SuperAssist: design and evaluation of a personal diabetes assistant
Geert de Haan (1), Olivier Blanson Henkemans (1),(2), Mark A. Neerincx (1),(2) and Charles A.P.G. van der Mast (1)
(1) Unit of Man-Machine Interaction
Department of Mediamatics, Delft University of Technology, Mekelweg 4, 2628 CD,
Delft, the Netherlands
(2) TNO Human Factors Research Institute
P.O. Box 23, 3769 ZG,
Soesterberg, the Netherlands
THE SuperAssist PROJECT
TNO Human Factors, Delft University of Technology and Leiden University Medical Centre are developing guidelines, models and methods for joint user-"electronic assistant" supervision of critical equipment and information. The aim is to establish effective and efficient distributed supervision of networked information compilations and technical equipment, which is trustworthy for the user and takes place in a socially approved manner. Specific innovative project results are: communication and interaction models for the assistants; methods for joint human-computer supervision; improved test methods, tools and criteria for systematic assessment of user experience; "best practice" implementation-method and guidelines; and a "proof of concept" in the transmural health care domain (e.g. diabetes). For the medical application domain, the SuperAssist framework will reduce costs by improving the local, self-care capacity of people by efficient employment of remote, distributed expertise.
The project's business partners - Science & Technology, Philips Research, Pemstar and Sigmax PDA Solutions - bring in their technology and contribute to the development and validation of SuperAssist elements. The joint activities are included in cognitive engineering cycles, in which the foundation, specification and demos of the SuperAssist concept are being refined and extended. The SuperAssist research takes place in the medical domain, but it aims at a generic solution for the distributed supervision of complex environments.
A USER SCENARIO
Ms. Brown is a vital 72 year old who is diagnosed with type II diabetes for which a diet and medication were prescribed. Since ms. Brown is well overweight, she has been asked to participate in a therapeutic program whose purpose is to attempt to let participants lose some of that weight in a responsible yet playful manner. As a result, every day before breakfast and before bedtime Ms. Brown consults her personal diabetes assistant, provided to her as part of the program, to check her blood glucose levels and to help her remind whether she has taken her pills or not. She can also fill in a questionnaire regarding food intake, exercise, and stress in order to help her manage her food intake in relation to her activities. To make using the assistant as easy as possible, both the form, the presentation and the content of the dialogue have been adapted to ms. Brown's preferences, eyesight and the way she uses the assistant.
On three consecutive days, ms. Brown's blood glucose level has been slightly higher than normal and today it is rather high. An abnormal reading is not necessarily a cause for alarm. It may be that the technique let her down, that ms. Brown has forgotten to take her pills or that she ate something wrong. Instead of calling the district nurse, ms. Brown hits the help-button on the diabetes assistant. A friendly voice first assures her that there is no cause to worry and goes on to suggest to redo the measurement with the little finger of her other hand. Now ms. Brown learns that her blood glucose level is only slightly higher than normal and her assistant asks her to take her pills, including an extra TZD "you know, the big blue one" just to be on the safe side.
BEHIND THE SCENARIO
By this time, also behind the scenes some activity has taken place. Because of the measurement error, a maintenance module inside the assistant increased the problem count of the measurement module, reset it and performed a self evaluation test in order to exclude a range of technical problems. Also a temporary wireless network is set-up for a number of routine and problem reports. When the assistants' problem count exceeds a certain level of serious measurement or transmission problems, a technical expert is informed for further maintenance or for a replacement of the device. When serious problems occur the district nurse will be informed of the existence of a possibly faulty device, so that he can check out to take over or provide a replacement diabetes assistant. Because in this case, the measurements remained within the safety boundaries, there was no need to alarm the specialist diabetes team, although, as a matter of routine, both blood glucose readings and the measurement problem are fed into ms. Browns medical dossier.
Finally, because there has been a change in ms. Brown's otherwise rock stable blood glucose level which deviated from normal over a number of days, a reminder is send to the district nurse. The personal patient-visiting assistant agent will remind the nurse the next time he goes on a periodical visit to ms. Brown. Even though the diabetes assistant is "allowed" within certain boundaries to change a patient's medication, only medical specialists (or in their place the district nurses) are allowed to make any enduring or substantial changes.
ESSENTIAL ISSUES IN SuperAssist AND THE FUTURE OF HEALTHCARE
In the SuperAssist project we intent to follow a scenario-based approach (Carroll, 1995) in that the project consists of a number of phases, each of which is approached iteratively, and guided by hypothetical and real scenario's of would-be situations. In dealing with the novel situation of having multiple types of users communicate and cooperate with multiple types of agents, the domain is relatively new and, according to Erickson (1995), a scenario-based approach is the preferred method. In addition to such standard HCI practices, it is a "sine qua non" that users should participate in the development of a personal service or consumer product that SuperAssist aims at (Kemp and van Gelderen, 1996).
