Note: Descriptions are shown in the official language in which they were submitted.
~;~3493~
INTERACTIVE EDVCATION~L SYSTEM WITH VOICE REACTION
AND ACCESS USING TONE-GENERATING TELEPHONE
BACKGROUND O~ 'l'H~ INVBNTION
The concept of continuing formal education of in-
formation-based professionals is an idea which is both impor-
tant and necessary. It is important because, in our rapidl~
changing world, a professional individual cannot maintain
maximum effectiveness unless he is able to constantly review
and revise his Xnowledge of his particular field. This is true
of all disciplines, including law, medicine, engineering, and
science. Both the individual and society have an interest in
maximizing the effectiveness of the individual professional by
maximizing the currency of his knowledge.
Formalized, and even mandatory, continuing education
is necessary because even the most dedicated professional can
find perfectly rea~onable excuses for not seeking to update
his knowledge. Given a choice between tending immediately to
the needs of a patient or client, on one hand, or, on the othex
hand, studying information which may or may not be of immediate
use, places the professional in an-unfair dilemma. This dilemma
is made all the more destructive if the continuing education
medium is, or is perceived to be, inefficient, ineffective,
inconvenient, or unintere~ting.
1~39~13~
One stalwart of the txaditional continuing education
system is the classroom concept, carried over from the tradi-
tional school environment~ Numerous aspects of the classroom
system render the approach of marginal value in a continuing
education program. Inflexibility of scheduling, necessary to
pl~n for a larg~ number of p~rtlclpAnt~ and th~ noc~eslty ~or
the participant~ to travel to a location central enough to be
available to a sufficient number of participants, xender the
approach of limited value.
Another primary basis of traditional continuing
education involves the professional publication. Use of the
professional publication in a continuing education program is
necessarily limited because of the nature of the publication.
First of all, the traditional professional publication is not
necessarily designed as an educational tool, but rather is an
instrument by which researchers publish thP initial announce-
ment of their breakthroughs. Elaborating the practical im-
plications of the breakthroughs is generally not the primary
objective of the authors, so that those practical aspects are
often buried in a mass of "scienti~ic" information. Further-
more the publication provides no feedback mechanism by which
the individual professional can determine whether he understood
what he read; nor does it provide a mechanism for society to
know whether he understood what he read, or even if he read
the material.
The modern continuing education approach has
i~tegrated a testing component into the traditional
pro~e~lonal publlcatlon approach. Generally, a
publication will include a classroom-type examination to
be taken after the professional has read the materials
~2~
~ 93 7
in the publication~ The examination is taken by the pro-
fessional and mailed to a centrali~ed program administrator.
The administrator ~rades the examinations and indicates to the
professional whether he received a passing grade. The practical
implcmentatlon o~ thi~ type o~ pro~ram h~s numerou~ shortcomin~.
F~r~t of all~ the olassroom-typ6 written examinAtlon 1~ ~enerally
not a very stimulating or interesting exercise. Furthermore,
the feedback gi~en to the professional by a grade is gen~rally
rather unenlightening in terms of indicating where his short-
comings were or any other type of information about the nature
of his new knowledge. In addition, the grade generally does
not come back for some period of time. Finally, if the grade
is poor, it can easily discourage the student and curtail his
enthusiasm. For these reasons, the examination process is not
the stimulating and educational experience that it would be if
the examination were conducted on a person-to-person basis in
which an interrogator could respond immediately to the students
answers.' The concept of person-to-person dialogue, either in
person or over the telephone, is most desirable, but, as a
practical matter, is impossible.
These and other difficulties experienced with the
prior art systems have been obviated in a novel manner by
the present invention.
Therefore~ the outstanding object of this invention
is to provide an educational system in which a student at a
remote location can interact with an automated educational
center.
(3)
123~9;~7
1 Another object of this invention is the provision
of an educational system in which the interaction takes
place over ordinary telephone lines.
A further object of the present invention is the
provision of an educational system in which the student is
able to respond to interrogation from the central system by
using the machine-distinguishable signals generated by the
standard push-button type telephone instrument commonly
known under the trademark Touch-Tone.
It is another object of the instant invention to
provide an educational system in which the student is
interrogated, provided with multiple choice answers, chooses
an answer, and then is immediately presented with informa-
tion concerning his answer.
A still further object of the invention is the
provision of an educational system in which the student can
participate at a time and place totally of his or her
choice.
It is a further object of the invention to provide
an educational system which provides maximum educational
effectiveness with minimum cost and inconvenience.
