Virtual assistants like Amazon's Alexa could change the way care is delivered

Alexa can order your groceries, hail you a ride and tell you how many teaspoons are in a tablespoon (it's three).

Now, the Amazon virtual assistant can also give you medical advice and look up and recite clinical information.

Just as consumers are turning to voice-activated virtual assistants for tasks they previously performed on smartphones, healthcare providers and patients alike are beginning to do the same using devices from Amazon, Google and others that respond to a human voice.

Information from WebMD, for example, is available via Alexa, as is medical advice from Healthtap's Doctor A.I. Another tool, called One Drop, lets diabetes patients track their blood sugar information by telling it to Alexa.

Other pilot programs, run by hospitals, are in place so patients can ask Alexa questions about their health and providers can ask the digital assistant questions about protocols and other clinical information.

Although technological and HIPAA-related hurdles lie ahead, those types of changes stand to transform the way we interact with health information, making it more accessible and less onerous to use.

Now, with the tech industry singing the praises of voice as the next best interface, healthcare is joining the chorus as providers seek to boost patient engagement and reduce their administrative burden through the use of artificial intelligence-driven virtual assistants.

“Where we think it's going to have its ultimate great power is in the home,” said Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston, who sees Alexa as a tool that can help keep patients engaged and informed. “We want to keep you healthy in your home because we'll be paid for outcomes and quality.”

Because Alexa is already a consumer tool used in an estimated 8 million households, the promise for virtual assistants is huge.

“It's pretty darn likely that our grandkids will laugh at us for ever using a keyboard,” said Ben Greenberg, WebMD's vice president of mobile products and user experience. “Speech is such a more natural, hands-free, convenient and faster way to communicate.”

WebMD is banking on that being the case. The company has developed an Alexa “skill”—the name Amazon has given to what is essentially a voice app—to deliver some of its web content via voice in response to questions consumers ask their Alexa-enabled devices. Virtual assistants are expected to be adopted in healthcare because of their ability to offer interactions that feel natural, and they don't demand adopting an entirely new workflow because it's the same one used for talking to people.

Many consumer-facing applications, such as WebMD's, focus on giving patients information. Boston Children's Hospital's Alexa skill KidsMD, for instance, provides parents with healthcare advice about basic conditions that might affect their children.

“Voice has become this natural tool that people are now starting to adopt in the household,” said John Brownstein, chief innovation officer at Boston Children's. “Our idea was, why not bring healthcare experience to Alexa and give Alexa some healthcare education to arm families with information about acute conditions?”

Providing patients with that kind of information in the home is important given the simultaneous move toward value-based care and the ever-rising complexity of the healthcare system. “Over the last 30 years, people have become scared of the healthcare system because it's complex, and it's difficult to communicate with providers effectively,” said Harry Wang, senior director of research for Park Associates, a market research and consulting firm specializing in emerging consumer technologies. “Voice technology is erasing barriers and helping care providers manage patients more efficiently.”

Part of that work involves keeping patients up-to-speed and onboard with their care. “One of the big challenges in any population is getting patients engaged in their own care through digital experiences,” said Nathan Treloar, president and chief operating officer of software company Orbita. Those experiences might be a patient asking for a ride to a doctor appointment or receiving discharge instructions at home when they're not in a post-surgical haze.

“Voice is how everyone communicates most of the time. We want to recognize that,” said Dr. John Loughnane, chief of innovation for Winter Street Ventures, the healthcare accelerator affiliate of the Commonwealth Care Alliance, a specialized care delivery provider that's using Orbita to develop a way for its members to use Alexa to manage the use of personal care assistants.

“Especially for our patients with behavioral and physical barriers, we thought this could create a better care model,” he said. “It will directly impact care, making it more effective and more efficient.”

One of the ways it could drive efficiency is by reducing some of the burden on providers, whether that's scheduling or getting information about drug interactions. “Voice can be a quick way to get information,” Boston Children's Brownstein said, especially in sterile environments, where tapping on a screen or clicking with a mouse can be difficult.

Boston Children's is piloting the use of Alexa for giving information to clinical staff. “There's so much documentation,” Brownstein said. “For existing protocols or guidelines, we digitize that information and put it in a database. On the front end, you use voice to pull up that documentation.

But not everything can be pulled up so easily with a voice because voice devices do not conform to requirements under the Health Insurance Portability and Accountability Act. “Right now, we're not doing anything around patient information because of some of the limitations around HIPAA compliance,” Brownstein said. “Right now, it's very much focused on standard, non-identifiable information.”

Until the HIPAA barriers are overcome, the ways voice assistants are used likely will be less important clinically than they could be. Brian Kalis, managing director of digital health and innovation for Accenture's health practice, said that HIPAA compliance is the biggest barrier to widespread adoption of voice-driven virtual assistants. But Kalis expects Alexa and other voice services will eventually become HIPAA-compliant.

For that to happen, Amazon would have to make Alexa one of its HIPAA-eligible services, said Valerie Montague, a partner with the law firm Nixon Peabody. “Amazon has the structure; it's just a matter of implementing it for the Alexa product line,” she said.

But that can't happen until the technical aspects of HIPAA obligations are met. At this point, she said, “they don't have the appropriate processes and controls in place to protect protected health information.”

What's more, Montague said, providers would have to implement new processes too, figuring out who's allowed in the room when Alexa is being used, for instance, and what kind of measures to put in place so Alexa doesn't mishear something and cause a clinical error. “It's a lot bigger deal to order the wrong drug than it is to order the wrong pizza,” she said.

If Alexa or other virtual assistants were 
HIPAA-compliant, they could become more powerful. “You could imagine a dialogue,” Halamka said. “We think this combination of ambient listening plus services connected from an EHR to the cloud will allow us to give patients a much more positive experience than they have today.”

In the meantime, one way to get around the need for HIPAA compliance is to take advantage of Alexa's ignorance and be conscious of what information Alexa can glean from an interaction. Beth Israel Deaconess, for example, has been experimenting with how to use Alexa to give patients information about their care before the device itself is deemed HIPAA-compliant.

“Alexa has no idea who the person asking is,” Halamka said, so the information transmitted can't be linked to a specific patient.

The hospital is now pilot-testing technology that would let patients ask the virtual assistant questions like “What's my room number?” or “What's my care plan for today?"