Patent No. 5722418 Method for mediating social and behavioral processes in medicine and business through an interactive telecommunications guidance system

 

Patent No. 5722418

Method for mediating social and behavioral processes in medicine and business through an interactive telecommunications guidance system (Bro, Mar 3, 1998)

Abstract

A method for mediating social and behavioral influence processes through an interactive telecommunications guidance system for use in medicine and business (10) that utilizes an expert (200) such as a physician, counselor, manager, supervisor, trainer, or peer in association with a computer (16) that produces and sends a series of motivational messages and/or questions to a client, patient or employee (50) for changing or reinforcing a specific behavioral problem and goal management. The system (10) consists of a client database (12) and a client program (14) that includes for each client unique motivational messages and/or questions based on a model such as the transtheoretical model of change comprising the six stages of behavioral change (100) and the 14 processes of change (114), as interwining, interacting variables in the modification of health, mental health, and work site behaviors of the client or employee (50). The client program (14) in association with the expert (200) utilizes the associated 14 processes of change (114) to move the client (50) through one of the six stages of behavioral change (100) when appropriate by using a plurality of transmission and receiving means. The database and program are operated by a computer (16) that at preselected time periods sends the messages and/or questions to the client (50) through use of a variety of transmission means and furthermore selects a platform of behavioral issues that is to be addressed based on a given behavioral stage or goal (100) at a given time of day.

Notes:

CROSS-REFERENCED RELATED APPLICATION

This application is a continuation of application Ser. No. 08/112,955 filed Aug. 30, 1993 (now U.S. Pat. No. 5,377,258 issued Dec. 27, 1994.

TECHNICAL FIELD

The invention pertains to the general field of information exchange services, in business, education and personal health care and more particularly to a computerized telecommunication system that conveys health awareness and goal management messages which maintain surveillance over patents, clients or employees by periodically sending behavioral motivation reinforcement messages and/or questions that require a patient's or employees interaction. In addition, the system uniquely utilizes social power through the avenue of telecommunications for modifying human behavior. It draws upon or is utilized by various authority figures or peers alternatively for modifying or reinforcing individual behavior. The invention can be supplemented by the addition of an additional expert or authority figure such as a physician or administrator to the system for providing interactive behavioral and motivational guidance to increase healthy behavioral changes to the patient or employee's prescribed medical regimens or work goals based upon his interaction over a period of time. Alternatively, peers or other persons of social influence may be added through its system to enhance each individual's performance.

BACKGROUND ART

One of the major advances of present-day society is in the field of computerized telecommunications. Today, in the growing fields of social psychology, behavioral medicine, and human motivation, formal verbal interchange is essential to provide modification of behavior and reinforcement. By using computerized telecommunications coupled with voice recognition technology, a client's or employees behavior can be modified and reinforced at the site where behavior occurs and wherever the client or employee goes. It has been found that as the frequency of reinforcing feedback increases, the client shows more rapid progress towards a particular goal. Similarly, the establishment of goals requires feedback and feedback requires goals, thus feedback is one of the key mechanisms in which goals are attained.

However, numerous studies have shown that feedback in itself does not have the power to motivate performance without the establishment of goals. By utilizing a system of continuous computerized reinforcement, a client or employee can be provided with more opportunity and greater frequency of therapeutic contact or feedback than through treatment or supervision in person. Additionally, the use of an interactive system vastly increases the therapeutic effect of this method of behavioral modification and reinforcement. As such, the subject invention uniquely mediates positive or beneficial expectancies of the physician, counselor, manager, administrator or other authority figure to the patient, client or employee.

Learning is enhanced through interactive feedback, and feedback in some form heightens the learning experience. The number of times in school a teacher asks any one child for an answer is fairly limited. Most of the time, children raise their hands and respond, and get back a "right" or "wrong." If they are wrong, they have lost their chance, and someone else is called upon for the answer. In traditional adult education, motivation and behavioral modification, the amount of continuing feedback is limited to the time actually spent with a counselor or supervisor, or in a class or seminar. Here, too, the feedback is limited to the actual time the physician, counselor, supervisor or trainer spends providing interaction with any one client or employee. By contrast, the addition of a computer and telecommunications or broadcast transmission allows "narrowcast" interaction and feedback on a continuous 24-hour basis to the client or employee wherever he goes, allowing for far greater frequency of interaction. Most importantly, in the case of adult behavior modification, this feedback, reinforcement and resulting motivation becomes available for the first time at the site where the behavior occurs.

