In recent years, we have witnessed a rise in the use of digital assistants in our everyday life. Amazon Echo (Alexa), Apple’s Siri, and Microsoft’s Cortana are literally household names as they are now a common feature in many homes. These digital assistants utilise artificial intelligence to mimic human interaction and do everything from scheduling appointments to managing emails and to-do lists to sending reminders. Some can even provide emotional companionship! With advances in natural language processing (NLP), voice, eye and gesture recognition, the interactions provided by digital assistants are becoming increasingly sophisticated.
Digital assistants in healthcare
Digital assistants in healthcare are also gaining popularity. They include chatbots and voice assistants to answer questions, apps to monitor heart rate, wearable devices that track fitness levels, and so on.
Increased access to smartphones, increased digital literacy, increased patient/consumer expectations and the transition to personalised care are all factors driving the fast adoption of digital technology in health.
A recent Deloitte (2018) survey of 4,530 American adults found that among those who used technology for health, 75% rely on digital assistants for reminders or alerts about medications, while 72% use digital assistants to monitor their health. Millennials are more likely to use digital technology for health (over 80%) than seniors. While millennials used them more to monitor health, their tech savvy seniors were more likely to use them to receive medication reminders.
People want more choice and control over the way their care is planned and delivered. They want care that is tailored to their individual needs, strengths and what matters to them. Digital assistants can help to achieve this as they put the individual in the driver’s seat.
Virtual assistants also have the potential to help relieve the stresses associated with the delivery of healthcare by improving diagnosis, providing more personalised care at the convenience of the user, expanding access to healthcare services, driving operational effectiveness, and reducing the strain on healthcare professionals (Edelmann 2019).
The emerging evidence on the effectiveness of using digital assistants in healthcare is positive. Chatbots and conversational agents have been found to be useful in the field of mental health, particularly in psychoeducation and self-adherence (Vaidyam et al. 2019). Bibault et al. (2019) reviewed the effectiveness of using conversational agents in the field of oncology and found that chatbots were effective in cancer screening and mental health. A study among African American men found that those who used iDecide – a chatbot which delivers information about prostate cancer to patients – experienced signiﬁcant improvements in their knowledge of prostate cancer and intention to engage in informed decision making (Owen et al. 2018). Fitzpatrick et al. (2017) found that Woebot, a chatbot delivering cognitive behavioural therapy (CBT), significantly reduced symptoms of depression. Unsurprisingly, studies have also found that chatbots that express sympathy and empathy are favoured over unemotional provision of advice (Liu and Sunder 2018).
The NHS is also testing the use of digital assistants. For example, a pilot project in Stoke-on-Trent and across Staffordshire involved the distribution of 50 digital assistant kits ( Echo Show) to 50 patients with health or dependence needs (dementia, multiple sclerosis, Behcet’s disease and generalised anxiety and depression). Patients reported being better able to manage their health conditions and lead more independent lives. Some even reported that the device was a source of welcome companionship (Chambers and Beaney 2020).
Digital assistants in the time of Covid-19
The potential advantages of going digital have never been more obvious than now. The coronavirus pandemic has led to a demand surge across the globe for inpatient and intensive care unit beds and associated health services and resources. This, coupled with the high transmissibility of the virus, has laid bare the limitations of a health care delivery system that relies mainly on face-to-face contact. The need to reduce the spread, while continuing to provide optimal care and contain costs has resulted in many countries, health systems, healthcare providers, and clinicians deploying digital health tools.
For example, The World Health Organization (WHO) released a text-based chatbot called Health Alert via the highly popular messaging app, WhatsApp, to respond to public questions about Covid-19 (WHO 2020). Apple released an app to share Covid-19 information and updates using CDC resources, which can also be accessible through Siri (Apple 2020). Amazon released Alexa VA features to help users set up routines while staying at home and provide tips, information and guidance about Covid-19 (Amazon 2020). The UK government built the NHS Covid-19 app to help track and trace the virus.
As with anything new, the use of digital assistants in healthcare too comes with its own share of concerns.
