WO2015021208A1

WO2015021208A1 - Apparatus and methods for assisting and informing patients

Info

Publication number: WO2015021208A1
Application number: PCT/US2014/050019
Authority: WO
Inventors: Robert John QUINN; Xiangdong Shi; Neal Kumar SIKKA
Original assignee: Gamgee, Inc.
Priority date: 2013-08-06
Filing date: 2014-08-06
Publication date: 2015-02-12

Abstract

Personal health assistant apparatuses and methods for delivering interactive personalized health-care information in a hands-free manner that may provide guidance in preparing for a medical procedure and/or self-treatment care following a medical procedure, particularly where the information includes hands-on requirements. Also described herein are apparatuses and methods for preparing personalized health-care information from a dynamic (e.g., changeable) library of sub-dialogs. The personalized health-care information may be customized both the individual patient, but also to the medical provider. Finally, the medical provider generating/providing the interactive information content may provide weighting measures to weight the response and to determine how to react to patient responses to embedded inquiries.

Description

APPARATUS AND METHODS FOR ASSISTING AND INFORMING PATIENTS

CROSS REFERENCE TO RELATED APPLICATIONS

[0001] This patent application claims priority to U.S. provisional patent application no. 61/862,911, filed on 8/6/2013, and titled "APPARATUS AND METHODS FOR ASSISTING AND INFORMING PATIENTS;" U.S. provisional patent application no. 61/890,017, filed on 10/11/2013, and titled "APPARATUS AND METHODS FOR ASSISTING AND INFORMING PATIENTS;" and U.S.

provisional patent application no. 61/890,031, filed on 10/11/2013, and titled "APPARATUS AND METHODS FOR IMPROVING SPEECH RECOGNITION." Each of these patent applications are herein incorporated by reference in their entirety.

INCORPORATION BY REFERENCE

[0002] All publications and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.

FIELD

[0003] Described herein are apparatuses (including devices, systems, software, firmware, hardware, and the like) and methods (including methods of making and using these apparatuses) for assisting and informing medical patients. In particular, described herein are apparatuses and methods for assisting and informing patient's preparing to undergo and recover from one or more procedures for diagnosis and/or treatment of a medical condition. For example, described herein are personal health assistant apparatuses and methods of making and using them.

[0004] The personal health apparatus may simplify the presentation and comprehension of medical information provided to patients ("patient handouts"), may provide an enhanced or specific voice- interface/voice recognition module, and may include a reminder system to assist a patient preparing or undergoing treatment.

BACKGROUND

[0005] In the U.S., virtually all adults receive medical care at some point, and often for extended periods of time. Indeed, end-of-life medical care is growing, particularly as medical knowledge and medical treatments increase in effectiveness and complexity. Unfortunately, patient comprehension, and therefore patient compliance, decreases as complexity increases. It is believed that more than half of all Americans with chronic disease do not follow accurately dosing regimes or lifestyle guidance set forth by their physicians. Failure to take prescription medications correctly leads to 10 percent of all hospital admissions and 23 percent of all nursing home admissions.

[0006] Although a number of devices have been developed to assist with patient medication compliance and/or other health related factors, such devices have generally proven ineffective, at least in part because they are overly complex, or are otherwise ineffective. In particular, such devices have as yet been unable to reduce the burden on patients by simplifying medical treatment and preparation for treatment rather than merely adding another layer on top of the already confusing patient burden.

[0007] For example, several companies are currently marketing or have plans to market hand-held personal digital assistants designed to provide drug administration scheduling, drug administration verification and electronic documentation of drug administration. Such personal digital assistants (PDAs) can store a user's daily schedule, as well as an address book, notes, lists, etc. Information is typically entered into the PDA by the user on a small visual display controlled by a stylus or keyboard. Speech enabled interfaces for portable personal devices have also been described in U.S. Patent Application Publication No. 2002/0055844. For example, U.S. Pat. No. 6,158,613 discloses a voice announcement medication storage and dispensing device with a medical storage portion and a closure portion with a data storage means in the closure portion. The device is activated by access to the storage container and can be programmed with medication information including medication dosage, schedule, medical warnings and patient information. This medication storage and dispensing device has a self-contained power source with data processing and memory chip and electronic data interface with audio output. Use of this device, which is described as disposable, is limited to a single prescription or dosing regime. Similarly, U.S. Patent Application Publication No. 2008/0071543 describes personal health information systems configured to track compliance with drug therapies.

[0008] None of the above-described devices provide a means for simplifying and

conversationalizing patient medical information (handouts) for patient information collection and patient education, accurate voice recognition of spoken natural language patient interaction, simplification of patient medical information, and tailored presentation of patient information and reminders. Accordingly, there is a need for personal health assistant apparatuses that help take patient information and provide patients with simplified and relevant medical information, as well as assist patients in preparing to receive and/or recover from medical treatments.

[0009] Furthermore, studies of patient education provided before and after medical (e.g., hospital) treatment have demonstrated time savings and cost reductions as well as improvements in patient satisfaction, better health outcomes, better compliance, more empowered patient decision making, and reduced medical malpractice. In a healthcare environment where there is relentless pressure to reduce costs, the value of patient education as a cost savings tool is appreciated.

[00010] Patient education tools are important. On average, Americans visit their doctor 3.5 times per year— totaling more than 1 billion patient encounters per year. More than 40 million people have surgery each year. Each of these encounters or procedures generates an opportunity for patient education both before and after the procedure and may dramatically improve patient outcomes. Physicians and hospitals currently use a variety of methods for patient education. The primary tool for patient education is direct communication, such as talking between the provider and the patient. Often times the provider uses demonstrations, such as by using previously prepared or contemporaneously prepared images to supplement the discussion. Written materials, such as brochures, handouts, and other written material can also be provided to the patient. Audiovisual material, such as videos can sometimes be provided to the patient, or given to the patient to watch in their own homes, or in a waiting room or lobby. These materials, such as handouts, are generally approved by the physician and/or hospital, and may be specific to the physician and/or hospital, but are generally not customized to the individual patient.

[00011] These methods of preparing a patient for a medical procedure have associated costs in time or materials, and limitations. In present healthcare provider settings, providers often do not have enough time to fully explain diagnoses or procedures to patients. Materials that are previously prepared may not explain the particular details that make a particular patient's procedure different than one that is common or routine. Audiovisual materials, with nothing further, do not provide ability for the patient to ask questions.

[00012] Thus, what are needed are apparatuses (including systems and devices) for both generating, delivering and implementing personalized and/or interactive patient education, preparation and information tools. For example, apparatuses that can interactively deliver health pre- or post- treatment information in a hands-free manner. Described herein are apparatuses and methods that may address these needs.

SUMMARY OF THE DISCLOSURE

[00013] The present invention relates to personal health assistant apparatuses and methods of making and using them to deliver interactive personalized health-care information in a hands-free (e.g., spoken and natural language) manner that may provide guidance in preparing for a medical procedure and/or self- treatment care following a medical procedure. For example, described herein is a virtual "coach" or mobile healthcare assistant that is adapted specifically allow effective hands-free presentation of health information.

[00014] For example, described herein are healthcare assistant systems and methods of presenting to a user a healthcare information sequence for performing a physical care task in incremental steps. The information presented typically includes one or more manual steps (e.g., having the user manually perform a physical task). The health care information sequence may be presented using: text, graphics, animation, voice, video, or combinations of two or more of these. In particular, the apparatus is adapted to deliver spoken word (voice) information and conversation (dialogs) to the subject, and to "listen" for vocal control instructions and/or responses. For example, a device and method may present a series of pieces (or sets) of health information, which may generally include questions, instructions and education, and can require confirmation from the user (e.g., that the step has been understood or performed) before moving to the next step, and can receive and act on requests to repeat steps or go back to previous steps. In general, these methods and systems are configured to operate in a hands-free manner, such as by presenting the information verbally and monitoring for user commands and responses that are verbal (e.g., by voice) or verbal and visual (e.g., gestural). The device/method may continuously monitor for user input even as the incremental steps of the health care information are presented and after presenting. In particular, the apparatus or method may monitor continuously for control commands. For example, a patient (e.g., subject, user, etc.) may verbally indicate (hands free) a command to interrupt, request repeating, request making it louder (volume control), slow down/speed up the presentation of the portion(s), request more detail on a portion, indicate problems requiring contact with caregivers or clinical staff via phone or messaging, and/or request skipping to other portions of the health care information.

[00015] In general, the health care assistant may be executed on a smart phone, pad computer, laptop computer, desktop computer, or over a telephone (including land line, e.g., by calling into a number).

[00016] In general, any of the apparatuses and methods may generally be used or configured to be used with any type of health care procedure or setting. Although many of the examples provided herein are made in the context of a health care assistant for use in preparing for and/or recovery from a colonoscopy procedure, they may be used with any procedure. Examples of medical procedures may include surgical procedures (e.g., appendectomy, biopsy, carotid endarterectomy, cataract surgery, cesarean section, cholecystectomy, coronary artery bypass, dilation and curettage (D & C), free skin graft, hemorrhoidectomy, hysterectomy, hysteroscopy, inguinal hernia repair, low back pain surgery, mastectomy, partial colectomy, prostatectomy, releasing of peritoneal adhesions, tonsillectomy, blood transfusions, hip replacement, spinal fusion, ), preventative care (e.g., vaccinations and inoculations, fetal monitoring, diagnostic ultrasounds, hemodialysis, colonoscopy and/or biopsy, endoscopy, catheterization, etc.), or the like.

[00017] In addition apparatuses and methods for presenting and using the customized healthcare instructions, also described herein are apparatuses and methods for assembly of customized healthcare instructions. In general, the customized instructions described herein may be assembled from a library of micro-dialogs. The library of dialogs may be used by a physician, technician, hospital, or the like, to build a customized set of health care instructions, guidelines, questionnaires, and fact sheets that may be used for one or more procedures. Thus, a physician, medical group, hospital or other health care provider may generate a set of health care instructions and may structure them (e.g., organize, order, or conditionally link them) into a presentation. This set of healthcare instructions may then be formatted into a presentation that can be executed on a computer, phone, or other device (e.g., smartphone, pad, laptop, etc.) and operated by a patient, as mentioned.

[00018] For example, described herein are apparatuses (systems and devices) and methods that include a library of health-care "micro-dialogs", which may include health care instructions and/or inquiries for the patient. Micro-dialogs are typically each tagged with one or more keyword indicators (e.g., smoking, medical conditions, etc.). Micro-dialogs may be in one or more languages (e.g., the same micro-dialog may be translated into multiple languages, and the tagged with the language (e.g., English, Mandarin, Tagalog, Spanish, etc.). A system may allow a user to access the micro-dialogs and search for micro-dialogs related to one or more desired subjects, collect a sub-set of these micro-dialogs from the library, and organize the sub-set into aa tailored sequence aimed at accomplishing a larger healthcare objective. The tailored set can then be prepared for presentation to a class of subject's or a specific target subject (e.g., on a smartphone, via phone call, etc.). Responses to any inquiries within the micro-dialog may be stored, analyzed, and/or transmitted. In generating the tailored set, the system can pre-search/rank the micro-dialogs based on information already acquired about the target subject, or based on weights provided by the health care provider. Each micro-dialog may include between 2-12 questions or educational or motivational segments in a related subject. Alternatively or additional a micro-dialog may include instructions related to patient health care relevant to a specific subject (e.g. procedure, etc.). The systems described herein for building a customized set of health care instruction from a library of micro- dialogs may also allow the formation of new micro-dialogs. The system therefore may include a repository (library) of indexed micro-dialogs, a user interface allowing searching of the repository, and collection and/or organization of a subset of the micro-dialogs; the system may also include a processor adapted to configure the assembled set of health care information as a presentation (which may also be referred to as a dialog, as any of these presentations may include interactive components, including asking inquiries from the patient and guiding/modifying the presentation based on the response). Optionally, the systems described herein may include an interface for inputting micro-dialogs. These micro-dialogs (and collections of micro-dialogs organized into presentations) may be generated and marked as institution- specific forms or instruction sets. For example, a presentation may be customized for use by patients of a particular physician or health care provider, e.g., hospital, including specific instructions unique or preferred by the provider and/or reference to the provider, such as phone numbers/contact information, addresses and the like.

[00019] Thus, described herein are apparatuses (devices and systems) and methods, including method of operating them, that are customized by the health care provider. For example, described herein are systems and methods of assisting a subject using a mobile healthcare assistant such as a mobile device executing an assembled, customized presentation. The mobile healthcare assistant may generally provide (e.g., hands free) health care information to the subject and may receive feedback from the subject in response to inquiries posed by the presentation from the mobile healthcare assistant. In general, the inquiries may be adapted/approved by a health care provider, for the purpose of assessing health status or level of adherence with health-related instructions and guidelines. The system may analyze the response to the inquiries and score the responses. The scoring may be done based on rules with specific criteria defined by the health care provider. For example, the system may respond in a score-specific manner based on the responses to inquiries, to either: do nothing (take no action), provide a specific set of health care information to the patient, and/or suggest that the subject contact the health care provider. The system may also transmit the responses (and scores) to a remote server and/or to the health care provider, and/or to the subject's electronic medical records.

