Graphical Access to Medical Expert Systems: IV. Experiments to Determine the Role of Spoken Input

E. Isaacs; C. E. Wulfman; J. A. Rohn; C. D. Lane; L. M. Fagan

doi:10.1055/s-0038-1634891

Methods of Information in Medicine, Table of Contents

Methods Inf Med 1993; 32(01): 18-32
DOI: 10.1055/s-0038-1634891

Original Article

Schattauer GmbH

Graphical Access to Medical Expert Systems: IV. Experiments to Determine the Role of Spoken Input

E. Isaacs

¹Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA

,

C. E. Wulfman

¹Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA

,

J. A. Rohn

¹Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA

,

C. D. Lane

¹Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA

,

L. M. Fagan

¹Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA

› Author Affiliations

Abstract

Abstract:

The goal of our research is to design improved interfaces for medical expert systems. Previously, the use of graphical techniques was explored to improve the acceptance by clinicians of the user interface. Now that devices that accept spoken input are available, we wish to design interfaces that take advantage of this potentially more natural modality for interaction. To understand how clinicians might want to speak to a medical decision-support system, we carried out an experiment that simulated the availability of a spoken interface to the ONCOCIN medical expert system. ONCOCIN provides therapy advice for patients on complex cancer therapy protocols based on a description of the patient’s current medical status and laboratory-test values. In the experiment, we had oncologists present a clinical case while observing the ONCOCIN flowsheet display. A project member listened to the presentation and filled in values for the flowsheet, as well as introducing purposeful misunderstandings of the input. The results suggest that each individual developed a stereotypical grammar for communicating with the program. Our experience with the purposeful miscommunications suggests particular ways to tailor requests for repetition based on the part of the utterance that was not understood.

Key-Words

Continuous-Speech Recognition - Human-Computer Interfaces - Decision-Support Systems - Unseen-Operator Experiments - Oncology

Full Text

References

REFERENCES
1 Shortliffe EH. Computer programs to support clinical decision making. J Am Med Assoc 1987; 263: 1114-20.
2 Tsuji S, Shortliffe EH. Graphical access to a medical expert systems: I. Design of a knowlege engineer’s interface. Meth Inf Med 1986; 25: 62-70.
3 Lane CD, Walton JD, Shortliffe EH. Graphical access to medical expert systems: II. Design of an interface for physicians. Meth Inf Med 1986; 25: 143-50.
4 Walton CE, Musen MA, Combs D. et al. Graphical Access to Expert Systems: III. Design of a knowledge-acquisition environment. Meth Inf Med 1987; 26: 78-88.
5 Wulfman CE, Isaacs EA, Webber BL. et al. Integration discontinuity: Interfacing users and systems. In: Sullivan JW, Tyler SW. eds Architectures for Intelligent Interfaces: Elements and Prototypes. Monterey CA: ACM/ SIGCHI; 1988: 57-68.
6 Clark HH, Marshall CR. Definite reference and mutual knowledge. In: Joshi AK, Webber B, Sag I. eds. Elements of Discourse Understanding. Cambridge MA: Cambridge University Press; 1981: 10-63.
7 Grice HP. Logic and conversation. In: Cole P, Morgan JL. eds. Syntax and Semantics, 3: Speech Acts. New York: Academic Press; 1975: 41-58.
8 Searle JR. Speech Acts. Cambridge University Press; 1969
9 Sperber D, Wilson D. Relevance. Cambridge Mass: Harvard University Press; 1986
10 Clark HH, Schaefer EF. Collaborating on contributions to conversations. Language and Cognitive Processes 1987; 02: 19-41.
11 Clark HH, Wilkes-Gibbs D. Referring as a collaborative process. Cognition 1986; 22: 1-39.
12 Blass T, Siegman AW. A psycholinguistic comparison of speech, dictation and writing. Lang Speech 1975; 18: 20-34.
13 Gould JD, Conti J, Hovanyecz T. Composing letters with a simulated listening typewriter. Commun ACM 1981; 26: 295-308.
14 Drieman GH. Differences between written and spoken languages: An exploratory study. Acta Psychol 1962; 20: 78-100.
15 O’Donnell RC. Syntactic differences between speech and writing. American Speech 1974; 49: 102-10.
16 Chafe WL. Integration and involvement in speaking, writing, and oral literature. In: Tannen D. ed. Spoken and Written Language: Exploring Oraity and Literacy. Norwood NJ: Ablex Publishing; 1982: 35-53.
17 Devito JA. Psychogrammatical factors in oral and written discourse by skilled communicators. Speech Monographs 1966; 33: 73-6.
18 Devito JA. Levels of abstraction in spoken and written language. J Commun 1967; 17: 354-61.
19 Horowitz MW, Newman JB. Spoken and written expressions: An experimental analysis. J Abnorm and Soc Psychol 1964; 68: 640-7.
20 Cohen P. The pragmatics of referring and the modality of communication. Computational Linguistics 1984; 10: 97-146.
21 Van Katwijk AF, van Nes FL, van Bunt HC. et al. Naive Subjects Interacting with a Conversing Information System. IPO Annual Progress Report 1979; 14: 105-12.
22 Searle JR. Indirect speech acts. In: Cole P, Morgan JL. eds. Syntax and Semantics, 3: Speech Acts. New York: Academic Press; 1975: 59-82.
23 Gibbs RW. Contextual effects in understanding indirect requests. Discourse Processes 1979; 02: 1-10.
24 Gibbs RW. Your wish is my command: Convention and context in interpreting indirect requests. J Verbal Learning and Verbal Behavior 1981; 20: 431-44.
25 Francik EP, Clark HH. How to make requests that overcome obstacles to compliance. J Memory and Language 1985; 24: 560-8.
26 Sacks H, Schegloff EA, Jefferson G. A simplest semantics for the organization of turn taking in conversation. Language 1974; 50: 696-735.
27 Hauptmann AG, Rudnicky Al. Talking to Computers: An Empirical Investigation. Carnegie-Mellon University. Department of Computer Science. CMU-CS-87-186, 1987
28 Winograd T, Flores F. Understanding Computers and Cognition. A New Foundation for Design. Norwood NJ: Ablex; 1985
29 Shortliffe EH. Medical expert systems: Knowledge tools for physicians. West J Med 1986; 145: 830-9.
30 Grosz B. The Representation and Use of Focus in Dialogue Understanding. SRI International. Technical Report 151. 1977
31 Malhotra A. Design Criteria for a Knowledge-based English Language System for Management: An Experimental Analysis. Cambridge Mass: Massachusetts Institute of Technology; MAC TR-146, 1975
32 Haas C. Does the medium make a difference? Two studies writing with pen and paper and with computers. Human Computer Interaction 1989; 04: 149-69.