In my last post just a few days ago I noted that I hadn’t posted for many months before that.  I have been quite busy since January focusing on developing new Alexa Skills and helping several start-up companies build healthcare & non-healthcare applications with a voice component.  I wanted to take this opportunity to post an updated table with all my 21 Alexa Skills, their descriptions, and Quick Links to them in the Alexa App on an Echo/Alexa device user’s smartphone.  Just click on the link of any of the listed Skills to check it out.   In case you don’t use Alexa, I should explain what a Skill is.  Very simply, the term “Skill” is the name Amazon has given to the applications that work with their Echo & Alexa devices.

If I were to categorize my Skills, most of them would fall into one of the following three categories:

• Humor
• Organizational
• Health & Wellness

Let me mention a few of them:

In the Humor category, Our Little Secret, provides a comical peek into what you might be saying in your home.  In it, a fictional brother & sister with psychic abilities give Secrets and Deeper Thoughts.  All the responses are entirely fictitious, but it makes you wonder what you would hear if “walls could talk!”  While the Secrets are free, the user must pay a low, one-time fee to hear the Deeper Thoughts.  Another humorous Skill is Wine Jester in which Alexa gives comical reviews of any wine you may place before her.

An example of Organizational Skills is Your Expert Log which enables the user to log experts that they may have heard about in different professions, such as, physicians, handymen, and others for retrieval later. My Favs allows the user to log their favorite meals and restaurants to be retrieved randomly. Conference Contact Helper was created after I attended a recent conference to help track the contacts made at conferences and the associated to-do list items.

Most of my certified Skills fall into the category of Health & Wellness. These first two were developed to help us focus on the goodness in our world and help improve one’s psychological health.  Kindness Counts lets the user record kindnesses for which they are the doer, recipient, or witness.  Gratitude Log lets the user log three of their blessings at a time.  After they have logged several sets, they can ask Alexa to play three randomized blessings at a time.  Healthy Text Scheduler allows the user to schedule text messages about healthy eating to help them form healthier behaviors surrounding their nutritional behaviors.  Track My Dose was designed to help individuals manage as-needed medications, so they know when to take the next dose.  They can even schedule reminders at the time the next dose can be taken.  Finally, Symptom Helper helps the user organize the symptoms they wish to discuss with their healthcare provider before an upcoming visit.  They answer several questions posed by Alexa, and she organizes that information into a concise statement that can be entered into a custom list on their Alexa App that can be shared with the clinician.

For Your Health – Dr. Bob

Click the link below to go to a table of my Alexa Skills or click the Download button on the right to download its PDF file:

In my last post, I showed some of the information that the patient could provide before their office visit displayed on their physician’s Electronic Health Record (EHR) screen. The physician could use this information to better connect with their patient and identify patients that are being affected by loneliness. Here I’ll talk about two other use cases for Alexa, the Scribe and, the Zebra Finder.

The Scribe would enable the physician to carry on a conversation with the patient and speak the elements of his or her examination of that patient without needing to break their contact with the patient. No more turning from the patient to the computer keyboard. Ideally, the Scribe would present two versions of the encounter, one in the language of medicine that would become part of the EHR and the other that the patient could understand and suggest edits if needed.

While the Scribe would be used for every office visit, the Zebra Finder would only be used for the difficult cases with which the doctor gets confronted from time to time. In medical school, you are taught that when you assess a patient’s symptoms you should think that common things occur commonly. Or, in other words, when you hear hoofbeats, think horses, not zebras! However, sometimes a patient has a rare condition, a zebra.

An experience of mine in my early clinical years led me to propose Zebra Finder as another use case for Alexa in healthcare delivery. After I completed my Internal Medicine training, I joined a three-man Internal Medicine group outside Washington, D.C. One Friday evening when I was on-call, one of my associate’s patients was admitted to the hospital. He was a gentleman about 30 years old who had been having a fever for over 2 weeks without a diagnosis after undergoing extensive outpatient testing. Many tests, including chest x-ray, blood & urine cultures were all negative. Yet the patient was very ill and warranted hospitalization. While examining this patient, in addition to his fever of about 102 degrees, two things were abnormal:

1. He had tender lymph nodes in his right armpit, and
2. A small, circular, pale patch of skin on his right hand near his thumb that was anesthetic. In other words, he couldn’t feel me touch him there.

