Analysis: Why Alexa’s Bedside Manner Is Bad For Health Care

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Yves here. I can’t understand why anyone would trust Amazon with health care data. However, the author’s closing comment is disconcerting, since she appears to be unaware of the fact that electronic medical records are optimized for billing, and as we’ve documented (courtesy Health Care Renewal) for at least four year, are a serious detriment to patient care.

By Elisabeth Rosenthal, Editor-in-Chief of Kaiser Health News. Before that, she was a correspondent with The New York Times, where she did a stint in the Beijing bureau, and covered SARS, bird flu and the emergence of HIV/AIDS in rural areas. Her book, “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” (Penguin Random House, 2017), was a New York Times best-seller and a Washington Post notable book of the year. She is a graduate of Stanford University and Harvard Medical School and briefly practiced medicine in a New York City emergency room before converting to journalism. You can reach her at and @rosenthalhealth. Originally published at Kaiser Health News

Amazon has opened a new health care frontier: Now Alexa can be used to transmit patient data. Using this new feature — which Amazon labeled as a “skill” — a company named Livongo will allow diabetes patients — which it calls “members” — to use the device to “query their last blood sugar reading, blood sugar measurement trends, and receive insights and Health Nudges that are personalized to them.”

Private equity and venture capital firms are in love with a legion of companies and startups touting the benefits of virtual doctors’ visits and telemedicine to revolutionize health care, investing almost $10 billion in 2018, a record for the sector. Without stepping into a gym or a clinic, a startup called Kinetxx will provide patients with virtual physical therapy, along with messaging and exercise logging. And Maven Clinic (which is not actually a physical place) offers online medical guidance and personal advice focusing on women’s health needs.

In April, at Fortune’s Brainstorm Health conference in San Diego, Bruce Broussard, CEO of health insurer Humana, said he believes technology will help patients receive help during medical crises, citing the benefits of home monitoring and the ability of doctors’ visits to be conducted by video conference.

But when I returned from Brainstorm Health, I was confronted by an alternative reality of virtual medicine: a $235 medical bill for a telehealth visit that resulted from one of my kids calling a longtime doctor’s office. It was for a five-minute phone call answering a question about a possible infection.

Virtual communications have streamlined life and transformed many of our relationships for the better. There is little need anymore to sit across the desk from a tax accountant or travel agent or to stand in a queue for a bank teller. And there is certainly room for disruptive digital innovation in our confusing and overpriced health care system.

But it remains an open question whether virtual medicine will prove a valuable, convenient adjunct to health care. Or, instead, will it be a way for the U.S. profit-driven health care system to make big bucks by outsourcing core duties — while providing a paler version of actual medical treatment?

After all, my doctors have long answered my questions and dispensed phone and email advice for free — as part of our doctor-patient relationship — though it didn’t have a cool branding moniker like telehealth. And my obstetrician’s office offered great support and advice through two difficult pregnancies — maybe they should have been paid for that valuable service. But $235 for a phone call (which works out to over $2,000 per hour)? Not even a corporate lawyer bills that.

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  1. sd

    Disclaimer – my mother had Kaiser under Medicare. She recently passed away. I spent the last two years interfacing with Kaiser on her behalf. So there’s some background context that’s missing if you are unfamiliar with how Kaiser coordinates care.

    The author writes for Kaiser, so there’s a strong assumption she also has Kaiser for her health care. Kaiser is extremely efficient, costs are explained upfront, copays and billing is at point of service. There’s no mystery meat involved, for instance, invoices do not arrive two years after service even when receiving services through a partner (nursing facility for instance)

    Kaiser also offers – for free – an 24 hour nurse hotline. I was on the line in one particular call where the nurse was carefully describing symptoms to watch for, and at what point to call an ambulance. Five minutes later, I called an ambulance because of that call.