It is a still further object of the present
invention to provide an educational system which easily and
inexpensively generates information which can be used by
vendors to isolate potential customers.
With these and other objects in view, as will
be apparent to those skilled in the art, the invention
resides in the combination of parts set forth in the
specification and covered by the claims appended hereto.
(4)
~2 3 49 3~
SUMMARY . OF THE _VENTION
This invention involves an automated educational
to~tlng sy~tcm ln whlch ~u~ont~ ~t romot~ loa~lon~ ~ro
push-button
able to u e a standard/Touch-Tono-type telephone and or~inary
telephone lines to interact with an automated educational and
testing center. The ~tudent is provided with a publication
at his location and is able to study the material in the
publication at his leisure. At any time that he wishes to
be tested on the material, he need merely telephone the center r
to be exposed to a number of test modules. Each module will
consist of a voice presentation of a question and a number of
possible answers. Each answer will be related to a specific
button on the telephone. The student will choose the answer
he believes is correct by pressing the appropriate button on
the telephone, and thereby, generating a machine-recognizable
signal to the center. Automated equipment at the center will
recognize the answer, choose an appropriate reaction to that
answer and, deliver the appropriate voice reaction to the stu-
dent. Provision is made for signaling a repeat of the question
and providing various other signals to the center by means of
the buttons on the telephone.
~5)
~4~3~
BRIEF DESCRIPTION OF THE DR~WINGS
The character of the invention, however, may be
be~t understood by reference to one of its structural forms,
as illustrated by the accompanying drawings, in which:
FIG~ 1 1B a dlagrammatlc representatlon o~ the
organization of elements in an educational system embodying
the principleg of the present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to FIG. 1, wherein are shown the general
features of the invention, the educational system, indicated
generally by the reference numeral 10, is shown as having a
source location 11 and a subject location 12, located remotely
from the source location 11. Although the source location 11
will generally be discussed as if it were actually a single
location, it will be understood by those skilled in the art
that modern communication techniques will allow the operating
elements of the source location to be perceived as a single
location even though they may, in fact, be physically
diversely located and connected by communication links. One
element apparently located at the source location is the
publication generating organization 13~ The objective of this
(6)
~34~
1 organization is to provide the subject location 12 with a
publication 14 on a regular basis. In the preferred
embodiment, the publication wou:Ld be a printed publication
such as a magazine. It would also be possible for the
publication to take the form of a broadcast program, such as
a television or radio program. It might also be possible
for the publication to take the form of a computer terminal
display.
Another element at the source location 11, is the
controller 15. The controller 15 would normally be a pro-
gramable digital computer. The controller 15 is connected
by a communication link 16 to a report generating instrument
such as printer 17. The controller 15 is also connected by
a cummunication link 18 to a storage unit 19 having "floppy"
discs and a drive. In the preferred embodiment, the storage
unit 19 would be capable of storing both normal digital
information and also information capable of being converted
into a normal human voice. The controller 15 is also con-
nected through communication link 20 to interface unit 21.
The interface unit 21 is also connected through a
communication link 22 to the storage unit 19. The interface
unit 21 is also connected through communication link 23 to a
telephone 24 at the subject location 12. In the preferred
embodiment, the telephone is a standard push-button type
telephone system commonly known under the tradmark Touch-
Tone. The push-button telephones which are used with the
present invention are of the type which generate a series of
machine-distinguishable signals of standard frequency, each
signa] being associated with the pressing of one button
on the telephone face. In
~ (7)
123~ 7
1 this way, a properly equipped interface unit 21 can be
adapted to respond when it detects a specific one of the
phone buttons being pressed while the line between the
telephone 24 and the interface unit 21 is open. In
situations where only dial-phones are available, a
separate tone generator, which feeds into the mouthpiece
or line, could be used. In the preferred embodiment, the
storage unit of the present invention includes a first
initiating declaration file containing data adapted to be
delivered in audible form to the telephone under super-
vision of the controller. The data includes a response-
inviting statement and a plurality of possible responses,
each being associated with a different one of the machine
distinguishable signals of the telephone. The storage
unit also includes a plurality of reaction files. One of
the reaction files represents and is associated by the
controller with each of the machine distinguishable
signals when that signal is generated by the telephone
over the first communication link. Said one file is
thereafter delivered in audible form to the telephone
under supervision of the controller. The reaction file
is stored either as digital signals or analog signals.
In the preferred embodiment, the storage unit carries the
reaction files in analog form and carries the digital
information necessary for the controller to locate and
use a specific reaction file.
(8)
~23493~
_ _ , .. . ..
