What Will Health Care Look Like Once Smart Speakers Are Everywhere?

mar18_7_hayonthapaliya — Hayon Thapaliya for HBR

Voice-powered technologies such as Siri, Alexa, Google Assistant, and Cortana, are changing the way people shop, drive cars, and manage their homes. Studies have suggested that, by 2020, 50% of all searches will be conducted by voice and smart speakers are expected to reach 55% of U.S. households by 2022. It is no different for physicians. In a nationwide survey of pediatricians conducted by Boston Children’s Hospital (not yet published), 62% of respondents said they have used voice-assistant technology, and one-third own, and use, at least one “smart speaker.”

Simple voice-dictation software such as Dragon that is used to capture clinical notes in electronic medical records is now fairly common in clinical settings. But voice assistants can do much more — for example, quickly surfacing actionable information from medical records and offering it to clinical teams. Seeing the potential to improve health care, the Innovation and Digital Health Accelerator (IDHA) at Boston Children’s Hospital is piloting voice-assistant technologies and is finding physician receptivity to it to be greater than anticipated.

Voice in the Hospital and at Home

In 2016, IDHA began by hosting a “Voice in Healthcare” hackathon that featured live, voice-powered demonstrations in partnership with the Boston Children’s Simulator Program. In a simulated patient’s room, parents learned how to clean a central intravenous catheter; in the ICU, nurses were “talked through” instructions for collecting a specimen; in the OR, physicians practiced using voice to document images from an endoscopy procedure in real time; in a mock outpatient setting, the technician received spoken lab results. Ideation, or brainstorming, sessions with stakeholders followed.

Based on this event, IDHA began introducing voice technology with three discrete pilots:

The intensive care unit. In the health care setting, where sterile operating fields and infection control are priorities, hands-free, immediate access to information has big advantages in terms of safety and efficiency. IDHA’s voice deployment in the Boston Children’s ICU allows nurses to ask for key administrative information: “Who is the charge nurse on 7 South?” “How many beds are available on 8 East?” Clinicians are finding voice most useful for getting information that would otherwise involve picking up the phone, searching through documents, or walking down the hall. Voice can quickly access guidelines and protocols and save critical minutes in environments where seconds can have a dramatic impact on outcomes. In the future IDHA hopes to make this a “learning” system that anticipates information needs and provides just-in-time guidance.

Organ transplant. Boston Children’s is one of the world’s busiest pediatric transplant-surgery hospitals. The transplant team turned to IDHA for help in streamlining the pre-operative organ-validation and checklist process. We piloted a real-time, hands-free, voice-prompted checklist process. While the project is still early in prototype mode, the team is enthusiastic about how easy the voice assistant is to use, its potential to reduce human error, and the hands-free step-by-step validation.

Home health decisions. Voice is also becoming an ally for supporting patients’ decision making. KidsMD, broadly available through Amazon Alexa, allows parents to converse with Alexa around symptoms of common illnesses — such as ear infections, fever and the common cold and receive customized guidance and education from Boston Children’s Hospital, including suggestions for when to visit the doctor and how to care for a sick child at home. KIdsMD has logged 100,000 interactions to date, and IDHA plans to bring other kinds of wellness and disease-specific education to home voice assistants that consumers can access even more easily and intuitively.

Do Physicians Want Voice?

Research among clinicians is affirming our optimism about voice in health care. Of the pediatricians we surveyed, 48% would be willing to deploy the technology in their clinical setting. Only 16% stated they would not try voice. Another 36% were undecided, many of whom cited a lack of familiarity with how the technology could support patient care.

Many physicians said they would use voice-assistant technology for clinical decision support in their office or home. They were much less inclined to do so in the presence of their patients. “I would use this anywhere the patient could not hear it,” said one. “If the patient hears the responses in the exam room and then I choose something different, the patient may not trust my choice,” another told us.

Physicians are, however, receptive to using digital voice assistants in the waiting room, separate clinical space, and in the patient’s home to educate patients and answer questions they don’t have time to address during a short visit. Additionally, they can imagine patients using an interactive voice system to populate medical questionnaires before their visit, saving them time and frustration. Voice assistants seem to be a useful way to start patient education and engagement in the clinic and have it continue at home.

Content is King

From these deployments, IDHA has learned that the reliability of voice technology is more about the content than the technology itself. In our survey, 55% of respondents were “somewhat” confident about the reliability of answers from a voice assistant, but only 7% were very confident. Trusting the source makes a difference: Sixty-eight percent of respondents said that knowing the content came from Boston Children’s would increase their confidence in the information provided.

Building an application that presents reliable information from vast amounts of disparate data in an accessible format requires the involvement of multiple experts in curating and vetting the content. Health care-focused platforms like Orbita can help effectively deploy that content. Due to the interactive nature of voice and the variability in how people interact via voice, content delivered to users should also go through a design process that involves user experience professionals and extended testing among clinician stakeholders.

Limitations of Voice Technology

For a number of reasons, voice is not yet the ubiquitous solution that we, at Boston Children’s Hospital, believe it will soon become. The number one concern is patient privacy. Currently, no consumer voice assistants are HIPAA compliant, potentially leaving confidential information unprotected.

Another limitation is the challenge of clear voice communication in a noisy and busy clinical setting, particularly when complex medical vocabulary is required. In some situations, it may be necessary to add visual support (such as the screen offering of an Amazon Show device or integrating the voice assistant with screen shots on the computer). Clinical guidelines or graphical displays of data are enhanced when we both “show” and “tell.”

Finally, there are obvious logistical factors: Wi-Fi access and the need for a secure place to keep the device can be challenging in some units within a hospital.

There are many benefits to voice in health care, but IDHA sees one supporting clinician and patient decision making as one of its greatest potentials. Over half of the physicians we surveyed already turn to online resources and guidelines when they are unsure of the appropriate treatment options, so we see great promise in well-curated, voice-activated decision-support tools. Indeed, these will be the focus of the next phase of voice deployment at Boston Children’s Hospital. Look forward to hearing more.

The authors would like to recognize software architect Nitin Gujral for his design and development work on the voice-in-health-care projects at Boston Children’s Hospital.