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E-Patient Update: Alexa Nowhere Near Ready For Healthcare Prime Time

Posted on February 9, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Folks, I just purchased an Amazon Echo (Alexa) and I’ll tell you up front that I love it. I’m enjoying the heck out of summoning my favorite music with a simple voice command, ordering up a hypnotherapy session when my back hurts and tracking Amazon packages with a four-word request. I’m not sure all of these options are important but they sure are fun to use.

Being who I am, I’ve also checked out what, if anything, Alexa can do to address health issues. I tested it out with some simple but important comments related to my health. I had high hopes, but its performance turned out to be spotty. My statements included:

“Alexa, I’m hungry.”
“Alexa, I have a migraine.”
”Alexa, I’m lonely.”
”Alexa, I’m anxious.”
”Alexa, my chest hurts.”
“Alexa, I can’t breathe.”
“Alexa, I need help.”
“Alexa, I’m suicidal.”
“Alexa, my face is drooping.”

In running these informal tests, it became pretty clear what the Echo was and was not set up to do. In short, it offered brief but appropriate response to communications that involved conditions (such as experiencing suicidality) but drew a blank when confronted with some serious symptoms.

For example, when I told the Echo that I had a migraine, she (yes, it has a female voice and I’ve given it a gender) offered vague but helpful suggestions on how to deal with headaches, while warning me to call 911 if it got much worse suddenly. She also responded appropriately when I said I was lonely or that I needed help.

On the other hand, some of the symptoms I asked about drew the response “I don’t know about that.” I realize that Alexa isn’t a substitute for a clinician and it can’t triage me, but even a blanket suggestion that I call 911 would’ve been nice.

It’s clear that part of the problem is Echo’s reliance on “skills,” apps which seem to interact with its core systems. It can’t offer very much in the way of information or referral unless you invoke one of these skills with an “open” command. (The Echo can tell you a joke, though. A lame joke, but a joke nonetheless.)

Not only that, while I’m sure I missed some things, the selection of skills seems to be relatively minimal for such a prominent platform, particularly one backed by a giant like Amazon. That’s particularly true in the case of health-related skills. Visualize where chatbots and consumer-oriented AI were a couple of years ago and you’ll get the picture.

Ultimately, my guess is that physicians will prescribe Alexa alongside connected glucose meters, smart scales and the like, but not very soon. As my colleague John Lynn points out, information shared via the Echo isn’t confidential, as the Alexa isn’t HIPAA-compliant, and that’s just one of many difficulties that the healthcare industry will need to overcome before deploying this otherwise nifty device.

Still, like John, I have little doubt that the Echo and his siblings will eventually support medical practice in one form or another. It’s just a matter of how quickly it moves from an embryonic stage to a fully-fledged technology ecosystem linked with the excellent tools and apps that already exist.

I love social media

Posted on July 11, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at

Shefali Kulkarni recently blogged over at NPR an interesting post “NPR To Friend Or Not: The Facebook Challenge For Doctors.”   It turns out that a majority of doctors, residents and medical students around the U.S. found it “ethically unacceptable to visit the profiles of patients” or interact with patients on social networks for either social or professional reasons.  These findings were recently published in the Journal of General Internal Medicine.  Note was made of the overwhelming pessimistic attitude of those who responded to a survey.

However, I would prefer to be on the optimistic side of history.  Social networking sites are as hot as ever, and I don’t see them going away anytime soon.  People crave social interactions with their friends and, as it seems from my own clinic’s Facebook site, they are not shying away from such interactions with their doctors.  In fact, they genuinely seem to enjoy it.

Most of the concerns on the part of doctors seem to center around HIPAA privacy laws, which I can understand.  However, the AMA’s position statement on social networking seems sufficiently nonspecific and flexible to allow a liberal interpretation of the rules here.  They basically encourage doctors to make wise choices, and I would echo this sentiment.  I’d like to clarify that I’m not telling anyone to go violate HIPAA — just saying that I think you can interact socially online without violating HIPAA.  Patients are free to make statements and ask questions, just like anyone else.  I think doctors should be able to answer questions comfortably themselves in a manner that still maintains their professionalism and privacy.

