Case Study: xAPI at The U-M Health System’s Stroke Center


The University of Michigan Health System is an academic medical center owned by the University of Michigan (U-M) in Ann Arbor, Michigan. The Health System is widely regarded as a premier research institution and has been named to U.S. News & World Report’s “Honor Roll of America’s Best Hospitals” 17 times. It is one of the world’s top hospitals in several areas of specialized care including Neurology and Neurosurgery. The U-M Neurosciences has been officially certified by the Joint Commission (a medical accreditation organization recognized by the American Heart Association and the American Stroke Association) as a Comprehensive Stroke Center for its commitment to continuous improvement and high quality patient care.


Stroke is a significant health risk in the United States. It’s the leading cause of long-term disability and the fourth leading cause of death. The University of Michigan Health System’s Stroke Center team wanted a way to educate the public to recognize symptoms of a stroke and to get potential stroke victims to the emergency department quickly. Speed is of the essence as timely treatment and medication can dramatically reduce the impact and severity of stroke.


TorranceLearning helped the Stroke Center’s team deliver quick, video-based learning via tablet to non-stroke patients sitting in clinics and doctors’ offices while waiting for their routine doctor appointments. The team will then evaluate an immediate increase in knowledge as well as longer term impact on stroke recognition and early treatment. The initial target audience is a low-literacy population, so there’s very little text on screen and information is largely audio-visual. The learner chooses a narrator/guide for their experience and watches an informational video about responding to stroke. Then the learner can watch one or more video scenarios and select how to respond in each case: wait and do nothing, drive to the hospital, call 911 for an ambulance, or call the doctor.

The tablets may not always be connected to the internet during use, so the transactions are stored locally on the tablet and transmitted once the tablet connects to Wi-Fi.


The tablets are offline while the learners use them. A number of course development tools and LMS products provide offline SCORM players, but the xAPI was designed to work disconnected from the Internet. It constructs and stores the activity statements locally. Once connected to the Internet, it sends the statements, checks to ensure receipt, and then clears the statements from local storage to avoid duplicate sends later on.

Learners are allowed multiple attempts at each video scenario, and with the xAPI we record each attempt. This allows us to compare success rates over time and experience. Although some more sophisticated LMS products do handle repeated attempts in a traditional SCORM approach, only the last attempt is stored and reported in the LMS. Learners are presented with a screen displaying eight people who represent a range of ages, genders, and races. Users choose a narrator/guide for the interactions from this menu. Their selection is sent as an xAPI statement, which is further subdivided by gender and race.

Learners do not log in but are instead tracked using an anonymous unique identifier. xAPI allows the Stroke Center to collect the statements and analyze the data without requiring learner login or personal information so no privacy laws are compromised.

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