Even though the project targets at a novel type of application in a new area of multi-agent multi-user interaction, it does not start from scratch. First, the project will present (in Dutch) in a personalised, adaptable and context-sensitive way an existing "diabetes manual" (Stewart, 2004) in paper form. Secondly, SuperAssist attempts to build further upon the PALS project, a Dutch project investigating the requirements to meet changing user needs and usage contexts with respect to web-services (see: PALS, Neerincx and Streefkerk, 2003). From this and other projects, two factors turned out to be of critical importance for the success of human-agent interaction: trust and cooperation.
Trust is essential in the sense that people need a basic level of trust in a system or personal assistant to "do business" with them. Both the patient, the medical specialist and the nurse need to trust their personal assistant as a prerequisite to delegate part of their tasks and responsibilities to the electronic device. To enable trust and delegation between people and electronic assistants, it is a first necessity that the form and content of the interaction dialogue are acceptable to the human user, including a possibly frightened patient or an excessively busy medical worker. As an example, it may be possible to adapt the dialogue to the current context of use including aspects like fear and stress (Neerincx and Streefkerk, 2003).
Cooperation is essential in the sense that, like in human-human cooperation, participants rely on images, models or ideas about the communication and cooperation abilities of their discussion partners in order to set appropriate expectations. Cooperation for problem solving between people and their assistants and the cooperation between assistants among themselves requires some kind of model which at least describes 'what to expect from whom' in terms of questions, actions, etc. In order to properly assign tasks to the human user, a software agent or the interaction between them, especially in the case of usage difficulties, an agent-communication model will be created to specify what other participants may contribute and how to ask them; either directly or by means of some user-agent. In the scenario this is exemplified by ms. Brown's diabetes assistant asking her (on behalf of some supervision agent) to redo the measurement of her blood glucose. Also here, personalisation and adaptation come into play, for instance in deciding whether is appropriate to ask the patient to do something or to alarm the nurse.
The SuperAssist project attempts to set up an integrated healthcare service in the area of diabetes treatment, assisted by electronic devices and software agents. The project is intended as a test case for a range or healthcare and other services and not just to find yet another smart solution for a particular problem. Only by introducing, testing and validating general tools, we will be able to help keep future healthcare costs within the boundaries of affordability and manageability - at the very least for individual patients like ms. Brown.
The SuperAssist project also employs diabetes as a vehicle to learn general lessons about how to introduce trustworthy and cooperative electronic or software assistants into the everyday life of real people. Until recently, human-agent interaction has been studied in settings where a single agent assisted a single user, as in supporting searching, information filtering, and critiquing systems. In the SuperAssist project, research and development are extended to multi-user multi-agent communication and cooperative problem solving. This novel research area does not only introduce new types of questions and new types of problems but it is also a starting point for the integration of separate intelligent applications into intelligent overall services.
REFERENCES
1. Carroll, J.M. (1995). Scenario-based Design: Envisioning Work and Technology in System Development. New York, John Wiley.
2. Erickson, T. (1995). Notes on Design Practice: Stories and Prototypes as Catalysts for Communication. Carroll, J.M. (ed.) Scenario-Based Design: Envisioning Work and Technology in System development, 37-58.
3. Kemp, J.A.M. and van Gelderen, T. (1996). Co-discovery Exploration: an informal method for the iterative design of consumer products. In: Jordan, P.W., Thomas, B., Weerdmeester, B.A. and McClelland, I.L. (eds.) Usability Evaluation in Industry, pp. 139-146. Taylor and Francis.
4. Stewart, R. (ed.)(2004). The Diabetes Manual, Warwick Diabetes Care, University of Warwick, UK.
5. PALS, Personal Assistant for onLine Services. IOP/MMI project website; see http://www.tm.tno.nl/pals
6. Neerincx, M.A. and Streefkerk, J.W. (2003). Interacting in Desktop and Mobile Context: Emotion, Trust and Task Performance. Proceedings of the first European Symposium on Ambient Intelligence (EUSAI), Eindhoven, The Netherlands. Springer-Verlag.
Paper presented at the 3rd UK-UbiNet Workshop on Ubiquitous Computing. Designing, evaluating and using ubiquitous computing systems. University of Bath, Bath, UK, 9-11 February 2005.