2021年4月13日 星期二

On Tech: Can medical Alexas make us healthier?

Plus, hacking technology, with long distance operators.

Can medical Alexas make us healthier?

Ariel Davis

Are voice recognition technologies like Alexa helpful in medicine or are they hogwash? For now, the short answer is a little of both.

Microsoft on Monday said that it would spend roughly $16 billion to buy Nuance Communications, whose speech transcription software is used in health care.

Microsoft as well as other tech companies like Google and Amazon have big ambitions to transform the industry with artificial intelligence technologies, including in voice recognition programs and efforts to identify signs of illness and disease.

The big hope of technology in medicine is that it can help make us healthier and improve America's expensive and often ineffective and unjust health care system. The message that I have heard from medical experts is that there's potential there, but there is also a lot of hot air.

The hope of medical Alexas:

For years, doctors have used Nuance's transcription software to speak notes about patients and convert them into text for medical records. In theory, that frees doctors from having to do paperwork so they can spend more time treating us.

Nuance and other tech and health care providers want to do much more with our voices. One idea is that microphones might record (with permission) interactions between physicians and patients and log the relevant details into medical files — without much human involvement. Computers would also be smart enough to order any necessary tests and handle billing.

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This sounds cool and perhaps a little creepy. These ideas are still under development, and it's not clear how well these medical Alexas would work. But Dr. Eric J. Topol, a professor of molecular medicine at Scripps Research and the author of several books on technology in medicine, told me that voice recognition systems are one of the most consequential uses of artificial intelligence in health care, at least in the short term.

At Cedars-Sinai, a health system in Southern California, most hospital rooms have been outfitted with voice activated devices, said Darren Dworkin, the organization's chief information officer. For now, the devices are mostly used for relatively mundane interactions, such as a nurse asking a device to show a patient a video on preventing dangerous falls.

Dworkin said that he was most optimistic about using voice and other technologies to automate administrative work, such as authorizing insurance for medical treatments and sending tailored text messages to patients.

Dworkin said that those uses of technology might not be what many considered a wow factor, but that busywork was a huge cost and challenge in health care.

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"Not everything has to be state of the art," Dworkin said. "Don't let the simple stuff pass you by." (Another vote for the importance of boring technology!)

Where hope meets harsh reality:

Just about every technology used in health care — and many other fields — promises to reduce administrative work and costs. And yet, health care expenses and bureaucracy in the United States mostly continue to go up.

Dr. Dhruv Khullar, a physician and assistant professor of health policy and economics at Weill Cornell Medicine, said that he was optimistic that voice tech and artificial intelligence could reduce administrative burdens and help patients. But he said that his hope was not yet backed by rigorous proof.

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"There is not a lot of evidence at this point that A.I. reduces costs or improves health outcomes," Dr. Khullar told me. (I borrowed the "medical Alexas" line from him.)

I asked these health experts an overarching question: What role should technology play in tackling the root problems of American health care?

They largely agreed that advances in technology could help reduce costs and improve the quality of service in our health care system, but that it was not a silver bullet for our biggest problems.

"I would say, it's part of the answer but not a large part of it," Dr. Khullar said.

(And read more from DealBook: How has Microsoft mostly avoided the government's antitrust attention? My answer: Microsoft's essential technology is mostly dull. That is a good thing.)

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YOUR LEAD

Hacking technology, with long distance operators

Last week, I pointed to a terrific article about Indians adapting to expensive mobile phone calls by coming up with new ways to communicate that involved hanging up mid-ring. An On Tech reader, Morris Fried of Somerset, N.J., wrote to us about his family's missed call communications system from decades ago:

Your note about using missed calls for communications in India stirred old memories of the same technique in this country. (I will be 75 next month.)

When I was a child, we would drive back home to Philadelphia after visiting my grandmother in Brooklyn. My mother would then call the operator and request a person-to-person long distance call to her own name at my grandmother's phone number.

My grandmother would answer the phone and tell the operator that my mother was not there. My mother thereby succeeded in informing her mother that we had arrived home safely without incurring the then not-insignificant expense to us of a long distance telephone call.

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Before we go …

Hugs to this

"If you've always wanted your own haunted Victorian child in the body of a small dog that hates men and children …" I laugh-cried at this extremely detailed description of Prancer on Facebook and his MANY peculiar habits, posted by a New Jersey pet adoption league.

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2021年4月12日 星期一

On Tech: Hearing aids for the masses

Plus, giving away your phone? Be sure to delete everything.

