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