In its 8implle5t orm p the interface unit would
merely be a modem and tone discriminator opera~ing under the
control of the controller 15. In the preferred embodiment,
the interface unit would be provided with its own microprocessor
programed to carry out a range of administrative functions.
One such ~unction would involve using the "call waiting"
- ~ capability of the telephone system to bring additional capacity
on line and to switch a waiting call to that capacity. In
that way, the student would not have to wait for access, but
computing capacity would be provided only when needed. The
interface unit and storage device in the preferred embodiment is
a LVM-80 Business Communicator sold by Votrax, a division of
Federal Screw Works, 500 Stephenson Highway, Troy, Michigan.
Use and operation of the invention will now be readily
understood in view of the above description. It would be
understood that the description of the operation is for the
purpose of example and does not necessarily create limitations
on the scope of the invention.
At regular, predetermined intervals, the publication-
2~ ~enerating organization 13 generates a publication 14. The pub-
lication w~ll contain oducatio~al material to which the ~tudent i~
to be exposed. ~or the purpose of this example, let us consider
that the student is a physician. The publication might include
an article on a novel approach to dealing with a certain medical
(8a)
~L234~3'7
problem. The publication might also include a case study of
a situation to which test questions might be directed. Further~
more, the publication might include the actual question~ and,
associated with each question, a number of possible answers.
Whenever the physic~an would liko to be te~t~d on hi~ knowledge
of the material in the publication, he need on~y to go to any
telephone and communlcate with the ~ource center using stand-
ard telephone lines. When the physician reaches the source
center, the controller 15 would cause the equipment at the
source centex to answer the telephone in a human voice. The
voice would give the physician certain introductory material
and then introduce the contents of a first initiating declara-
tion file found in the storage unit l9 to the interface unit 21
for communication to the telephone 24. To assure that
physician receives credit ~or his interactive efforts ! each
physician will be asked to enter a preassigned continuing
education number. After that number is veri~ied, the interactive
educational sequence,will begin.
The first initiating declaration file to the physician
will include information necessary to pose a response inviting
statement in a human voice. This response-inviting statement will
generally be a question. Also contained in the first initiating
file will be a plurality of possible responses to the question and
those responses will be listed to the physician in a human voice.
The physician may then press the telephone button which corre-
sponds to the question which he believes is the most,correct. The
interface unlt 21 wlll react to the m~chlne-d1~tingulshAble slgn~l
generated by touching that buttsn and the controller will then
provide to the interface un~t 21 the contents of a reaction file
which corresponds to the particular tone cho~en by the physician.
~9)
~3,4~3'7
The reaction might be a simple statement that the answer is
either correct or incorrect. It might also include elabora-
tions and other sorts of information which might be useful in
maximi7ing the educational component of the interrogation. In
S the preferred embodiment, one of the telephone but~on~ would
commun$cate to the source location 11 that the physiclan would
like to have the possible answers repeated. Another button would
communicate that the phy~ician would like to move on to the
next question. The controller would keep trac~ of the correct-
ness of the students answers. The next question would be stored
in a second initiating declaration file and the process would be
continued throughout the number of questions.
In the normal procedure, the student would be required
to code in his identification number usin~ the telephone buttons.
In this way, the controller 15 would be able to provide a record
of the results of the examination to the accrediting organizationsO
This would normally be done through reports printed out by the
report-generating equipment 17. An additional important aspect
of this is that the student could be asked whether he would
like more information about the examination materials or whether
he would like in~ormation about products or services which
relate to the educational materials and which vendors would
like to sell to the students. This information could be commu-
nicated to the vendors to provide them with valuable commercial
leads.
(10
~3a~93~7
Because the system is automated, it can be avail-
able to the student at any time and from any phone location
which the student chooses~ ~uxthermore, the automated equip-
ment oan be pxogr~mmed in suah a way that additional on
line capacity can be automatically brought into force to deal
with large numbers of students wishing to use the system at a
given time. Thus~ the system is able to utilize all o~ the
efficiency generating characteristics of modern automation
and yet, because the system uses human ~oices to interact
with the student, the system retains a very human character.
The following is an actual example of some of the
textual material which might be used in a typical educational
module.
This example is directed to physicians. The
physician would xeceive a monthly publication, For each simu-
lated patient management problem, the publication would include
a brief patient history and a list of choices for each question.
