Conversational Interfaces for Reporting Patient Safety Incidents: a - - PowerPoint PPT Presentation

30th July 2018

Using Voice-Activated Conversational Interfaces for Reporting Patient Safety Incidents: a Technical Feasibility and Pilot Usability Study

OWEN SUN JESSICA CHEN & FARAH MARABI

Centre for Health Informatics AUSTRALIAN INSTITUTE OF HEALTH INNOVATION

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 2

“Alexa, Play ‘Africa’ by Toto”

A “Voice-Activated Conversational Interface”

Voice-Activated Conversational Interface – Voice-activated computer systems that interact on a turn-by-turn basis through spoken language.

• N. Fraser 1997

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 3

Background

Patient Safety Incident Reports are the “cornerstone” of initiatives to improve health service safety.

Pham et al. 2011

System quality of incident reporting is the second largest factor in both facilitating and preventing effective reporting.

Archer et al. 2017

Voice-activated systems reduce turnaround times in healthcare settings.

Johnson et al. 2014

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 4

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 5

• 1. Assess technical feasibility of speech

recognition software in incident reporting

• 2. Conduct a pilot study of the application’s

usability in clinical contexts

Objectives

A Voice-Activated Conversational interface was built: ― Modified online template ― Javascript, HTML, CSS & Mozilla’s “SpeechRecognition” interface Responses stored as text files in Javascript Object Notation (JSON) on MongoDB’s database Hosted online through Heroku

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 6

Method – Technical Feasibility

• Two participants: Specialist Medical Doctor & Pharmacist
• Reported two mock scenarios

― Simple vs. Complex

• Usability rated on the System Usability Scale (SUS)

― 10 item questionnaire that reliably captures usability ratings

• Additional comments recorded

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 7

Method – Pilot Study

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 8

• 1. Describe the incident when you were using your computer and its peripherals (e.g. printer)?

Tramadol is prescribed for a patient on a selective serotonin reuptake inhibitor (SSRI).

• 2. What was the result? Describe actual and potential consequences.

The patient developed symptoms of serotonin syndrome: sweating, tremor, confusion and was noted to be hypertensive, tachycardic and hyper-reflexive.

• 3. What did you do to fix the problem?

Advised the patient to stop intake of Tramadol immediately. Alternative SSRI compatible medication was considered.

• 4. Why did this incident happen?

The prescribing software did not provide any warning about the interaction.

• 5. How could the incident have been prevented?

The prescribing software should have provided a warning about the interaction.

Simple Scenario

After Magrabi et al. 2015

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 9

Conversational Interface

Application was successfully created ― Responses recorded and stored on an online database

10

Results – Technical Feasibility

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION

• Participants found the system easy to use, quick to learn and not

unnecessarily complex

• SUS Scores: 97.5, 77.5 (above average of 68)
• Regarding Graphical User Interface (GUI):

― Minimal design ― Minimal Interaction

• Suited for general purpose use in health contexts without specific

training

11

Verdict: Easy to use, but…

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 12

• 1. Voice Recognition
• 2. Socio-Technical
• 3. Individual

Issues Encountered

• Specific technical terms were not picked up by the interface:

― e.g. “nephrectomy”

• General speech misrecognition

― “a patient” was written as “APT”

13

?

Issues with Voice Recognition

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION

OFFICE | FACULTY | DEPARTMENT 14

Field Example

Describe the incident when you were using your computer and its peripherals (e.g. printer) last night at about 11 o'clock APT on the mental ward was given Tramadol when it when there are some very high dose of ssris What was the result? Describe actual & potential consequences. add round midnight the patient develops symptoms of serotonin syndrome we

• bserve sweating tremor and confusion upon further investigation when I was that

she was hypertensive tachycardic and hyperreflexive

• Sensitive patient info and clinical errors or system problems being

discussed out loud

• Background noise, especially in loud and busy healthcare environment

15

Socio-Technical Issues

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION

• Having to plan out a response before speaking makes it more difficult

to give a coherent response ― Partially mitigated by going back to edit with keyboard and mouse

16

Challenges to the Reporter

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION

• Task level incompatibility with speech recognition and processing

information ― Incident reporting as story telling vs. clinical notes

• Voice recognition issues, socio-technical barriers and challenges to

reporting ― These must be addressed before voice-activated reporting systems are implemented

• Future work into voice recognition should focus on these issues first
• Further applications can be made from open-sourced tools

17

Discussion

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION

Special thanks to: Associate Professor Farah Magrabi Ms Jessica Chen Additional thanks: The medical doctor and pharmacist for their assistance with pilot testing; Mr Tony Wu and Mr Vitaliy Kim for their assistance in programming the conversational-interface.

AUSTRALIAN INSTRITUTE OF HEALTH INNOVATION 18

Acknowledgements

Thank You

Owen Sun

B Advanced Science (Psychology/Statistics), UNSW

• .sun@student.unsw.edu.au