Learning by playing and doing is fundamental to all mammals. While audio broadcast or telecommunications are media based upon hearing, and video broadcast is a medium based upon seeing, interactive feedback utilizing these architectures is a medium based upon doing or responding to the stimulus of feedback. Recent studies have revealed that the single best way to increase mammalian intelligence is through interactive stimulation. The frequency of feedback that we receive in relation to goals generally is the single greatest factor affecting learning, motivation and modifying behavior. Further, learning by receiving immediate feedback is preferable to receiving a delayed response. Children prefer interactive television games to merely watching a television program. They become impatient with long strings of dialogue, and the focus of their attention is diverted by devices providing rapid feedback. Adults display the same behavior throughout their lives. For example, when purchasing an appliance, they rarely read the instructions before trying to use it. The need to receive continuing feedback, at all levels of life, is a human characteristic, thus providing a basic survival mechanism which fosters learning and continuing growth. When feedback is combined with goals it becomes a powerful motivating force.

Research indicates that learning is enhanced by interactive feedback. Where the quantity of interactive feedback is increased, focus is sustained or increased, thereby stimulating keen responsiveness, as is the case with video games. The active involvement required to respond by answering provocative questions stimulates conscious awareness of and focus on the issue at hand. Learning, motivation and behavioral modification systems that incorporate rapid feedback foster problem-solving abilities, pattern recognition, management and allocation of resources, logical thinking patterns, memory, quick thinking, and reasoned judgment. Most importantly, when these skills are practiced at the site where the desired behavior is to occur, learning is more vivid and is quickly integrated into real life.

A sense of control is perceived with the provision of feedback. By engaging the client or employee to direct his focus and asking provoking questions, involvement is increased and stimulation results. When the individual learner achieves success and immediately receives positive feedback, self-esteem is rapidly built. When success is rewarded, confidence and resilience are enhanced and knowledge is created.

Historically, individuals have sought self-improvement, guidance and learning through self-help books, manuals, seminar workshops, personal counseling and programs of a periodic or short duration. With the best of intentions relapse usually occurs within several days after reading a book or attending a seminar, or several months after the conclusion of a behavioral modification program.

In contrast, computer-derived, self-adjusting motivational guidance, which interactively cues and polls the client and comments on his performance as he goes about his daily life throughout the year, has a more lasting effect. It differs importantly from seminars and visits to counselors or with a supervisor in that it modifies behavior at the site where the behavior occurs, with personal or customized intervention. The more frequent interactive dialogue between the counselor or supervisor-controlled computer and the client or employee enhances the feedback and therapeutic simulation in much the same way as has been experienced in other interactive communication structures, such as education and entertainment. For instance, consumers accord a higher value to interactive entertainment software than to passive software, due to the greater stimulation afforded by this mode. In entertainment software, an example would be some of the new video games that present a mode which runs like an animated cartoon until one elects to interact. As an animated cartoon, the video usually becomes boring within minutes. But as an interactive video game, the software stimulates the user with hours of entertainment.

In our culture, it is usually assumed that, given adequate information, people will use it rationally. Numerous studies have indicated that compliance with medical recommendations alone is less than perfect and generally only approaches 50 to 60 percent in many instances. Many physicians assume that if an individual is exposed to verbal information pertaining to his or her health issue, that behavioral change will take place. Given this viewpoint, the physician's responsibility is often seen as ending when the proper words are spoken. In fact, many problem behaviors and compliance with various medical requirements require constant feedback and adjustment over an extended period of time. Likewise, in other forms of education, personal management, sales and advertising, continuing reinforcement is often necessary to achieve the desired results.

Before a patient or employee can be expected to follow the intended recommendation of a physician, supervisor or counselor, he must have a thorough understanding of what is expected of him/her. One major criticism of contemporary medical care is that patients do not receive as much information as they would like. The resultant dissatisfaction precipitates a tendency to (1) ignore the physician's or counselor's recommendations, (2) forego follow-up appointments and (3) "shop" physicians rather than continue with one whom he feels is too vague.

