Can we use voice assistants in helping people with chronic conditions and capture health events
Management of chronic conditions has always been challenging, especially for younger patients and the families with children having medical complexities (CMC). We formed a team of clinicians, developers, designers, nurses, caregivers, scientists and clinical informaticians to discuss current problems, opportunities and challenges in using technology in medical communications and care coordination. We gathered recommendations to improve not only record keeping of patient care at home, but also communications among patients, caregivers, and care providers through technological solutions.*
Who are CMC?
CMC are the kids who have medical fragility, medical technology dependence, functional impairment, and intensive care needs. Commonly, they are one of the most frequently hospitalized kids, care follow-ups are more complex compared with regular patients, requiring multiple specialties, they use multiple medications, and they are more likely to have complications post discharge.
Challenges
Helping CMC and families provide the right home-administered treatments at the right time, promptly documenting clinical events (medication, therapy, oxygen treatment, etc), recording symptoms as they happen, and reaching out for timely assistance are critical to promote self-management and coordinated care skills and for successful care coordination. Within the scope of home care and use of technologies for care coordination, we identified 3 problematic care coordination gaps to be addressed:
1. Untimely and incomplete capture of health events at home
2. Lack of home care coordination tools
3. Long term adoption problem for health care apps.
Recommendations
To address these gaps in the current apps and tools landscape, it is essential to engage all stakeholders of CMC using human-centered design principles to create an accessible and inter-operable solution. Our multi-stakeholder team did not focus on finding the silver bullet, but rather, it focused on identifying a potential solution to nudge patients, caregivers, and medical providers in a direction that will achieve better coordination at home. Focusing on reducing challenges, blending in with daily routines, increasing engagement, enabling convenient communication, and tracking/coaching in the home setting, the team recommends the adoption of voice interaction technologies for in-home documentation and information delivery to enhance ease of use and technology adoption.
The figure below shows the proposed model for an ecosystem of voice interactive care coordination unifying home-care with health care institutions.
Suggested functionalities for a voice interactive tool are:
Based on the suggested ecosystem and functionalities above, we developed user stories. One of these stories covers capturing symptoms at home setting:
Implementation
The figure below provides the conceptual state for voice assistant applications outlining risk, value and impact. Currently, the implementations in health care are moving from "information" to "assistance" level in a low-risk and limited-service approach, such as medical reminders and other messages used only in the hospital setting, similar to the current state of voice assistants in self-management. However, as the use of voice interactive devices and services grows, both their impact on health care and the risks on privacy and security increase.
Conclusion
The use of voice interactive technologies in the home setting could enhance communication of health events and improve coordination. Considering the increasing investments in health care and voice technologies and the current trajectory of voice interactive device adoption, voice interactive platforms will have an impact as household health communication tools or as telemedicine tools in the long term.
*This article a summary of our recent perspective paper published in JMIR. You may read in detail each of the challenges and solutions in the paper. It is open access. Please see the first reference below.
Resources
Sezgin E, Noritz G, Elek A, Conkol K, Rust S, Bailey M, Strouse R, Chandawarkar A, von Sadovszky V, Lin S, Huang Y. Capturing at-home health and care information for Children with Medical Complexity using voice-interactive technologies. J Med Internet Res 2020;22(1):e14202. Open access copy available at http://www.jmir.org/2020/1/e14202/
Sezgin E, Militello L, Huang Y, Lin S. A scoping review of patient-facing, behavioral health interventions with voice assistant technology targeting self-management and healthy lifestyle behaviors. Transl Behav Med 2020:1-20 (forthcoming). [doi: 10.1093/tbm/ibz141] Open access copy available at: https://www.researchgate.net/publication/332951249_A_Scoping_Review_of_Patient-Facing_Behavioral_Health_Interventions_with_Voice_Assistant_Technology_Targeting_Self-management_and_Healthy_Lifestyle_Behaviors
