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July 18, 2018

Hey Alexa, you don't provide great medical advice, providers say

Daily Briefing

    Read Advisory Board's take on this story

    Amazon's Alexa can shop, set reminders, and answer basic questions with a simple voice command—but it turns out health care-related questions might not be Alexa's cup of tea, according to an analysis by Quartz.

    According to Quartz, there are about 1,000 health-related tools available on Amazon's Alexa. However, Alexa is not compliant with HIPPA, meaning those tools:

    • Cannot collect personal medical information from users;
    • Cannot imply that suggested medical advice is life-saving; and
    • Must include a disclaimer that states Alex does not provide "medical advice" and suggests that users consult a health care provider if they think they need medical attention.

    Analysis details

    For the analysis, Quartz sought to determine whether Alexa's tools could provide valid responses to 14 questions about common health symptoms. For instance, questions ranged from, "How do I treat a sore throat?" to "When should I go to the hospital if I'm having contractions?" Quartz then asked two independent physicians to review how Alexa responded to the questions.

    The analysis focused on 16 of Alexa's health care tools. According to Quartz, nine of the tools identified keywords from a user's description of their symptoms, performed a database search for those key words, and returned a response with all the information related to the keywords from its database. The other seven tools used the voice assistant to engage users in conversations concerning their symptoms by asking follow-up questions to determine a diagnosis and offer treatment options.


    Overall, Quartz found 10 of the 16 tools provided at least one valid answer to the questions. The tools offered the "most detailed prognoses" for diarrhea, influenza symptoms, and sore throats, Quartz reports. For instance, seven of the nine data-based tools identified the correct keyword when asked, "How do I know if I have the flu?" However, the tools provided fewer responses for questions related to less-common symptoms, such as those regarding pain in the abdomen or knee, Quartz found.

    According to Quartz, the tools that used a voice assistant to ask follow-up questions about user's symptoms provided valid responses to questions about health symptoms in some instances. For instance, Alexa's Flu Tool, which was built by Vanderbilt University researchers, correctly diagnosed symptoms of the common cold after asking users eight follow-up questions.

    However, Quartz found GYANT, an Alexa tool developed by a startup by the same name, did not provide a diagnosis until users answered a total of 25 questions, including 'yes' or 'no' questions. According to Quartz, "the final results" provided by GYANT "weren't particularly useful," because the tool provided users with three possible diagnoses—two of which were technical terms—without offering further explanation. According to Quartz, "A Google search would have taken much less time for clearer results."

    Quartz ultimately concluded that its findings "suggested Alexa health skills provide mediocre health advice in the best-case scenarios."

    Physicians weigh in

    According to Quartz, "physicians who reviewed [the] analysis agreed" with Quartz's findings.

    Cate Mackenzie, a family medicine physician at Dr. Everett Chalmers Regional Hospital, said Alexa's tools in many instances offered generally appropriate treatment advice, but some of the recommendations potentially could be dangerous for specific groups of patients. For example, WebMD's Alexa tool recommended users take "over-the-counter pain reliever like acetaminophen or ibuprofen" to treat a migraine, but Mackenzie noted, "[T]here are some patients who should never take acetaminophen or ibuprofen" because of allergies or pre-existing medical conditions.

    Tian Wang, a neurologist at Georgetown University, said Alexa's tools provide answers that "all sound like they just extract information from Wikipedia (which contains a lot of incorrect information) using very simple 'yes' or 'no' algorithms." He said, "Based on my judgment, these are all bad responses."

    Mackenzie and Wang each cited particular concerns with the GYANT tool. Wang said, "At first glance, GYANT seemed smart. However this is the worst type of patient encounter. During medical school and residency training, we were repeatedly told the worst type of patient encounter is asking suggestive, leading 'yes' or 'no' questions, as this will lead to the wrong way and cloud your clinical judgment. Open-ended questions are preferred, particularly ones like 'tell me more about your pain,' because they don't suggest where or how a person's pain should feel."

    Still, Quartz reports that Alexa could have some use in medicine, even though it is not likely to replace patient-doctor interactions. "In her current state, it's easy to see how Alexa could play a meaningful role in health care today," Quartz reports, noting that "artificial intelligence is capable of keeping track of patterns of speech, and it's not a major leap to imagine voice assistants that could be programmed to ask and learn about their owner's sleeping, eating, exercising, and language usage patterns, in order to flag when something is wrong." According to Quartz, Alexa eventually could use such tools to "prompt [users to] go to the doctor, or it could connect straight to the doctor's office and make the appointment for [them]" (Foley/Zhou, Quartz, 7/12).

    Advisory Board's take

    Anna Yakovenko, Practice Manager, Market Innovation Center, and Emily Heuser, Consultant, Market Innovation Center

    While voice-assisted technology often falls short diagnosing and providing clinical advice to patients, we've seen hospitals and health systems use Alexa in a number of other innovative ways in order to attract and engage patients.

    According to a report from Juniper Research, voice-enabled smart devices will be installed in a majority, 55%, of U.S. households by 2022. Depending on your organization’s goals, this fast-growing technology may deserve a place in your digital marketing strategy.

    We've seen organizations experiment with Alexa for consumer marketing and patient care in several ways, including:

    1. Embedding the organization in patients' care search.
    2. More patients are using their smart speakers to ask questions such as "where is the closest primary care doctor?" or "where is the nearest urgent care?" Northwell Health System tapped into these inquires by creating an Alexa skill that tells consumers the closest urgent care or ED to their location and provides up-to-date information on the shortest wait times. Because Northwell owns the search process and helps patients make an informed choice, they increase the chance of patients choosing Northwell over a competing organization. They've also found that patients are more content when they know how long they'll have to wait—meaning that the Alexa skill may also improve the patient experience.

    3. Helping track information for disease management
    4. Other organizations have used voice assistant technology to help high-risk patient's longer-term care management. Libertana Home Health, for instance, created an Alexa skill that allows patients to use verbal commands to report medical data (such as weight, blood pressure, or blood sugar), receive medication reminders, and call their care teams. These verbal commands can improve patient satisfaction by creating an easier care experience for patients.

    5. Allowing easy access for patients to their care team.
    6. Some organizations have used Alexa to make it easier for patients to connect with their providers. Lenovo has created a skill that allows users to reach out to their care team to request a ride to their appointment or a prescription refill—potentially improving medication adherence and reducing the rate of patient no-shows.

    For more examples of how your organization can use voice assistant technology—and a host of other new technology platforms—in innovative ways, view out research report on creating a consumer-focused digital strategy.

    Read the Report

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