Why voice-technology will transform healthcare
Alexa, I took my medications and checked my blood glucose today
I will admit that I am a big Alexa fan despite the recent privacy concerns — truly, Alexa makes my life easier. I use Alexa to help me with my schedule, to understand the weather outside before leaving the house, to walk me through recipes, and to play music on demand.
Voice-technology has brought the benefit of convenience and ease-of-use to technology interfaces. I can communicate hands-free, I do not need to navigate (or, learn) the various software application UI/UX, and it is a very natural method of communication. But, what is, perhaps, more important is the ability to receive a voice-prompt from the device.
Healthcare is plagued by a lack of user-friendliness, a failure to collect or leverage data, and poor communication. We have all experienced the long wait times, the unintelligible labwork, the missed prescriptions, the 15-minute visits with physicians, and plenty of other system failures.
System gaps like these have a major impact on patient outcomes and the ability to successfully manage their conditions — particularly chronic conditions. The number varies a bit, but about 75% of our national healthcare spending is attributable to chronic disease.
Conditions like diabetes, heart disease, cancer, COPD, autoimmune conditions, and dementia-related illness are the major disease-drivers of our healthcare spending.
Our healthcare model is often referred to as reactive. It diagnoses patients when they are sick, it suggests a treatment plan, and it throws patients out into the world with the expectation that they self-manage their conditions.
When this goes wrong, the system reacts once the patient shows up to the emergency department or hospital for an inpatient stay.
This model is effective for car accidents, infectious diseases, and conditions that occur infrequently — in fact, much of the system we inherited from our past was built to handle industrial accidents.
But, for these lifelong chronic conditions, the system fails to provide the support that helps patients manage their conditions in their daily lives. Because of this, there has been a large movement to innovate in ways that flip the health system to a more proactive model.
The digital health industry has emerged with this goal in mind. The use of technology, mobile devices, and wearables to collect real-time data and to facilitate communication with a patient’s care team is the overarching goal.
We have seen the growth of these technologies over the past decade with billions of dollars of investment. Now, in the time of COVID-19, venture capital funding of digital health companies that help facilitate virtual, telehealth, and remote patient care has skyrocketed (figure 1).
In the first quarter of 2020 alone, $3.1 billion has been pumped into digital health companies that can help the healthcare system provide services during a pandemic.
These companies are primarily mobile- and web-app-based solutions and represent the whole medical field when it comes to disease specialization, target customers, and specific clinical focus.
The overall digitization of healthcare is well-overdue (figure 2), and, now that COVID-19 has come along, the revolution appears to be arriving a few years faster than previously anticipated.
Prior to COVID-19, much of the focus in the space had been on chronic conditions like diabetes and heart disease (hypertension and CHF).
Technology has been theorized as core to the ways in which the reactive models can be transformed for patients with these conditions.
Enter Voice-Technology
Voice-technology has been slow to diffuse into the consumer tech market. We all remember Apple’s Siri hitting the market early on, and those of us with iPhones, know that it is not a perfect product.
But, advancements in speech recognition, text-to-speech technologies, artificial intelligence, and cloud-based computing have pushed voice-technology into the home of millions across the globe.
This is a big development. Amazon’s Alexa, in my experience, works pretty well. Each day as users have new interactions and new skills are added, Alexa is able to learn and improve. Now that the technology is more reliable and diffuse, it has opened the door for healthcare use-case exploration.
When it comes to any tech in healthcare, reliability is a crucial component when lives are on the line. There is a certain threshold of trust that is required for healthcare adoption of any technology.
Voice-tech + Chronic Disease Management
With a product we can trust, the field is open for the development of healthcare solutions that leverage voice-technology. This is crucial to the chronic disease issue.
Any new model looking to provide enhanced care to patients with chronic illness must seek to collect more frequent actionable data and must more effectively communicate with patients — at a bare minimum.