Hearing aids for the masses

Yoshi Sodeoka

On Tech is back from a spring break, and the magnolia trees are blooming outside On Tech headquarters (a.k.a., my New York apartment).

Today, let's talk about relatively simple technology and a change in government policy that could unleash more innovation for Americans who have difficulty hearing.

I've been speaking with audiologists, consumer advocates and technology companies about what could be a revolution for our ears — hearing aids at a fraction of the cost and hassle of conventional devices.

Here's how things stand now: Hearing loss is a pervasive and serious health problem, and many people are reluctant or can't afford to get conventional hearing aids. Nearly 38 million American adults report some degree of hearing loss, but only a minority of people who could benefit from hearing aids have ever used them.

Hearing aids typically cost thousands of dollars, require multiple visits to specialists and often aren't covered by health insurance. Untreated hearing loss is associated with cognitive decline, dementia and other harms. Overcoming barriers to hearing treatment may significantly improve Americans' health.

The federal government is poised to help. Congress in 2017 passed legislation that would let anyone buy hearing aids approved by the Food and Drug Administration without a prescription from an audiologist. The F.D.A. has missed a deadline to release draft guidelines for this new category of over-the-counter hearing aids.

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Experts told me that when the F.D.A. moves ahead, it's likely to lead to new products and ideas to change hearing aids as we know them.

Imagine Apple, Bose or other consumer electronics companies making hearing aids more stylish and relatively affordable — with people having confidence that the devices had been vetted by the F.D.A. Bose told me that it's working on over-the-counter hearing aid technology.

Barbara Kelley, executive director of the Hearing Loss Association of America, an advocacy organization, told me that she can't wait for more affordable and accessible hearing help. "I'm really excited for the market to open up to see what we got and see how people are reacting," she said.

It is already possible to buy a hearing helper — they can't legally be called hearing aids — without a prescription. These devices, called personal sound amplification products or PSAPs, vary wildly in quality from excellent to junk. But when shopping for them, people often can't tell the difference.

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(The Wall Street Journal also recently wrote about hearing helper technologies, including earbuds that can amplify quiet sounds. And Consumer Reports has a useful guide to hearing aids and PSAPs.)

Nicholas Reed, director of audiology at the Johns Hopkins Cochlear Center for Hearing and Public Health, told me that the F.D.A. process should provide a path for the best PSAPs to be approved as official over-the-counter hearing aids. He expects new companies to hit the market, too.

You may doubt that a gadget you buy next to the toilet paper at CVS could be a serious medical device. Dr. Reed's research, however, has found that some hearing helpers for $350 or less were almost as good as prescription hearing aids for people with mild-to-moderate hearing loss.

Dr. Reed described the best lower-cost devices as the Hyundai of hearing help. (This was a compliment.) They aren't flashy, but they will get many people safely and effectively where they need to go. He also imagines that the F.D.A. rules will create the conditions for many more people to buy hearing aids — both over the counter and by prescription.

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Over-the-counter hearing aids won't be able to help everyone, experts told me. And the traditional hearing aid industry has said that people are best served by customized devices with expert help.

There is also more technology brewing at the luxury end of the spectrum. A Silicon Valley start-up called Whisper has a novel monthly payment option for its hearing aids and says that its software "learns" over time based on an individual's hearing deficits.

Health care in the United States can often feel as if it's stuck, and technology is usually not the solution. But with hearing aids, technology and a change in government policy could bring helpful health innovation.

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TIP OF THE WEEK

Giving away your phone? Be sure to delete everything.

Don't let a stranger see all your old texts and photos! Brian X. Chen, The New York Times's consumer technology columnist, has advice for what to do before you hand over your old phone.

At some point, you will bid farewell to your smartphone. You might give it away to a family member because you bought a new one, or you could trade it in at a retail store to get credit toward an upgrade.

Whatever the case, you should make sure to wipe all data from your device before handing it over.

First things first: Make sure you have a backup of your data. Apple has instructions on its website for how to back up iPhones, and Google has instructions for Androids.

After you've completed that step, plug in the device and erase all data from it. For iPhones, follow Apple's instructions to purge your data. For Androids, the steps will vary depending on the device manufacturer and operating system version. Search inside the settings app for a reset option.

And then, you're good to go.

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Before we go …

Hugs to this

Coconut, an African fruit bat, is enjoying a reward of apple juice after some nail trimming.

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