In medical practice, initially, the physician must establish a baseline of the patient's knowledge to determine the extent of the patient's understanding, his grasp of the rationale behind the recommended behavioral changes, and his perception of the actions such changes will entail. It is important that the physician confirm the patient's understanding by having the patient repeat the explanations and instructions he has received, or by asking the patient to rephrase them in his own words. Too frequently, a physician will disregard this procedure because of time constraints or because he is uncomfortable doing so--circumstances that need to be addressed by the physician.

Of valuable assistance in successful behavioral modification is social or referent power, which is defined as the "primary basis of the social action becoming a significant other, a person whose approval and acceptance is highly regarded." Incorporating the use of social or referent power into a behavioral modification program entails three phases: (1) building, (2) using, and (3) retaining referent power.

Phase I is typically established during the physician/patient information-provision stage, during which the patient database is determined. Once established, referent power can be applied during Phase 2, with the physician offering both directives and encouragement to the patient.

Behavior modification necessitated by a medical condition requires that the patient subscribe to a particular medical regimen. Tailoring a regimen comprises (1) consideration of the various facets of the patient's existing routine and (2) modification of the regimen to minimize changes in the patient's lifestyle. The patient's cooperation is often proportionate to the degree of change demanded of him. If fewer behavior modifications are expected, the patient is more likely to adhere to the regimen.

The quality of the physician-patient relationship is critical to the success of a prescribed medical regimen, with the physician's interpersonal skills and manner central to the patient's perception of the physician. A patient responds to the forthcoming changes in his lifestyle emotionally; a physician responds professionally. The result is frequently a dissatisfied patient, one who sees his physician as unfriendly and uncaring. Equipped with this opinion, a patient is much less likely to heed the parameters of his regimen. The evolution of a therapeutic physician-patient alliance can only occur if the physician conveys--both verbally and nonverbally--his interest in the patient, vis a vis giving a patient the cathartic opportunity to tell his own story, expressions of respect, and empathetic concern.

In research literature on social power and influence, the degree to which patients comply with the recommendations of health care practitioners has often been seen as directly related to the physicians' use of referent, reward and coercive powers. Generally, medical recommendations are mentally internalized by patients based upon the regard in which they hold the caregiver and the continuation of some form of positive reward or reinforcer. However, in modern medical practice, physicians have shown that they generally lack the time, inclination or financial incentives for the continuing monitoring of a patient's behavior and compliance with the prescribed regime.

Therefore, a need exists for a computer driven interactive two-way communication link that increases the opportunity to create realistic and engaging behavioral reinforcement and guidance in the home or office and at remote locations, with both stationary and portable wired and wireless communication devices to assist the physician in the practice of medicine by facilitating compliance with medical requirements in regard to their patients. Similarly, a parallel situation exists in business organizations for the motivation of employees on a continuing basis in their natural environment.

Although in medicine, a physician is crucial to achieving permanent behavior change, other components of the primary health care organization are also important. Optimally, the physician-patient contact provokes a commitment from the patient and the initiation of a behavior modification program. Maintenance of such change necessitates methodical instruction, coaching, and protracted follow-up. For example, a patient diagnosed with chronic heart disease will require more than just prescribed medication. He will need to institute or revise his exercise regimen, relearn cooking habits, and appraise stress-inducing activities. Such extreme behavior modification will involve not just physician and patient, but nurses, clinic aids, conferences, and possibly educators, dieticians, social workers and psychologists.

Furthermore, psychotherapy outcome studies have been aimed at how people change their behavior, with and without the use of psychotherapy counseling. The results of these outcome studies have produced a number of definitive structures or models of the process of change that underlies both self-initiated and therapy-assisted modification of human behavior.

In the past, these processes have been administered ad hoc or randomly by various counselors and supervisors within verbal exchange processes, in person or through various methods including but not limited to bibliotherapy, direct telephone contact and counseling, group therapy sessions and seminars. Furthermore, it must be remembered that outpatients, on the average, spend about 99 percent of their waking week outside of a therapy situation. Therefore, in medicine there are advantages to having a medical regimen and behavioral guidance parallel those self change efforts or techniques that patients utilize outside of the physician's office into their daily lives. The disadvantages of the prior art are overcome by the present invention which provides a more comprehensive approach while affording greater convenience and increased interactive contact for physicians, psychotherapists and various counselors as well as supervisors, managers and administrators in a commercial setting.

