Buchanan BG et al. 1995 "An intelligent interactive system for delivering individualized information to patients."

Buchanan BG, Moore JD, Forsythe DE, et al. An intelligent interactive system for delivering individualized information to patients. Artif Intell Med 1995;7(2):117-154.
"This paper is a report on the first phase of a long-term, interdisciplinary project whose goal is to increase the overall effectiveness of physicians' time, and thus the quality of health care, by improving the information exchange between physicians and patients in clinical settings. We are focusing on patients with long-term and chronic conditions, initially on migraine patients, who require periodic interaction with their physicians for effective management of their condition. We are using medical informatics to focus on the information needs of patients, as well as of physicians, and to address problems of information exchange. This requires understanding patients' concerns to design an appropriate system, and using state-of-the-art artificial intelligence techniques to build an interactive explanation system. In contrast to many other knowledge-based systems, our system's design is based on empirical data on actual information needs. We used ethnographic techniques to observe explanations actually given in clinic settings, and to conduct interviews with migraine sufferers and physicians. Our system has an extensive knowledge base that contains both general medical terminology and specific knowledge about migraine, such as common trigger factors and symptoms of migraine, the common therapies, and the most common effects and side effects of those therapies. The system consists of two main components: (a) an interactive history-taking module that collects information from patients prior to each visit, builds a patient model, and summarizes the patients' status for their physicians; and (b) an intelligent explanation module that produces an interactive information sheet containing explanations in everyday language that are tailored to individual patients, and responds intelligently to follow-up questions about topics covered in the information sheet."

"To increase the overall effectiveness of physicians' time, and thus the quality of health care, by improving the information exchange between physicians and patients in clinical settings."

Type Clinic
Specialty care
Type Specific
Type of Health IT
Informational resource
Type of Health IT Functions
A history-taking module "collects information from patients [such as medical history, allergies and past medications] ... and summarizes this information for the physician... It produces a printed summary of the patient's history, which is presented to the physician before the consultation with the patient and is added to the patient's chart after the visit." After the patient has seen the physician "the patient can interact with the explanation module to receive information relevant to the doctor's diagnosis and prescribed treatment."
Workflow-Related Findings
One patient "received enough information from the system and the physician to convince her to schedule a follow-up appointment." Another patient said she had received enough information to understand how to manage her headaches and "now felt hope that they could be treated."
"The average time spent using the history-taker was 33 minutes, answering, on average, 44 questions...The average time spent per question-screen was 45 seconds."
"We scheduled one hour for patients to interact with the explanation program; several wanted to stay longer."
"63% of the subjects thought that the history-taker gathered more information than the doctors that they had seen and the same percentage could not thing of any information that the program had missed."
"Sixty-nine percent reported no problems in using the system and the same percentage found none of the questions confusing. All subjects reported that the questions supplied answer alternatives that were applicable to themselves."
Eighty-eight percent of respondents reported that they felt comfortable with a computer collecting their history; 81 percent "would recommend the program to a friend, and all of them would agree to use it again if their doctor asked them to."
"94% of the subjects thought that the program told them something they did not already know...and 75% thought they had learned something that they would not have asked their doctor."
"81% of the subjects thought that the information presented made sense. However, when asked if any piece of information was confusing or inappropriate, 50% also answered 'yes'...All the subjects found the software easy to use, and only 13% felt the hardware was less than easy to use."
All of the respondents "said that they liked using the program, and that they felt comfortable getting this kind of information from a computer...All said they thought it was worth the trouble using it."
Patients mostly "felt that information exchange was improved" by using the program.
"The main criticism was that the program did not have information specifically about the drugs they were taking. However, there is considerable information available to be read: one subject spent 3 hours reading all the information the program could generate, and would have spent more."
Study Design
Only postintervention (no control group)
Study Participants
The study participants included 16 patients with symptoms of migraines.