Understanding the Use of Alexa/Virtual Assistants in Healthcare Facilities
Requested By: DCMC SNF Leadership
On two occasions clinical staff members have asked about the use of Alexa in patient care areas of Door County Medical Center (DCMC) and the Skilled Nursing Facility (SNF). This review explores the risks and benefits of the use of Alexa and/or other virtual assistants in DCMC facilities.
Alexa is a virtual assistant developed by Amazon. It is capable of voice interaction, music playback, making to-do lists, setting alarms, streaming podcasts, playing audiobooks, and providing weather, traffic, sports, and other real-time information, such as news. Alexa can also control several smart devices using itself as a home automation system. Users are able to extend the Alexa capabilities by installing "skills" (additional functionality developed by third-party vendors, in other settings more commonly called apps such as weather programs and audio features). This guidance applies to Alexa and other virtual assistants provided by Google, Apple, etc.
Amazon is moving into healthcare. Following a trial of using virtual assistants in patients' rooms at Cedars-Sinai, the company this morning announced an invite-only program allowing select developers to create and launch HIPAA-compliant healthcare skills for Alexa. The skills allow consumers to ask the virtual assistant for help with things like booking an appointment, accessing hospital post-discharge instructions, checking on the status of a prescription delivery and more. Los Angeles medical center Cedars-Sinai is piloting a program that places Amazon Echos in more than 100 patient rooms. The smart speakers use Aviva, a voice assistant platform for healthcare, and is intended to help patients communicate with their caregivers. Letting patients use Alexa to perform basic tasks like changing TV channels also frees up nurses to perform medical care. After a patient tells Alexa what they need, Aiva routes it to the right person's mobile phone. For example, if someone needs medicine, their request goes to a registered nurse. If a response takes too long, Aiva reroutes the request "up the chain of command." Voice assistants are currently being tested in several capacities in healthcare. For example, virtual assistants in Boston's Children's intensive care unit let nurses ask for administrative information, like who is the charge nurse on duty or how many beds are available in a ward. Boston Children's also piloted voice-enabled versions of the checklist used to validate organs before transplant, with prompts to help reduce error. KidsMD, a program powered by Alexa, is meant to be used by parents at home to help them decide if their kids need to see a doctor.
Limitations of Virtual Assistants
Nursing Home Residents: The use of Alexa or another virtual assistant for a nursing home resident raises additional questions as the nursing home is the individual's "home" and residents have different rights regarding their home. Virtual assistants for the elderly provide benefits that may outweigh any potential privacy risks. Benefits may include:
As the virtual assistant may be actively recording interactions it is strongly recommend as a courtesy to others that signage be placed outside the room indicating that a virtual assistant is in place. Language for the sign should state:
"Virtual Assistant Present in Room; Interactions May be Recorded"
Wisconsin recording law stipulates that it is a one-party consent state. In Wisconsin, it is a criminal offense to use any device to record or share use communications, whether they are wire, oral or electronic, without the consent of at least one person taking part in the communication. This means that in Wisconsin, you are legally allowed to record a conversation if you are a contributor, or with prior consent from one of the involved parties, barring any criminal intentions. Wis. Stat. Ann. @ 968.31
Compliance – Regulatory Influences:
Hospital/Clinic Use: Without solid documentation (e.g., contract, business associate agreement) of HIPAA compliance, the use of a virtual assistant for clinical operations or in clinical areas at this time is not feasible. However, with continued advances in this technology, the feasibility of virtual assistants should be reviewed periodically.
Nursing Home Resident Personal Use: DCMC SNF provides individual rooms for residents as their personal homes. Rooms are set up with WIFI and rooms are maintained and equipped at the resident's or his or her representative's design. If a resident should desire that a personally-owned virtual assistant be utilized in his or her room, DCMC SNF should make every effort to reasonably accommodate this use contingent on the Organization's network/bandwith resources.
Reviewed and Supported By:
Nancy Davis, Director of Compliance & Safety