The new voice of pa­tient en­gage­ment is a com­puter

Modern Healthcare - - NEWS - By Rachel Z. Arndt

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.

“Where we think it’s go­ing to have its ul­ti­mate great power is in the home. We want to keep you healthy in your home be­cause we’ll be paid for out­comes and qual­ity.”

Dr. John Halamka Chief in­for­ma­tion of­fi­cer Beth Is­rael Dea­coness Med­i­cal Cen­ter

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-tospeed 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 Lough­lane, 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.”

HIPAA hur­dles

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 im­ple- ment­ing 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?”

Not ev­ery­thing can be pulled up so eas­ily with a voice be­cause the de­vices do not con­form to re­quire­ments un­der the Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act.

Tap is one of many Ama­zon de­vices fea­tur­ing Alexa.

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