    1. leapfrog

      I’ve been getting “surprise” bills with the crappy Bronze 60/40 plan offered by my employer. When I pay my portion of the co-pay at point of service, a month later I get a bill for more. I’ve had Kaiser for 25+ years and never had this issue before. Of course, I had a better plan before this downgrade to the awful Bronze plan. Part of the reason I used to like Kaiser was (as you mentioned) “no mystery meat.” Now, I’m not so sure I like them anymore.

      1. sd

        Thank you. Still would help to know which plan the author has, the context is missing.

        Everyone has a different experience under different plans that’s it’s like we’re all speaking different languages to each other.

        1. Angie Neer

          BTW, I had Kaiser health care from 1984 to 1996, including my wife’s pregnancy and delivery, and early care of our son. I was quite happy with it. While they were clearly super cost-conscious, they had a well-integrated system that seemed genuinely oriented toward care, rather than billing. If it’s still working well, that gives me a little hope that such things are possible.

  2. Arizona Slim

    If a business is referring to its customers as “members,” that’s a BS tell.

  3. Ep3

    Yves, I don’t know where you (or the author) goto the doctor. But in the LANSING Michigan area, the doctor makes his diagnosis before even seeing the patient. First the nurse (MA, not a nurse, a 2 yr degree) comes in, asks questions, reviews everything. They generate a report that the doctor reads before he sees the patient. He uses this to decide treatment. By the time the doctor walks into the room, he has already decided what to do. The procedures he engages in are just to cover his liability (“yes I pressed on the patient’s stomach but couldn’t diagnose they had stomach cancer”). The doctors are limited in the amount of time they spend with the patient (insurance limits reimbursement if they spend too much time). Many doctors are part of “doctor companies”. They are employees of a company that oversees the management of the practice, the billing, and helps lower other overhead. These micromanage all aspects of the business. So with that said who knows if such companies don’t generate scripts for the doctor before he sees patients? Maybe he goes to a website, looks up “high cholesterol over 65” & his company says “check this ask this then prescribe this”. Reduces liability, automates patient interaction, maximizes billing too (a formula calculates profit margin from certain procedures so if u do this, then u should make this much money).
    My point, medicine is already compromised in the name of profits. Ppl have been asleep thinking that “oh this won’t ever happen to me” until it’s too late.

    Thanks Yves keep up the good work

  4. Cal2

    Patients and customers of the medical establishment should demand face to face time with doctors and nurses. After my recent ordeal with the medical establishment, and thanks to reading N.C., I became aware of what those steps should be and what I could do to avoid the slippery slope to the horror show described in the article.

    FWIW, set up a dedicated free email for medical only. If you have an alternate land line, never give them your cell numbe. Start a dedicated medical only calendar where all activities past and future appointments can be logged.

    Get hard copies of all lab results plus images on disk and keep them at home in a file.
    Do not join an internet “medical portal.” Have everything sent to you in the U.S. Mail. Let them print it for you. “I don’t own a computer nor smart phone” gets that by law.

    Keep a log of all calls, who you spoke to and record the important ones, with their knowledge.
    Make scans of all checks. Keep a running log of costs.

    Our insurance company backed down twice and covered bills when presented with evidence like this. Was able to deflect demands for collection from providers and refer them back to the insurance company as well. Trust no institution, but spread love with the underpaid and stressed people in medicine.

  5. flora

    And if we’re trying to bring health care into the tech-enabled 21st century, how about starting with low-hanging fruit: Does any other sector still use paper bills and faxes?

    At the risk of sounding hopelessly out-of-date, I want paper bills for the same reason I want paper ballots hand marked. It’s much too easy for computers to make a hash of things. (My career is IT so I know something about this.) If there’s a billing dispute I want a paper record that can’t be ‘lost’ in the computer upgrade, or ‘modified by mistake’, etc.

  6. dr john

    $100 for an aspirin,

    $250 for a chat with alexa

    Like they used to say, “USA people didn’t die from their health-care system, they died, because they no longer could afford their system”

    Well its not too late if your still alive, get-out, and go live a country with free, or close to free health-care.

    USA system is designed to bleed people until bankruptcy or death, and preferably you die exactly when your funds go to zero.

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