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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
1   Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA
,
C. E. Wulfman
1   Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA
,
J. A. Rohn
1   Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA
,
C. D. Lane
1   Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA
,
L. M. Fagan
1   Section on Medical Informatics, Stanford University School of Medicine, Stanford Cal, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2018 (online)

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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

1 Currently at Sun Microsystems, Inc. This work has been supported by the National Library of Medicine under grants LM-04864 and LM-05208. Computer facilities were provided by the SUMEX-AIM resource and through equipment grants from Xerox Corporation and Speech Systems, Incorporated.


 

  • REFERENCES

  • 1 Shortliffe EH. Computer programs to support clinical decision making. J Am Med Assoc 1987; 263: 1114-20.
    PubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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.
    Google Scholar
  • 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.
    Google Scholar
  • 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.
    Google Scholar
  • 8 Searle JR. Speech Acts. Cambridge University Press; 1969
    Google Scholar
  • 9 Sperber D, Wilson D. Relevance. Cambridge Mass: Harvard University Press; 1986
    Google Scholar
  • 10 Clark HH, Schaefer EF. Collaborating on contributions to conversations. Language and Cognitive Processes 1987; 02: 19-41.
    CrossrefPubMedGoogle Scholar
  • 11 Clark HH, Wilkes-Gibbs D. Referring as a collaborative process. Cognition 1986; 22: 1-39.
    CrossrefPubMedGoogle Scholar
  • 12 Blass T, Siegman AW. A psycholinguistic comparison of speech, dictation and writing. Lang Speech 1975; 18: 20-34.
    CrossrefPubMedGoogle Scholar
  • 13 Gould JD, Conti J, Hovanyecz T. Composing letters with a simulated listening typewriter. Commun ACM 1981; 26: 295-308.
    PubMedGoogle Scholar
  • 14 Drieman GH. Differences between written and spoken languages: An exploratory study. Acta Psychol 1962; 20: 78-100.
    CrossrefPubMedGoogle Scholar
  • 15 O’Donnell RC. Syntactic differences between speech and writing. American Speech 1974; 49: 102-10.
    CrossrefPubMedGoogle Scholar
  • 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.
    Google Scholar
  • 17 Devito JA. Psychogrammatical factors in oral and written discourse by skilled communicators. Speech Monographs 1966; 33: 73-6.
    CrossrefPubMedGoogle Scholar
  • 18 Devito JA. Levels of abstraction in spoken and written language. J Commun 1967; 17: 354-61.
    CrossrefPubMedGoogle Scholar
  • 19 Horowitz MW, Newman JB. Spoken and written expressions: An experimental analysis. J Abnorm and Soc Psychol 1964; 68: 640-7.
    PubMedGoogle Scholar
  • 20 Cohen P. The pragmatics of referring and the modality of communication. Computational Linguistics 1984; 10: 97-146.
    PubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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.
    Google Scholar
  • 23 Gibbs RW. Contextual effects in understanding indirect requests. Discourse Processes 1979; 02: 1-10.
    PubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 25 Francik EP, Clark HH. How to make requests that overcome obstacles to compliance. J Memory and Language 1985; 24: 560-8.
    PubMedGoogle Scholar
  • 26 Sacks H, Schegloff EA, Jefferson G. A simplest semantics for the organization of turn taking in conversation. Language 1974; 50: 696-735.
    CrossrefPubMedGoogle Scholar
  • 27 Hauptmann AG, Rudnicky Al. Talking to Computers: An Empirical Investigation. Carnegie-Mellon University. Department of Computer Science. CMU-CS-87-186, 1987
    PubMedGoogle Scholar
  • 28 Winograd T, Flores F. Understanding Computers and Cognition. A New Foundation for Design. Norwood NJ: Ablex; 1985
    Google Scholar
  • 29 Shortliffe EH. Medical expert systems: Knowledge tools for physicians. West J Med 1986; 145: 830-9.
    PubMedGoogle Scholar
  • 30 Grosz B. The Representation and Use of Focus in Dialogue Understanding. SRI International. Technical Report 151. 1977
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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.
    CrossrefPubMedGoogle Scholar