[00020] Thus, described herein are hands free mobile healthcare assistants (coaches, aides, etc.) that are particularly useful for pre- and/or post- medical procedures self (e.g., home) care. For example, described herein are methods for hands-free mobile healthcare aid to a subject, the method comprising: presenting in spoken language, from a mobile device, a plurality of discrete pieces of health care information wherein at least one of the pieces of health care information comprises an instruction for the performance of a physical task by the subject; monitoring the subject, using the mobile device, for a verbal control command while presenting the health care information, wherein the presentation control command controls the presentation of the health care information and is selected from the group consisting of: a pause presentation command, a stop presentation command, a repeat presentation command, a go back presentation command, a next presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command; interrupting the presentation of the health care information to perform the presentation control command by the mobile device; and waiting, between presentation of each piece of health care information, for a verbal response from the subject before presenting the next piece of health care information.

[00021] For example, a method for hands-free mobile healthcare aid to a subject may include:

presenting, from a mobile device, a set of health care information wherein the health care information comprises an instruction for the performance of a physical task by the subject; monitoring, using the mobile device, the subject for a verbal, visual or verbal and visual presentation control command while presenting the health care information, wherein the presentation control command controls the presentation of the health care information and is selected from the group consisting of: a pause/stop presentation command, a repeat presentation command, a restart presentation command, a next presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command; and interrupting the presentation of the health care information to perform the presentation control command by the mobile device.

[00022] A method for hands-free mobile healthcare aid to a subject may include: presenting, from a mobile device, a plurality of discrete pieces of health care information from a set of health care information, wherein at least one of the pieces of health care information comprise an instruction for the performance of a physical task by the subject; monitoring, using the mobile device, the subject for a verbal, visual or verbal and visual presentation control command while presenting the health care information, wherein the presentation control command controls the presentation of the piece of health care information and is selected from the group consisting of: a pause/stop presentation command, a repeat presentation command, a restart presentation command, a next presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command; interrupting the presentation of the piece of health care information after receiving the presentation control command to perform the presentation control command from the mobile device; and pausing after the presentation of each piece of health care information and confirming that the information has been received before presenting another piece of health care information.

[00023] As mentioned above, any of the methods and devices for hands-free presentation of healthcare information/inquiries may be adapted to verbally interact with the subject. For example, presenting may comprise presenting in a spoken voice from the mobile device. During the presentation of the set of health care information, the apparatus (e.g., any device/processor presenting) may request a response from the subject to an inquiry.

[00024] In general, the presentation of health care information may include presenting the set of health care information by selecting a piece of health care information based on a verbal, visual or verbal and visual input from the subject made in response to request for information from the subject. Typically, the interaction may be limited to verbal.

[00025] In general, the methods described herein may include parsing the set of health care information into an ordered sequence of the discrete pieces of health care information. The ordered sequence may be conditional, e.g., based on the subject's response to one or more of inquiries that may be included within a piece of health care information.

[00026] As mentioned above, presenting the set of health care information may include presenting information to prepare the subject for a medical procedure. For example, presenting the set of health care information may include presenting information to prepare the subject for a colonoscopy.

[00027] Although the presentation may be a dialog (e.g., spoken word), in some variations presenting the set of health care information also comprises presenting audiovisual information including one or more of movies, images, music, or the like. In general, presenting the set of health care information may include sequentially presenting discrete pieces of health care information to the subject from the mobile device.

[00028] The discrete pieces of information may be extremely short (e.g., less than about 10 seconds, less than about 20 seconds, less than about 30 seconds, less than about 40 seconds, less than about 50 seconds, less than about 60 seconds, less than about 90 seconds, less than about 120 seconds, less than about 150 seconds, less than about 3 minutes, etc.). Each piece of information may be referred to as a dialog quantum of information and may include one or more instructions (e.g., "mix the laxative with water", "remove the bag", etc.) and/or one or more inquiries ("does your stomach hurt?" "have you taken your medicine?"), and/or one or more factual statements ("you may feel nauseous afterwards", "it is common to feel pain in your arm"). A micro-dialog may include a plurality of such dialog quanta, and may include rules for organizing them (e.g., ordering them, conditionally ordering them, etc.). As mentioned above, in general, a presentation may include a plurality of such dialog quanta, which may be grouped into micro-dialog groupings. For example, presenting the set of health care information may comprise sequentially presenting discrete pieces (dialog quanta) of health care information to the subject that are less than 3 minutes long. Thus, in general, presenting a set of health care information may include presenting a combination of health care information and patient inquiries.

[00029] In any of the methods for presenting the health care information described, the hands-free methods may generally include concurrent presentation (e.g., verbal/spoken word presentation) of the pieces of information and monitoring to detect a verbal presentation command (and/or response to an inquiry). Thus, any of the systems implementing these methods may filter the presented information and listen for verbal commands/responses from the subject. [00030] In general, the presentation control commands may be provided using spoken language (verbally) and may control or regulate the presentation; when control command is detected, the presentation is, depending on the command, interrupted so that it can be performed. Monitoring the subject for a presentation control command may include detecting a verbal message from the subject and comparing the verbal message to a menu of natural-language responses. Although the control commands described herein are primarily verbal, alternatively or additionally, control commands that are non-verbal (e.g., gestural and/or tactile) may also be used. For example, a control command for "stop" may be indicated by pressing a button (e.g., on the touchscreen of a phone).

[00031] Any appropriate control command may be used and may modify the presentation. For example, a stop command (which may correspond to a subject saying "stop", "pause", "hang on", "wait", "hold on" or similar), may suspend the presentation, e.g., until a resume command is heard or received (e.g., "go on", "continue", "resume", "go", "start", "restart", etc.). Other control commands may include an end or quit the entire presentation command ("quit", "end presentation", "turn off, etc.); a repeat command, which may repeat the most recent piece of information presented ("repeat", "what was that?", "say that again", "say again", "one more time", etc.); a restart command, which may jump back to an previously presented piece of information ("restart", "go back", etc.); a next command, which may skip to the next piece of information ("next," "jump ahead", "skip", etc.); a slow command, which may slow the rate of the presentation, including the rate that the piece of information is being read aloud (e.g. "slow down", "slow", "slower", etc.); a faster command, which may increase the rate of the presentation, including the rate that the piece of information is being read aloud (e.g., "speed up", "faster", etc.); a provide more detail command ("tell me more about...", "more info", "what do you mean?", etc.); and volume command controls, such as an increase volume command ("louder", "I can't hear you", etc.), and a decrease volume command (e.g., "softer", "quieter", etc.). Any of these commands may be performed either without further notification, or after confirming and/or notifying the subject. In addition, after the presentation of each piece of health care information, the method or apparatus may wait for a verbal instruction from the subject to continue ("go one", "ok", "I understand", "done", etc.).

[00032] As mentioned, the method or an apparatuses configured to present the health care information may, in addition to monitoring for control commands, also monitor for a verbal response to an inquiry during and after the presentation of the at least one piece of health care information. In general, the health care information presented may be modified based on verbal responses from the subject received by the mobile device during or after the presentation of earlier-presented health care information.

[00033] As mentioned above, any of the methods of presenting the health care information described above may be performed by a processor (e.g., a smart phone, etc.). Thus, also described herein are non- transitory computer-readable storage mediums storing a set of instructions capable of being executed by a processor of a mobile device, that when executed by the processor, causes the processor to: sequentially present a plurality of discrete pieces of health care information to a subject from the mobile device, wherein a subsequent piece of health care information is presented only after receiving feedback from the subject confirming completion of a prior piece of health care information; concurrently monitor for a visual, verbal or visual and verbal presentation control command from the subject during the presentation each piece of health care information, wherein the presentation control command controls the presentation of the piece of health care information and is selected from the group consisting of: a pause presentation command, a stop presentation command, a repeat presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command; and act on any presentation control command received by interrupting the presentation of the piece of health care information after receiving the presentation control command to perform the presentation control command from the mobile device; and pause after the presentation of each piece of health care information and confirming that the information has been received before presenting another piece of health care information.

[00034] Also described herein are non-transitory computer-readable storage medium storing a set of instructions capable of being executed by a processor of a mobile device, that when executed by the processor causes the processor to: parse a health care information set into a sequence of discrete pieces of health care information, wherein at least one of the pieces of health care information describes a physical task to be performed by a subject; sequentially present the discrete pieces of health care information to the subject from the mobile device, wherein a subsequent piece of health care information is presented only after receiving feedback from the subject confirming completion of a prior piece of health care information; concurrently monitor for a visual, verbal or visual and verbal presentation control command from the subject during the presentation each piece of health care information, wherein the presentation control command controls the presentation of the piece of health care information and is selected from the group consisting of: a pause presentation command, a stop presentation command, a repeat presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command; and act on any presentation control command received by pausing the presentation of the piece of health care information if the pause presentation command is received, stopping the presentation of the piece of health care information if the stop presentation command is received, repeating the presentation of the piece of health care information if the repeat presentation command is received, slowing the presentation of the piece of health care information if the slow presentation command is received, providing more detail on the piece of health care information if the provide more detail on presentation command is received, increasing the volume of the presentation of the piece of health care information if the increase volume of presentation command is received, decreasing the volume of the presentation of the piece of health care information if the decrease volume of presentation command is received, speeding up the presentation of the presentation of the piece of health care information if the speed up presentation command is received, and skipping the presentation of the piece of health care information if the skip presentation command is received.

[00035] For example, the set of instructions, when executed by the processor, may further cause the processor to request a subject response during the presentation of the set of health care information. A set of instructions, when executed by the processor, may also causes the processor to select a piece of health care information based on a verbal, visual or verbal and visual input from the subject made in response to request for information from the subject. The set of instructions, when executed by the processor, may further cause the processor to parse the set of health care information into a sequence of the discrete pieces of health care information.

[00036] The set of instructions, when executed by the processor, may cause the processor to present the information to prepare the subject for a medical procedure, such as (but not limited to) a colonoscopy.

[00037] In some variations, the set of instructions, when executed by the processor, may cause the processor to present the set of health care information by presenting audiovisual information including one or more of movies, images, and spoken words. The set of instructions, when executed by the processor, may cause the processor to present the pieces of health care information by sequentially presenting discrete pieces of health care information to the subject that are less than 3 minutes long.

[00038] As mentioned above, methods and apparatuses for generating tailored health-care presentations that can be presented using a patient's personal electronic device (e.g., smartphone) are also described herein. For example, described herein are methods of generating a patient-specific health-care presentation for presentation on a patient's personal electronic device, the method comprising: accessing a library of micro-dialogs, wherein each micro-dialog comprises a set of health-care information and patient health-care related inquiries, indexed by one or more topic subjects; searching the library of micro-dialogs by topic subject; assembling a subset of micro-dialogs from the library of micro-dialogs into a patient-specific set of health-care information; and formatting the patient-specific set of health-care information into a machine-readable, interactive and patient-specific health care presentation for display on the patient's personal electronic device.

[00039] Also described herein are methods of generating patient-specific health-care presentations for presentation on a patient's personal electronic device, the method comprising: accessing a library of micro-dialogs, wherein each micro-dialog comprises a set of health-care information and patient healthcare related inquiries, indexed by one or more topic subjects; searching the library of micro-dialogs by topic subject, based on a medical procedure to be undertaken by the subject; assembling a subset of micro-dialogs identified by the search from the library of micro-dialogs into a patient-specific set of health-care information; and formatting the patient-specific set of health-care information into a machine- readable, interactive and patient-specific health care presentation; and delivering the patient-specific health care presentation to the subject's personal electronic device.

[00040] In general, the library may be secured. Thus, the step of accessing the library may include engaging a secure user interface to access the library. In some variations, the library may include generic (publically accessible) micro-dialogs as well as private or protected micro-dialogs. For example, certain medical providers may include private or protected micro-dialogs that are accessible only to those medical providers or medical providers provided with access. For example, the step of accessing may comprise selecting a medical provider and accessing the library that is tagged with the medical provider. [00041] In general, the step of searching the library may include searching the library of micro- dialogs by topic subject and/or type of the micro-dialog, including language of the micro-dialog (English, Spanish, etc.)- The library may include a plurality of types of multi-media micro-dialogs, including at least some of the micro-dialogs comprise video and audio. The micro-dialogs may include between 2 and 20 questions for the patient subject.

[00042] Formatting the patient-specific set of health-care information may include organizing the micro-dialogs into a personalized patient handout specific to a procedure to be undertaken by the patient. Organizing may be ordering, as well as linking, including conditionally linking, micro-dialogs or pieces of information (dialog quantum) within micro-dialogs. Conditional linking means that the answers to inquiries within a piece of information may trigger presenting (or similarly, may trigger skipping or not presenting) other pieces of information.

[00043] The step of formatting the patient-specific set of health-care information may include preparing the set of health-care information for presentation by a patient's handheld mobile device. In particular, formatting may include formatting as executable code (e.g., as a script that can be loaded onto a device such as a smartphone to control the processor of the smartphone to present the information as indicated herein), and/or formatting in a format that can be read by a generic machine (including a generic device executing software, hardware and/or firmware) controlling the device to present information as described herein. For example, health-care information may be formatted for use with a commercially available electronic health records (EHR) devices and/or software, such as "MyChart" by EPIC. For example, formatting may include marking patient-specific health care presentations with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a third party. For example, the presentation may include an electronic address and access instructions for transmitting and/or storing patient responses so that a provider may have access to them, or may analyze them as described below. For example, formatting may include marking the patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of healthcare information to a secure server. Formatting may include marking the patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a medical provider.

