Are we ready to use voice assistants (VA) in healthcare delivery during the pandemic?

Voice assistants (VA) have been widely adopted virtual assistants in the market, and they are almost available within every digital device. There are implementations to use VA in health care, but are we ready to use them in healthcare delivery during the pandemic?

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With the pandemic, the importance of remote care and health communication has increased, and there has been a rapid shift towards digital health solutions (e.g. telehealth) in healthcare delivery. The transition has also accelerated our research by extending our current projects (1–6) towards understanding  the value of voice technologies during pandemic and under isolation.  

Earlier this year, Hollander et al.(7) shared their perspective on telemedicine use during the pandemic crisis and suggested digital solutions and strategies to monitor and screen patients as well as keeping the spread under control. Their perspective has been an inspiration to think and ideate about how we can leverage voice assistants (VA) in remote care. When we started working on this idea, we have listed major pain points during the pandemic regarding the health information needs and digital health and VA solutions to address these problems during pandemic. Our list had the ideas and implementations including: automated remote screening through conversation, using voice as a biomarker and continuous screening and detection of pandemic symptoms such as identifying respiratory disorders, addressing health equity and communicate critical health information with public including vulnerable populations, especially including the patients with low literacy or physically unable to read or engage with devices, reducing the contact to digital communication devices and using voice commands to navigate digital health and telemedicine services. Our further investigation and research around these thoughts established the foundation of our paper. 

In our recent publication at NPJ Digital Medicine, we reported the current state of voice assistants (VAs), the readiness of the health system, the readiness of the technology providers, and  how VA could impact in post-COVID health delivery.

Principally, VAs are virtual assistants which need voice commands to initiate interaction and to complete the tasks (e.g., Amazon Alexa and Alexa skills).(8) They could be autonomous as they can leverage AI to gather and share information on the pandemic (public health level) as well as provide personal health feedback (personalized health level).

However, there is a need to strategize the design, development and deployment of VAs to gather up-to-date information from designated resource channels maintained by health authorities.  Strategic approaches should include establishing connections with federal, state, and local government health agencies, establishing agreements and contracts for compliant services, creating data flow channels, and potentially training AI to synthesize information to deliver and communicate personalized content optimally. One idea was  to segregate information resources and distribute them at state-level to city-, county- and hospital-levels which could ensure the relevance and validity of the information.

Looking at the future, a new perspective on voice-user interface design could be necessary for VA to engage with end-users with various healthcare needs during a crisis to communicate and exchange health information effectively. At-risk communities who can potentially benefit from VA, such as the elderly, should especially be considered.(9,10)

At the hospital side, VA could facilitate the control for infection and reduce the hands-on documentation burden by assisting physicians with dictating visit notes, ordering tests, and charting or navigating EHR hands-free (11), and could assist the nurse triaging by assessing the risk level of the patients through conversational assessment, as proposed with chatbots.(12)

In the bottom line, VA demonstrated the capability and potential in healthcare delivery use. The readiness of healthcare systems, infrastructure, and technology providers are essential to build VAs in response to pandemic and support healthcare delivery while aiming to mitigate the risk of the disease spread and reduce the stress on the health system. 

Note: This blogpost was also published at NPJ Digital Medicine Community website: https://npjdigitalmedcommunity.nature.com/posts/are-we-ready-to-use-voice-assistants-va-in-healthcare-delivery-during-the-pandemic

References

1. Sezgin, E. et al. Capturing at-home health and care information for Children with Medical Complexity using voice-interactive technologies. J. Med. Internet Res. 22, e14202 (2020).

2. 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. 10, 606–628 (2020).

3. Sezgin, E., Noritz, G., Hoffman, J. & Huang, Y. A Medical Translation Assistant for Non–English-Speaking Caregivers of Children With Special Health Care Needs: Proposal for a Scalable and Interoperable Mobile App. JMIR Res. Protoc. 9, e21038 (2020).

4. O’Donovan, R., Sezgin, E., Bambach, S., Butter, E. & Lin, S. Detecting Screams From Home Audio Recordings to Identify Tantrums: Exploratory Study Using Transfer Machine Learning. JMIR Form. Res. 4, e18279 (2020).

5. Yang, S., Lee, J., Sezgin, E., Bridge, J. & Lin, S. Voice Assistant Clinical Advice in Postpartum Depression Using Apple Siri, Amazon Alexa, Google Assistant, and Microsoft Cortana: A Cross-sectional Investigation (Preprint). JMIR Prepr. (2020).

6. Militello, L. K., Sezgin, E., Huang, Y. & Lin, S. Delivering Perinatal Health Information via a Voice Interactive App: A Mixed Method Study (Preprint). JMIR Prepr. (2020) doi:10.2196/preprints.18240.

7. Hollander, J. E. & Carr, B. G. Virtually Perfect? Telemedicine for Covid-19. N. Engl. J. Med. 382, 1679–1681 (2020).

8. Hoy, M. B. Alexa, Siri, Cortana, and More: An Introduction to Voice Assistants. Med. Ref. Serv. Q. 37, 81–88 (2018).

9. Reis, A. et al. Using intelligent personal assistants to assist the elderlies An evaluation of Amazon Alexa, Google Assistant, Microsoft Cortana, and Apple Siri. in TISHW 2018 - 2nd International Conference on Technology and Innovation in Sports, Health and Wellbeing, Proceedings 1–5 (IEEE, 2018). doi:10.1109/TISHW.2018.8559503.

10. Trajkova, M. & Martin-Hammond, A. ‘Alexa is a Toy’: Exploring Older Adults’ Reasons for Using, Limiting, and Abandoning Echo. in Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems 1–13 (ACM, 2020). doi:10.1145/3313831.3376760.

11. Kumah-Crystal, Y. et al. Electronic Health Record Interactions through Voice: A Review. Appl. Clin. Inform. 09, 541–552 (2018).

12. Schwamm, L. H., Erskine, A. & Licurse, A. A digital embrace to blunt the curve of COVID19 pandemic. npj Digit. Med. 3, 64 (2020).