For a number of reasons, the time that a clinician and a patient have to converse during an office visit is decreasing. Symptom Helper is a Skill to help increase the efficiency of one aspect of that interaction – the recounting of the patient’s symptoms to their care provider. There is specific information that the clinician needs to start the diagnostic process. Until now, the clinician had to ask those questions of the patient during the office visit. As a retired physician, I thought that many of those questions could be asked through Alexa at the patient’s home prior to the visit, and a short, relevant symptom statement could be generated that could then be shared with the clinician. That could help move the conversation to the more unique aspects of the patient’s situation. After answering Symptom Helper’s questions about the symptom, the patient can hear that symptom statement through an Echo device, see it on an Echo device with a display or access it on a unique custom Symptom Helper List on their Alexa App. Once on the Alexa App, that symptom list can be read or shown to the clinician in their office during that office visit.

What it does

The ultimate goal of Symptom Helper is to transfer the user’s symptoms to a custom Symptom Helper List on their Alexa App. To do that you must first:

  1. Enable Symptom Helper and register in the database log with a first name, by saying “Register me.” This registration process enables Symptom Helper to allow each member of your household to log their own symptoms and create their own custom Symptom Helper List on the Alexa App.
  2. You can then enter symptoms into the skill, by saying “Let me log a symptom.” You will then be given the choice of answering approximately 12 questions at once (Log it all) or answering about half of them at that time (Log Part 1). Should you choose to enter just the first 6 questions, you will be able to complete the rest when you are ready. With either choice, you will get a concise symptom summary. Why so many questions? Well typically, there are some key questions that the clinician will want to know about the symptom, including onset, frequency of occurrence, things that improve it & things that worsen it, among others.
  3. To answer the remaining questions for a partially entered symptom just say, “Tell me the symptoms I should complete.” Alexa will then give you a list of those symptoms from which you choose the symptom you wish to complete.
  4. An extremely useful feature of Symptom Helper is the ability to create a custom Symptom Helper list on your Alexa App on your smartphone. To do that, simply say, “Create a Symptom Helper list for me.” You will be asked to give the name you used to register. (If you have not granted permission to allow access to both read and write lists, you will be guided to change them in your Alexa App before the custom list can be created.) Once your custom Symptom Helper List is created, you will be able to see it on the Alexa App with the name, Symptom Helper List For (YOUR NAME).
  5. Now, you can say, “Tell me my symptoms,” to retrieve a list of your symptoms formatted concisely from the symptom database.
  6. If you have already created a Symptom Helper list on your Alexa App, you can add any of these spoken Symptoms to that list. For example, to add symptom 2, just say, “Add symptom number 2 to my list.”

Here are a few more features of Symptom Helper:

  1. To delete an individual symptom, just say, “Let me delete a symptom,” and you will be led through the process to delete the symptom from the log.
  2. To start the process to delete a logged patient, you can say, “Let me delete a patient.” This will also delete any associated symptoms in the database as well as the patient. It will not delete any symptoms already on the patient’s Symptom Helper List on the Alexa App.
  3. To get some coaching on how to describe your symptom in preparation for your doctor visit, you can say, “Coach me on describing my symptoms.”
  4. Finally, you can say, “Help” to hear some tips on using Symptom Helper.

Remember, the ultimate goal of Symptom Helper is to share better-organized descriptions of your symptoms with your clinician in their office by your reading or showing them on your custom list on your smartphone's Alexa App or having Alexa speak them by pressing the Alexa button on the App & asking, “Read the symptoms on my Symptom Helper List For (User Name).” Undoubtedly, even after answering all the questions, your clinician will probably have a few more to ask, but by using Symptom Helper you can give that conversation a great start.

How I built it

I used JavaScript, MySQL, and Amazon Alexa with APL support for devices with displays.

Challenges I ran into

As I was preparing to enter the Skill, I noted that the Symptom Helper List on my smartphone Alexa App gets cut off, though on my tablet and computer when the landscape orientation is an option, each entered symptom can be viewed in its entirety. On August 24th I reached out to the Alexa Support Team to report this problem. Meanwhile, I determined that Alexa would read the symptoms from the custom list by pressing the Alexa icon on the Alexa App and saying, “What symptoms are on my Symptom Helper List For Bob?” This is still not the best solution, but I am hopeful the Support Team will have some ideas before the close of the hackathon.

Learning how to create & add symptoms to custom lists for the Alexa App.

Determining the best way to help the user organize their symptoms in preparation for the office visit.

Accomplishments that I’m proud of

Learning how to create custom lists and add the symptoms to them.

What I learned

Custom list functionalities.

What's next for Symptom Helper

Since I think this approach is an opportunity to provide clinical information from the patient to the clinician in an efficient way to optimize the value of the visit. Symptom Helper is a prime example of where voice in healthcare delivery can go. I am hopeful that appropriate organizations, such as, Medical Groups & Electronic Health Record (EHR) vendors see the benefit of this approach and move to apply the System Helper approach more expeditiously to benefit both patients and clinicians. With my experience on both sides of the stethoscope plus voice development skills, I believe I would be a good partner to help move this along. I have already developed a prototype for using Alexa to provide post-procedure information to a patient. I am hoping that Symptom Helper can provide a pathway to that goal.

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