[00044] As mentioned above, any of these methods may include adding one or more micro-dialog to the library of micro-dialogs, including marking the added micro-dialog with one or more index topic.

[00045] Any of the methods described herein may also be configured for use and operation as an apparatus, including in particular a system for generating patient-specific health-care dialogs for presentation on a patient's electronic device. For example, a system may include: a library of micro- dialogs, wherein each micro-dialog comprises a set of health-care information and patient health-care related inquiries, indexed by one or more topic subjects, further wherein the micro-dialogs comprise video and audio; a user interface module configured to access the library of micro-dialogs, search the library of micro-dialogs by topic subject, and collect a sub-set of micro-dialogs from the library of micro- dialogs; and a formatting module adapted to format the sub-set of micro-dialogs collected by the user interface module into a machine-readable, interactive and patient-specific health care presentation for display on the patient's personal electronic device. In general, a micro-dialog may include a plurality of individual pieces of information (e.g., dialog quantum); for example, a micro-dialog may include between 2 and 20 patient health-care related inquiries.

[00046] Any of the systems described herein may include a user input module configured to allow user input of a new micro-dialogs into the library of micro-dialogs, and indexing of the new micro-dialog.

[00047] In general, the formatting module may be configured to encode the interactive and patient- specific health care presentation for display on the patient's handheld mobile device. For example, a formatting module may be configured to encode the interactive and patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a secure server. The formatting module may be configured to encode the interactive and patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a medical provider.

[00048] Also described herein are non-transitory computer-readable storage medium storing a set of instructions capable of being executed by a processor, that when executed by the processor, causes the processor to: access a library of micro-dialogs, wherein each micro-dialog comprises a set of health-care information and patient health-care related inquiries, indexed by one or more topic subjects; search the library of micro-dialogs by topic subject, based on a medical procedure to be undertaken by the subject; collect a subset of micro-dialogs identified by the search from the library of micro-dialogs into a patient- specific set of health-care information; and format the patient-specific set of health-care information into a machine-readable, interactive and patient-specific health care presentation.

[00049] The set of instructions, when executed by the processor, may further cause the processor to deliver the patient-specific health care presentation to the subject's personal electronic device. In some variations, the set of instructions, when executed by the processor, further cause the processor to select a medical provider, and/or present micro-dialogs associated with the selected medical provider. In general, the processor may engage a secure user interface to access the library.

[00050] The set of instructions, when executed by the processor, may further cause the processor to access the library of micro-dialogs wherein at least some of the micro-dialogs comprise video and audio.

[00051] In general, the set of instructions, when executed by the processor, may further cause the processor to organize the micro-dialogs into a personalized patient handout specific to a procedure to be undertaken by the patient. For example, the set of instructions, when executed by the processor, may further cause the processor to prepare the set of health-care information for presentation by a patient's handheld mobile device.

[00052] As mentioned above, in general, the presentation may include routing information for directing the response to any responses to included inquiries. For example, the set of instructions, when executed by the processor, may cause the processor mark the patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a third party, to a secure server, and/or to a medical provider.

[00053] The set of instructions, when executed by the processor, may also be configured to cause the processor to add a micro-dialog to the library of micro-dialogs.

[00054] As mentioned, the information presented may be customized to the patient. For example, the formatted presentation may access patient information from patient health records, or any other source. This information may be used to select (or suggest) micro-dialogs to include, and/or ways to organize the presentation.

[00055] Also described herein are methods and devices in which the presentations are also customized to the health-care provider. Thus, described herein are health-care provider customized personal digital healthcare assistants. For example, a method for assisting a health care provider in treating a patient may include: generating a patient-specific set of health-care information comprising patient health-care related inquiries; weighting the patient health-care related inquiries based on preferences provided by the health-care provider; formatting the patient-specific set of health-care information into a machine-readable, interactive and patient-specific health care presentation for performance by the patient's personal electronic device; receiving patient responses to the patient-specific health care presentation; scoring the patient responses to the patient-specific health care presentation; and performing a score-specific action based on the score.

[00056] Any appropriate score-specific action may be taken, including, for example, altering the health care provider, alerting the patient of a potential issue, transmitting the patient responses to an electronic medical record, etc., including combinations of these. For example, if the responses to inquiries within the presentation indicate a potential health risk, the apparatus (including an application software/hardware/firmware) presenting the presentation, may send a message to the health care provider or may present a message asking the patient if he/she would like to contact the health care provider, etc.

[00057] For example, weighting may include allowing the health-care provider to weight the patient health-care related inquiries. Thus, the method may include allowing a health-care provider to approve the patient-specific set of health-care information. Generating a patient-specific set of health-care information may include patient health-care related inquiries comprises assembling the set of health-care information from a library of micro-dialogs, including health-care information specific to a health-care provider's guidelines. Formatting may include formatting the patient-specific set of health-care information into a machine-readable, interactive and patient-specific health care presentation for performance by the patient's smartphone.

[00058] The method of claim 68, wherein receiving patient responses to the patient-specific health care presentation comprises receiving the patient responses by the patient's personal electronic device. Receiving patient responses to the patient-specific health care presentation may comprise receiving the patient responses by a remote processor. Formatting may comprise formatting the patient-specific set of health-care information with the weighting information. The step of generating a patient-specific set of health-care information comprising patient health-care related inquiries may include generating a patient- specific set of health-care information related to a medical procedure. The methods described herein may also include generating a patient-specific set of health-care information comprising patient health-care related inquiries and/or generating a patient-specific set of health-care information related to a colonoscopy.

BRIEF DESCRIPTION OF THE DRAWINGS

[00059] FIG. 1 illustrates one example of a system process (micro-dialog) for patient registration carried out by a personal health assistant apparatus as described herein.

[00060] FIG. 2 illustrates one example of a system process (micro-dialog) for stopping anticoagulant medications carried out by a personal health assistant apparatus (e.g., software).

[00061] FIG. 3 illustrates one example of a system process (micro-dialog) for patient reminder carried out by a personal health assistant apparatus/program.

[00062] FIG. 4 illustrates one example of a system process (micro-dialog) for walking a patient through an at-home therapy carried out by a personal health assistant apparatus/program.

[00063] FIG. 5 illustrates one example of a system process (micro-dialog) for patient reminder carried out by a personal health assistant apparatus/program.

[00064] FIG. 6 illustrates one example of a system process (micro-dialog) for post-op patient reminders carried out by a personal health assistant apparatus/program.

[00065] FIG. 7 illustrates one example of a system process (micro-dialog) for post-op complication reminders carried out by a personal health assistant apparatus/software program.

[00066] FIG. 8 illustrates a schematic for checklist and task item prioritization, e.g., organizing a set of micro-dialogs into a healthcare provider-customized presentation for a patient's mobile device.

[00067] FIG. 9 illustrates one example of a checklist management system carried out by a personal health assistant apparatus/program.

[00068] FIG. 10 illustrates a predictive model carried out by the personal health assistant apparatus/program.

[00069] FIG. 11 shows one embodiment of a clinic dashboard showing a patient preparation level.

[00070] FIG. 12 is an example of a patient prep status showing a preparation level of a patient to a medical provider.

[00071] FIG. 13 illustrates one method of operating an apparatus (e.g., control

software/hardware/firmware) on a mobile device for present health care information in a hands-free manner.

[00072] FIG. 14 illustrates methods of generating customized presentations of health-care information from a library of micro-dialogs, including (optionally) adding new micro-dialogs to the library and customizing the micro-dialogs by weighting inquiries within micro-dialogs. DETAILED DESCRIPTION

[00073] Described herein are personal health assistant apparatuses and methods of making and using them. In particular, described herein are personal health assistant apparatus configured to simplify the presentation of customized (e.g., customized for a particular health care provider and/or customized to the patient) health care information, and particularly health care information to aid the patient in preparing for and recovering from a medical procedure. Current medical forms and handouts provided to patients for this purpose are complex and include much non-specific and distracting unnecessary information. In addition, such information is static, time consuming for the health-care provider to prepare and update. Many patients, and particularly terminally ill patients, and their caregivers may have a difficult time understanding and complying with the relevant portions of these forms and/or handouts. The personal health assistant apparatuses and methods described herein may simplify and tailor such medical forms to a particular patient and/or health care provider.

[00074] For example a personal health assistant apparatus described herein may include a system that enables medical patients to engage in speech-based and text-based human-machine dialogue to better prepare them for the medical procedure. The system may help users comply with all clinic requirements before the procedure starts. Clinic requirements can be pre-configured into the system in the form of a sequential set of information (in some variations a checklist of requirements) and answers to associated questions that patients are likely to ask. Within each sequence there can be a series of statements and questions that the system asks users, so as to educate them and guide them into compliance with the requirements. In the meantime, users can ask medical-related oral or textual questions of the system, with the system not only providing answers, but also engaging in deeper level of dialogues to 1 ) provide additional detailed information specific to users with particular characteristics; 2) ensure that users truly understand what they need to do to comply; and 3) record the user's statement that he or she has indeed complied with the prep requirement. This back-and-forth conversation between the user and the system is the core value to drive a higher level of preparedness for medical procedures.

[00075] In general, the presentations referred to herein must be presented in a manner that will be effective, particularly to the elderly and ill, who may not be able to manually operate a device, particularly when following instructions provided by the presentation. Thus, the methods and apparatuses described herein may be adapted to provide optimal hands-free interactive presentations. For example, the apparatuses and method may present the information (which may be referred to as a dialog and/or as a presentation or interactive presentation), in verbal, spoken language, and may receive input, e.g., presentation control instructions and answers to inquiries, as spoken language input(s) from the user. Thus, any of the apparatuses and methods described herein may include natural-language interpretation module(s) to interpret natural (spoken) language received by the device. Further, control commands for controlling virtually any aspect of the presentation, may be received verbally, including during the presentation of information by the apparatus (which may 'interrupt' the presentation to execute the control command). Interruption of the presentation may mean actually pausing or stopping the presentation or it may mean simply performing the control command (e.g., increasing volume, decreasing volume, speeding up, slowing down, etc.) while continuing the presentation and interrupting the current status of the presentation parameter being modified with the new parameter.

[00076] In general, a presentation may be made up of one or more micro-dialogs (and in particular, multiple micro-dialogs), where each micro-dialog typically concerns a particular topic/subject. The micro-dialog is typically made up of a plurality of individual pieces of information, which may be facts, instructions or inquiries. These pieces of information may be referred to as pieces of dialog, dialog quantum, or the like. Examples of pieces of information, arranged into micro-dialogs, as well as an example of a micro-dialog arranged into a presentation are provided below.

[00077] A personal health assistant apparatus can be configured as executable code (e.g., stored in a non-transient medium for controlling a processor) that can execute as, e.g., a software program, and display to the patient or user an avatar or 'virtual human' who collects health-related information from the user and conveys clinically validated information to the user. He or she is the user's point of input to the program in addressing personal healthcare challenges. The information is also and primarily verbally presented (spoken) by the device.

[00078] The software program includes set of tasks needed to carry out to ensure that the user is well prepared for the medical procedure. These tasks include substantive clinical ones like question answering and checklist management, as well as non-clinical ones like registration, settings management and so forth. The tasks can be primarily carried out within the mobile app, but can also include the key server- initiated task of 'push notification', in which a message is sent to the user when there is a change in time- sensitive instructions related to exam prep.

[00079] The personal health assistant apparatus can prioritize tasks according to the needs of exam prep and the user, and to choose the appropriate current task according to these priorities. Each task can be carried out via a set of inter-woven microdialogues whose purpose is to complete subtasks in the service of the overall task goal.

[00080] Personal health assistant apparatus of the current disclosure can be configured to

"conversationalize" patient medical forms. By "conversationalizing" a patient medical form, the information on the form/handout may be converted into smaller, patient-specific content and presented in a convenient manner. For example, the conversationalized content may be converted for presentation in a hand-held device, such as a personal computer, smartphone (e.g., iPhone™, Android™, etc.), tablet device (e.g., iPad™), or other, equivalent device. For example, a hand-held device may include or be configured to run executable instructions for communicating with a patient and presenting patient-tailored content. The patient-tailored content may be determined by the executable instructions on the hand-held device (e.g., as part of the "application" or "app"), or they may be determined remotely and

communicated to the hand-held device. Users of the personal health assistant apparatus can input information in a variety of ways, such as with an input device such as a mouse or keyboard, through a graphical user interface on a touch-screen of the apparatus, or (in particular) by speaking to the apparatus to input data via voice recognition software. [00081] Although spoken input may be preferred, other types of input (tactile/touch, visual, etc.) may be used. For example, Table 1 describes various types of user input into the system:

[00082] Table 2 describes various responses of the system to user input:

Statements and Questions as

Answers to User Clarification part of a checklist item that Small Talk

Questions Request expect user inputs as answers

Expects Expects

Expects

Multiple open

Sub Type YES /NO

Choice ended

answer

answers answers

3 parts: Summary, welcome, Dialogue Detail and Micro- goodbye, should be Dialogue how you redirected

Note doin'? after two consecutive clarification request

Answer to "What

do 1 need to buy to

Expects Y/N answer:

prepare for the 1 didn't Have you found someone to

procedure?" understand drive you home after the

Summarv: You Hello, your question, procedure?

