Alexa Can Truly Give Patients a Voice in Their Health Care (Part 1 of 3)

Posted on October 16, 2017 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The leading pharmaceutical and medical company Merck, together with Amazon Web Services, has recently been exploring the potential health impacts of voice interfaces and natural language processing (NLP) through an Alexa Diabetes Challenge. I recently talked to the five finalists in this challenge. This article explores the potential of new interfaces to transform the handling of chronic disease, and what the challenge reveals about currently available technology.

Alexa, of course, is the ground-breaking system that brings everyday voice interaction with computers into the home. Most of its uses are trivial (you can ask about today’s weather or change channels on your TV), but one must not underestimate the immense power of combining artificial intelligence with speech, one of the most basic and essential human activities. The potential of this interface for disabled or disoriented people is particularly intriguing.

The diabetes challenge is a nice focal point for exploring the more serious contribution made by voice interfaces and NLP. Because of the alarming global spread of this illness, the challenge also presents immediate opportunities that I hope the participants succeed in productizing and releasing into the field. Using the challenge’s published criteria, the judges today announced Sugarpod from Wellpepper as the winner.

This article will list some common themes among the five finalists, look at the background about current EHR interfaces and NLP, and say a bit about the unique achievement of each finalist.

Common themes

Overlapping visions of goals, problems, and solutions appeared among the finalists I interviewed for the diabetes challenge:

  • A voice interface allows more frequent and easier interactions with at-risk individuals who have chronic conditions, potentially achieving the behavioral health goal of helping a person make the right health decisions on a daily or even hourly basis.

  • Contestants seek to integrate many levels of patient intervention into their tools: responding to questions, collecting vital signs and behavioral data, issuing alerts, providing recommendations, delivering educational background material, and so on.

  • Services in this challenge go far beyond interactions between Alexa and the individual. The systems commonly anonymize and aggregate data in order to perform analytics that they hope will improve the service and provide valuable public health information to health care providers. They also facilitate communication of crucial health data between the individual and her care team.

  • Given the use of data and AI, customization is a big part of the tools. They are expected to determine the unique characteristics of each patient’s disease and behavior, and adapt their advice to the individual.

  • In addition to Alexa’s built-in language recognition capabilities, Amazon provides the Lex service for sophisticated text processing. Some contestants used Lex, while others drew on other research they had done building their own natural language processing engines.

  • Alexa never initiates a dialog, merely responding when the user wakes it up. The device can present a visual or audio notification when new material is present, but it still depends on the user to request the content. Thus, contestants are using other channels to deliver reminders and alerts such as messaging on the individual’s cell phone or alerting a provider.

  • Alexa is not HIPAA-compliant, but may achieve compliance in the future. This would help health services turn their voice interfaces into viable products and enter the mainstream.

Some background on interfaces and NLP

The poor state of current computing interfaces in the medical field is no secret–in fact, it is one of the loudest and most insistent complaints by doctors, such as on sites like KevinMD. You can visit Healthcare IT News or JAMA regularly and read the damning indictments.

Several factors can be blamed for this situation, including unsophisticated electronic health records (EHRs) and arbitrary reporting requirements by Centers for Medicare & Medicaid Services (CMS). Natural language processing may provide one of the technical solutions to these problems. The NLP services by Nuance are already famous. An encouraging study finds substantial time savings through using NLP to enter doctor’s insights. And on the other end–where doctors are searching the notes they previously entered for information–a service called Butter.ai uses NLP for intelligent searches. Unsurprisingly, the American Health Information Management Association (AHIMA) looks forward to the contributions of NLP.

Some app developers are now exploring voice interfaces and NLP on the patient side. I covered two such companies, including the one that ultimately won the Alexa Diabetes Challenge, in another article. In general, developers using these interfaces hope to eliminate the fuss and abstraction in health apps that frustrate many consumers, thereby reaching new populations and interacting with them more frequently, with deeper relationships.

The next two parts of this article turn to each of the five finalists, to show the use they are making of Alexa.