Monday, December 17, 2007

Good night, nurse! BMC tests virtual RN for discharges

By Ryan McBride

With an eye toward controlling costs and improving care, Boston Medical Center plans to study the use of computer-animated characters to fill in for human nurses during patient discharges.

When patients leave the hospital, some don't understand how to care for themselves and end up back in the infirmary -- adding unwelcome expenses, researchers say. But hiring extra nurses to spend more time to teach patients how to manage their health during discharges would be pricey as well. So Boston Medical Center hopes to solve the problem with a shot of cutting-edge technology.

The Boston hospital expects to begin a clinical trial in February to see how well patients fare after a visit from virtual nurse "Louise" versus those who receive discharges from human nurses. The trial may determine whether the virtual nursing technology is adopted nationally, said Brian Jack, a physician at the hospital and lead investigator in the study.

"I think every hospital in the country is going to want this," Jack said, "because it will improve their (clinical) outcomes."

The technology in the study was developed by Tim Bickmore, an assistant professor of computer science at Northeastern University. He and his team have programmed computer-animated nurses to tailor their verbal responses and facial expressions based on how patients answer questions on a touchscreen during the discharge. The virtual nurses would greet patients on computer monitors in their hospital rooms.

Bickmore said he would like to license the technology to a health-care software firm, although no such deals have yet happened. Also, Boston's Partners HealthCare System, which manages Massachusetts General Hospital, is using Bickmore's virtual characters to serve as weight-loss coaches in a study slated to start in spring 2008.

For patient discharges, the health-care community appears to be open to using the technology.

"There may be some people who object to bringing 21st century (technology) into the hospital," said Jason Lee, vice president of programs at the New England Healthcare Institute, a think tank in Cambridge. "But if it lowers costs and it increases quality, and if patients don't object, it's great."

Boston Medical's Jack said he plans to enroll 750 patients in the discharge study over an 18-month period. In the meantime, his colleagues plan to test the technology at the University of California San Diego Medical Center.

The virtual nurses talk patients through an 11-step process to inform them of such things as medication regimens and dates of follow-up medical exams. Then the program quizzes patients on how well they comprehend the information. The entire process takes 52 minutes, Jack said.

Jack said he has developed the clinical content of the program over the past several years with federal grants of

$4.5 million from the National Heart, Lung and Blood Institute and the Agency for Healthcare Research and Quality. The National Quality Forum, a Washington, D.C.-based nonprofit that develops safety standards for health care, has already endorsed the clinical component of the discharge program.