Example need to buy ... welcome could you

Detail: You can get to ... rephrase?

Expects an open answer

both at ... Here is a

Who is going to drive you

picture of ...

home?

Micro-Dialogue:

Have you bought

[00083] FIG. 1 illustrates one embodiment of a personal health assistant apparatus executing a software program to gather patient medical input and registration information as part of a customized presentation (e.g., an registration micro-dialog portion of a customized presentation). In this example, the presentation is customized by the health care provider (e.g., clinic, physician, hospital, etc.), including approval of the specific information/requests, as well as including contact information for the provider. The presentation may also be customized to the patient, e.g., based on input from the patient, or directly from the patients electronic health record which may determine which micro-dialogs to present, and/or automatically populate requested information (inquiries), etc. The personal health assistant apparatus and software program can be presented to a medical patient to simplify patient registration and gather applicable medical information relating to the patient's care. In the illustrated embodiment, the software program can be executed on or accessed remotely by a smartphone, tablet, or personal computer.

[00084] FIG. 1 is presented as a series of screenshots of the apparatus (e.g., in this example a software program controlling a smart phone), operating as a personal health assistant apparatus to illustrate the various permutations of the registration process. The FIG. 1 embodiment is specifically tailored to a patient who is scheduled to undergo a colonoscopy procedure. Screen 102 illustrates a welcome screen of the software program where the patient or user is introduced to a medical avatar of the program. The medical avatar can be one or more images of a medical provider, such as a nurse, doctor, or physician's assistant. The medical avatar can be used to personalize the registration experience as if the patient was interacting directly with a medical provider. Each "screen" may be considered a single dialog quantum (piece of information), although multiple screens may be used for a single piece of information and/or multiple pieces of information may be used on different screens. All statements by the medical avatar can be presented in the form of written text on the screen of the personal health assistant apparatus along with spoken dialogue through the apparatus' speakers.

[00085] Screen 104 illustrates a first input screen, where the patient can be asked to input their first and last name. Next, at screen 106, the patient may be asked to input the date and time of the scheduled procedure or medical appointment. A verification screen, at screen 108, can display back to the user the inputted name and procedure date. If the patient identifies an error in the inputted information, there can be an option to go back and re-enter or edit the incorrect data.

[00086] Next, at screen 1 10, the patient can be asked to input the name(s) of medication that has been provided or prescribed to the patient. In this particular embodiment the patient can be asked to specify which laxative the medical provider told the patient to use prior to the colonoscopy procedure. However, it should be understood that in general, the software program can request that the patient input any type of medication being used during the registration process. [00087] At screen 1 12, the patient can be asked to enter and re-enter a PIN number or password. This PIN number or password can be used to prevent un-authorized users from accessing the patient inputted data. A final confirmation screen at screen 114 can display to the user everything that has been inputted till this point, and if the patient confirms that the data is correct, a final "registration successful" screen or popup can be shown at screen 116.

[00088] Next, the software program of the personal health assistant apparatus can request medical information from the patient that may have an impact on the planned procedure or on the type of medical care required by the patient. For example, at screen 118, the medical avatar can ask the patient if they have a specific medical condition, such as diabetes. It should be understood that this function can be repeated several times, to ask the patient if they have any other serious medical conditions or severe allergies. The question can be asked in a simple yes/no format, so that the patient can easily respond to the query. In this example, the patient can input "no" at screen 118, to indicate that they do not have diabetes, or "yes", to indicate that they do have diabetes. Depending on how the patient responds, the software program can progress to either screen 120, or screen 122.

[00089] In general the system is typically monitoring for control commands from the patient concurrently with presenting the information. Thus, at any time during the presentation, the patient may speak a control command to control one or more of the presentation parameters. These control commands are generally spoken out loud (verbal). Examples of control commands are shown in Table 3 :

Backup Jump back to an previously presented "restart", "go back", "backup" piece of information

[00090] After the software program has completed collecting patient data, the personal health assistant apparatus can compile and display a "to-do checklist" at screen 124 (which will be discussed in more detail below), along with an "exam info" page at screen 126 that displays to the patient all the relevant information relating to the upcoming procedure. For example, this exam info page can show the exam/procedure date, time, and location, along with the prescribed medicine and contact information.

[00091] Colors, fonts, and graphics of the software program running on the personal medical assistant apparatus can be designed and chosen based on the target patient population. For example, colonoscopy patients will likely be over the age of 50, therefore more saturated colors, greater contrast, and larger fonts/graphics are of greater importance for ease of use.

[00092] In some variations, the engine converting medical information into tailored content may be software, firmware of hardware that is part of the local application or it may be separate and may communicate with the application. The executable instructions may operate by selecting relevant information from a content schema based on patient information determined by communicating directly with the patient or patient caregiver.

[00093] A personal health assistant apparatus may be configured to provide time-sensitive (e.g., "just in time") notification/reminders to a patient to perform one or more tasks related to a medical procedure or treatment. For example, the apparatus may push notifications (e.g., on the handheld device) indicating that a patient should perform an action (e.g., a last chance to eat before fasting, medication reminders, refraining from strenuous activities). In general, such notifications may include one or more of diet, medication and activity.

[00094] Any of the personal health assistant apparatus described herein may also be configured to provide patient-specific reminders, education and assistance. A personal health assistant apparatus configured to provide reminders and treatment (pre-treatment) information. In this example, the personal health assistant apparatus is configured for use by a patient preparing for a colonoscopy. The personal health assistant apparatus may be configured specifically for colonoscopy patients. For example, the personal health assistant apparatus may be configured as a colonoscopy personal health assistant apparatus. Alternatively, the personal health assistant apparatus may be a multi-purpose or general- purpose device, configured to provide patient-tailored information specific to numerous medical conditions/procedures. Further, the personal health assistant apparatus may be configured to assist the user in non-medical or affiliated tasks, including scheduling medical appointments, reminders for appointments (including medical appointments), taking medication, scheduling transportation to/from medical appointments, and the like.

[00095] FIG. 2 illustrates one embodiment of a personal health assistant apparatus executing a software program to provide specific reminders to the patient relating to an upcoming medical procedure, exam, or appointment. The reminder can be, for example, a reminder to stop taking or ingesting a certain medication, food, or product a specified time prior to the procedure, exam, or appointment. FIG. 2 is presented as a series of screenshots of the software program operating on the personal health assistant apparatus to illustrate the various permutations of the reminder process. In the illustrated embodiment, the reminder can be tailored towards stopping ingestion of specific drugs or products prior to a colonoscopy procedure.

[00096] At screen 202 of FIG. 2, a reminder screen can pop up on the personal health assistant apparatus a specified time period prior to an upcoming procedure, exam, or appointment (such as on the user's smartphone running the software program). For example, for a patient with an upcoming colonoscopy procedure, screen 202 can pop up on the user's smartphone 5 days prior to the procedure to remind the patient to stop taking certain medications. At screen 202, the medical avatar can communicate to the patient through text or speech that it's 5 days until the colonoscopy and time to stop taking certain medications. The user may be required to indicate that they are ready to continue orally and/or by pressing a button on the apparatus, such as by indicating "next" or "I understand" before the software program advances to the next screen.

[00097] At screen 204, the apparatus can indicate to the user to stop taking a certain type of product. In this example, the program can indicate to the user to stop taking Aspirin products and Plavix. A separate screen, shown in screen 206, can indicate to the patient alternative products or medications that may be used in place of the restricted products, such as Tylenol in place of Aspirin.

[00098] At screen 208, the patient can be asked if they understand and are okay with stopping the ingestion of the restricted product or medication. If the patient answers yes, then the reminder is completed at screen 210. If however, the patient answers no, then the apparatus can at screen 212 explain to the patient why it is necessary to restrict the specific medication or product. In this example, the medical avatar of the software program can instruct the patient that Aspirin and Plavix increase the risk of bleeding during a colonoscopy procedure. By instructing the patient of the risks associated with continuing the use of the product or medication, the apparatus and software aim to increase patient compliance with medical instructions to increase patient safety during the planned procedure.

[00099] At screen 214, the patient can once again be asked if they are okay with stopping the ingestion of the restricted product or medication. If the patient answers yes, then the reminder is completed at screen 216. If the patient once again answers no, the apparatus can prompt the patient to call the medical provider for further explanation. The patient has the option to call the provider directly from the program, as shown in screens 218 and 220. If the patient does not wish to call the provider at that time, a reminder screen 222 can be displayed to the user. This reminder may also be scheduled on the apparatus to be shown to the patient at a later time, to remind the patient again to call the provider and stop ingesting the restricted product or medication.

[000100] The embodiment of FIG. 2 specifically refers to the patient restricting the use of Aspirin and Plavix however it should be understood that this program can be used to remind the patient to stop taking any restricted product, food, or medication any specified number of days prior to a procedure, exam, or appointment. For example, a patient may be reminded at screen 204 to stop taking Coumadin (Warfarin), and at screen 212 may be educated that failure to stop taking blood thinners could increase the risk of bleeding during a procedure.

[000101] Similarly, at 204 the patient can be reminded to stop taking anti-inflammatory medications, such as Ibuprofin, Motrin, Nuprin, etc., and at 212 the patient may be educated that failure to stop taking anti-inflammatories may increase the risk of bleeding during the procedure.

[000102] As described above, the patient may also be reminded to avoid eating certain foods prior to a procedure. Thus, at 204 the patient can be reminded to stop eating certain foods, such as nuts, seeds, popcorn, grapes, peas, onions, beans, and tomatoes. Additionally, the patient can be reminded to stop eating all solid foods and to only ingest clear liquids. At 212, the program can explain that these specific restricted foods may make it more difficult to find polyps during a colonoscopy procedure. Similarly, at 212 the program can explain that avoiding solid foods and ingesting only clear liquids can improve the chances of finding polyps during a colonoscopy procedure.

[000103] In addition to reminders to stop taking a certain food, medication, or product, as described above, the personal health assistant apparatus and software can also be configured to provide reminders to a patient to acquire or start taking certain products, medications, or foods. FIG. 3 illustrates one embodiment of a personal health assistant apparatus executing a software program to provide specific reminders to the patient relating to an upcoming medical procedure, exam, or appointment. FIG. 3 is presented as a series of screenshots of the software program operating on the personal health assistant apparatus to illustrate the various permutations of the reminder process. In the illustrated embodiment, the reminder can be tailored towards acquiring specific drugs or products prior to a colonoscopy procedure.

[000104] At screen 302 of FIG. 3, a reminder screen can pop up on the personal health assistant apparatus a specified time period prior to an upcoming procedure, exam, or appointment (such as on the user's smartphone running the software program). For example, for a patient with an upcoming colonoscopy procedure, screen 302 can pop up on the user's smartphone a specified time prior to the procedure to remind the patient to purchase a specified medication. At screen 302, the medical avatar can communicate to the patient through text or speech that it's time to purchase 2 bottles of MiraLAX. The user may be required to press a button on the apparatus, such as "next" or "I understand" before the software program advances to the next screen.

[000105] At screen 304, the apparatus can indicate to the user that the medication can be purchased with or without a prescription. In the illustrated embodiment, MiraLAX does not require a prescription and the screen 304 can include images or information to indicate the quantity and volumes of medication required. A separate screen, shown in screen 306, can indicate to the patient alternative products or medications that may be used to help or supplement the required medication. For example, in this embodiment, the program can suggest Vitamin A&D ointment to help with comfort while taking MiraLAX.

[000106] At screen 308, the patient can be asked if they are able to purchase or acquire the required product before preparation for the procedure must start. If the patient answers yes, then the reminder is completed at screen 310. If however, the patient answers no, then the apparatus can at screen 312 explain to the patient why it is necessary to purchase the specific medication or product. In this example, the medical avatar of the software program can instruct the patient that without proper bowel prep, the risk for cancer may be higher. By instructing the patient of the risks associated with failing to purchase and use of the product or medication, the apparatus and software aim to increase patient compliance with medical instructions to increase patient safety during the planned procedure.

[000107] At screen 314, the patient can once again be asked if they can purchase the required product or medication. If the patient answers yes, then the reminder is completed at screen 316. If the patient once again answers no, the apparatus can prompt the patient to call the medical provider for further explanation. The patient has the option to call the provider directly from the program, as shown in screens 318 and 320. If the patient does not wish to call the provider at that time, a reminder screen 322 can be displayed to the user. This reminder may also be scheduled on the apparatus to be shown to the patient at a later time, to remind the patient again to call the provider and stop ingesting the restricted product or medication.

[000108] The embodiment of FIG. 3 specifically refers to the patient purchasing MiraLAX for bowel prep, however it should be understood that this program can be used to remind the patient to purchase any product, food, or medication any specified number of days prior to a procedure, exam, or appointment. Thus, in one embodiment, the apparatus can remind the patient at screens 302 and 304 to purchase another medication, such as OsmoPrep, Golytely, Nulytely, Trilyte, Colyte, or SUPREP. If the medication requires a prescription, the apparatus can include a notification to call the medical provider if the patient has lost the prescription.

