Digital voice assistants such as Amazon Echo and Google Home could add a PhD after their names in the near future.

In an exclusive interview with Clinical Innovation & Technology at HIMSS 2017 in Orlando, Nathan Treloar, president and COO of Orbita, a firm focused on connected home healthcare solutions, explains how digital voice assistants have advanced and what’s to come in the future.

Clinical Innovation & Technology: Can you give us a summary of how digital voice assistants are improving patient engagement?

Nathan Treloar: We believe voice assistants like Amazon Alexa—Alexa is Amazon’s voice assistant software, Echo is the physical device—and Google’s counterpart—Google Assistant and Google Home—will transform patient engagement in home healthcare, for three reasons:

1. Voice is simply a more natural way for humans to interact.
2. An always-on, always-available virtual assistant removes physical barriers of adoptions.
3. The fact that these experience include more than just monitoring or healthcare-specific features makes it more of a “whole health” solution.

This last point is important. One of the main complaints of digital home healthcare and so-called "remote monitoring solutions" is that patients do not want to feel they are being monitored nor do they want to be constantly reminded about their condition or illness. The fact that you can ask Alexa the weather, have her play your favorite song and check your care attendant schedule (with an Orbita-powered solution), we assert, will drive much more engagement than a standalone app for monitoring a few healthcare vitals.

Are patients hesitant to use such applications? Are older patients more skeptical?

Like any new technology, some individuals warm to it more quickly than others. But relative to smartphone apps, our studies indicate that voice assistant technology like the Amazon Echo is much more likely to be embraced by the elderly and technophobes. In addition to being a much more natural interface, it is better suited to individuals with impaired vision, which includes a significant percentage of the elderly population. Adoption is, of course, also highly dependent on the quality of the experience itself. A poorly designed voice experience will suffer the same sort of adoption and abandonment issues as a poorly designed website or smartphone app.

Are there limitations to exactly how these devices can improve patient engagement?

Yes, there are limitations. It is not for everyone. For starters, the patient needs to be able to speak clearly and loudly enough so that the voice assistant can understand. The technology has improved dramatically in the past few years, but it is still not quite as good as a human at interpreting all the nuances of speech. Also, devices like the Echo are designed to work in the home, not in loud common areas. So, they are not particularly well-suited, for example, for a hospital reception area. Finally, they are intrinsically language dependent. Alexa supports English and German only, right now.

Could such interfaces, one day, be the fastest link between patient and physician?

Soon. It is possible now to initiate a phone call through Alexa commands—for example, “Alexa, call my doctor”—but it not possible to have a conversation with another person over the Echo device itself. Not yet, anyway. We expect this to change as it is an obvious and potentially valuable feature.

What do you see this technology going in the next three or five years?

We expect voice to be a much more mainstream user experience across a variety of applications. It will not replace smartphones, tablets and other digital interfaces, but it will become common for applications in settings where voice is simply a more convenient interface—in the home while doing the dishes, preparing a meal, bathing, etc. The core technology will also continue to improve as providers like Amazon and Google refine their algorithms. Lastly, we expect healthcare-specific voice experiences to become more commonplace and standardized.

Did you face challenges complying with HIPAA? What was the most difficult aspect of meeting regulations?

Orbita is a HIPAA-compliant business, which means we have in place processes, policies and technology to ensure that any protected healthcare information we touch is kept private and secure. Amazon does not claim HIPAA-compliance for Amazon Alexa, so we must take efforts to anonymize all patient data that passes through the voice applications we power. If a patient, for example, reports a healthcare vital through an Orbita-powered voice experience, Amazon Alexa will see only an encrypted number that identifies the patient solely in the secure Orbita system. No protected health information is stored with Amazon Alexa.

Patient data safety is a major concern for users, how are these technologies keeping that information safe?

We can learn from other similar solutions—specifically interactive voice response or interactive voice response—about how to ensure protection of patient data. For example, like these systems, a best practice we have implemented in our voice assistant technology is to require the user to provide a PIN to confirm access to the voice application.