regular part of the healthcare system throughout the world," Friedman says. "The hardest thing to do is predict when."

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