[000109] Additionally, the personal health assistant apparatus can be configured to walk a patient through a therapy or treatment process, such as a process of taking medication in preparation for another procedure, exam, or appointment. FIG. 4 illustrates one embodiment of a personal health assistant apparatus executing a software program to provide specific instructions on how to take medication. FIG. 4 is presented as a series of screenshots of the software program operating on the personal health assistant apparatus to illustrate the various permutations of the therapy or treatment process. In the illustrated embodiment, the reminder can be tailored mixing, dosing, and taking specific drugs or products prior to a colonoscopy procedure.

[000110] At screen 402 of FIG. 4, a reminder or pop-up notification can appear on the personal health assistant apparatus at a specified time. For example, for a patient about to undergo a colonoscopy procedure, the reminder or notification can appear at the proper time prior to the procedure. In FIG. 4, the medical avatar can appear on the apparatus and instruct the patient that it is time to start the bowel preparation process for the upcoming colonoscopy procedure. The medical avatar can communicate with the patient with text and/or speech, as described above.

[000111] At screen 404, the apparatus can display to the user the types and amount of product required for the specific therapy. In this example, the apparatus can display to the user that two bottles of MiraLAX will be required, plus 8oz of water per dose of MiraLAX. [000112] At screen 406, the apparatus can display dosing information to the patient. For example, the apparatus can include a screen of the medication to be used with information on what constitutes a single dose. In this example, a single dose of MiraLAX can be a single capful of the medication. The apparatus and program can include a picture or animation of the dose of medication being mixed with the 8oz of water, along with verbal or written instructions.

[000113] Once the patient indicates that they know what the dosage is and are ready for the next step, screen 408 of the program can give instructions on how to take the dose of medication. In this example, the program can include written or verbal instructions to the user to drink the entire glass of fluid including the dose of medication.

[000114] At screen 410, the medical avatar can remind the patient the time interval and number of doses that must be ingested to complete the therapy. For example, in one embodiment, a patient may be required to take 18 doses of MiraLAX every 10-15 minutes.

[000115] At screen 412, the program and apparatus can ask the patient if they would like a timer to be set to remind the patient to take the subsequent doses. This can be optional, as shown, in which the patient can reject setting a timer to get a confirmation screen at 414 that reminds them the number and frequency of doses, or alternatively, the patient can request a timer to advance the program to screen 416.

[000116] At screen 416, the program or apparatus can provide additional instructions to the patient during the therapy or medication taking process. For example, in the illustrated example, the program can remind the patient to remain close to a bathroom during the bowel cleansing process.

[000117] At screen 418, an alarm/reminder can pop-up on the screen of the device to remind the patient to take the second dose. The program can also, at screen 420, provide other tips or

recommendations to the patient to make the therapy process easier. For example, the program can remind the patient that a vitamin A&D ointment can soothe soreness.

[000118] Screens 416, 418, and/or 420 can repeat as the patient is instructed to take the subsequent doses of medication. In one embodiment, as shown in screen 422, the patient can be asked if they'd like to take a break in the process, such as if they are experiencing side effects of the medication like nausea. At this point in the process, the patient can have the opportunity to elect to take a break, as shown in screen 424, or to continue taking the doses as shown in screen 426.

[000119] The program or apparatus can also display words of encouragement to the patient during the process, and can remind the patient why they are taking the medication and the benefits that the medication will provide. This encouragement can be used to assist the patient in completing the therapy process, especially in dose-intensive applications like colon cleansing. In this example, at screen 428, the program or apparatus can remind the patient that the goal of the medication is to empty the colon for the upcoming procedure.

[000120] Finally, the last timer 430 and dosage screen 432 can be displayed to the patient once all doses have been taken and the therapy process is completed. [000121] The program illustrated in FIG. 4 can be implemented with any type of medication, product, or home therapy procedure. For example, this program could give the patient instructions on how to use a number of medications, including OsmoPrep, Golytely, Nulytely, Trilyte, Colyte, or SUPREP.

[000122] The program can implement various graphics, videos, and instructions during the process shown in FIG. 4. For example, the program at screen 406 can show a video instructing the patient how exactly to measure and mix a dose of medication. During the repeat reminder process, illustrated in screens 412 through 432, the program may display a graphic to the user keeping track of how many doses have been ingested and how many doses remain.

[000123] The personal health assistant apparatus and software program can also be configured to provide reminders to the patient about day-of-procedure requirements, such as transportation to/from the medical facility for the procedure. In FIG. 5, at screens 502 and 504, the program can remind the patient that they will be drowsy and unable to drive themselves home the day of the exam. The program can remind the patient that they will need to arrange for alternative transportation home from the medical facility.

[000124] At screen 506, the program can remind the patient that public transportation is acceptable if accompanying by another adult. Then, at screen 508, the program can ask the patient if they have arranged for transportation. If yes, the reminder can be completed at screen 510. However, if the patient has not arranged for transportation, the program can remind them to do so at screen 512. In some embodiments, the program can provide the telephone numbers for car or taxi services, or can pull up the real-time bus or public transit schedules from near the medical facility to the patient's home address.

[000125] In another embodiment, as shown in FIG. 6, the personal health assistant apparatus and software program can provide post-op instructions and reminders to a patient after a medical procedure has been performed. For example, the program can provide specific instructions to the patient tailored to the specific procedure. In FIG. 6, a process is illustrated with instructions to a patient after a colonoscopy procedure.

[000126] For example, in one embodiment, as shown in screen 602 of FIG. 6, the patient can be reminded by a medical avatar of the personal health assistant apparatus to get plenty of rest and avoid physical activity after the medical procedure. At screen 604, the patient can be reminded to avoid making important legal decisions, like signing legal papers, since the lingering effects of medication or the medical procedure may impair judgment. At screen 606, the patient can be reminded to avoid driving for a specified time, and reminded as to the proper diet and medicine regime. Additionally, screen 608 can remind the patient to call the medical provider with any questions, and can provide a clickable link that will connect the patient to the medical provider (if the program is being run on a smartphone, for example).

[000127] The personal health assistant apparatus and software program can also be configured to provide input and assistance if the patient experiences any post-op complications as a result of the medical procedure. In FIG. 7, a screen 702 can inform the patient that complications after a procedure are rare. At screens 704 and 706, the program can instruct the patient to call the medical provider if any of a list of symptoms or side effects are experienced after the procedure. The program can include a button or input that allows the patient to call the medical provider directly from the personal health assistant apparatus if the apparatus is a smartphone. Screen 708 shows the smartphone calling the medical provider directly from the software program.

[000128] In some variations, the personal health assistant apparatus may also include patient tailored checklists, and provide checklist management. For example, the apparatus may generate a dynamic to-do list for a patient for a specific time period, such as a single day, week, month, etc. The personal health assistant apparatus may prompt the user to perform these tasks and/or allow the user to follow the checklist in review and completing the tasks. Further, the personal health assistant apparatus may also check for compliance in performing one or more of the task. In some variations, the checklist may be interactive. For example, the patient or caregiver may select one or more items on the checklist and the personal health assistant apparatus may provide additional information on the item.

[000129] Tasks are units of work in the personal health assistant apparatus system, where dialogues can be used to accomplish specified task objectives. Types of tasks and task lists are outlined in FIG. 8. For each colonoscopy patient, use of the system is expected to last about a week (from approximately 5 days before the procedure to about 2 days after the procedure), and during this time the overall goal of the system - adequate exam preparation - is accomplished via two substantive task types: Checklist

Management and Question Answering. The system can have stored within it a set of checklist tasks mapped to time periods of relevance, according to the clinic's instructions. The system's goal is to ensure that the patient understands and performs these tasks, by notifying a user when that particular task is relevant, stepping the user through key information about that task, confirming that the task is completed, and answering relevant questions asked by the user along the way.

[000130] Checklist items specify the inventory of content driving all substantive user interaction for the app. The item text is used for both answers to recognized user questions as well as system-driven compliance checking. These items can be described by cells in a cube, where the dimensions can be

Category/Item Type (Medications, Diet, Activity and Explanation), Restriction (Must Do, Can Do, Can't Do), and Time (specified periods before and after the exam). This cube can be configured to describe the checklist items for virtually any medical test or procedure.

[000131] Tasks can be selected from the outstanding task list and carried out according to priorities that are assigned by the system, calculated in real-time based on preconfigured importance of task items and ongoing compliance status and usage pattern of each user. The prioritization can be highly dynamic, so that a task may be interrupted by another task with a newly assigned higher priority.

[000132] As the priorities of tasks are dynamic, each of these tasks might be delayed by response to an even higher-priority task, such navigating to settings in response to "I need to change the time of my exam." Interrupted tasks can be put on the outstanding task list with highest priority, and users can be informed that such tasks will be completed soon.

[000133] Each task can go through a lifecycle of states that depend on the type of task (e.g., checklist item or question) and the level of interaction with the user so far (e.g., Active, Reviewed, etc) [000134] The system can assign priorities to tasks and pick the highest-priority task from this task list. The system can evaluate the priority of each task in the task list before each occurrence of system utterance, and pick the task with the highest priority as a base for the next round of dialogue.

[000135] A checklist embodies the preparation requirements of a procedure. The items can have associated with them an active time period, priorities for specific time windows, and content- text and graphical display content as well as TTS content and 'microdialogue' response trees defining the interaction needed to give more specific instructions to specific types of users (e.g., those who need a ride to the medical provider and back). One example of a screen showing a checklist for a specific medical procedure is illustrated in FIG. 9. This checklist can correspond to the checklist shown in screen 124 of FIG. 1.

[000136] In the particular example of FIG. 9, the checklist can be displayed to the user to outline all the required and suggested tasks both before and after the scheduled medical procedure. For example, in FIG. 9, the patient can be reminded to check with the medical provider for additional instructions if they have diabetes or another serious medical condition. The checklist can also include task items arranged by the date they must be carried out. In this example, the patient will be reminded to stop taking aspirin, buy MiraLAX, and arrange a ride home on a specific date, and to stop taking Coumadin on another date. These specific tasks will vary depending on the individual patient and scheduled medical procedure. As these tasks are completed (or not completed), the system can track user interaction with the individual tasks and dynamically remind the patient or re-adjust priorities to better prepare the patient for the medical procedure.

[000137] A time window of each checklist item can be marked by three points in time called S.U.E times: A Start Time (S), when the checklist item becomes relevant, an End Time (E), when the checklist item becomes irrelevant again, and an Ultimatum Time (U) defined to be a time in between the Start Time and End Time when the checklist item becomes urgent and must be completed as soon as possible.

[000138] In addition, each checklist item can have a recurring time window parameter, which specifies the duration the system should wait to check the compliance of this checklist item again when the checklist item is put in a REVISIT status (meaning the item is not CHECKED OFF but the user promises to be compliant in the future). In one embodiment, the default value of this recurring time window is 24 hours, and this time can decrease as the current time is approaching the End Time of the checklist item.

[000139] The importance of checklist items can be marked by an attribute Severity, which denotes the severity of consequences when a checklist item of is not CHECKED_OFF before the procedure. There can be four Severity of checklist items, including ABORT - the procedure must be aborted/cancelled, AGGRAVATION - significant step must be taken by the clinic, such as arranging a ride service, ANNOYANCE - some mild impacts on the procedure such as causing it to be slightly longer than necessary, and BENIGN - no material impact on the procedure.

[000140] The relative importance of checklist items at any given time can be quantified by priority, which is a function of time and severity. Each Severity can be preconfigured with three numbers; Start Priority at Start Time, SP, Ultimatum Priority at Ultimatum Time, UP, and End Priority at End Time, EP. [000141] The priority of a checklist item at any given time is calculated from these three preset priority values and the time relative to the procedure time.

[000142] Before Start Time, priority is always Start Priority. After End Time, the priority drops to 0. At time T between Start Time and Ultimatum Time, priority can be linearly interpolated:

[000143] P(T) = P (Start Time) + [P (Ultimatum Time) - P(Ultimatum Time)]*[T- Start Time]/[ Ultimatum Time - Start Time]

[000144] At time T between Ultimatum Time and End Time, priority is also geometrically interpolated:

[000145] P(T) = P(Ultimatum Time) + [P(End Time) - P(Ultimatum Time)]*[T- Ultimatum

Time]/[End Time - Ultimatum Time] +{[T- (Ultimate Time + End Time) *0.5]^A2/(End Time - Ultimatum Time) 2 - 0.25} * *[P(End Time) - P (Ultimate Time)]

[000146] The special advantage of this geometrical interpolation is that the slope is flat in the beginning, at the Ultimatum Time, and rises progressively more steeply as time approaches End Time. This behavior fits well with the urgency of the End Time approaching.

[000147] A Checklist Item goes through these statuses in its lifecycle: INACTIVE, ACTIVE, REVIEWED, REVISIT, UNDERSTOOD, CHECKED OFF, and ALARM.

[000148] Before Start Time, all checklist items are INACTIVE. An inactive checklist item is not ignored by the system. It just has a lower priority. At Start Time, checklist items turn ACTIVE. After a checklist item is shown to the user and compliance is probed, the item turns REVIEWED. When the user affirms that an item has been complied with, the item turns CHECKED OFF. The goal of the system is to help user turn all checklist items CHECKED OFF before their respective End Time. When a user explicitly expresses non-compliance with a checklist item, or a checklist item passes End Time without being CHECKED OFF, its status turns ALARM.

