Developing Intelligent Interviewers to Collect the Medical History: Lessons Learned and Guidelines.

BACKGROUND: Physicians spend a lot of time in routine tasks, i.e. repetitive and time consuming tasks that are essential for the diagnostic and treatment process. One of these tasks is to collect information on the patient's medical history. OBJECTIVES: We aim at developing a prototype for an intelligent interviewer that collects the medical history of a patient before the patient-doctor encounter. From this and our previous experiences in developing similar systems, we derive recommendations for developing intelligent interviewers for concrete medical domains and tasks. METHODS: The intelligent interviewer was implemented as chatbot using IBM Watson assistant in close cooperation with a family doctor. RESULTS: AnCha is a rule-based chatbot realized as decision tree with 75 nodes. It asks a maximum of 44 questions on the medical history, current complaints and collects additional information on the patient, social details, and prevention. CONCLUSION: When developing an intelligent digital interviewer it is essential to define its concrete purpose, specify information to be collected, design the user interface, consider data security and conduct a practice-oriented evaluation.

Use it or lose it! Cognitive activity as a protec-tive factor for cognitive decline associated with Alzheimer's disease.

Because of the worldwide aging of populations, Alzheimer's disease and other dementias constitute a devastating experience for patients and families as well as a major social and economic burden for both healthcare systems and society. Multiple potentially modifiable cardiovascular and lifestyle risk factors have been associated with this disease. Thus, modifying these risk factors and identifying protective factors represent important strategies to prevent and delay disease onset and to decrease the social burden. Based on the cognitive reserve hypothesis, evidence from epidemiological studies shows that low education and cognitive inactivity constitute major risk factors for dementia. This indicates that a cognitively active lifestyle may protect against cognitive decline or delay the onset of dementia. We describe a newly developed preventive programme, based on this evidence, to stimulate and increase cognitive activity in older adults at risk for cognitive decline. This programme, called "BrainCoach", includes the technique of "motivational interviewing" to foster behaviour change. If the planned feasibility study is successful, we propose to add BrainCoach as a module to the already existing "Health Coaching" programme, a Swiss preventive programme to address multiple risk factors in primary care.