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Implementing Voice Communication Technology in Patient Applications

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Implementing Voice Communication Technology in Patient Applications UPTEC IT 20030 Examensarbete 30 hp Augusti 2020 Implementing voice communication technology in patient applications Victor Munthe Institutionen för informationsteknologi Department of Information Technology Abstract Implementing voice communication technology in patient applications Victor Munthe Teknisk- naturvetenskaplig fakultet UTH-enheten AstraZeneca as a biopharmaceutical company performs clinical trials on human volunteers every day. It is crucial that these participants complete the trial to Besöksadress: maximise the medical learning from the trial but also to decrease the cost for Ångströmlaboratoriet Lägerhyddsvägen 1 AstraZeneca. Dropout’s from clinical trials can not be eliminated but as a part of the Hus 4, Plan 0 work that AstraZeneca is doing to reduce dropouts, this thesis investigates the possibility to implement voice control into patient applications. The goal is to increase Postadress: the usability of the systems used in clinical trials and in return reduce dropouts and Box 536 751 21 Uppsala increase medical knowledge. Telefon: This thesis results in a discussion that can be used for future work on this topic. 018 – 471 30 03 Opportunities that a voice-controlled system brings, together with its limitations are Telefax: presented and results in a discussion regarding “data ownership”. One of the main 018 – 471 30 00 conclusions is that a voice-controlled system would bring a lot of positive features but that either the technology or the authorities are ready for such a system today. A Hemsida: suggested way forward can be to start trying clinical trials, where free-text responses http://www.teknat.uu.se/student are used for some questions, instead of fixed responses. This can help show the authorities the benefits of such a system and motivate them to open up for more technology. Handledare: Mats Pettersson Ämnesgranskare: Bengt Sandblad Examinator: Lars-Åke Norde’n UPTEC IT 20030 Tryckt av: Reprocentralen ITC Popularvetenskaplig¨ sammanfattning AstraZeneca ar¨ ett lakemedelsbolag¨ som utfor¨ kliniska studier pa˚ frivilliga deltagare varje dag. Det ar¨ avgorande¨ att deltagarna avslutar studien for¨ att maximera utfallet av medicinsk kunskap men aven¨ ur ett kostnadsperspektiv. Den har¨ rapporten undersoker¨ mojligheten¨ att implementera roststyrning¨ i kliniska studier for¨ patienter som en del i arbetet AstraZeneca gor¨ for¨ att minska avhoppen. Malet˚ ar¨ att oka¨ anvandbarheten¨ av systemen som anvands¨ i kliniska studier idag som i sin tur minskar antalet avhopp och bidrar mer till medicinsk kunskap. Rapporten resulterar i en diskussion som kan anvandas¨ i ett fortsatt arbete inom amnet.¨ Mojligheterna¨ som ett roststyrt¨ system medfor¨ tillsammans med dess begransningar¨ pre- senteras och slutar i en diskussion kring agandeskap¨ av data. En tydlig slutsats som ar- betet resulterar i ar¨ att implementationen av ett roststyrt¨ system medfor¨ manga˚ positiva aspekter men att myndigheterna och teknologin inte har kommit lika langt.˚ Ett foreslaget¨ satt¨ att fortsatta¨ ar¨ att borja¨ testa kliniska studier med fragor˚ dar¨ svaret bestar˚ av fri text istallet¨ for¨ svarsalternativ. Resultatet fran˚ studien kan da˚ i sin tur anvandas¨ i diskussion med myndigheterna for¨ att visa pa˚ alla positiva foljder¨ som ett roststyrt¨ system medfor.¨ ii Acknowledgements I would like to give a special tanks to some people that have helped and supported me through my master thesis work. Anders Lofgren,¨ AstraZeneca. Thank you for connecting me with my supervisor and for guiding me through this thesis work. It has been great to always be able to reach out to you! Mats Pettersson, AstraZeneca. Thank you for the opportunity to write my master thesis at AstraZeneca and thank you for all the interesting discussions. Bengt Sandblad, Uppsala University. Thank you for being my reviewer and thank you for all the support! A special thanks to you for providing important inputs to my work in a relaxed and inspiring way. Caroline Algvere, thank you for the daily stand up meetings and all the motivational pep-talks. iii Contents 1 Introduction 1 2 Background 1 2.1 AstraZeneca . 2 2.2 Clinical trials . 2 3 Motivation 2 3.1 Challenge . 2 3.1.1 Free information flow . 3 3.1.2 Compliance . 3 3.1.3 Miss communication . 3 3.2 Goal . 4 4 Delimitation’s 4 5 Related work 5 5.1 Virtual assistant in clinical trials . 5 5.2 Virtual assistants in the lab environment . 5 5.3 This thesis contribution . 5 6 Theory 6 6.1 Clinical trial . 6 6.1.1 Compliance . 8 6.1.2 Dropouts . 9 6.1.3 Compensating participants . 10 6.1.4 Adverse events . 10 iv 6.1.5 Placebo effect in clinical trial medication . 11 6.2 Chatbots and intelligent virtual assistants . 11 6.3 Patients withholding information from their clinician . 11 6.4 Usability . 12 7 Method 12 7.1 Usability tests on users . 13 7.1.1 Qualitative method . 