The benefits of voice-tech as it can be related to chronic disease care models can be broken down into three major categories: 1) improved accessibility for all users, 2) improved patient engagement, and 3) and home-based locations.
When we look at the patient-populations with the highest rates of chronic disease we find ourselves looking at an older demographic above the age of 50. Among Medicare beneficiaries (age 65+) the rates are high.
Medicare data reveals the scale of the problem. Among beneficiaries, conditions with the highest prevalence rates are hypertension (58.7%) and high cholesterol (48.3%). Roughly, one-third of the population has been treated for arthritis (34.2%), ischemic heart disease (27.8%), and/or diabetes (28%).
With aging comes mobility issues and the diseases of longevity. But, when it comes to providing more effective care for the patients in the Medicare demographic, the use of mobile technology becomes a bit more challenging.
My grandma is ~71 years old and she is a tablet/iPhone user. She knows how to do things and can be easily taught to use a digital health application — in fact, I already have. There are many people from age 50–70 that are either tech-native or have adopted the technologies with relative ease.
However, there are many people that have not taken to the smartphones and mobile-technologies with the same affinity of others. These individuals are the people that may benefit from the ease-of-use and accessibility of voice-technologies.
In either case, the benefits of voice-technology span the population. Both young and old can benefit from engaging interactions with Alexa and Google Home. When it comes to older adults, the focus of digital health companies is on accessibility and ease-of-use.
But, the core metric that is essential to these companies’ success is patient engagement — the number of users and their frequency of sustained use of the applications.
This is where voice-technologies can be inserted to improve real-time data collection and supported the self-management of conditions. It is easy to use and the capabilities are excellent and engaging. The voice-technology is also based in the home where the patient spends the majority of their time outside of the health system.
It is crucial to meet patients in their daily lives when you are looking to support them in a life-long condition journey. Home-based care has accelerated in recent years and the trend will continue. Now, COVID-19 transformed the existing trend into a major need.
An Example: Boston Children’s Hospital
To provide a concrete example, one of the first Alexa-based health applications is Boston Children’s Hospital’s MyChildren’s Enhanced Recovery After Surgery Alexa Skill.
While not specifically for chronic disease, this is one of the first use-cases of Alexa for a home-based care management solution. Here is the description of the skill:
This skill, developed by Boston Children’s Hospital, is part of the Enhanced Recovery After Surgery (ERAS) program, which is designed to help parents and caregivers of children who have recently undergone heart surgery. In its first version, the skill will support parents and caregivers post-discharge, allowing them to provide quick updates to their care team around recovery progress (including pain and activity level). Additionally, Alexa can provide parents and caregivers information regarding their scheduled post-op appointments.
The Alexa prompts can help parents communicate with their child’s care team and can collect real-time data (e.g. pain and activity level). These data points are crucial to understanding the condition of the patient after surgery, and, in our current system, the expectation may be that the patient reaches out if there is a problem so the system can step-in — reactive.
Now, through Alexa, the care team is able to proactively monitor patients and can step-in quickly if something wrong is detected.
For patients with chronic conditions like diabetes, Alexa can collect information on a patient’s insulin adherence, blood glucose readings, and daily symptoms. Alexa can provide reminders to take medications (medication adherence issues is a major driver of cost) and can provide educational resources for patients.
If something of concern is identified, that patient can be flagged for outreach from a healthcare professional before the sirens start sounding and the emergency department becomes a life-saving need.
Voice-technology has the potential to bring more proactive and effective care to patients. By facilitating clinical data collection more frequently and in real-time, patients can be guided towards healthy behaviors and a clinical safety-net can be established to step in for patients when needed.
It is also fun, engaging, and relatively passive. In the next four years, I predict that voice-tech will continue to be leveraged in the healthcare system.
Robert L. Longyear III is the author of Innovating for Wellness, a book about innovation in healthcare covering health policy and digital health. He is VP of Digital Health and Innovation at Wanderly and a former Medicaid researcher focused on value-based payment, high-risk care coordination, and social determinants of health.