[000149] When the status of a checklist item is marked REVISIT, the checklist item will be reverted to REVIEWED status after the recurring time window is passed. The recurring time window is based on this formula:

[000150] ΔΤ = 24 hours if EndTime - 1 > 60 hours

[000151] ΔΤ = (EndTime - 1)/4 if EndTime - 1 <= 60 hours

[000152] ΔΤ = 1 hour if EndTime - 1 <= 4 hours

[000153] When the system launches and opens a dialogue with the user, either the user or the system can initiate a substantive information exchange (after any initial greetings and small talk, usually initiated by the system). The dialogue can then go into one of the two type of flows: a Q&A flow if the user starts the substantive information exchange by asking a question; or a Checklist flow if the system starts the exchange by presenting an outstanding checklist item. During the dialogue, either the system or user may choose to switch to the other type of flow. The system can determine which flow type is preferred.

[000154] Table 4 illustrates examples of the two types of checklist flows available:

Flow Type Description Example User: "What does Miralax look like?"

User asks a

System: "Here is a picture and description of Miralax." question, and

Q&A

expects an answer

User: "Can 1 eat corn?"

from System.

System: "Yes. You can't eat popcorn, however."

System initiated a System: "You need to buy Miralax today. Have you question, or a bought Miralax?"

directive, and User: "No. 1 haven't."

Checklist expects a System: "Here is a picture and description of Miralax.

confirming user You may buy it at any pharmacy. Do you have someone answer driving you to a pharmacy?"

[000155] The following factors influence the placement of tasks within the task list: User input (tap/text/speech), whether user input is substantive information exchange, or another type, the type of substantive information exchange (Q&A vs. Checklist), the priority of any outstanding checklist items at the current time window, current time window (answer to user question may vary by time window), how the app is launched (via app icon or via push notification), user reading level (medically sophisticated or naive- to be used in future versions), user comprehension level in the current session (indicated by frequent or few clarification requests), user interaction history in the current session (repeating the same utterance multiple times vs. asking the first time), and user response time.

[000156] The default priority as a function of time for a stand-alone checklist item or a user question associated with this checklist item is specified above. But during a dialog, the ad hoc priority for a task in the task list of the system can depend on the factors outlined in the previous section.

[000157] A task list is the queue of outstanding checklist items, user questions, and navigation commands ordered from the highest priority to the lowest priority. A current task is the task that is currently presented to user for interaction. When the current task is completed it is removed from the task list, and the next task in the list with the highest priority will become the new current task. A new task is created when the user asks a new question, issues a new navigation command, or when a checklist item changes status. The new task may interrupt the current task if its ad hoc priority is determined to be higher than that of the current task. Otherwise, the new task can be put in the task queue waiting to be handled.

[000158] To determine whether a new task will interrupt the current task, the guideline can be: (1 ) avoiding interrupting current task unless truly necessary (2) respecting user intention. Based on this guideline, the following rules can be implemented by the system:

[000159] New task from user tapping a navigation button: priority = 100 (User tapping is the basic interaction mode across all mobile apps). New task from user speech of navigation command: priority = 5 (Considered a Soft Navigation Command). New task from repeated user speech/tap input of navigation command that is already in the queue: priority = 1000 (User intention should be respected when repeated). Current task - checklist item or user question during Q&A: priority = default priority + 1 (Current task has an enhanced priority). Current task that is a checklist item - one more answer to reach CHECKED OFF status: priority = 200. New task from repeated user question that is already in the queue: priority = 100 (User intention should be respected when repeated). New task from user tapping of a notification to go to a Checklist item: priority = 100 (user intention). When a new task becomes the Current task, its new priority will be calculated according to the rule of a current task. Tasks whose status is changed to REVISIT are removed from the task list. They can be re-inserted into the list when they are re-activated after their recurring time windows have passed. Tasks whose status is CHECKED OFF or ALARMED can also be removed from the task list.

[000160] The system can identify the next task according to the following rules: Compare all outstanding tasks, and pick the one with the highest priority. If two or more checklist items have the highest priority at the moment, the one with the earliest End Time wins. If two or more outstanding questions have the highest priority at the moment, the one associated with a checklist item with the earliest End Time wins. If none of the questions with the highest priority are associated with a checklist item, the question asked more recently wins. If tasks with the highest priority are a mix of checklist items and questions, the types that fit the current flow win. E.g., system picks from questions in Q&A flow, from checklist items in Checklist flow. In case of a tie, the system randomly picks one to win. If the highest priority task is a checklist item in a Q&A flow, the system will at least respond with a summary answer to the current (lower-priority) outstanding question before executing the highest priority checklist item task. If the highest priority task is an outstanding question, the system will execute the task in the order of providing a summary answer (question status - SUMMARIZED), a detailed answer (question status DETAILED), and go into a micro-dialogue until user indicates he/she is okay with the answer (question status - CONFIRMED), or user chooses to ask another question (previous question status -> CONFIRMED).

[000161] A notification is a message the system server can push to a user or the medical provider. There can be two types of notifications - notifications to clinics or medical providers, and notifications to users.

[000162] Notifications to Clinic can be sent in email or other electronic form to the clinic or individual medical provider. As such, a contact email address or telephone number is a mandatory field of the medical provider entity. Notifications to clinic can be sent in the following situation: One or more of a user's MUST DO or CANNOT DO checklist items attains an ALARM status.

[000163] Notifications to users can be pushed to the user's mobile devices - including both iOS and Android devices. This requires each device registers a token with the system server during the user registration process. System servers can store this token for each user account, so that it can submit the token along with the notification message to OS-specific notification servers when the system needs to push notifications to the device.

[000164] The system server can send notifications to user in the following situations: 1) A checklist item becomes ACTIVE (when Start Time passes). The message can alert and provide to the user a summary of the checklist item. 2) A MUSTJDO checklist item is about to be in ALARM status (when End Time is today and status is not CHECKD_OFF). In case of an item with Start Time and End Time at the same day, notification can be sent in the same hour as the End Time. The message can alert and notify the user that the checklist item is about to expire and provide a summary of the checklist item. 3) User has not engaged the system application for N days. N is configurable per procedure by the clinic or the system. The message can alert the user to view checklist items on the apparatus to prepare for the medical procedure.

[000165] If more than two notifications are generated for a single user at the same time, they can be aggregated into a single notification.

[000166] To avoid disturbing users at night, the system can define a quiet period for notification to users. Notifications generated during the quite period can be queued until the quiet period passes.

[000167] In any of the variations described herein, the personal health assistant apparatus may include a natural-language interpreter customized to the personal health assistant apparatus. For example, the personal health assistant apparatus may include a natural-language module (tailored module) that uses the output of a machine learning module to analyze the runtime speech-recognition output, identify and ignore flaws/errors in the speech recognition and thus more accurately map to a correct system response. The apparatus may therefore capture the intent of the speaker. This module may therefore work with a general speech-recognition platform, but enhances the speech recognition by analyzing the output by the general speech-recognition interpreter in a context-specific manner. This may effectively eliminate many mistakes otherwise possible from the natural-language interpreter, and cause the perception of more accurate natural language understanding and more effective dialogue.

[000168] Many medical tests and procedures require that patients comply beforehand with specific instructions related to diet, activities and medical regimens such as taking or refraining from taking medications. Failure to comply with these instructions leads to a poor test or procedure outcome and higher costs for both clinic and patient- yet the average non-compliance rate for prep instructions is high. A system able to accurately forecast which patients will show for their test or procedure poorly prepped, or fail to show at all, would be quite valuable to clinics, particularly if it is able to show clinical staff which patients are most at risk— particularly if it can do so days in advance when steps can be taken to alter patient behavior or reschedule the appointment and reclaim the calendar slot for another patient.

[000169] In some embodiments, the personal health assistant apparatus helps patients prepare for their procedure or test or can serve as a basis for such a system, since it is configured to collect data that can be used to predict which patients will show up poorly prepped or not at all. The data collected include demographic information such as clinic location, patient age range and gender, etc., as well as data related to the patient's use (or lack of use) of the prep assistant application itself. Data such as app invocations, reminder taps, checklist item inspection and checking off, questions asked of the system and other interaction data may be used to predict no-show and poor prep risk, and the latter may be presented to clinicians in a 'dashboard' that efficiently shows clinic staff which patients are at risk for what, and offer them a convenient way to call those patients most in need of the staffs telephone time and effort.

[000170] In some embodiments, the personal health assistant apparatus can utilize statistical analysis and machine learning to predict a preparation level of a patient and also predict the probability of the patient showing up to a scheduled medical appointment. Referring to Fig. 10, the personal health assistant apparatus can use predictor variables from the patient in the prediction analysis, such as installation of the personal health assistant software on their smartphone or tablet, interaction with the personal health assistant apparatus, such as keyboard entry, touchscreen taps, or speech interaction, and completion of the personal health assistant apparatus checklists, including the number of items checked off and the type of task completed. The personal health assistant apparatus can also use predicted variables from previous patients or even the current patient's history in the prediction analysis, such as show/no-show history, acceptance/rejection interactions within the personal health assistant apparatus, quantitative prep adequacy, and the specific type of procedure that is scheduled.

[000171] The personal health assistant apparatus can use these predictor and predicted variables to complete a statistical analysis and form a predictive model. As the apparatus collects more data on patients and their preparation and attendance levels, the apparatus can continue to "learn" and iteratively improve the accuracy of the model. The predictive model can provide a preparation level (e.g., great, good, adequate, poor) to a medical provider, for example. The predictive model can also provide a percentage or indication to the medical provider as to the likelihood that the patient will show up for a scheduled appointment.

[000172] FIG. 11 illustrates one embodiment of a clinic dashboard display screen that can be presented to a medical provider showing the preparation level of upcoming patients. As shown, the clinic dashboard can list the patients' names, the number of days until each patient's exam, appointment, or procedure, a phone number or way to contact each patient, and each patient's status or preparation level based on the predictive model. In the illustrated embodiment, the status can be displayed as a color, e.g., green = good, yellow = adequate, and red = poor preparation. It should be understood that other display icons can be implemented.

[000173] The clinic dashboard allows a medical provider to contact a patient if the provider notices that the patient is poorly prepared for an upcoming procedure or appointment. For example, a medical provider looking at the clinic dashboard in FIG. 1 1 would notice that patient Evan Howard has an exam scheduled on the present day and has a poor preparation level for the exam. The medical provider would then have the option to call or contact the patient to remind him of the exam and even remind him to complete the tasks required prior to the exam. The same medical provider would also notice that patient Andita Karandikar, with an exam scheduled for tomorrow, is prepared for the exam and would be likely to show up for the exam without a reminder. The data fields in the clinic dashboard can be customized depending on the specific information required by each medical provider and based on the type of exam, appointment, or procedure.

[000174] The data collected by personal health assistant apparatus during the course of patient preparation can also be used by a medical provider prior to or during the action patient exam, procedure, or appointment. For example, in FIG. 12, a medical provider could pull up a patient prep status on their tablet, smartphone, or computer prior to examining a patient. This patient prep status can be based on the patient's interactions with the personal health assistant apparatus. In the illustrated example, the medical provider would know that patient Carmen Ramirez indicated to the personal health assistant apparatus that she had discontinued medication such as aspirin and Coumadin, completed a Miralax bowel prep, and discontinued solid foods and dairy including nuts, seeds, etc. This patient would be classified as having a good or excellent bowel prep status in preparation for a colonoscopy. If the patient hadn't indicated completion of these tasks on the personal health assistant apparatus, the medical provider would know prior to meeting with the patient.

[000175] FIG. 13 shows one example of method for presenting health information, as described. As mentioned herein, this type of presentation (and apparatuses configured to operate as illustrated and described herein), may be particularly well suited for hands-free operation, particularly when at least one portion of the presentation refers to or requires the performance of a physical task by the user. This may refer to any physical task, such as, e.g., in reference to FIG. 4, mixing and drinking a laxative, a removing a dressing on a bandage, etc.

[000176] In FIG. 13, the patient (who may also equivalently be referred to as a user or subject) activates a mobile device 1301 that is controlled to deliver the customized, interactive presentation. The spoken language and/or visual presentation may then begin 1303, while at the same time concurrently listening for any control commands (see Table 3, above) 1309. Individual pieces of information (dialog quantum) are presented sequentially 1305; when the dialog quantum includes an inquiry (question) 1307, the apparatus may allow the patient to answer 131 1 and record, transmit and/or analyze their response. The presentation may be configured so that the natural-language response may determine how to proceed with the presentation (e.g., skipping to anew portion of the micro-dialog, etc., as illustrated in FIGS. 1 to 6, above). After presenting of some, or every dialog quantum, there may be a pause until the patient indicates that they are ready to proceed 1317. Alternatively, the presentation may be continued immediately (or after a predetermined delay) to move on to the next piece of information 1305.

[000177] Concurrently with the rest of the presentation 1303, the apparatus may monitor continuously for a spoken control command 1309, and if a control command 1313 is received, it may act on the control command 1315.

[000178] In addition to interactively presenting health care information, also described herein are apparatuses and methods for forming and managing the presentations. In particular, apparatuses and methods for generating a customized health-care presentation. For example, a health-care provider such as a physician, clinic, or hospital, may generate custom presentations that can run on an individual patient's mobile device, and may also communicate with a third-party (e.g., remote server, medical health records manager, etc.) and/or the health-care provider directly.