Years ago, family physicians developed their social power to such a high degree that patients would strive to get well by compliance with his medical recommendations. Due to trends toward greater specialization, medical economics, and use of evolving technology, the physician house call has generally become no longer possible. The subject invention, by utilizing various telecommunication devices and computers, uniquely permits the greater personalization of medical treatment on a continuing basis. Today, physicians are not able to spend the time to make effective use of the variety of behavioral techniques available for motivating patient compliance. However, by the use of the present subject invention which extends the physician's recommendations and monitors their implementation uniquely through a counselor and computer, former patient rapport and affiliation can be reestablished. In the commercial marketplace, various supervisors can orchestrate and monitor employee goals by providing continuing feedback and guidance regardless of where they are located.

Therefore, a need exists to apply and distribute behavioral change processes, individually and collectively, through the medium of computerized telecommunication in association with a physician, manager or person of authority or influence. More particularly, this need is magnified due to the large number of variables and combinations in timing the administration of processes and behavioral changes throughout a given, prescribed medical regimen. The computerized administration and transmission of these social, behavioral and motivational processes, both separately and collectively, is a novel and unique advancement not known in the art.

In summary, a computerized interactive system increases the patient's or employees ability to resolve his medical or work problems at the site where his behavior occurs, and adjusts him within the framework of a preset goal. By including, within the context of the personalized message, challenges in the form of questions, an entertaining and stimulating process can be added due to the increased feedback or interactive nature of new telecommunication technology.

With regard to the prior art, many types of systems have endeavored to provide an effective means for providing surveillance over the behavioral modification of a patient or client by using a telecommunication link. However, these prior art systems have not disclosed an adequate and cost-effective telecommunication network that uses a computer in combination with a telephone or other platforms to provide positive behavioral based motivational messages and/or questions that are answered by a patient or client by means of a dual tone multifrequency telephone set or other platforms.

Further, the prior art systems have not disclosed utilization with such hardware as voice stress analyzers, on line services, olfactory units, CD-ROM platforms, interactive television in connection with a telecommunication link as a further behavioral modification means in use with the client or employee.

A search of the prior art discloses patents that show different types of feedback mechanisms:

