Alexa Can Truly Give Patients a Voice in Their Health Care (Part 3 of 3)

Earlier parts of this article set the stage for understanding what the Alexa Diabetes Challenge is trying to achieve and how some finalists interpreted the mandate. We examine three more finalists in this final section.

DiaBetty from the University of Illinois-Chicago

DiaBetty focuses on a single, important aspect of diabetes: the effect of depression on the course of the disease. This project, developed by the Department of Psychiatry at the University of Illinois-Chicago, does many of the things that other finalists in this article do–accepting data from EHRs, dialoguing with the individual, presenting educational materials on nutrition and medication, etc.–but with the emphasis on inquiring about mood and handling the impact that depression-like symptoms can have on behavior that affects Type 2 diabetes.

Olu Ajilore, Associate Professor and co-director of the CoNECt lab, told me that his department benefited greatly from close collaboration with bioengineering and computer science colleagues who, before DiaBetty, worked on another project that linked computing with clinical needs. Although they used some built-in capabilities of the Alexa, they may move to Lex or another AI platform and build a stand-alone device. Their next step is to develop reliable clinical trials, checking the effect of DiaBetty on health outcomes such as medication compliance, visits, and blood sugar levels, as well as cost reductions.

T2D2 from Columbia University

Just as DiaBetty explores the impact of mood on diabetes, T2D2 (which stands for “Taming Type 2 Diabetes, Together”) focuses on nutrition. Far more than sugar intake is involved in the health of people with diabetes. Elliot Mitchell, a PhD student who led the T2D2 team under Assistant Professor Lena Mamykina in the Department of Biomedical Informatics, told me that the balance of macronutrients (carbohydrates, fat, and protein) is important.

T2D2 is currently a prototype, developed as a combination of Alexa Skill and a chatbot based on Lex. The Alexa Skills Kit handle voice interactions. Both the Skill and the chatbot communicate with a back end that handles accounts and logic. Although related Columbia University technology in diabetes self-management is used, both the NLP and the voice interface were developed specifically for the Alexa Diabetes Challenge. The T2D2 team included people from the disciplines of computer interaction, data science, nursing, and behavioral nutrition.

The user invokes Alexa to tell it blood sugar values and the contents of meals. T2D2, in response, offers recipe recommendations and other advice. Like many of the finalists in this article, it looks back at meals over time, sees how combinations of nutrients matched changes in blood sugar, and personalizes its food recommendations.

For each patient, before it gets to know that patient’s diet, T2D2 can make food recommendations based on what is popular in their ZIP code. It can change these as it watches the patient’s choices and records comments to recommendations (for instance, “I don’t like that food”).

Data is also anonymized and aggregated for both recommendations and future research.

The care team and family caregivers are also involved, although less intensely than some other finalists do. The patient can offer caregivers a one-page report listing a plot of blood sugar by time and day for the previous two weeks, along with goals and progress made, and questions. The patient can also connect her account and share key medical information with family and friends, a feature called the Supportive Network.

The team’s next phase is run studies to evaluable some of assumptions they made when developing T2D2, and improve it for eventual release into the field.

Sugarpod from Wellpepper

I’ll finish this article with the winner of the challenge, already covered by an earlier article. Since the publication of the article, according to the founder and CEO of Wellpepper, Anne Weiler, the company has integrated some of Sugarpod functions into a bathroom scale. When a person stands on the scale, it takes an image of their feet and uploads it to sites that both the individual and their doctor can view. A machine learning image classifier can check the photo for problems such as diabetic foot ulcers. The scale interface can also ask the patient for quick information such as whether they took their medication and what their blood sugar is. Extended conversations are avoided, under the assumption that people don’t want to have them in the bathroom. The company designed its experiences to be integrated throughout the person’s day: stepping on the scale and answering a few questions in the morning, interacting with the care plan on a mobile device at work, and checking notifications and messages with an Echo device in the evening.

Any machine that takes pictures can arouse worry when installed in a bathroom. While taking the challenge and talking to people with diabetes, Wellpepper learned to add a light that goes on when the camera is taking a picture.

This kind of responsiveness to patient representatives in the field will determine the success of each of the finalists in this challenge. They all strive for behavioral change through connected health, and this strategy is completely reliant on engagement, trust, and collaboration by the person with a chronic illness.

The potential of engagement through voice is just beginning to be tapped. There is evidence, for instance, that serious illnesses can be diagnosed by analyzing voice patterns. As we come up on the annual Connected Health Conference this month, I will be interested to see how many participating developers share the common themes that turned up during the Alexa Diabetes Challenge.

About the author

Andy Oram

Andy Oram

Andy Oram writes and edits documents about many aspects of computing, ranging in size from blog postings to full-length books. Topics cover a wide range of computer technologies: data science and machine learning, programming languages, Web performance, Internet of Things, databases, free and open source software, and more. My editorial output at O'Reilly Media included the first books ever published commercially in the United States on Linux, the 2001 title Peer-to-Peer (frequently cited in connection with those technologies), and the 2007 title Beautiful Code. He is a regular correspondent on health IT and health policy for He also contributes to other publications about policy issues related to the Internet and about trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business.