Voice assistants may ease EHR burden for docs, but challenges exist
The Commonwealth Care Alliance, a Boston-based accountable care organization, is working with voice-first technology company Orbita to manage patient care at home using Amazon's Echo.
Voice-activated assistant programs such as Amazon's Alexa and Google Assistant have the potential to help doctors reduce the time they spend using electronic medical records, but companies need to first tackle integration with the EHR and develop voice-to-text capabilities before they could be used regularly in medical practice, experts say.
“Physicians are saying, ‘I feel like I'm a data entry clerk,'” said Matt Arnold, principal analyst at DRG Digital. “We're in this painful birthing era — big data — where there's this enormous burden on doctors to input all this data and render it usable, and they're spending a huge chunk of their day doing that.”
According to DRG, physicians now spend on average 3.9 hours per day using the EHR, compared to 2.8 hours in 2014.
Voice assistants may one day give physicians greater empathy and satisfaction because they can spend more time face-to-face with their patients, said Paul Balagot, chief experience officer at Precisioneffect.
“I went to see my physician for a regular checkup recently — he was talking to me via his computer screen,” said Balagot. “The less they have to interface with administrative duties like charting and prior authorization, the more fluidly they can practice medicine.”
Companies like Nuance and M*Modal already provide software-based dictation services to physicians, said William Febbo, CEO of OptimizeRx, which partners with about 370 EHR systems.
But the reason voice-activated technology isn't more widely used among physicians is likely due to the challenge of integration, and that the more popular consumer tools like Alexa and Siri cannot yet transcribe voice files, said Balagot and Febbo. Some doctors take notes using a recording device and then that information has to be transcribed before it is entered into the EHR.
"There are services that enable voice-to-text transcription such as Google Docs and Google Slides but they haven't fully been integrated into the voice systems we've been discussing," said Balagot.
"While very large tech companies like Amazon and Google are getting into health now, the key to adoption of a service like voice-to-text is getting integrated to the workflow within the EHRs,” said Febbo. “Physicians are now spending over three hours a day using the EHR on average, so technologies which reduce that time will be adopted more quickly. Voice-to-text is a great fit for that type of efficiency and there are a few innovating and growing, like Nuance."
See also: Infographic: The physician view on EHRs
About 73% of physicians use or are interested in using tools that allow them to input data into their EHR systems by speaking rather than typing, according to a recent DRG study.
DRG surveyed 2,784 U.S. physicians across more than 26 specialties and found that the top three scenarios for voice assistants are: recording clinical notes (58%), looking up medical information (55%), and verifying dosing information (55%).
Still, even that kind of voice-activated online search may be a challenge at this point.
If “someone wants to know the indications of Coumadin, you have to process and understand the name of the drug, and the voice assistant needs to know how to pronounce” it, said Nate Treloar, president and chief operating officer at Orbita, which uses voice-activated technology in healthcare. “How do you make sure that Coumadin is pronounced ‘Coumadin' and not something else?”
DRG found that physicians who use voice-activated technology see on average 105 patients per week, compared to the average of 96 patients per week among physicians who don't use the technology. The early adopters also wrote more prescriptions, averaging 119 prescriptions per week, compared to 103 per week among their peers.
“What Amazon has done is made it possible to build custom voice applications on top of the Alexa platform through Amazon Skills, which you can publish,” said Treloar. “They've opened it up to allow third parties to develop tools.”
The Commonwealth Care Alliance, a Boston-based accountable care organization, is one example of a healthcare provider that is using Amazon's Echo. The ACO is working with Orbita's platform and the Echo device to schedule, coordinate, and track caregiver services provided to patients at home. Currently, Orbita's platform is focused on Alexa, but it plans to eventually offer its services across all voice-assistant programs.
“If you build a website, you want it to work on Chrome, Internet Explorer, and Safari,” said Treloar. “We want to provide our customers the flexibility to reach these different channels.”
Febbo said he expects it will take at least two years until voice-activated technology will reach mainstream adoption among healthcare professionals. “Once the integration happens with the EHR, you'll get adoption because physicians are used to transcribing so it'll be a similar service but directly connected to the EHR,” he explained. “You're using a different medium — your mobile or tablet — instead of going to a transcription service. The ones that will do it faster will be cloud-based EHRs because the update they need to get to their users is streamlined.”