Analysis: Why Alexa’s Bedside Manner Is Bad For Healthcare


Amazon has opened a brand new health care frontier: Now Alexa may be used to transmit patient data. By using this new feature – which Amazon called a “skill” – a business named Livongo allows diabetes patients – so it calls “members” – to use the device to “query their last blood sugar levels reading, blood sugar levels measurement trends, and receive insights and Health Nudges which are personalized to them.”

Private equity and venture capital firms have been in love having a legion of companies and startups touting the benefits of virtual doctors' visits and telemedicine to revolutionize health care, investing almost $10 billion in 2021, a record for the sector. Without stepping into a gym or a clinic, a startup called Kinetxx will give you patients with virtual physical therapy, together with messaging and exercise logging. And Maven Clinic (which is not actually a physical place) offers online medical guidance and personal advice focusing on women's health needs.

In April, at Fortune's Brainstorm Health conference in North park, Bruce Broussard, CEO of health insurer Humana, said he believes technology will help patients receive help during medical crises, citing the benefits of home monitoring and also the ability of doctors' appointments with be conducted by video conference.

But when I returned from Brainstorm Health, I had been confronted by an alternative reality of virtual medicine: a $235 medical bill for a telehealth visit that resulted from one of my children calling a longtime doctor's office. It had been for a five-minute telephone call answering a question about a possible infection.

Virtual communications have streamlined life and transformed many of our relationships for that better. There is little need anymore to sit down over the desk from a tax accountant or tour operator in order to stand it a queue for a bank teller. And there is certainly room for disruptive digital innovation in our confusing and overpriced health care system.

But it remains an open wonder if virtual medicine will prove an invaluable, convenient adjunct to health care. Or, instead, will it be a means for that U.S. profit-driven healthcare system to make big bucks by outsourcing core duties – while providing a paler form of actual medical treatment?

After all, my doctors have long answered my questions and dispensed phone and email advice for free – included in our doctor-patient relationship – though it did not have a cool branding moniker like telehealth. And my obstetrician's office offered great support and advice through two difficult pregnancies – maybe they ought to happen to be paid for that valuable service. But $235 for any telephone call (which fits out to over $2,000 each hour)? Not really a company lawyer bills that.

Logic holds that some digital health tools have tremendous potential: A neurologist can observe a patient by video to see if lopsided facial movements suggest a stroke. A patient by having an irregular heart rhythm could submit digital tracings to see if a new prescription medication is working. But the tangible benefit of many other virtual services offered is less certain. Many people may like receiving feedback regarding their sleep from an Apple Watch, but I am not sure that's medicine.

And if virtual prescription medication is pursued within the name of business efficiency or simply profit, it's enormous possibility to make healthcare worse.

My doctor's nurse is much better equipped to reply to a question about my ongoing health problem than someone at a answering services company reading from a script. And, however thorough a virtual visit may be, it forsakes some of the diagnostic information which comes if you notice and touch the individual.

A study published recently in Pediatrics discovered that children who were built with a telemedicine visit for an upper-respiratory infection were much more likely to have an antibiotic than those who physically saw a physician, suggesting overprescribing reaches work. It seems sensible: A physician can't make use of a stethoscope to listen to lungs or wiggle an otoscope into a kid's ear by video. Similarly, an online physiotherapist can't have the knots in muscle or watch a fleeting wince on a patient's face via camera.

More important, perhaps, virtual medicine means losing the support that has long been an essential part of the marketplace. There are programs to supply iPads to individuals in home hospice for resources about grief and chatbots that purport to deal with depression. Maybe people at such challenging moments need – and deserve – human contact.

Of course, the likes of those mentioned expect to become reimbursed for that remote monitoring and virtual advice they offer. Investors, consequently, get generous payback without having to employ a lot of actual doctors or any other health care professionals. Livongo, for example, has raised a total of $235 million in funding over six rounds. And, as of 2021, Medicare announced it might allow such digital monitoring tools to “qualify for reimbursement,” if they're “clinically endorsed.” But, ultimately, will the well-being of patients or investors decide which tools are clinically endorsed?

So far, with its new so-called skill, Alexa will be able to execute a half-dozen health-related services. Along with diabetes coaching, it may discover the earliest urgent care appointment in a given area and check the status of the prescription drug delivery.

But it won't provide a lot of things patients desperately want, which technology will be able to readily deliver, like a reliable price estimate to have an upcoming surgery, the infection rates at the local hospital, the location of the cheapest cholesterol test nearby. And if we're trying to bring healthcare in to the tech-enabled 21st century, how about beginning with low-hanging fruit: Does any other sector still use paper bills and faxes?