_______PATENT NO. INVENTOR ISSUED _______________________

3,742,938 T. J. Stern 03 July 1973

3,808,694 W. Y. Hutchinson et al. 07 May 1974

4,112,425 G. J. Zobrist et al. 05 Sep. 1978

4,237,344 Moore 02 Dec. 1980

4,328,494 R. Goodall 04 May 1982

4,377,214 G. G. Hansen et al. 22 Mar. 1983

4,396,976 G. P. Hyatt 02 Aug. 1983

4,602,127 J. F. Neely et al. 22 July 1986

4,773,492 E. Ruzumna 27 Sep. 1988

4,831,242 W. H. Englehardt et al. 16 May 1989

4,835,372 Gombrich et al. 30 May 1989

4,916,435 Fuller 10 Apr. 1990

4,922,514 Bergeron et al. 01 May 1990

4,912,552 Allison III et al. 27 Mar. 1990

4,933,873 Kaufman et al. 12 June 1990

4,952,928 G. T. Carroll et al. 28 Aug. 1990

5,008,835 Jackmann et al. 16 Apr. 1991

5,014,298 Katz 07 May 1991

5,018,736 Person et al. 28 May 1991

5,023,901 Sloan et al. 11 June 1991

5,036,462 Kaufman et al. 30 July 1991

5,038,800 K. Oba 13 Aug. 1991

5,068,080 Impink Jr. et al. 26 Nov. 1991

5,085,527 P. A. Gilbert 04 Feb. 1992

5,126,957 S. B. Kaufman, et al. 30 June 1992

5,127,003 W. J. Doll, Jr. et al. 30 June 1992

5,142,484 S. B. Kaufman, et al. 25 Aug. 1992

5,170,426 F. D. D'Alessio, et al. 08 Dec. 1992

5,189,395 M. S. Mitchell 23 Feb. 1993

5,206,897 N. Goudreau, et al. 27 Apr. 1993

5,218,344 J. G. Ricketts 08 June 1993

5,219,322 L. R. Weathers 15 June 1993

5,224,173 R. J. Kuhns, et al. 29 June 1993

5,245,656 S. K. Loeb, et al. 14 Sep. 1993

The Sloan et al., patent discloses a surveillance system which integrates voice identification with passive monitoring mechanisms. The system comprises a central station located at a supervisory authority and a plurality of remote voice verification units. Each unit is located at a designated locality for an individual under surveillance and is connected to the central station via telephone lines. The central station consists of a control computer system and a violation computer system. The central station maintains and analyzes all relevant data for each individual, and initializes and retrieves information from each voice verification unit. Each voice verification unit conducts a voice verification test of a respective individual according to test schedules outlined by the central station. Test and monitoring results obtained during a defined surveillance period are transmitted to the central station on a periodic or exigent basis. Each remote station has a modem input, test means input connected to a microphone, and a third input to receive passive monitoring signals. The active and passive signals are analyzed according to an algorithm and command signals received from the central station. The test means also has an output to prod the individual to speak a preselected series of words. The test schedule in each remote is randomly created for each period and individual.

The Fuller patent discloses a remote confinement monitoring station and system with a central office that provides means for automatic selection of a specific confinee. The central office selects scheduled or semi-random monitoring calls, to avoid a high degree of predictability by the confinee, auto dialing means for transmission of a prerecorded or synthesized audio instruction message to the confinee, and recording of information received in response to the acts of the selected confinee preformed in response to the communicated message. The central office has a computer with a telephone line modem, a voice synthesizer, and other accessories and displays for automatic recording of data received including a visual camera image and breath analyzer results, and can include automatic image comparison and violation signal alarming.

The Moore patent discloses a rapid response hospital health care communications system. The system includes an auto dialer telephone system to allow patients to communicate from outside the hospital to receive advice and health care as indicated by the patient's medical profile. The communications system includes a health care console with an information storing computer connected through various communication paths to in-hospital patients, and by telephone means to out-of-hospital patient locations. Each out-of-hospital location includes a communication interface with a telephone, a console, and a hand-held remote control comprising a plurality of sensors, indicators and features. The interface includes an auto dialer and auto identifier that dials the health care console and identifies the patient by a computer recognizable code.

The Kaufman et al., patent discloses an interactive patient assisting device that has both preselected doses of medicine and a physical testing device that can communicate with a remote medical center over the telephone system. The system includes a clock/calendar unit that can be programmed to establish a schedule of a variety of activities, a pharmaceutical dispenser, a voice synthesizer and recognition unit, a computer, displays, and monitor means for blood pressure, oxygen and temperature. For communicating to a remote location, an automatic dialer, modem and telephone are included.

The Bergeron et al., patent discloses a method and system for the dispatch of resources to remote sites in response to alarm signals. A processor accesses the database of, for instance, a field service engineer designated to provide services to particular remote sites in response to the alarm signals received from those sites. The processor then attempts to establish a telephone connection with the field service engineer and provide the engineer with information by means of synthesized voice messages. The system may execute remote diagnostic programs and determine the results and attempt to communicate with selected resources. The system has a conventional processor with a database, voice synthesizer, voice system and auto dialer. When the system dials and the telephone is answered, the system requests an identification code by means of the touchtone buttons before it communicates.

The Hutchinson patent discloses a weighing and height measuring device. It is especially adapted for use with a remote digital read-out system. The device comprises a weight responsive moving platform connected by cable to a remote digital read-out unit. One of the objects of the invention is to provide a weight measuring device adapted for use with a remote read-out and/or computer input device.

The Stern patent discloses a cardiac pacer and heart pulse monitor for remote diagnosis wherein information from a pair of sensors is transmitted by means of a telephone handset and transmitter, over a commercial telephone system to a remote receiver. Information received at the receiver may then be processed by means of an appropriate computer and program system.

The Carroll patent discloses an adaptable electronic monitoring system. The system is configured to fit the needs of a particular monitoring or identification application by selecting appropriate modules. The system provides for monitoring at a central location and communication between the location of the sensed information to the processing site by means of a normal telephone communications system.

The Doll patent discloses a digital/audio interactive communications network. The digital network may be a wide area, metropolitan or local area network, and may communicate with other networks. The digital network ties a digital LAN server and an audio server together. The system works with software directed to a client/server architecture in an application that requires recording and playback of audio information.

The D'Alessio patent discloses a method and system for home incarceration using a telephone network and voice verification. The system has a control center with a process server connected to controllers through a LAN such as an ethernet or wide area network. New inmates are added by voice training so that the system can create voice templates of selected words. A data base of the voice templates and phone numbers, work schedules, etc. is created. Calls received are screened by using caller ID. Calls to and from the inmate are performed on a predetermined or random frequency, the frequency being a function of the patient's behavior. All activities are maintained in a log file.

