Adding these apparently simple touches of humanity does appear to influence how people interact with the program. Patients more accurately reported their health information when interacting with the virtual character than they were when filling out a standard electronic questionnaire.
“This was designed from the ground up to be patient-friendly, warm and engaging; it’s not necessarily the most lifelike and real-human-looking representation, but through trial and error, they have found the characteristics that resonate with patients,” says Steven Simon, chief of general internal medicine at the VA Boston Healthcare System. “I think they are just scratching the surface in terms of how it can best be used, such as in patients with chronic conditions, such as asthma and diabetes.”
Such technologies will become increasingly important with rising health-care costs and an aging population. “We already know we don’t have enough health-care providers to go around, and it’s only getting worse,” says Kvedar. “About 60 percent of the cost of delivering health care comes from human resources, so even if you can train more people, it’s not an ideal way to improve costs.”
Kvedar worked with Bickmore on a second, home-based trial, in which a virtual coach called Karen encouraged overweight sedentary adults to exercise. Users checked in with Karen three times a week, and she gave them recommendations and listened to their problems. Over 12 weeks, those who talked to the coach were significantly more active than those who simply had an accelerometer to record how much they walked.
“Older adults seem to be really accepting. They like the social aspect of it,” says Bickmore. “With the home-based agent, I think they would like to chat with them longer than we let them.”
Some users wanted to know more about their virtual coaches, so Bickmore’s team experimented with giving the characters a backstory. They found that participants whose virtual coach told them stories in the first person were more likely to log into the system than those who heard the same stories in the third person.
“They had more frequent conversations with the coach when it was being more human, and they did not report feeling more deceived,” says Bickmore. He adds that when asked, participants do understand the character is virtual, but they say they sometimes forget. “They say they will feel guilty about not logging in, which means they have formed some kind of emotional bond.”
But not everyone responded well to Karen. One of the challenges in broadening the use of this technology will be creating virtual characters that can learn from users and adapt to their preferences.
Bickmore’s team is now working on a virtual nurse that would reside in the hospital room. Patients can talk to it about their hospital experience, report pain levels, and ask questions. The researchers are also integrating sensors into the system, to record when the patient is sleeping, for example, or to track when different doctors enter the room.
In a pilot study, patients had an average of 17 conversations with the nurse per day. “When we interviewed them afterward, we found that the agent seemed to be effective at addressing the loneliness you often feel if you’re at the hospital by yourself,” says Bickmore.