Privacy: How our personal health information is collected, stored and secured is of concern to many in a world where data sharing with third parties is common. People also have concerns about government surveillance through apps such as NHS Track and Trace.
Integration: The efficacy of digital assistants relies on integration with existing health infrastructure. These technological systems cannot replace the physicians and should be considered as a resource to enhance the efficacy of healthcare interventions.
Patient Safety: There haven’t been many studies looking at the potential harm associated with a reliance on conversational agents for medical information. One study cautioned against depending on digital assistants for answers to medical questions and to always check with a medical practitioner before acting on them (Bickmore et al. 2018).
Effectiveness: Another concern would be the quality of these tools in achieving its desired outcomes. Do these tools go far enough? For any digital solution to be effective, it would need to be designed around the needs of the individual or the health system for optimised functionality and user experience. Furthermore, digital assistants that aim to change behaviour such as improve sleep, increase physical activity or encourage healthy eating habits, would need to employ evidence-based and persuasive content. Appropriate use of behaviour change techniques integrated within the content can have positive outcomes.
Digital literacy: Any digital innovation would require a certain level of digital literacy for it to be successful. Internet connectivity and data costs are also a concern for many populations.
In conclusion, digital assistants have a real potential to improve the quality and delivery of healthcare. They play a significant role in the shift to personalised care, giving individuals, families and communities more control over their care and support plans. The concerns around privacy and patient safety mean that there is a need for regulation. Furthermore, their effectiveness lies in how closely aligned these tools are to the needs of individuals from a design and content perspective. Evidence-based content that is personalised and contextual using established behaviour change techniques can improve the effectiveness of these tools in improving health outcomes.
Amazon (2020) Alexa and Amazon Devices COVID-19 resources. Amazon https://blog.aboutamazon.com/devices/alexa-and-amazon-devices-covid-19-resources
Apple (2020). Apple releases new COVID-19 app and website based on CDC guidance. Apple https://www.apple.com/newsroom/2020/03/apple-releases-new-covid-19-app-and-website-based-on-CDC-guidance/
Bibault J et al. (2019) Healthcare ex Machina: Are conversational agents ready for prime time in oncology? Clinical and Translational Radiation Oncology 16. DOI: 10.1016/j.ctro.2019.04.002
Bickmore TW et al. (2018) Patient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: An Observational Study of Siri, Alexa, and Google Assistant. J Med Internet Res. 2018 Sep 4;20(9):e11510. doi: 10.2196/11510.
Chambers R and Beany (2020) The potential of placing a digital assistant in patients’ homes. Br J Gen Pract. 2020 Jan; 70(690): 8–9. doi: 10.3399/bjgp20X707273 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919512/
Deloitte (2018) Connected health: How digital technology is transforming health and social care. https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-connected-health.pdf
Edelman S (2019) 7 ways digitization will shape the future of healthcare. HealthcareTransformers.com
Fitzpatrick KK, Darcy A, Vierhile M. (2017) Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR Mental Health 2017;4:e19
Goldstein IM, Lawrence J, Miner AS. (2017) Human-machine collaboration in cancer and beyond: the centaur care model. JAMA Oncol 2017;3:1303–4.
Liu B and Sunder SS (2018) Should Machines Express Sympathy and Empathy? Experiments with a Health Advice Chatbot. Cyberpsychology, Behavior, and Social NetworkingVol. 21, No. 10. https://doi.org/10.1089/cyber.2018.0110
Owens OL, Felder T, Tavakoli AS, et al. (2018) Evaluation of a computer-based decision aid for promoting informed prostate cancer screening decisions among African American men: iDecide. Am J Health Promot 2018. 890117118786866.
Vaidyam AN et al. (2019) Chatbots and Conversational Agents in Mental Health: A Review of the Psychiatric Landscape. Can J Psychiatry. 2019 Jul; 64(7): 456–464. doi: 10.1177/0706743719828977
WHO (2020) WHO Health Alert brings COVID-19 facts to billions via WhatsApp. WHO https://www.who.int/news-room/feature-stories/detail/who-health-alert-brings-covid-19-facts-to-billions-via-whatsapp
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