The Ricketts patent discloses a method and system for monitoring personnel using computers and transceivers and a network. The interactive system monitors the identity and location of the inmates of a correctional facility, hospital, school or the like, and can alert the inmate that the inmate is entering a restricted area, or being approached by another inmate within a predetermined threshold distance. The inmate's transceiver can include a bar code for use of vending machines, telephone and the like, with the transactions being allowed or denied by the computer.

The Weathers patent discloses a psychotherapy apparatus and method for treating undesirable emotional arousal of a patient. The system presents visual and audio stimuli in each ear and eye separately and synchronously and alternately, the presentation being controlled in response to the patient's physiological responses to the stimuli. In addition to the behavior modification stimuli supplied to the patient by the computer, an operator, using a microphone, can direct the patient's attention.

The other cited patents are for background purposes and are indicative of the art to which the invention relates.

It will be noted that the above mechanisms and systems do not allow the utilization of various well known elements used in a unique random calling manner with a client, employee or patient database and client, employee or patient program of prescribed messages and/or questions for particular persons. More particularly, the instant apparatus and method provides a uniquely reinforcing approach of allowing the physician, person in authority, peer, or expert to use prescribed messages and/or questions for particular persons. More particularly, the instant apparatus and method provides a uniquely reinforcing approach of allowing the use of random calls at random locations from a list of possible locations where a client, employee or patient may be located. Furthermore, this system utilizes existing telecommunication technology including pagers, online services, etc., unlike many of the devices described in the above referenced patents.

SUMMARY OF THE INVENTION

The automated and interactive positive motivational system is designed to be used by doctors, psychologists, counselors, managers, administrators, peers or other trainers to provide motivational messages and/or questions to clients, employees and patients having behavioral and various addiction, volitional or motivation problems. Its basic configuration comprises:

(a) means for recording and accessing a patient's database that includes for each patient the name, schedule of telephone numbers where the patient may be reached during each 24-hour period, personal identification number, and previous history of messages and the patient's responses;

(b) means for measuring and recording a patient's weight without revealing their weight to them and transmitting said weight information telephonically for use in a weight reduction program;

(c) first means for recording and accessing a patient's or employees program that includes for each patient or employee specific motivational messages, personal and unique metaphoric references, goals, and/or questions that are to be responded to by the patient or employee through either the telephone, one- or two-way interactive beeper, personal communicator, modem, personal computer, or interactive television;

(d) a computer having means for accessing the patient database and said patient or employee program. If a match is found between a patient's or employee's database and patient or employee's program, the computer produces a sequence, a digital telephone signal which corresponds to his telephone number or beeper or personal communicator number, a digital patient or employee validation request signal and a digital motivational message(s) and/or questions. The messages and/or questions are only then sent if the patient's or employee's validation request signal is responded to by the patient with a valid personal identification number (PIN) in the telephone mode, or broadcast without a PIN with a beeper or personal communicator;

(e) means for converting the digital signals produced by the computer to telephone tone signals that are sent to a patient's dual tone multifrequency telephone set or computer and modem via a telephone network. The telephone set or a computer is used to respond to the computer's validation request, hear the motivational message(s) and/or to respond to the questions;

(f) means for converting the telephone tone signals originating at the patient's telephone set, personal computer, or hand-held wireless device, to digital signals for application to and processing by the host computer; and

(g) second means for permanently recording all the outgoing and incoming patient or employee communications.

An important object of the invention is that the system manipulates speech messages that are stored, not in an analog format common to audio tape storage systems, but in digital format that is stored on a read-only compact disc, a computer hard drive or the like. The use of compact discs allows the system to access files quickly and accurately. Therefore, it is possible for the computer to access more than one speech file at a time. Each telephone line that the system is servicing is actually a small "slice" of computer time during which speech files are being played from or recorded. The more lines that are active, the more slices of time that must be managed. The system provides the functions to operate with more than one telephone line simultaneously, thereby allowing a physician, manager or other counselor, at all times over a 24-hour period, to process and supervise many more patients or employees than otherwise. In addition, the system allows for a patient or employee to receive more doses of behavioral intervention over any time period than in any other manner.

