Personalised Hypertext Explanations for Patient Education

Alison Cawsey and Kim Binsted

Department of Computing Science, University of Glasgow, Glasgow G12 8QQ
Ray Jones
Department of Public Health, University of Glasgow, Glasgow G12 8QQ
WWW: http://www.dcs.gla.ac.uk/ www/Piglet.html
email: alison@dcs.gla.ac.uk

Introduction: Computer-based Patient Education

The importance of providing the public with more information about health issues is widely
accepted. Indeed, recent studies have shown that, by providing asthma patients with personalised
booklets about their condition, hospital admissions were reduced by 54% [OAB+ 94]. One way
of improving patient education is to provide computer-based access points where patients can
browse through information screens explaining medical concepts. It has been demonstrated that
such systems, if carefully designed, are considered helpful by patients [JNM93].
One good starting point for such systems is the patient's medical record. It is now a le-
gal requirement (in the UK at least) that doctors provide patients with access to their records.
Where such records are computerised this can be conveniently provided (given a suitable inter-
face) through the computer. Access to records can further provide a motivating starting point
for an exploration of medical concepts related to the patient's conditions. Each concept can be
explained in language appropriate to the patient, with hypertext links to further explanations for
clarication and elaboration.

An Articial Intelligence Approach

We are investigating the use of articial intelligence techniques in developing a system of this kind.
Specically, we are looking at how natural language generation techniques can be used to generate
personalised hypertext explanations of medical concepts given a simple medical knowledge-base
and information available in the patient record. Such techniques have been successfully used to
automatically generate technical documentation (adapted to the category of user) [RML92] and to
produce explanations of the use of a statistical package [dRdCP93]. More recently there has been
work on using such techniques in patient education [CM93], however no link is made with patient
records. All of these systems are promising, but clearly experimental prototypes, with little or no
realistic user evaluation.
In our application the use of these techniques has several possible advantages (compared with
conventional hypertext construction). First, it is possible to provide personalised explanations
with no overhead. Texts are constructed from basic principles rather than being written by
hand, so it is easy to make them depend on facts in the medical record, and indeed incorporate
reminders about these facts (e.g., \X is a drug to treat Diabetes. You were prescribed X in 1991..").
Second, as texts are constructed from an underlying knowledge-base of medical information the
cost of maintenance of the explanation system (given changing medical beliefs and practice) may
be reduced. If the recommended drug for treating a given condition changes, then one entry
in the knowledge-base must be changed. Maintaining conventional hypertext potentially requires

1
searching through thousands of texts in case that drug/condition is mentioned. Finally, we believe
the incremental eort in extending the system to explain new drugs etc may be reduced.

Evaluating the Approach

These claimed advantages need to be demonstrated, rather than taken without question! It is not
self-evident that personalised explanations are better than well constructed \xed" explanations,
and any advantages of (potentially) reduced system maintenance and extension costs have to be
balanced against slightly greater initial costs. Also it is unclear whether generated texts will be
of sucient quality for critical applications with naive users (where their health is at issue).
We are therefore aiming to assess our approach through the rapid development of an initial
prototype in a restricted domain (diabetes), followed by a succession of evaluation sessions with
doctors and patients. We will be particularly concerned to determine the perceived benet of the
personalised explanations and the general acceptability of the explanations provided. Through pro-
totype development we will also be able to determine the eort of system maintenance/extension
given new patients and changing medical recommendations.
The rst stage of our evaluation involves health professionals (role playing patients). Data
is being collected by observation of use and questioning while using the system, followed by a
structured interview at the end of the session. We have completed an initial study involving three
postgraduate medical students at Glasgow University, and are currently evaluating the revised
system with consultant diabetologists and diabetes nurse specialists in the Glasgow area.
We also plan to evaluate a version of the system using the World Wide Web, soliciting feedback
from doctors and diabetics suerers across the world. We will be revising our system so that the
output of the text generator is in HTML (HyperText Markup Language), readable by WWW
browsers such as Mosaic. Users will complete a questionnaire using the \form page" facilities.
In the second stage of evaluation we will be testing the system with patients attending clinics.
We plan an initial primarily formative evaluation based on structured interviews, followed in
due course by a summative evaluation based on measures of changes in diabetes knowledge and
adjustment to diabetes, as well as acceptability and use of the system.

Conclusion
Currently we have a prototype system able to generate personalised hypertext explanations of
concepts in the medical records of diabetes patients. Our work so far suggests that the texts
produced are acceptable and the eort in system development is not excessive. We have found
that quite simple techniques are sucient to provide the claimed benets of the approach, and
are now consolodating this initial work through empirical evaluation.

References
[CM93] G. Carenini and J.D. Moore. Generating explanations in context. In Proceedings on the 1993
International Workshop on Intelligent User Interfaces, pages 175{182. 1993.
[dRdCP93] F. de Rosis, N. de Cardis, and S. Pizzutilo. User tailored hypermedia explanations. In
INTERCHI '93 Adjunct Proceedings, pages 169{170, 1993.
[JNM93] R.B. Jones, L.M. Navin, and K.J. Murray. Use of a community-based touch-screen public-
access health information system. Health Bulletin, 51:34{42, 1993.
[OAB+ 94] L.M. Osman, M.I. Abdulla, J.A.G Beattie, S. Ross, I.T. Russell, J.A. Friend, J.S. Legge, and
J.G. Douglas. Reducing hospital admissin through computer-supported education for asthma
patients. British Medical Journal, 308, 1994.
[RML92] E. Reiter, C. Mellish, and J. Levine. Automatic generation of on-line documentation in the
IDAS project. In Proceedings of the Third Conference on Applied Natural Language Processing,
pages 64{71, Morristown, N.J., 1992. Association for Computational Linguistics.