[000179] Thus, described herein are tools that may be web-based analytical and user-interface tools that enable the rapid conversion of text instruction sets into machine-readable content supporting customized, personalized and interactive patient-facing apps and services. The content may include healthcare term dictionaries, reminder text and timing, and dialogues for educating patients, coaching them on care tasks, and collecting information related to health and compliance status, as illustrated above. [000180] For example, the tools may include a library of micro-dialogs that are indexed by subject and/or characteristic, and the tools may also include tools for accessing (securely, remotely), and building custom dialogs (presentations) from this library of micro-dialogs. The same or additional tools may be used to organize selected micro-dialogs into the presentation, and/or customizing them (e.g., to input the medical providers contact information or to individually edit the micro-dialogs to change language, add/remove dialog quantum, etc. Modified micro-dialogs may be saved in the library or in a custom sub- library.

[000181] Any of the "tools" described herein may be software tools, including web-based tools, as mentioned. For example, a user (health care provider) interface may be used to provide access to the library, as illustrated schematically in FIG. 14. In this example, the healthcare provider accesses the library 1402 with a tool that allows searching of the library 1405. The library may be maintained locally (e.g., in a local copy on a device (computer, server, etc.) or it may be maintained remotely (including in a remote server or distributed server(s)), and combinations of this (e.g., mirrored sites). The same or additional tools may allow the healthcare provider to generate new micro-dialogs and/or to modify existing micro-dialogs 1412. New or existing micro-dialogs may be indexed 1414 for future searching. New or modified micro-dialogs may be specific to the generating healthcare provider, or they may be shared with others in the general library 1416.

[000182] The operator (e.g., healthcare provider or their agent) may generate a custom interactive presentation from these micro-dialogs by collecting, from the library (and/or custom libraries) a sub-set of micro-dialogs 1406, and then assemble the collected micro-dialogs 1408 into a custom presentation. Once assembled, the presentation may be examined, and then formatted into a machine-readable presentation that can be delivered to the patient 1410.

[000183] In general, the formatting may include formatting the presentation as a stand-alone application ("app") that can be sent or otherwise provided to a patient or group of patients, or offered from a digital source (e.g., webpage, etc.). For example, the formatting may include preparing the presentation for delivery using the hands-free mobile devices as described above. Other, third-party healthcare assistant software and/or hardware may also be used, and thus the tools may allow formatting a presentation into a format that is compatible with such existing software/hardware.

[000184] As mentioned, a healthcare provider or their agent may customize any of the interactive presentations described herein, including customizing the actions or reporting generated by the presentation when interacting with the subject. For example, any of the presentation described herein may include inquiries made to the patient, and the presentation (or device/software implementing the presentation) may take action based on the responses provided to these inquiries. The action taken may be specified by the healthcare provider, for example, by "weighting" the responses received. This weighting (or predetermining the response of the presentation to particular responses to inquiries) is illustrated in FIG. 14, showing the inquiries may be weighted 1422. For example, based on the response to questions such as those shown in FIGS. 3-6, if the patient responds in a certain manner (e.g., not complying with instructions, requesting additional information, etc.) the system executing the presentation may contact the healthcare provider, may have the patient phone the healthcare provider, may send a message directly to the healthcare provider (text, etc.), or may enter a comment into a patient- specific record, etc. Weighing the patient responses may include indicating by flags (e.g.,

red/green/yellow indicators) that provide a metric to the health care provider of the patient compliance and/or readiness. For example, in response to questions about patient-reported conditions (e.g. experience pain, bleeding, etc.) a flag or weighting may be modified. This flag or weighting may be used to score patient responses and the score may be interpreted to indicate urgency of communication/contact with the health care provider. For example, "red" flag events may be indicated by the health care provider (e.g. a "yes" response to a question about bleeding may trigger a red flag), and a defined number of "red" flag responses may indicate that the apparatus will automatically contact the health care provider and/or instruct the patient to contact the health care provider. Similarly, yellow or green flags may be defined and a set of rules based on the number or on particular pieces of information (questions) may be defined by the health care provider. The interactive presentation may also inform the patient by indicating that it will or the patient should contact the health care provider (e.g., "I should call you because of x").

[000185] Thus, in general, described herein are healthcare assistants, which may include a runtime virtual mobile 'coach' that offers patients help with preparation, discharge and ongoing care. In addition, also described are content production systems and methods, which allow healthcare providers or their agents to use pre-runtime system that allows rapid conversion of a static, text-based patient handout into an interactive, personalized application. For example, the healthcare assistant described herein (aid) may be configured as a mobile app for smartphones/tablets that reminds patients of key prep or care items, appointments, etc.; educates them with respect to their conditions; indicates upcoming treatments, etc.; collects healthcare and lifestyle-related information from patient using vocal and/or typed interactions.

[000186] These methods and apparatuses are a hybrid of unstructured and structured information collection dialogues that can, in some variations, efficiently build comprehensive and approved lists of things like meds, foods eaten, etc. The assistant may ask for (by vocal interaction) information for efficient bulk input of, e.g., meds and supplements, then use a more structured approach to add/refine. The result may be a thorough list produced efficiently and specifically customized to the patient.

Similarly, the apparatus may generate and maintain for a particular patient a medical problem list, diet diary and other use cases.

[000187] In addition, the methods and apparatus described herein coaches patients in a step-by-step manner with respect to physical care tasks. As mentioned above the presentation may include a multimodal interface, including text, graphics, animation, engaging human-recorded voice, that may all be inter-coordinated. In general, the apparatus may offer assistance with sequential care steps, each step may be a dialog quantum that is narrow enough to be effective, and not surpass patient attention span, etc.

[000188] As mentioned above, the interactive spoken language for both presenting and receiving patient input may be useful. Vocal navigation by the patient may allow hands-free use, effective for multiple health scenarios like laxative mixing, cast care, stoma replacement, self-injection, active meds collection, etc. In addition, the presentation (e.g., the apparatus) may include interstitial checks with the patient to determine and assist in progress. The system and methods described herein are configured to keep the patient-coach conversation in sync so the system and patient are on the same step of the care task.

[000189] Any of the health care assistant apparatuses (methods) described herein may also be configured to motivate patients regarding keeping appointments, complying with instructions, engaging in healthy behaviors, or the like, via appropriate emotional responses from the assistant (e.g.,

encouragement, disappointment, etc.). In addition, any of the apparatuses and methods described herein may include playing of recorded motivational testimonials from other patients (e.g., some of the micro- dialogs may include such testimonials). Further, patients may be invited to tell their own stories, which may be shared (e.g., in the library or micro-dialogs, transmitted to the health care provider, etc.). For example, any of the apparatuses and methods described herein may include a recording module to allow recording session for patients wanting to tell their stories or give advice to other patients. A recording module may show recording progress line, allow the patient to iterate the recording until satisfied, etc.

[000190] As mentioned, the apparatus and methods described herein may also be configured to monitor the patient by checking for compliance with instructions, intent to keep appointments, etc., checking on adverse events, and/or other aspects of health status. In addition, the apparatuses and method described herein may also be configured to survey patients after appointment regarding satisfaction with care from the health care provider. The survey may be brief (e.g., a an 'abridged version' of a survey via mobile device) to provide a greater response rate and offer a healthcare provider 'advance warning' of metrics like low patient satisfaction. The method of surveying with the apparatus may include identifying the smallest number of questions that are highly correlated with overall score on standard surveys of patient satisfaction.

[000191] As described above, the apparatuses and method described herein may provide one or more alerts to caregivers and clinical staff of patients needing attention (e.g., patients that are non-compliant with instructions or experiencing health-related problems), via a "Patient Dashboard" (e.g., FIG. 1 1 ), or via automated calls to clinical staff or digital notifications to existing healthcare information systems (e.g., electronic health record systems); for example, as illustrated above, voice call and texting service may be integrated with mobile app. These components may deliver via interactive voice call or texting service a subset of the assistant (e.g., mobile app) content that is consistent with a provider's patient instructions. The apparatus may convert instruction sets into key reminders about changes in diet, medications and activities that are required by imminent procedures or condition care plans.

[000192] Thus, an interactive mobile application may allow a patient to request reminders via voice call to a specified line, and text messages to facilitate download of the mobile app. As discussed above in the context of FIG. 1 1., the feedback dashboard is a provider- facing component that may show clinicians feedback from patient interaction with the mobile app and/or voice call service. The apparatuses described herein may analyze user behavior and responses to reflect health, prep and/or recovery and instruction compliance status using a summary graphical metaphor (red-yellow-green light) with click- through drill-down to detail. This "dashboard" may be used to prioritize patients with respect to time required by human patient-outreach staff - enabling them to be more efficient (e.g., identifying patients not requiring their attention). This dashboard may be correlated with the content management system described above, to allow health care providers the ability to customize the patient-interaction dialogues and reminders within the dashboard.

[000193] Terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. For example, as used herein, the singular forms "a", "an" and

"the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms "comprises" and/or "comprising," when used in this specification, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. As used herein, the term "and/or" includes any and all combinations of one or more of the associated listed items and may be abbreviated as "/".

[000194] Although various illustrative embodiments are described above, any of a number of changes may be made to various embodiments without departing from the scope of the invention as described by the claims. For example, the order in which various described method steps are performed may often be changed in alternative embodiments, and in other alternative embodiments one or more method steps may be skipped altogether. Optional features of various device and system embodiments may be included in some embodiments and not in others. Therefore, the foregoing description is provided primarily for exemplary purposes and should not be interpreted to limit the scope of the invention as it is set forth in the claims.

[000195] The examples and illustrations included herein show, by way of illustration and not of limitation, specific embodiments in which the subject matter may be practiced. As mentioned, other embodiments may be utilized and derived there from, such that structural and logical substitutions and changes may be made without departing from the scope of this disclosure. Such embodiments of the inventive subject matter may be referred to herein individually or collectively by the term "invention" merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept, if more than one is, in fact, disclosed. Thus, although specific embodiments have been illustrated and described herein, any arrangement calculated to achieve the same purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the above description.

Claims

What is claimed is:

A method for hands-free mobile healthcare aid to a patient, the method comprising:

presenting in spoken language, from a mobile device, a plurality of discrete pieces of health care information wherein at least one of the pieces of health care information comprises an instruction for the performance of a physical task by the patient;

monitoring the patient, using the mobile device, for a verbal control command while presenting the health care information, wherein the presentation control command controls the presentation of the health care information and is selected from the group of: a pause/stop presentation command, a repeat presentation command, a restart presentation command, a next presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command;

interrupting the presentation of the health care information to perform the presentation

control command by the mobile device; and

waiting, between presentation of each piece of health care information, for a verbal response from the patient before presenting the next piece of health care information.

presenting, from a mobile device, a set of health care information wherein the health care information comprises an instruction for the performance of a physical task by the patient;

monitoring, using the mobile device, the patient for a verbal, visual or verbal and visual presentation control command while presenting the health care information, wherein the presentation control command controls the presentation of the health care information and is selected from the group of: a pause/stop presentation command, a repeat presentation command, a restart presentation command, a next presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command; and

control command by the mobile device.

presenting, from a mobile device, a plurality of discrete pieces of health care information from a set of health care information, wherein at least one of the pieces of health care information comprise an instruction for the performance of a physical task by the patient; monitoring, using the mobile device, the patient for a verbal, visual or verbal and visual presentation control command while presenting the health care information, wherein the presentation control command controls the presentation of the piece of health care information and is selected from the group of: a pause/stop presentation command, a repeat presentation command, a restart presentation command, a next presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command;

interrupting the presentation of the piece of health care information after receiving the

presentation control command to perform the presentation control command from the mobile device; and

pausing after the presentation of each piece of health care information and confirming that the information has been received before presenting another piece of health care information.

The method of claim 2 or 3, wherein presenting comprises presenting in a spoken voice from the mobile device.

5. The method of claim 1 , 2 or 3, further comprising during the presentation of the set of health care information, requesting a patient response.

6. The method of claim 1 , 2 or 3, wherein presenting the set of health care information comprises selecting a piece of health care information based on a verbal, visual or verbal and visual input from the patient made in response to request for information from the patient.

7. The method of claim 1 , 2 or 3, further comprising parsing the set of health care information into a sequence of the discrete pieces of health care information.

8. The method of claim 1, 2 or 3, wherein presenting the set of health care information comprises presenting information to prepare the patient for a medical procedure.

9. The method of claim 1 , 2 or 3, wherein presenting the set of health care information comprises presenting information to prepare the patient for a colonoscopy.

10. The method of claim 1, 2 or 3, wherein presenting the set of health care information comprises presenting audiovisual information including one or more of movies, images, and spoken words.

1 1. The method of claim 1, 2 or 3, wherein presenting the set of health care information comprises sequentially presenting discrete pieces of health care information to the patient from the mobile device.

12. The method of claim 1, 2 or 3, wherein presenting the set of health care information comprises sequentially presenting discrete pieces of health care information to the patient that are less than 3 minutes long.

13. The method of claim 1 or 2, wherein presenting the set of health care information comprises presenting a combination of health care information and patient inquiries.

14. The method of claim 1 , 2 or 3, wherein monitoring the patient for a verbal, visual or verbal and visual presentation control commands comprises detecting a verbal message from the patient and comparing the verbal message to a menu of natural-language responses.