Another object of the invention is directed to accomplishing most tasks in a voice response application by accepting, recognizing and making decisions based on a keypad input from the caller's dual tone multifrequency telephone or computer. The telephone keypad generally sends dual tone multifrequency (DTMF) tone signals but occasionally multifrequency (MF) tones are used by certain types of telephone switching equipment. While these two signalling methods are not compatible, the system will work with either one equally well.

Still another object of the invention is the use of digitized voice signals for the transmission of messages to the patient or employee. Digitized voice signals are typically made by sampling the voice wave form 6000 to 8000 times per second in order to accurately reconstruct good speech quality. Each sample takes 8 to 12 bits, this results in 48,000 to 96,000 bits of information per second that must be stored. It is common in telephonic applications for a digitized voice to be compressed by storing only the differences between samples. Therefore, the speech card that the system supports uses a compression technique known as Adaptive Differential Pulse Code Modulation (ADPCM) which recognizes that there is only a small difference between the speech samples and stores a logarithmic function of the difference between speech samples. The result is good speech quality at only 3000 bytes per second of data throughput.

Yet still another object of the invention is the utilization of an expert, such as a physician or authority figure, to a system of behavioral motivation and guidance which adds an additional dimension of support and, most importantly, increases the impact of the intervention. Often, individuals regard certain "experts" with elevated respect and regard their advice with increased attention. Various categories of experts, such as doctors, educators, scientists, and public personalities, are attributed elevated or enhanced knowledge by the public at large and their recommendations and advice are accorded greater recognition and enhanced value. Today in modern commerce, recommendations and endorsements by experts and public personalities are traded for monetary value in recognition of their value in facilitating the sale of goods and services to consumers. Likewise, in the practice of medicine, the recommendation of a physician is generally accorded higher import to a patient than that of a layman. In the field of commerce, a parallel example would be that of a person of influence who sits higher in hierarchy of his employer than that of his immediate superior. Alternatively, peers mediate social influence through their equalitarian or reciprocal relationships.

Therefore, the present invention involves a method to increase the impact of various behavioral modification formats, delivered by telecommunications, and administered by one or more computers. uniquely extends the prior art of physician counseling and sales, marketing and personal management techniques by the addition of an "expert" who is regarded by the patient, consumer or employee with a degree of respect or regard at appropriate or strategic times during the behavioral process or intervention. In addition, it provides for the addition of peer influence for additional reinforcement and support.

Yet, another object of the invention is that the patient or employee program may be directed to any subject matter such as motivational training, teaching, psychological behavior modification, and reinforcement of a medical regimen, wherever motivations would be facilitated by daily or periodic intervention. The following is a partial list of some of the component areas that the patient or employee program may be directed to:

1. nutrition

2. exercise

3. weight loss (diet/weight management)

4. optimism (and hope)

5. life-long learning

6. time management

7. stress management

8. optimal health management

9. immune system enhancement

10. midlife transformation/emergence

11. women and men in aging and transition (heart disease, menopause, etc.)

12. control or self-discipline

13. compliance with medical requirements

14. pain control

15. anger management

16. acceptance of mortality

17. reforming the concept of aging

18. memory management

19. reformation of self-destructive behavior

20. transformation of regret

21. anxiety management

22. mental and physical resilience

23. early cancer screening and detection

24. an interactive journal

25. wake up and sleep meditations

26. control of performance anxiety and mental rehearsal

27. enhanced self-esteem

28. Short and long term goal management

Accordingly it is an object of the present invention to record the daily or periodic activity schedule of each patient or employee enabling contact with the patient or employee on a scheduled or random basis by telephone, personal computer or other means such as a wireless alpha-numeric pager, laptop computer, personal communicator, cellular phone, or modem that is used to contact patients or employees wherever they may be during the day or night. If the patient or employee misses a call, they may call in to the computer and get their message by using a specific password.

Yet a further object of the invention is that the patient or employee program in association with the use of an expert or authority figure will utilize one of several types of behavioral modification techniques. By way of example, but not of limitation, one such behavioral modification technique used may be the transtheoretical model of change comprising the six stages of behavioral change and the 14 processes of change, as interwining and interacting variables in the modification of health and mental health behaviors of the patient. These six invariant stages of behavioral change, which have been identified and to which the patient program may be directed, are:

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

6. Relapse

The patient program further includes the associated 14 processes of change utilized to move the patient through the six stages of behavioral change. The following is a list of these 14 process areas that the patient program may be directed to:

A. Consciousness raising

B. Self Liberation

C. Social Liberation

D. Self re-evaluation

E. Environmental re-evaluation

F. Counter conditioning

G. Stimulus control

H. Reinforcement management

I. Dramatic relief

J. Helping relationships

K. Self efficacy

L. Temptations to relapse

M. Decisional pros

N. Decisional cons

The object of the present invention is to utilize these 14 processes within the previously cited six behavioral stages of individual growth, through computerized management and administration, by initiating prompts and cues and related educational material for guidance and reinforcement by the patient or employee program in association with the use of an expert or authority figure in addition to that of his supervisor, counselor or trainer.