The list would be brief--simpiy a reference so the physician
does not have to request that the questions be repeated. The
text might read as follows:
(11)
~3~a~9;~
PATIENT HISTORY
A 50-year-old white male presents with three weeks
of episodic fatigue and exertional dypsnea. Symptoms
have occurred at least once daily, and episodes have
lasted from a few minute$ to about one hour. With the
longer attacks, he notes a decreased ability to concen-
trate on hle work~ ~here h~ve boen no other aasocl~ted
symptoms.
The past history is notable only for peptic ulcer disease
at age 21, with no recurrence, but with occasional acid
indigestion. He smo~es one pack per day, and has about
four oUnces of alcohol daily. His family history is
unremarkable.
CHOICES
1. nitroglycerin
2. re-examine
3. echocardiogram
4. Holter monitor
5. stress test
6. thyroid test
7. upper ~I series
1. cardiovert
2. CCU
3. lung scan
4. quinidine
5. digoxin loading
6. digoxin maintenance
7. beta blocker
(12)
~3~337
~he publication would provide th physician with
the following instructions~
When you choose what you feel to be the best
course of action, indicate your choice by press-
ing the corresponding button on your telephone.
As soon as you enter your choice, you will find
out the outcome of that treatment. To maku a
s~cond o~oice, slmply press ~he ~orreapondlng
button on your telephone. You can contlnue to
make additional choices until you are satisfied
with the outcome of your decisions. If you
would like to have the questions repeated, press
the bottom left button~ the asterisk ~*~. When
~ou are satisfied with the pati~nt's response
to your choice, and are ready to go on, push the
bottom right button, the pound sign t#).
By picking up any/~ouch-~cne telephone, a physician could
hook up with an interactive, voice-responsive, patient
management problem that is truly a learning experience.
When the physician reached the source center, he would hear
the following in a human voice generated from the first
initiating declaration file in the storaye unit l9.
Thank you for calling the interactive CME tele-
phone line. You have chosen CARDIOLOGY MODULE I
and have had an opportunity to review the patient's
history.
On physical examination, this 50-year-old white ~ale
appears healthy, and is in no physical distress. Blood
pressure is 140 over 90, bilaterally. Pulse is 80
and occasionally irregular. The remainder of the
examination, including cardiac examination, in supine
and left lateral decubitus positions, is normal. Rou-
tine blood studies, resting electrocardiogram, and
chest x-ray are normal.
(13)
37
What would he ~our next step in the diagnosis and
treatment of this patient? ~n a moment, you will
be given several different options. When you choose
what you feel is the best course of action, indicate
your choice by pressing the corresponding button on
your telephone.
Choice one: you can prescribe nitroglycerin on a
pro~umptivo ~l~gno~1~ o~ ~ngln~ po~torlu. Chola0
two: you can re-examine your patient in both
standing and squatting positions. Choice three:
you can order an echocardiogram. Choice four: you
can order a Holter monitor. The fifth choice is a
stress test. The sixth choice is a thyroid function
test. And the seventh choice is ~o pursue the histor~
of indigestion with an upper GI series. Please make
a choice.
Depending on which button the physician presses, he
gets the following reactions in a human voice, generated from
one of the reaction files in the storage unit 19.
Button 1. The patient does not tolerate this
treatment. He has no relief of his symptoms, and
he feels--in fact--very badly.
Button 2. The patient's examination is ne~ative.
You can rule out mitral valve prolapse~ but still
need to consider other alternatives.
Button 3. The echocardiogram is normal. You can
rule out mitral valve prolapse in your consideration
of other alternatives.
Button 4. During the 24 hours the patient wears the
Holter monitor, it shows that he has recurrent runs
of atrial fibrillation, which--in fact--correlate
with his symptoms.
Button 5. There is a point five millimeter ST
depression in lead V5 when the patient reaches
85~ of his predicted heart rate, and he has no
symptoms at that time.
Button 6. Thyroid function is normal.
Button 7. The upper GI series is normal~
(14)
~l23~.~.33~7
When the physician is satisfied, he presses the
bound sign and hears the following in a human voice.
You have evaluated the results of whatever test
or tests you ordered. Your next step is to see
the patient again. When he comes to your office,
he is now in atrial fibrillation. He has a
ventricular rate of 140. You now have several
oholao~.
One: you can decide to electrically cardiovert
him. Two: you can admit him to the coronary
care unit~ Choice three: you can order a lung
scan, on the pr~sumption that he has recurrent
pulmonary emboli. The fourth pos~ibility: be-
cause your patient i5 in atrial ~ibxillation, you
can give him quinidine, 200 milligrams, four
times a day. Choice five: digitalize your
patient, giving him a loading dose of digoxin
in the ~irst 24 hours. Choice six: start
maintenance digoxin, giving point two five
milligrams for the ~irst three days, then re-
ducing the dose in half to point one two five
milligrams daily. Choice seven: give your
patient a beta-blocking drug. Please make a
choice.
