Dr Alexa is now available
In the future it is likely that voice recognition technologies will be utilised in mainstream health care, offering a diverse patient experience and reducing the administrative load on physicians, which is a major cause of burnout. It is estimated that by 2020, half of all internet searches will be conducted by voice-first rather than through typed search inputs.
Voice user interface (VUI) is a speech recognition technology that allows people to use voice as the input to control a range of devices. Google Home, Amazon ‘Alexa’ and Apple ‘Siri’ are examples. VUI can already analyse medical questions in order to achieve specific in-clinic uses and/or to aid healthcare delivery to patients within their homes. The recent announcement by Amazon that Alexa has achieved compliance with HIPAA has signaled that the vision for voice-first technologies is being realised, and demonstrates that voice-first health is an area that will need to be considered by early to mid-career healthcare professionals.
Alexa is HIPAA compliant
As mentioned, Amazon’s voice-interactive device ‘Alexa’ is now HIPAA compliant through the new Alexa Skills Kit. The Alexa Skills Kit enables Alexa to be utilised in particular healthcare capacities to transmit patients’ protected health information (PHI) in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
The purpose of HIPAA is to protect the collection and use of PHI. Amazon is now able to execute business associate agreements (BAAs) with HIPAA-covered entities, such as hospitals, to safeguard data in compliance with HIPAA guidelines. BAAs are generally required contracts for any organisation (a ‘business associate’) providing a HIPAA-eligible service to a covered entity.
This is a significant milestone in the delivery of voice-of-health technologies as, up until now, compliance with these laws has been a barrier preventing the transmission of PHI. However, Alexa will need to achieve compliance with Australian laws before its healthcare skills can be offered here.
The healthcare skills are at present only available to applications developers by invitation only, however, Amazon has stated that it expects to include additional companies and skills. The new healthcare skills that were launched for US consumers are as follows:
- Express Scripts (a Pharmacy Services Organisation): this enables the status of home delivery prescriptions to be checked and notifications provided via Alexa when shipment of prescriptions has taken place.
- Cigna Health Today (by Cigna, the global health service company): this skill enables certain eligible employees to monitor their health care using Alexa and receive incentives to do so.
- My Children's Enhanced Recovery After Surgery (ERAS) (by Boston Children's Hospital): progress on recovery of children at Boston Children’s Hospital and information about postoperative care can be provided to parents and caregivers via Alexa.
- Swedish Health Connect (by Providence St. Joseph Health, a healthcare system with 51 hospitals across 7 states and 829 clinics): the skill enables a patient to locate an urgent care center in proximity to them and schedule a same-day appointment.
- Atrium Health (a healthcare system with more than 40 hospitals and 900 care locations throughout North and South Carolina and Georgia): this skill enables customers in North and South Carolina to locate an urgent care centre near them and schedule a same-day appointment.
Livongo (a consumer digital health company that creates new and different experiences for people with chronic conditions): members can ask Alexa for their blood sugar readings, blood sugar measurement trends, and receive insights and Health Nudges that are personalised.
Purported benefits and oversight
VUI may make it easier for patients to access medical information. Given that VUI mimics ‘human’ interactions, some patients may feel more comfortable when speaking about their medical issues to a VUI device than when speaking to a human because they feel less pressure and judgment. Therefore, VUI may in certain contexts remove healthcare barriers and improve the patient experience.
Furthermore, patients can now use Amazon Alexa as a personal assistant to find urgent care facilities, determine their blood sugar readings, find wait-time information and schedule appointments. The expansion of VUI allows patients to become more engaged in their healthcare delivery.
An additional benefit is that VUI devices can help physicians save vital time writing patient notes because they can speak into a VUI device more quickly than they can write or type. VUI devices could thus potentially ease the pressures associated with administrative tasks.
There are questions of whether VUI could help reduce errors with the input and review of information contained in patient management systems. This is of particular interest in light of recent cases of medical mistakes and deaths from use of electronic patient management systems. Thus, the ability for VUI to benefit health care in this regard will be in its ability to accurately detect words spoken and transcribe these, as well as extract relevant data with high-level accuracy; purported benefits that will no doubt be subject to clinical trials in the future to determine the ability of VUI to reduce mistakes and achieve clinical benefits.
We also anticipate that privacy, ownership and control of data matters will require additional consideration by lawmakers, voice-of-technology companies and users as the range of medical skills expands.
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