Another object of the invention is that the use of an expert and the patient program may be directed to the field of chronic disease detection. More particularly, the patient program will provide periodic behavioral cues to aid the expert in the early diagnosis and cure of such chronic diseases as glaucoma, dental and periodontal disease, cancer, heart disease, and diabetes.

Still yet another object of the present invention is the use of the patient program to address issues for the management of such chronic diseases as diabetes, hypertension, and others where compliance with the expert's suggested medical regimen can be critical. By applying the aforementioned transtheoretical model, the patient program will provide the gradual courage to overcome individual resistance and to reinforce periodic self and physician examinations while extending the relationship with the expert in a manner heretofore not known.

Yet another object of the present invention shall be the formulation and publication of individually customized information in the form of reports, or graphs, indicating performance and response profiles, educational monographs, and tutorials and other materials necessary for providing motivation and education for use by both the counselor, expert and the patient or employee. By storing in a data base memory device a group of prerecorded informational data of a generalized nature and accumulating personal response profiles in said memory device, it is possible to mix or formulate a customized set of unique and individual printed educational and medical record documents.

Another object of the present invention would be that for each individual patient or employee, based upon his education, gender, age, demographic profile, psychological profile and prior response profiles, an educational document and text would be formulated according to the individual's present behavioral stage.

A further object of the present invention is to provide a large central mainframe computer or interconnected series of personal computers containing a multiplicity of microprocessors which could be used by local or regional clinics and hospitals for interactive, telecommunication and/or multivideo transmission for enabling thousands of individual patients to be provided interactive medical guidance and feedback in real time or delayed service, whereby a hospital may currently serve a greater outpatient population in its locality and place increasing emphasis on home health care.

Another object of the present invention is to use higher capacity transfer modes of transmission such as asynchronous transfer mode (ATM) and Integrated Services Digital Network (ISDN) as an alternative method of transmission for behavioral guidance and motivational reinforcement. Since the present invention relies upon telecommunications which are transmitted or delivered synchronously, this alternative embodiment relates to the asynchronous transmission of information by both wire and wireless means in private and public networks. Therefore, an additional object of the present invention is to use such higher capacity transfer modes as asynchronous transfer mode and ISDN for both data and real time and delayed transmissions; as an example, voice and video wherein it is equally adaptable to both local and wide area networks.

The rationale of the system is that man is in a continuous state of growth and development. The system provides the motivation and reinforcement through continuous daily monitoring of each patient as he works towards his basic goals for optimal health by maintaining prescribed regimens or goals. By this daily or periodic reinforcement and guidance utilizing interactive feedback, the system is able to maintain the organization and intervention between the physician, counselor, manager, the patient, or employee and his or her goals.

By mobilizing patients to accept responsibility for their own health through behavioral guidance in preventive health programs and to comply with medical prescriptions in the dispensing and taking of medicines, large savings can thereby be realized, contributing to national goals of medical cost containment. The aging of the population necessitates greater health care expenditures which in turn are aggravated by the possibility of older individuals having one or more chronic diseases wherein non-compliance with medical regimens can become financially costly, dangerous and even life-threatening. Likewise, large savings can accrue by keeping employees motivated and focused on assigned goals.

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There has been described and illustrated herein an improved system and apparatus for interactively changing a behavioral pattern of a patient 50. The aforesaid system uniquely extends the prior art of modifying individual behavior to the place where behavior occurs in a customized, personal manner utilizing various computer driven telecommunications platforms. While particular embodiments of the system and apparatus have been described, it is not intended that the invention be limited exactly thereto, as it is intended that the invention be as broad in scope as the art will permit. The foregoing description and drawings will suggest other embodiments and variations within the scope of the claims to those skilled in the art, all of which are intended to be included in the spirit of the invention as herein set forth. ##SPC1##