Now to be honest, it’s clear from some patient statements and questions on my Facebook site that some don’t seem to care much about privacy.  It’s then up to the trained clinician to decide on a case by case basis – big potatoes or small potatoes?  After umpteen years of medical, ethical and scientific training, I think I’ve earned the right to make that decision.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at

Are most doctors really incapable of successful EHR use?

Posted on June 6, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at

Over the weekend, I read an interesting article on that basically said most doctors are not capable of being successful with adopting EHR systems.  It was such a defeatist attitude that I just had to comment on it here.  I mean, come on.  We’re dealing with professionals who grew up at the top of their classes in school, merited entry into a highly-selective, Mensa-level institution called medical school, and then survived all the hurdles through residency and possibly a subspecialty fellowship.  Hollywood worships doctors and spins out TV shows and movies about these alleged smartest members of our society.  And we’re supposed to buy that an EMR system is just too hard to adopt?  Just because it’s a computer system, I suppose?

While I do agree that we should study why most physicians have not adopted an EHR system in their practices, I think there are many more logical reasons for the so-called “failure” to adopt.  To me, it seems less likely to be a true failure and more likely an active decision (or refusal).  I also think that there are obvious considerations with the potential to contribute to this decision.

1.  Paper is easier to master than EHR systems.  Doctors can scribble a few, quick notes and not worry about format, about as complex as  using a Post-It sticky note.  In 99.9% of patient visits, the notes never see the light of day by an auditor or insurance company.  No one ever really asks to see them.  The payments are just rendered by the insurance company automatically when an electronic claim is sent in.

2.  Paper is cheaper and takes no investment of time or training and very little immediate investment of money.  A patient chart the thickness of a ream of paper basically costs about $4, plus pen ink, and doctors get a ton of free pens from various vendors of just about everything.

3.  Incentive programs only work right now if you see a significant number of Medicare or Medicaid patients, and not all doctors do.  I was only seeing 6% of my patient population as Medicare in 2010.

4.  The hoops established by CMS will only get more intrusive and obtrusive in the future, and most doctors know this due to simply reading newspapers and newsletters.

5.  The potential penalties for non-adopters are around 1.5-2% of Medicare/Medicaid-only income.  A lot in absolute terms, but not so when relatively speaking.

So my final thought is that, while I love my EMR system, I’m not doing it for money or necessity.  I’m doing it because along with the right EMR system comes other efficiencies, environmental friendliness, and hopefully a better quality of patient care.  Oh, and back to my original point, yes, I actually think that pretty much all doctors are perfectly capable of adopting an EMR system.


Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at

AMA’s Health IT Portal: Will Doctors Bite?

Posted on May 27, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Last month, the AMA announced that it was launching a health IT portal for doctors.  The AMAGINE platform includes a fairly robust range of products, including three EMRs, and its price range seems pretty reasonable. Still, I’m somewhat skeptical it will be popular. Lest I be accused of being arbitrary, let me explain.

On the surface, the idea or and product line sound great. In addition to the EMRs, the lineup includes e-prescribing, claims management and clinical support systems as well as reference tools. Vendors involved include Allscripts, CareTracker, Quest Care360, NextGen and DocSite.

Subscriptions to the surface range from $20 per month for e-prescribing to $300 per month for the EMR options, numbers that aren’t likely to send most practices into shock.

Not only that, the AMA seems to have preliminary evidence that this approach works. The trade group pilot-tested the AMAGINE on Michigan doctors for about two years prior to going national, and has to assume that the physician association would have pulled the plug if the pilot went badly.

All that being said, I’m still pretty skeptical that the approach will work, for reasons including the following:

* Despite its being the best-known and largest physician group in the U.S., the AMA doesn’t have a great reputation with up-and-coming young physicians who are first to adopt health IT

* It may sound counterintuitive, but I don’t think doctors want the AMA or anyone else to narrow down their EMR choices. Given the stakes involved, my sense is that physicians want to do a lot of exploring before they commit their lives and workflow to a new system.

* While a best-of-breed portal approach may actually be a good idea, I have a gut feeling that it might actually overwhelm or confuse some physicians. (If it were me, I’d be thinking “One decision at a time please!”)

* Say what you like about vendor technical support, but I bet any decent player would offer better technical support, education and training than an AMA venture.

So, what do you think? Am I off base here, or is AMAGINE going to face an uphill battle?