As before, the physician would respond by pressing
a telephone button and would hear a reaction in a human voice.
Button 1. By the time you arrange with the
hospital to do the procedure, he's back in
regular rhythm. But you still need to diag-
nose his problem. Make another choice~ -
Button 2. You admit him to the coronary care
unit. He converts to regular rhythm spontaneously,
and has no further symptoms or arrhythmias for
48 hours. His en~ymes and EKG are all normal.
You still need to make another choice.
Button 3. The lung scan shows questionable
subsegmental areas of diminished perfusion at
the left lung base. At this point, you can
reconsider one of the other choices, or you can
order a pulmonary angiogram. If you choose to
order the angiogram, do so by pushing button
number eight.
~15)
~ 9~ ~
Button 4. The patient retuxns two days later.
He's still in fibrillation, feeling worse, and
his heart rate has now jumped to 180. Make
another choice.
Button 5. The next day the patient feels very
nauseated. He has skips in his heart beat, and
his electrocardiogram hows ventricular pre-
m~turo oon~A~tlo~u. Con~ldor anothor ahoiao.
Button 6 Your patient has no further symptoms
until ten days later. Then he has his usual
attack, but the symptoms are much milder. His
cardiogram reveals fibriliation, but a heart
rate of only 90. That's a good response'
Please push the pound button.
Button 7. Your patient complains that his medi-
cine makes him feel extremely tired all the time,
and tells you he can't take it. At this point,
you can reconsider one of the other treatment
regimens, or you can try another beta blocker.
If you want to try another beta blocker, do so
by pushing button number nine.
Button 8. As a result of the pulmonary angiogram,
you produce rapid atrial fibrillation by passing the
catheter, and your patient requires direct current
shock to get him back into regular rhythm. You
also produce a thrombosis of the femoral vein, and
the end result is that you also don't find any
emboli. If you chose to perform a pulmonary
angiogram on the basis of the lung scan, keep in
mind that the results of the scan, while somewhat
equivocal, were basically normal for a patient of
this age. The angiogram was clearly not a good
choice. Go back and make another choice.
Button 9. Your patient's arrhythmia is now under
control, and your patient tells you that his fatique
is "tolexable". If you want to consider another
choice, push the appropriate button. If you are
satisfied with this choice, push the pound sign.
(16~
1234L937
Pound sign button. A beta blocker is an
acceptable method of treatment~ However,
this patient responded best to a maintenance
dose of digoxin, with a reduction three days
later to half the initial dose. If you
chose this regimen, you might also consider
adding a long-acting quinldine preparation.
The quinl~in~ wlth the dl~oxln would ~rob~
ably elimlnate any further attac~s.
The diagnosis is paroxysmal atrial fibrilla-
tion in the absence of any underlying heart
disease. The diagnosis was confirmed by the
Holter monitor, which showed bursts of atrial
fibrillation, which correlated with the pa-
tient' 8 ~ymptom~. Further confirmation
would be elimination of any symptoms on a
regimen of digoxin and quinidine. If the
patient ever becomes intolerant of the
digoxin-quinidine regimen, the beta blocker
is an acceptable fallback position.
When the series of questions, answers and re-
actions is complete, the physician would hear the following
in a human voice.
That concludes this week's patient problem.
CARDIOLOGY MODULE I was brought to you by
, makers of . If
- you wouid like to receive~more information
about this clinical situation, please push
button number one. If you would like to have
a representative tell you more
about ~ ~~ , please push button
number two.
Be sure to call again next week, for a new
CARDIOLOGY MODULE patient problem. You can
hear a new program beginning every SaturdayO
Remember, for 00 Category I CME credits, you
can reach the CREDIT LINE 24 hours a day,
from your office, your ~ome, wherever you
can pick up a Touch-Tone phone.
(17)
~23~
This last paragraph demonstrates the market
research capability of this system. By combining auto-
mation with the human-voice question-answer-reaction se-
quence, a hlghly e~ lent method o~ ellcltlng ln~orm~tlon
over the telephone is developed.
It is obvious that minor changes may be made in
the form and construction of the invention without departin~
~rom the material spirit thereof. It is not, however,
desired to confine the invention to the exact form herein
shown and described, but it is desired to include all such
as properly come within the scope claimed.
The invention having been thus described, what 'lS
claimed as new and desired to secure by Letters Patent is
(18)