15. The method of claim 1, 2 or 3, wherein monitoring the patient comprises monitoring for tactile input as well as visual, verbal or visual and verbal input.

16. The method of claim 1 , 2 or 3, wherein interrupting the presentation of the health care

information to perform the presentation control command comprises stopping the presentation when the presentation control command is a stop command.

17. The method of claim 1 , 2 or 3, wherein interrupting the presentation of the health care

information to perform the presentation control command comprises pausing the presentation and awaiting a further control command when the presentation control command is a pause command.

18. The method of claim 1 , 2 or 3, wherein interrupting the presentation of the health care

information to perform the presentation control command comprises repeating a piece of health care information currently being presented when the presentation control command is a repeat presentation command.

19. The method of claim 1, 2 or 3, wherein interrupting the presentation of the health care information to perform the presentation control command comprises slowing the presentation of a piece of health care information currently being presented when the presentation control command is a slow presentation command.

20. The method of claim 1 , 2 or 3, wherein interrupting the presentation of the health care

information to perform the presentation control command comprises presenting one or more additional piece of information when the presentation control command is a provide more detail command.

21. The method of claim 1 , 2 or 3, wherein interrupting the presentation of the health care

information to perform the presentation control command comprises provide increasing or decreasing the volume of the presentation when an increase volume of presentation command or a decrease volume of presentation command are received.

22. The method of claim 1 or 3, wherein presenting comprises presenting at least one piece of health care information including an inquiry for the patient and monitoring, using the mobile device, the patient for a verbal response to the inquiry during and after the presentation of the at least one piece of health care information.

23. The method of claim 3, further comprising waiting, after the presentation of each piece of health care information, for a verbal instruction from the patient to continue.

24. The method of claim 1 , 2 or 3, further comprising modifying the health care information

presented based on verbal responses from the patient received by the mobile device during or after the presentation of earlier-presented health care information.

25. A non-transitory computer-readable storage medium storing a set of instructions capable of being executed by a processor of a mobile device, that when executed by the processor, causes the processor to:

sequentially present a plurality of discrete pieces of health care information to a patient from the mobile device, wherein a subsequent piece of health care information is presented only after receiving feedback from the patient confirming completion of a prior piece of health care information;

concurrently monitor for a visual, verbal or visual and verbal presentation control

command from the patient during the presentation each piece of health care information, wherein the presentation control command controls the presentation of the piece of health care information and is selected from the group consisting of: a pause presentation command, a stop presentation command, a repeat presentation command, a slow presentation command, a provide more detail on presentation command, an increase volume of presentation command, a decrease volume of presentation command, a speed up presentation command, and a skip presentation command; and

act on any presentation control command received by interrupting the presentation of the piece of health care information after receiving the presentation control command to perform the presentation control command from the mobile device; and pause after the presentation of each piece of health care information and confirming that the information has been received before presenting another piece of health care information.

26. A non-transitory computer-readable storage medium storing a set of instructions capable of being executed by a processor of a mobile device, that when executed by the processor causes the processor to: parse a health care information set into a sequence of discrete pieces of health care information, wherein at least one of the pieces of health care information describes a physical task to be performed by a patient;

sequentially present the discrete pieces of health care information to the patient from the mobile device, wherein a subsequent piece of health care information is presented only after receiving feedback from the patient confirming completion of a prior piece of health care information;

act on any presentation control command received by pausing the presentation of the piece of health care information if the pause presentation command is received, stopping the presentation of the piece of health care information if the stop presentation command is received, repeating the presentation of the piece of health care information if the repeat presentation command is received, slowing the presentation of the piece of health care information if the slow presentation command is received, providing more detail on the piece of health care information if the provide more detail on presentation command is received, increasing the volume of the presentation of the piece of health care information if the increase volume of presentation command is received, decreasing the volume of the presentation of the piece of health care information if the decrease volume of presentation command is received, speeding up the presentation of the presentation of the piece of health care information if the speed up presentation command is received, and skipping the presentation of the piece of health care information if the skip presentation command is received.

27. The non-transitory computer-readable storage medium of claim 25 or 26, wherein the set of instructions, when executed by the processor, further causes the processor to request a patient response during the presentation of the set of health care information.

28. The non-transitory computer-readable storage medium of claim 25 or 26, wherein the set of instructions, when executed by the processor, further causes the processor to select a piece of health care information based on a verbal, visual or verbal and visual input from the patient made in response to request for information from the patient.

29. The non-transitory computer-readable storage medium of claim 25, wherein the set of

instructions, when executed by the processor, further causes the processor to parse the set of health care information into a sequence of the discrete pieces of health care information.

30. The non-transitory computer-readable storage medium of claim 25 or 26, wherein the set of instructions, when executed by the processor, further causes the processor to present the information to prepare the patient for a medical procedure.

31. The non-transitory computer-readable storage medium of claim 25 or 26, wherein the set of instructions, when executed by the processor, further causes the processor to present information to prepare the patient for a colonoscopy.

32. The non-transitory computer-readable storage medium of claim 25 or 26, wherein the set of instructions, when executed by the processor, further causes the processor to present the set of health care information by presenting audiovisual information including one or more of movies, images, and spoken words.

33. The non-transitory computer-readable storage medium of claim 25 or 26, wherein the set of instructions, when executed by the processor, further causes the processor to present the pieces of health care information by sequentially presenting discrete pieces of health care information to the patient that are less than 3 minutes long.

34. A method of generating a patient-specific health-care presentation for presentation on a patient's personal electronic device, the method comprising:

accessing a library of micro-dialogs, wherein each micro-dialog comprises a set of healthcare information and patient health-care related inquiries, indexed by one or more topic subjects;

searching the library of micro-dialogs by topic subject;

assembling a subset of micro-dialogs from the library of micro-dialogs into a patient-specific set of health-care information; and

formatting the patient-specific set of health-care information into a machine-readable,

interactive and patient-specific health care presentation for display on the patient's personal electronic device.

35. A method of generating a patient-specific health-care presentation for presentation on a patient's personal electronic device, the method comprising:

searching the library of micro-dialogs by topic subject, based on a medical procedure to be undertaken by the subject;

assembling a subset of micro-dialogs identified by the search from the library of micro- dialogs into a patient-specific set of health-care information; and

interactive and patient-specific health care presentation; and

delivering the patient-specific health care presentation to the patient's personal electronic device.

36. The method of claim 34 or 35, wherein accessing the library comprises engaging a secure user interface to access the library.

37. The method of claim 34 or 35, wherein searching the library comprises searching the library of micro-dialogs by topic subject and micro-dialog language.

38. The method of claim 34 or 35, wherein accessing comprises selecting a medical provider and accessing the library that is tagged with the medical provider.

39. The method of claim 34 or 35, wherein accessing the library comprises accessing a plurality of multi-media micro-dialogs wherein at least some of the micro-dialogs comprise video and audio.

40. The method of claim 34 or 35, wherein accessing the library comprises accessing a plurality of micro-dialogs comprising between 2 and 20 questions for the patient.

41. The method of claim 34 or 35, wherein formatting the patient-specific set of health-care

information comprises organizing the micro-dialogs into a personalized patient handout specific to a procedure to be undertaken by the patient.

42. The method of claim 34 or 35, wherein the formatting the patient-specific set of health-care information comprises preparing the set of health-care information for presentation by a patient's handheld mobile device.

43. The method of claim 34 or 35, wherein formatting comprises marking the patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a third party.

44. The method of claim 34 or 35, wherein formatting comprises marking the patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a secure server.

45. The method of claim 34 or 35, wherein formatting comprises marking the patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a medical provider.

46. The method of claim 34 or 35, further comprising adding a micro-dialog to the library of micro- dialogs.

47. The method of claim 34 or 35, further comprising adding a micro-dialog to the library of micro- dialogs and marking the micro-dialog with an index topic.

48. A system for generating patient-specific health-care dialogs for presentation on a patient's

electronic device, the system comprising:

a library of micro-dialogs, wherein each micro-dialog comprises a set of health-care

information and patient health-care related inquiries, indexed by one or more topic subjects, further wherein the micro-dialogs comprise video and audio;

a user interface module configured to access the library of micro-dialogs, search the library of micro-dialogs by topic subject, and collect a sub-set of micro-dialogs from the library of micro-dialogs; and

a formatting module adapted to format the sub-set of micro-dialogs collected by the user interface module into a machine-readable, interactive and patient-specific health care presentation for display on the patient's personal electronic device.

49. The system of claim 48, wherein the library of micro-dialogs comprises between 2 and 20 patient health-care related inquiries.

50. The system of claim 49, further comprising a user input module, the user input module

configured to allow user input of a new micro-dialogs into the library of micro-dialogs.

51. The system of claim 48, further comprising a user input module, the user input module

configured to allow user input of a new micro-dialog into the library of micro-dialogs and indexing of the new micro-dialog.

52. The system of claim 48, wherein the formatting module is configured to encode the interactive and patient-specific health care presentation for display on the patient's handheld mobile device.

53. The system of claim 48, wherein the formatting module is configured to encode the interactive and patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a secure server.

54. The system of claim 48, wherein the formatting module is configured to encode the interactive and patient-specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a medical provider.

55. A non-transitory computer-readable storage medium storing a set of instructions capable of being executed by a processor, that when executed by the processor, causes the processor to:

access a library of micro-dialogs, wherein each micro-dialog comprises a set of health-care information and patient health-care related inquiries, indexed by one or more topic subjects;

search the library of micro-dialogs by topic subject, based on a medical procedure to be undertaken by the subject;

collect a subset of micro-dialogs identified by the search from the library of micro-dialogs into a patient-specific set of health-care information; and

format the patient-specific set of health-care information into a machine-readable, interactive and patient-specific health care presentation.

56. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to deliver the patient- specific health care presentation to the patient's personal electronic device.

57. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to select a medical provider.

58. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to select a medical provider and present micro-dialogs associated with the medical provider.

59. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to engage a secure user interface to access the library.

60. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to access the library of micro-dialogs wherein at least some of the micro-dialogs comprise video and audio.

61. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to access the library of micro-dialogs wherein each micro-dialog comprises between 2 and 20 questions for the patient.

62. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to organize the micro- dialogs into a personalized patient handout specific to a procedure to be undertaken by the patient.

63. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to prepare the set of health-care information for presentation by a patient's handheld mobile device.

64. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor mark the patient- specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a third party.

65. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to mark the patient- specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a secure server.

66. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to mark the patient- specific health care presentation with routing information guiding the transmission of responses to the patient health-care related inquiries in the patient-specific set of health-care information to a medical provider.

67. The non-transitory computer-readable storage medium of claim 55, wherein the set of

instructions, when executed by the processor, further causes the processor to add a micro-dialog to the library of micro-dialogs.

68. A method for assisting a health care provider in treating a patient, the method comprising: generating a patient-specific set of health-care information comprising patient health-care related inquiries;

weighting the patient health-care related inquiries based on preferences provided by the health-care provider;

formatting the patient-specific set of health-care information into a machine-readable, interactive and patient-specific health care presentation for performance by the patient's personal electronic device;

receiving patient responses to the patient-specific health care presentation;

scoring the patient responses to the patient-specific health care presentation; and performing a score-specific action based on the score.

69. The method of claim 68, wherein performing a score-specific action comprises altering the health care provider.

70. The method of claim 68, wherein performing a score-specific action comprises transmitting the patient responses to an electronic medical record.

71. The method of claim 68, wherein weighting comprises allowing the health-care provider to weight the patient health-care related inquiries.

72. The method of claim 68, further comprising allowing a health-care provider to approve the patient-specific set of health-care information.

73. The method of claim 68, wherein generating a patient-specific set of health-care information comprising patient health-care related inquiries comprises assembling the set of health-care information from a library of micro-dialogs.

74. The method of claim 68, wherein generating a patient-specific set of health-care information comprising patient health-care related inquiries comprises assembling the set of health-care information specific to a health-care provider's guidelines.

75. The method of claim 68, wherein formatting comprises formatting the patient-specific set of health-care information into a machine-readable, interactive and patient-specific health care presentation for performance by the patient's smartphone.

76. The method of claim 68, wherein receiving patient responses to the patient-specific health care presentation comprises receiving the patient responses by the patient's personal electronic device.

77. The method of claim 68, wherein receiving patient responses to the patient-specific health care presentation comprises receiving the patient responses by a remote processor.

78. The method of claim 68, wherein formatting comprises formatting the patient-specific set of health-care information with the weighting information.

79. The method of claim 68, wherein generating a patient-specific set of health-care information comprising patient health-care related inquiries comprises generating a patient-specific set of health-care information related to a medical procedure.

80. The method of claim 68, wherein generating a patient-specific set of health-care information comprising patient health-care related inquiries comprises generating a patient-specific set of health-care information related to a colonoscopy.

81. A method of collecting and analyzing medical information from a patient with a personal health assistant apparatus, comprising the steps of:

guiding the patient through a preparation task list for a medical examination or medical procedure;

obtaining inputs from the patient as the patient is guided through the preparation task list; determining a patient preparation level based on the inputs; and

providing the patient preparation level to a medical provider of the patient.

82. The method of claim 81 wherein the patient preparation level comprises a likelihood of the

patient showing up to the medical examination or medical procedure.

83. The method of claim 81 wherein the patient preparation level comprises an indication of a

completion percentage of the preparation task list.