Years ago during my training, I had seen a patient who also had an anesthetic patch of skin which is indicative of Hansen’s Disease, better known as leprosy. So, based upon my exam and remembering this fact that was lodged somewhere in my brain, leprosy was my working diagnosis. Further testing confirmed the diagnosis. I recount this story not to boast, but to show how a small bit of information can be important in medicine. For some reason, that nugget of medical knowledge popped into my head. This is especially important since the amount of medical information a person going through medical training must absorb continues to explode.

So, Zebra Finder would have Alexa connect through artificial intelligence to a database of medical information. It would help the physician when they are faced with a challenging case. The physician would tell Alexa the patient’s problems and physical findings. Then Alexa would guide the physician in their examination & testing required. It would be especially useful in more remote areas of the country where access to specialists is limited.

Well, these were the use cases I have identified for Alexa during an office visit. Next time I’ll talk about some after the visit. Please feel free to leave your comments.

For Your Health – Dr. Bob

Since my last post about a use case for Alexa before an office visit, I had some additional ideas and I also received some feedback from a few sources.

I thought a measure of loneliness might be useful and with a little research, I found the De Jong Gierveld 6-Item Loneliness Survey. I’ve added it to my demo Alexa Skill I’ve called Office Visit Prepper.  See a sample of the EMR page below:

Sample EMR Page

It shows the patient’s Goals, Barriers and Loneliness Survey responses requested by Office Visit Prepper.

There also were concerns from both patients and primary care physicians (PCP) regarding the lack of the physician’s access to specialist visit notes at the time the PCP office visit with the patient.  I believe Alexa could also help solve this issue but the process is quite a bit more complicated.  Let me suggest 2 approaches.  Each requires that Alexa has access to both the patient’s health insurance records and the PCP.s EMR.  Alexa could then determine what specialist visits occurred and whether the PCP’s EMR had those electronic records.  Then there could be a passive option to help solve this issue and an active one that would occur as part of the information gathering of a Skill like Office Visit Prepper:

1. Passive – The patient gets informed that records from some specialists are missing and Alexa asks the patient to contact the specialist offices to have them forward the information to the PCP.  Ideally, these would be in an electronic format.
2. Active – Alexa informs the patient of the missing records and asks the patient for permission to obtain them.  Once the patient approves, Alexa contacts the specialist offices to get the records sent to the PCP.

My plan is to post some more of my ideas for Alexa helping care delivery.  Next time I’ll talk about two use cases during the office visit.

I look forward to your comments about the uses cases I have posted and others you would like to see implemented in healthcare delivery.

To Your Health! – Dr. Bob

There is no doubt that the introduction of the vocal interface with devices such as the Amazon Echo/Alexa and Google Home is revolutionizing many industries.   This trend also includes healthcare.  As you know, developing Alexa Skills is one of my hobbies in retirement.  A good number of them are focused on health.  I thought I’d state a few use cases over the next few posts, and invite readers of this blog to suggest others.

One use case I think worthwhile is using Alexa to gather some information from the patient at home before their visit to the doctor.  In addition to the usual information, I think it could include information about the patient’s support system as far as the closeness of friends and relatives, and their short-term and long-term goals.  I think such a conversation would be more conducive to gathering this kind of information rather by answering questions on a computer screen.  My rationale for including this information is that it would help build a personal relationship between physician and patient.  Given the pressure on physicians to see as many patients as possible, there is less time to probe for this kind of information during the office visit.  If they are already available for the physician to read in the electronic medical record, then they would be able to, at the very least, acknowledge them at the visit.  When I practiced medicine many years ago, I was able to take the time to find out more about my patients rather than just their physical findings.  I truly enjoyed that aspect of practicing medicine immensely.

I’ll be looking forward to your comments and suggestions for other use cases.

Thanks,

Dr. Bob