1. Impact on research and development in the field of Socio-Technical systems. Our notion of hybrid society has the
potential to profoundly impact in this field. Recent researches highlight the aspects of interdependence and complex linkages between people (sociological systems) and ICTs (technological systems), and foretell the co-evolution of these connected systems. Such researches attempt to apply an understanding of the social structures, roles and rights (from the social sciences, and legal points of view) to inform the design of systems that involve communities of people and technology. We are inspired by the “general systems” theory, which attempts to find what the different disciplines of science have in common when they refer to systems. In fact, we intend to devise an architecture that may uniformly and flexibly represent, encompass and amalgamate relevant different interdisciplinary aspects. The envisaged “Hybrid Society” will be an incarnation of general systems theory, with a high level of flexibility.

2. Economic Impact. The economic impact of the project will be, in the Project’s follow-up when the proposed system will have been fully implemented and deployed, basically on sustainability of healthcare in Italy (and in perspective in Europe), and on the budget of families. This project has in fact the aim of modernizing the National Health Systems, and may deeply impact the digital transformation of the health system, which is one of the core goals of the Next-EU program EU4Health (https://ec.europa.eu/health/funding/eu4health_en) as well as of the National Recovery and Resilience Plan (PNRR in Italian), Mission 6 (Health). Families can reduce expenditures for private consultations to obtain personalized care plans and prevention strategies, as the PAs as envisaged in this Project are devised also in order to promote the self-management of chronic diseases by the patients themselves. The proposed system, thanks to its ability to provide qualified advice to patients, can potentially bring substantial savings to the National Health System concerning: (i) reduction in unnecessary tests, specialist consultations and emergency department visits, and, vice versa, (ii) reduction in hospital overcrowding, hospital days, and hospital costs related to a delay of the patients in consulting a specialist or going to the emergency department, (iii) reduction in overhead for clinicians, (i), (ii) and (iii) being all due to an inadequate patient’s or caregiver’s assessment of the severity of the situation. The amount of the savings can be better estimated during the case studies; however, studies show that just with a lifestyle and diet improvement, that the PAs could be able to promote, there would be a five-year savings (at a European scale) of approximately 37.5 billions [McCarron D. et al. (2004) ”Estimated healthcare savings associated with adequate dairy food intake”, American J. of Hypertension, Vol 17(1), 88–97], and that self-management interventions, enabled by the PAs, would lead to potential savings of $3.3 billion if the project results reached only 5% of the population with chronic diseases [Ahn, S. N. et al. (2013). ”The impact of chronic disease self-management programs: healthcare savings through a community-based intervention”. BMC Public Health 13].

3. Impact on the well-being of patients while allowing doctors to better organize their work. The envisaged system will be designed to generate personalized care plans where doctors from different specialities may cooperate to improve patients’ health. Existing health management systems include some useful features, such as the ability of continuously monitoring some health conditions and checking whether the patient is following the prescribed therapy. Our solution advances the state of the art, because plans devised by doctors for personalized medical and psychological care are managed by a PA entertaining a trust relationship with the patient. The PA can thus unobtrusively monitor whether a patient adheres to the prescribed protocol, can provide company and support in achieving nutritional and physical goals that involve some efforts and potential discomfort (checking whether the expected benefits are actually achieved), and also in case of serious illnesses involving invasive and painful therapies. This should result in better patient satisfaction, and in perceived higher well-being. Doctors rest assured to be consulted if necessary, and to be provided by the PAs with punctual and reliable reports on their patients’ conditions.

4. Impact on alleviating the problem of self-diagnosis. Recent data show that most people attempt a self-diagnosis by
searching on the Internet for which diseases are associated with their symptoms. The likely reasons are the immediate availability of information to satisfy one’s curiosities and anxieties and the fact that, sometimes, patients do not feel to receive adequate and clear explanations from medical doctors, either for lack of time or for lack of common terminology. However, with answers found on the Internet and not interpreted by a doctor, the risk of slipping into fake news or non-traditional unreliable treatment channels is high. PAs might alleviate the problem, since (in the perspective full implementations of our system) a PA can answer the user’s questions with all the time and patience in the world, can provide information and personalized explanations, can suggest slight rearrangements of the therapies, and can provide reassurances devised on the basis of the user’s profile.

5. Impact on gender issues in AI. In the Opinion on Artificial Intelligence by the EU Advisory Committee on Equal Opportunities for Women and Men (March 2020), it is suggested to “Increase the visibility of expert women in the field of AI […] by highlighting role models where possible.” They observe that the groups who currently design and use AI systems show a clear underrepresentation of women, and that current male predominance might act to some extent as a social censorship of women’s access to the AI field. In this Project, by explicit choice of the proposers we have tried to seriously address the issue of gender balance. In fact, the Principal Investigator and the Substitute Principal Investigator are women. The Principal Investigator, as an expert female researcher and developer in AI, commits herself since now to actively participate in dissemination activities so as to better inform and involve women at any level, whatever the age, qualification and job.

6. Impact on gender issues in healthcare. Gender-specific guidelines will be defined to develop PAs user interface, to mitigate the risk of reproducing gender bias. In fact, a PA can interact with users either via a chatbot or by being embodied in a robot; however, at present both chatbots and humanoid robots often reproduce the concept of the female figure as the key figure to support and assist. As regards case studies and dissemination, we will pay special attention to female healthcare personnel and caregivers, and to female medical students. Encouraging female personnel to be active users of AI eHealth systems should mitigate the problem of gender bias in medical practice and in the collection of medical data, that may lead to misdiagnosis and misdosage of medicines for women.