13 7.2 Conversation between subject and conversational assistant . 14 7.2.1 Interview questions . 15 7.2.2 Analysis of the captured data . 15 7.3 Locating key persons at AstraZeneca . 16 7.4 Literature study . 16 8 AstraZeneca’s way of performing clinical trials 16 8.1 Digitize the clinical trial process . 17 8.2 Contract Research Organization (CRO) . 17 8.3 Smart medical devices used in clinical trials . 17 8.4 Clinical outcome assessment (COA) . 18 8.4.1 How AstraZeneca use eCOAs in clinical trials . 18 8.5 Example instruments used in ePROs by AstraZeneca . 19 8.6 Communication possibilities during clinical trials between the partici- pant and investigator . 19 8.7 Using gamification as a motivation for participants to complete clinical trials . 20 8.8 Clinical trial process . 20 v 9 Peoples attitude towards AI and voice control 21 10 Conversational assistants 22 10.1 Relying on a conversational assistant to give correct medical recommen- dation . 23 10.2 Personalized voice profiles . 24 10.2.1 Voice biometric authentication . 24 10.2.2 External device authentication . 24 10.2.3 Password based authentication . 25 10.2.4 Federal guidelines for authentication . 25 10.3 Comparison of available systems . 25 10.3.1 Language support . 25 10.3.2 Emotions in conversational assistants . 26 10.4 Benefits of using conversational assistants in clinical trails . 26 10.5 Ways to implement conversational assistants into patient applications . 27 11 Identified possibilities of a voice-controlled system and its target group 27 11.1 Target users . 28 11.2 Analyzing patients psychological health without any extra effort to in- crease medical knowledge . 29 11.3 Patient-device event handling by voice . 29 12 Identified challenges with implementing a voice-controlled system 30 12.1 Regulatory challenges with a voice-controlled system . 31 13 Patient recorded outcome (PRO) through voice control 32 13.1 Identified challenges . 33 vi 14 Usability study 33 14.1 Implementation . 33 14.2 Result from the captured data . 34 15 Discussion 35 15.1 Free speech handling . 35 15.2 Solving the language problem . 36 15.3 Removing the risk of miss-communication between patient and virtual assistant . 36 15.4 Does a voice-controlled system increase expectations . 37 16 Evaluation 37 17 Conclusion 38 18 Future work 38 18.1 Recommendations for AstraZeneca . 38 vii 2 Background 1 Introduction Biopharmaceutical companies like AstraZeneca perform clinical trials with human vol- unteers all over the world every day, intending to add to medical knowledge. As- traZeneca is currently trying a digitized Clinical trial process in small scale, but usu- ally, they are performed without any digital tools. When digitizing the process, it is important to design a usable system for the user since it is crucial to keep participants from exiting the trial. this might in return reduce unnecessary costs and labour for the pharmaceutical company. This thesis investigates the possibility to implement a voice- controlled system for patients in clinical trials to increase usability and in return keep patients in the trial. The possible benefits will be discussed together with both technical and regulatory limitations. The challenges and goal are described on a deeper level in Section 3. A voice-controlled system is an extension to AstraZeneca’s current project “UnifyTM” that is described in Section 8. In the UnifyTM project, AstraZeneca is digitizing the clin- ical trial process with an application for the participants. The application will ease the workload both for the clinician and the participant’s to reduce the number of dropouts from the trial. With a voice-controlled system, usability can be increased even further. The system will, e.g, make it possible for people without reading/write knowledge to participate in the trial. The target group that can benefit from a voice-controlled system and possible benefits of such a system is discussed in Section 11. A major challenge with a voice-controlled system is that the communication from the participant can not be limited. As it is, for now, AstraZeneca uses pre-defined answers to questions described in Section 3.1.1. With a voice-controlled system, the user can say anything he/she likes and AstraZeneca will in return be obligated to handle this information from the user. This together with several other challenges are investigated and possible solutions for them are discussed in this report. 2 Background In this section, a brief explanation about clinical trials and the company AstraZeneca is provided to help the reader understand chapter 3. A more detailed theory that is relevant for this report is presented in section 6. 1 3 Motivation 2.1 AstraZeneca AstraZeneca is a global, science-led biopharmaceutical company who are operating in over 100 countries with millions of patients using their medicine. AstraZeneca’s re- search and development are concentrated to the headquarters in Cambridge (United kingdom), Maryland (USA) with a focus on biopharmaceuticals and Molndal¨ (Gothen- burg, Sweden) with a focus on traditional drugs.
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