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.

Click to see: 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.