Alexa, Am I Dying?

Amazon’s Alexa has reshaped how millions of American consumers live and behave at home. We might think of Alexa as that robot we yell at to set a timer, yet Amazon recently announced that it had bigger plans in store for the device. That’s right: Alexa just graduated from medical school. 

Well, it’s more like she barely passed nursing school at the University of Phoenix.

On April 4th, Amazon released news that Echo’s Alexa system is now legally capable of transmitting private patient data securely. This means, for example, that a patient could hypothetically use Alexa to communicate symptoms, updates, or needs with nearby hospitals.

In order for Alexa to be authorized to communicate private patient information, Amazon must comply with HIPAA (the Health Insurance Portability and Accessibility Act), a federal bill that mandates a slough of expectations for the communication of personal health information in the private sector. 

HIPAA does not obligate organizations to be vetted by any government agency. Indeed, HIPAA compliance not a form of federal authorization.  Strangely, most any company could truthfully make a claim to HIPAA compliance, and the veracity of this claim would only be tested should a complaint be filed on the contrary. In that case, the organization in question would be audited and potentially sued by the Office of Civil Rights. 

HIPAA is a starting point for securing private patient data, but it does not ensure the level of confidentiality patients should expect from the medical community. Taha Jangda, a partner at HealthX Ventures, explains, “HIPAA is a regulatory requirement in the U.S. healthcare market [that] …. does not, by itself, address all the data privacy and security concerns that exist with voice applications in healthcare.”

Therefore, Amazon’s announcement of ‘HIPAA compliancy’ doesn’t really certify that Alexa secure enough to share our private medical data. More accurately, the announcement signals that Amazon is confidently gambling that no complaints will be filed against its systems, and it is self-evident that Amazon’s claim to HIPAA compliancy may have served to obfuscate this legal reality to consumers. 

Amazon’s announcement signals that the company intends to contribute to a growing movement toward bringing healthcare to the home. Facilitating accessibility to healthcare services could reduce the economic, physical, and communicative obstacles many Americans face when seeking medical care or assistance. Indeed, in-home, personalized, and low cost services could very well aid elderly, disabled, and less technologically proficient Americans. Of course, these hypothetical positive outcomes are contingent upon the true reliability of devices like Echo. Amazon’s plans, as well as the general trend toward smart-healthcare begs the question: can a robot really replace the empathy and skills of a human healthcare provider?

Currently, Alexa can perform a limited set of health related tasks, including tracking prescription, communicating recovery updates to a care team at Boston Children’s Hospital, and reading out latest blood sugar measurement with health insights. As the tech juggernaut continues to edge in to the healthcare ecosystem, the sophistication of Alexa’s medical skills is likely to improve rapidly. Some reporters speculate that Amazon will seek expansion into telemedicine and offer to order a treatment for someone based on the device’s assessment of their health.

The seemingly inevitable future outcome of such a fast-paced, profit-driven movement toward home care is a world in which the human physician is largely replaced by devices such as Alexa. These devices would, of course, be responsible for making treatment recommendations and handling patients’ intimate health needs.

Perhaps this outcome could be a functional one. Many of the tasks completed by the medical community can, in fact, be completed by robots. Yet one skill not yet demonstrated by robots is crucial to the medical practice: empathy. Amazon is, in fact, investing in projects dedicated to building empathy, personality, and a natural human cadence into Alexa’s speech.

Yet no matter how close to human Amazon’s engineers make Alexa sound, and no matter how authentically empathetic they code Alexa to appear, these engineers simply cannot control for patients’ awareness of the distinction between a robot’s and a human’s care.

Amazon can’t tweak Alexa’s voice enough to convince a suicidal patient, for example, that she is not alone. 

Alexa’s developers have encountered a number of expressions of suicide ideation, and Alexa has a programmed response: “I’m so sorry you are feeling that way. Please know that you’re not alone. There are people who can help you. You could try talking with a friend, or your doctor. You can also reach out to the Depression and Bipolar Support Alliance at 1-800-826-3632 for more resources.”

Sure, Alexa might know to say all the right things in that situation. But she’s still a robot. That suicidal patient might, in fact, be alone. Perhaps being told by a robot that he isn’t alone only reminds him of his loneliness. Perhaps he ignores Alexa because of the very truth that Alexa is a robot. Maybe he needs a hug, or eye contact, or to see the shock on someone’s face when he says he wants to kill himself. 

When considering where Alexa’s healthcare skills could be one day, it is crucial that we consider the necessity of humanity of empathy as an inextricable component of healthcare. We are human beings, and we must be wary of valuing convenience, profit, or short-term positive effects over our collective wellbeing. 

The adoption of Echo devices as home health assistants requires consumer trust, and consumers don’t necessarily associate Echo or Alexa with security. Accidental recordings, false-voice attributions, and default settings giving Amazon employees access to consumer communications with Alexa  form a cursory list of Echo’s security failures since the device entered the market in 2017. 

"Health is one of the most personal industries, and automating it runs the risk of forgoing the empathetic, relationship-based care that we receive in the clinical setting in the pursuit of efficiency."

Nevertheless, Alexa’s mistakes have not cripplingly hindered sales or use. Scholars have found that while we may psychologically comprehend that Alexa is a bot, we still partially interpret the voice as a human. Scholars have suggested that voice is stronger communicator of emotion than facial expression.

In terms of data security, Amazon already houses tons of it in, meaning the company is highly incentivized to protect it. While a breach is always possible, it is unlikely that Amazon would not go to every length to secure private individual information.

Looking at the big picture, another issue that merits concern is the extent to which Amazon’s venture into healthcare further monopolizes the healthcare market and intensifies Amazon’s corporate power. If Echo devices are readily adopted for healthcare uses, Amazon would have a significant market share of home health access, an area that healthcare innovators are looking to expand into. With access to ‘tens of millions’ of homes, powerful actors in the healthcare ecosystem will be fighting to contract with Amazon and get their piece of the pie. Amazon will then have the power to select which healthcare companies — which hospitals, insurers, pharmacy benefit managers — get access to that market share and bring their corporate power into the home. This also functions to serve Amazon’s business interests. As Judith Shulevitz writes in the Atlantic, “they want to colonize space. Not interplanetary space. Everyday space: home, office, car. In the near future, everything from your lighting to your air-conditioning to your refrigerator, your coffee maker, and even your toilet could be wired to a system controlled by voice.” Amazon is filling a need by creating it, turning every element of home living into a commodifiable device that can bring them a high return on investment.

It is crucial to consider this in the context of Amazon’s recent movements into healthcare as well. Amazon has purchased the online pharmacy PillPack, and CEO Jeff Bezos is teaming up with Warren Buffett of Berkshire Hathaway and Jamie Dimon of J.P. Morgan to create their own health insurance venture for the employees of their three companies, and maybe the whole country. What started as an online bookstore now provides near-instant delivery of goods ranging from clothing to fresh produce from Whole Foods, streaming services of hit tv shows, and data storage solutions. With healthcare and pharmaceuticals in the mix, Amazon’s status as a tech superpower will be significantly magnified. Amazon’s rollout of Alexa’s home health skills begs the question of whether or not healthcare can retain its crucial interpersonal nature while also being automated by an inherently profit-focused technology monolith.

Photo: Original Artwork by Natalie Saenz

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