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August 7, 2017

Voice-activated assistants like Alexa could change hospitals—but can the law keep up?

Daily Briefing

Voice-activated virtual assistants are gaining traction among consumers, and hospitals and health care systems are taking note—and trying to navigate laws written at a time when tools such as Alexa and Siri were just science fiction, Modern Healthcare's Rachel Arndt reports.

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Alexa is currently used in an estimated eight million households, and a recent report estimates that more than 35 million U.S. residents will use some type of voice-activated tool at least once per month this year. According to Arndt, consumers are using the devices from Amazon, Google, and others "for tasks they previously performed on smartphones."

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

How hospitals, health systems are using virtual assistants

The health care industry's shift toward voice-activated virtual assistants is part of a broader effort to demystify the health care process: making health care less complicated and a bit more approachable for the average person, Arndt writes.

John Halamka, chief information officer at Beth Israel Deaconess Medical Center, said such tools can help patients stay engaged and informed about their care. "Where we think it's going to have its ultimate great power is in the home," he said, adding, "We want to keep you healthy in your home because we'll be paid for outcomes and quality."

For instance, Nathan Treloar, the president and COO of software company Orbita, said voice-activated virtual assistants could be used by patients who need a ride to the doctor's office, or they could provide discharged patients instructions on their care after they get home and have had time to relax.

According to Arndt, the Commonwealth Care Alliance is working with Orbita to develop software that would allow its members to manage their personal care assistants using Alexa. John Loughnane—chief of innovation for Winter Street Ventures, the health care accelerator affiliate of the Commonwealth Care Alliance—said, "Especially for our patients with behavioral and physical barriers, we thought this could create a better care model. It will directly impact care, making it more effective and more efficient."

WebMD, which was recently purchased by the private-equity firm KKR, developed an Alexa "skill"—the term Amazon uses to describe applications for its device—to provide some of the site's content in response to questions consumers may ask through Alexa-enabled devices.

Similarly, the Mayo Clinic is making health care information from the Mayo Clinic News Network available via Alexa. Consumers can now use their Echo-enabled devices to seek answers to voice queries on various topics, including cancer, cardiovascular care, brain health, transplants, advances in research, and tips for living a healthy lifestyle.

"At Mayo Clinic, the needs of the patients come first, and this latest technology is one more way to reach patients where they are," said John Wald, the medical director at Mayo Clinic Public Affairs and Marketing.

Beth Israel Deaconess also is piloting different ways to use Alexa to provide patient-specific information. For instance, the hospital hopes to be able to use Alexa to answer patient queries such as, "What's my room number?" or "What's my care plan for today?" Halamka said,the use should not raise patient privacy concerns, as "Alexa has no idea who the person asking is."

Boston Children's Hospital also has developed an Alexa skill, called KidsMD, that provides parents with basic health care advice on conditions that might affect their children. The hospital also is piloting the use of Alexa to support clinical staff. "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," Brownstein said.

One major obstacle

But there is one major legal obstacle preventing the full clinical integration of virtual assistants: HIPAA.

"Right now, we're not doing anything around patient information because of some of the limitations around HIPAA compliance," said Brownstein. "Right now, it's very much focused on standard, non-identifiable information."

Valerie Montague, partner with the law firm Nixon Peabody, noted that providers must also deal with legal obstacles such as determining who should be permitted to be in the room when Alexa is in use.

No virtual assistants currently conform to HIPAA standards, Arndt reports. However, Brian Kalis, the managing director of digital health and innovation for Accenture, believes that these devices will eventually become HIPAA-compliant.

Once that happens, Halamka envisions that virtual assistants could be used to facilitate "a dialogue." He 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" (Arndt, Modern Healthcare, 7/31; Streed, Mayo Clinic News Network, 6/6).

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