Chatbot in Health Care – a review

INTRODUCTION

Over the years in India, the life expectancy has increased and health status has enhanced to a great magnitude. In recent years India has made ground-breaking progress in reducing the Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR) and other health indicators. However, the non-communicable diseases take over the communicable diseases in the total disease burden of the country.¹

Health infrastructure and manpower shortage are one of the challenges in delivering equitable healthcare to every citizen of the country.² Smart technologies such as Artificial Intelligence (AI) play an important role indelivering health care.³ The Chatbot is one such technology widely used in many industries including healthcare. Let us discuss how Chatbots can be used in healthcare. 

What is Chatbot?

“Turing test is a test proposed (1950) by the English mathematician Alan M. Turing to determine whether a computer can think”30 

“A Chatbot is a computer program uses AI that simulates human conversation through voice commands or text chats or both”. There are a variety of Chatbot synonyms, including "talkbot," "bot," "IM bot," "interactive agent" or "artificial conversation entity”, "conversational agents”, “machine conversation systems”, “dialogue systems”, “digital assistants” and “virtual agents”.⁴

History of Chatbot Interestingly the first-ever Chatbot was developed in the field of Mental Health care. Joseph Weizenbaum, a Massachusetts Institute of Technology (MIT) computer scientist, created 'Eliza' in the year 1966, the first conversational computer program (Chatbot). It was designed to use neural language processing to imitate Rogerian Psychiatrists speech patterns in psychotherapy.⁵

In the year 1972, the second Chatbot i.e. “Parry” was created at Stanford University. This Chatbot was called an attitude-based version of Eliza. In contrast to Eliza, psychiatrists during a Turing test were able to distinguish just 48 percent of responses from a human and a parry.⁶

In the year 1988, “Jabberwacky”was introduced as the first Chatbot to simulate human voice. This Chatbot was created with the aim of allowing the Chatbot to pass the Turing test.⁷ Following Jabberwacky's footsteps, another Chatbot was developed in 1992 called "Dr Sbaitso." The Chatbot had a User Interface (UI) were Dr Sbaitso simulated the responses of a psychologist. And the first Chatbots for MS-DOS-based personal computers.⁸

In the year 1995, Richard Wallace creased the most famous Chatbot of 20th century - ALICE (Artificial Linguistic Internet Computer Entity). This Chatbot was also influenced by Eliza, but it was able to chat with people more effectively with its heuristic features. ALICE's sole purpose was to advance technology to new grounds, not to serve a customer.⁹

Later ALICE was an inspiration for various Chatbots includes Apple’s Siri, Google Now, Microsoft’s Cortana, Facebook Messenger, Amazon’s Alexa, Telegram and many more. Even thoughJoseph Weizenbauminvented Chatbot to deliver health care, now Chatbots are being used to support and scale business teams in their relations with customers in various industries. 

Application of Chatbots in Mental Health care

Bibault JE et. Al. identified that Chatbots can help the patients with breast cancer, to get advice for minor health concerns, so that they can reduce the hospital visit. Hence, the physicians can devote more time in treating patients who are most in need of a consultation.¹⁰

Greer S et al. identified that ‘Vivibot Chatbots’ are helpful in reducing the anxiety of the young adults treated for cancer at USA.¹¹

Jungmann et al. found that the ‘Chatbot (Ada)’ can be helpful in diagnosis of Mental Disorders at Germany.¹²

Abd-Alrazaq AA et al. reviewed 1039 citations and identified that Chatbots are widely used for therapy, training, screening and focused on depression and autism.¹³

Perski O et al. identified that the smoking cessation app users’ engagement was more than doubled and also improved self reported termination of smoking by adding a supportive Chatbot to a common smoking cessation app.¹⁴ 

Schmidlen T et al. found that Chatbots are used effectively to obtain consent for genetic counselling, and also such technology may be used to manage the other genetic counselling tasks.¹⁵

ChetlenA et. al. identified that the women who are undergoing breast biopsy felt that the Chatbots are very useful in providing health care information and understanding the procedure.¹⁶

Piau A et al. found that the remote phone monitoring Chatbots can be effectively used to monitor the chemotherapy of older adults with cancer.¹⁷ 

Stephens et al. identified that pediatric obesity and prediabetes treatment support can be provided with through Chatbot in a pediatric setting, which can be further used for a larger group of patients.¹⁸

Chaix B et al. used Chatbots to empower the patients with breast cancer and their relatives with personalised information through text. They identified that the adherence rate is much higher among the patients, who uses Chatbots than who did not.¹⁹

Goldenthal SB et al used Chatbots to deliver the information to patient post-ureteroscopy and identified that Chatbots was a convenient method to address common concerns post-ureteroscopy.²⁰

Park S et al. found that the participants had a chance for self-reflection with use of Chatbot (Bonobot) which facilitated the conversation for stress management.²¹

Vaidyam AN et al. did a review of Chatbots in mental healthcare and identified that Chatbots are very useful in psychoeducation and self-adherence, and the users were very much satisfied with it.²²

iDecidechatbot: is a Chatbot that provides information about prostate cancer to patients (prevalence, risk factors, management options and their side effects).²³

Woebotis a Web-based Cognitive-Behavioural Therapeutic (CBT) Chatbot that found to reduce the symptoms of depression²⁴ and track the mood changes.²⁵ It also provides programs of psychoeducation for coping with stress.²⁴

Chatfuel: is a Chatbot work through Empathy perception.²³

Shim Chatbot is used to deliver strategies in positive psychology to increase happiness and decrease negative symptoms.²³

FitTrack: To track the physical activityworking alliance inventory questionnaire is used to calculate the physical activity score.

Qdoc powered by Artificial intelligence technology that simulates a doctor i.e. asks clever questions, comprehends test reports and recommends further examinations.²⁵

WysaChatbot is a mental health assistant application which escalates the saviour cases for a human assistant based on the need.²⁵ 

Advantages

•  Accessible Anytime: Chatbots are digital robots that never get tired and keep running. Throughout the year, they will continue to operate every day without having to take a break. 
• Flexible attribute: Chatbots have the benefit that it can quite easily be used in any industry. 
• Communication with the user is easy. 
• Reduces human effort for reading files 
• Easy for maintenance²⁶ 
• Anonymity, privacy and security could be maintained with a privacy-enhancing approach.²⁵ 
• Chatbots are designed to be non-judgmental and therefore more compassionate towards patient worries. This could reassureindividuals to unhesitatingly unwrap.²⁵

Limitations: Powell J argues that health care services require wisdom and empathic relationship with the patient than only AI. Therefore, AI needs to be supplemented instead of replaced by healthspecialists and recognizingan appropriate place for AI in healthcare is a major challenge for the future.²⁷

Many doctors in the U.S. said that Chatbots could not efficaciously take care of all the needs of patients, show human emotions, and be responsible forcomprehensive diagnosis and management. Several clinicians also said that Chatbots for health care might pose a risk to patients if they diagnose themselves too often and fail to understand the diagnoses correctly.²⁸ 

The primary concern is confidentiality. Other concerns include universality of application, lack of standardization and monitoring, overdependence on the Chatbots, and lack of serious mental disorders.²⁹

Conclusion

These Chatbots will become an integral part of our lives in the coming years. These Chatbots will be able to analyse information, make their own decisions and provide suggestions. The notion of auto-decision of Chatbots can scare many people. But we believe this will enable people to solve their issues/problems effectively and efficiently. And we need Chatbots that match our culture. In order, to benefit from this technological advancement, we should have a regulatory and assessment process in place.

The sky is the limit, what the use of these artificially intelligent Chatbots will be or can be done.