An anxious patient sent out a text, “I was diagnosed today and I’m scared that my whole life will change. Can you help?”
Almost instantly, replies came. “Hi Anna, this is Ariana. Yes, I’m here for you. We’ll get through this together. Think of me as your personal coach. I’ll help you learn about your condition and therapy. I can give you helpful tips on how to manage your daily life and support your treatment. And I can answer your questions.”
“Ok what’s next?” Anna asked.
“First, get some rest, sleep on it. I’ll message you tomorrow morning and we can take it from there!” Ariana answered and surely, the next morning when Anna checked on her mobile, the first thing she read was, “Good morning Anna, how are you feeling today? I’ll check in every day from now. Please use a scale from 1 (couldn’t be worse) to 10 (couldn’t be better). That way we can easily keep track.”
Anna sent her response and the chat went on as she started the day. Ariana not only accompanied Anna but also offered exercise and diet tips and reminded her to take her medications. Like what it had promised, Ariana made an effort to check on her from time to time without fail.
Besides, Ariana would answer questions that Anna has for her medical condition. She plans to travel to Greece with her partner this summer and wonders if her condition allows her to take a plane. As always, Ariana advised her on health management and what she needs to take note of during the trip.
The genesis of Ariana
At a glance, Ariana seems to be a devoting coach but in reality, it is a chatbot. Dr. Carol Wildhagen, a surgeon and healthcare consultant, founded Ariana in 2017 with serial health entrepreneur and information technology expert Marc Bender. The rationale behind this creation was simple: both of them have a strong desire to forge and endorse meaningful caregiver-patient relationships.
As Dr. Wildhagen recalled during an interview with AIMed last week, when she was still in practice, the most fundamental experience she had was probably the understanding of being able to personally bond with patients and build connections which she knew would have helped them. However, most often, there was not enough consultation time catered to each patient. “An average doctor-patient conversation in Germany is seven minutes, if you are presented with life-changing, complex therapy that you need to go on, seven minutes absolutely don’t make the cut,” Dr. Wildhagen said.
As such, the former physician was looking for ways to “clone” herself; to scale the quality of doctor-patient relationship exponentially from minutes to whenever the patient has a query and is in need of professional support. Accessing the vibrancy of present-day technology, making use of natural language processing (NLP) seems to be the most sensible way out.
A chatbot, not human
What sets a chatbot apart from other machine learning algorithms is not so much about what goes on behind the scene, but the unique set of ethical questions it has to address. Primarily, users have to be informed that they are not talking to a person and there is no real human being hiding at the back of a chatbot to answer their questions.
To avoid confusion, Ariana’s users are briefed on their very first exchange. Ariana will clarify her chatbot status, her capabilities, and set perimeters during her self-introduction, making it clear to the care-receiver that she is a virtual product.
The next ethical concern revolves around the way a chatbot is being taught. In general, there are two groups of chatbot developers. One is to leave their chatbot online for users to freely feed them with new information during interactions. The other is to be highly supervised by the developer to correct everything that has been feed to the chatbot.
The former form of training tends to succumb to abuse as users consciously test the limits of the chatbot and guide it to reply inappropriately. The latter, on the other hand, requires successive human corrections.
Keeping users in shape
In the case of Ariana, as told by Dr. Wildhagen, a new user-interface was not created, so it sits within the messaging platform of the users. To keep user-abuse to the minimum, only officially diagnosed patients will receive assistance from Ariana. Most of the time, these patients are extremely engaged to have a meaningful conversation within the context of their diseases or drugs rather than regarding Ariana as an entertainment tool.
Furthermore, Ariana is built in a way that 80% of the informed conversation relationships sat around pleasant, small talks, while the remaining 20% is embedded with medical content relevant to the patients so that users will not be distracted and side-tracked to something else. This means Ariana is able to function without much human supervision and is able to deploy to situations where humans are not as available. All medical content is pre-scripted and closely aligned with the providers of the drugs Ariana supports.
At the same time, Ariana does require a certain level of human support for handling an emergency or adverse events. For example, if the patient begins describing some symptoms or discomfort that he/she has, Ariana is likely to reply “I am not allowed to handle this, please call the patient support hotline and they will follow-up with you personally to take care of this”.
Can chatbot be our new virtual healthcare coach?
Indeed, there are those “I am sorry, I do not know the answer” moments in Ariana but instead of expressing them out loud, it is likely to ask users to rephrase or clarify the situations, because “we have very clear requirements on what we allowed Ariana to deal with,” Dr. Wildhagen explained.
“We try to craft the conversations and use messaging platforms that users are already familiar with, to provide the best user experience… Ariana has a strong conversational design, so there is a lot of guidance she can offer to the patients so the conversation seldom goes off too much, so even if it fails, we try to fail gracefully,” Dr. Wildhagen added.
Presently, the distribution of Ariana is done through partnering pharmaceutical companies, together with the drugs that they sell and the patient support programs they have in place. The privacy agreement does not allow Dr. Wildhagen to reveal any upcoming plans but she did express that the pipeline is full and the oncology space may render Ariana a big opportunity.
Overall, Dr. Wildhagen believes in the value of Ariana; to close the gap where doctors wish they could be there more for their patients but they simply can’t due to time or medical cost constraints. As for the patients, Ariana provides support and reliable information through chat on an existing messaging platform. Patients do not need additional technology know-how or perform additional download to engage with Ariana, “so, I am truly excited and pleased about the fact that we are able to finally create this relationship that we can scale, and it’s not just about me, Ariana or the company, but about better health support that many people could receive,” Dr. Wildhagen remarked.