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How we are talking to Alexa

The NHS website team has worked with Amazon’s Alexa team to offer health information by voice search. Eva Lake, Head of Engagement for the website, explains how the collaboration is working.

Author:: Eva Lake, Head of Engagement, NHS.UK

Date:: 25 July 2019

The recent announcement about NHS content being available on Alexa devices sparked some interesting discussion about the challenges for the NHS of working with large commercial organisations like Amazon. I want to explain how we are working with Amazon and why such partnerships are important to achieving our mission of getting health information to people on the platforms they choose.

Why do we want our information on voice?

There are currently over 1,500 organisations consuming content from the NHS website. Our syndication service allows these third-party partners to integrate our clinically approved content and service information through free application programming interfaces (APIs) or widgets.

It is estimated that 14% of UK households now have voice-activated speakers. Whether or not you believe predictions that 50% of searches will be by voice by 2020, this is a significant market – and is particularly significant for health information. Using websites can be hard for people with literacy difficulties and accessibility needs. Voice-activated devices offer one way, for some people, of getting around these problems. So, this is an important new opportunity for us – but one that we have approached carefully.

Starting the conversation

Members of our syndication team went to NHS Expo 2017 to talk to people about the API offer from the NHS website. We met members of the Amazon Alexa team at the event and found there was mutual interest in exploring this further.

We had previously looked at how to build a ‘skill’, the equivalent of an app which individual users can enable on their Alexa speaker. We could have developed a skill ourselves, without a close partnership with Amazon, but the contact at Expo developed into a chance to take advantage of their expertise in creating content for voice. By adding our content to Alexa’s core knowledge base, it could be used for all relevant questions not requiring a user to enable a skill in advance. This is key when you consider the challenge of reaching those who are not actively engaging in their own health.

Navigating the development

There were a lot of complexities to address before we got to where we are now, and we frequently reviewed and discussed concerns with colleagues. When working with any organisation, especially commercial entities, we are aware that they have different priorities to the NHS and we, as a nation and as NHS staff, are very protective of our health system’s non-commercial ethos. This makes it a sensitive area to operate in, but, fundamentally, we are happy that Amazon wants to be able to offer trusted health information to answer questions from Alexa users. Our priority is to allow people to use their preferred channels to answer basic health questions.

What makes this collaboration special?

We offer a free API of NHS website content to anyone building digital products and services. While free of charge, there are specific terms about reporting and branding, plus partners must undertake to make no changes whatsoever to our content.

But we recognise that a voice platform has specific demands. A bullet list doesn’t work well on voice and you don’t have access to colours and positioning to help your users navigate high priority content. We have worked with Amazon to find an approach that allows only essential alterations for voice-specific content based on a core approach. We have stuck to the fundamental principle of not agreeing a way of working with Amazon that we would not be willing to consider with any single partner – large or small. We have been careful about data, commercialisation, privacy and liability, and we have spent months working with knowledgeable colleagues to get it right.

Some of the challenges and misunderstandings:

It might be helpful to capture some of the key themes that are coming through from feedback so far, and to reflect conversations we have had about mitigating these.

1. Fear that technology risks taking the humanity out of the NHS

Last year we ran a project to redesign the NHS website. As part of that, we explored people’s perceptions of digital health. It was clear that there is quite a lot of fear from people when we talk about opportunities in health and technology. They do not want supermarket-style self-checkouts where they can look after their own health. It is the staff that are the real heroes of the NHS; people do not want to lose that.

Alexa should absolutely not be thought of like a doctor, nurse or any health practitioner, despite some of the media coverage. We are only offering information from the NHS website, not attempting to give personalised health advice or triage.

We want to get relevant and effective information to people. What are the symptoms of chickenpox? How do you relieve a migraine? What can you do about flu? I do hope it saves NHS resource, helping people know when they can see a pharmacist, for example. But I do not see it as replacing that human connection in any way.

I also keep trying to intercept uses of the word ‘advice’ in this context. That’s not what the NHS website tries to do and it’s not what Alexa is trying to do. We aim for what we call ‘action-oriented content’. This helps you know what actions you could take and, where appropriate, Alexa will pick up on that, too.

2. What is Amazon going to do with the data and what about privacy?

We have worked with the Amazon team to ensure that we can be totally confident that Amazon is not sharing any of this information with third parties. Amazon has been very clear that it is not selling products or making product recommendations based on this health information, nor is it building a health profile on customers. All information is treated with high confidentiality. Amazon restrict access through multi-factor authentication, services are all encrypted, and regular audits run on their control environment to protect it

As has been observed by some journalists, this isn’t dissimilar to general search, but by voice, so some of the concerns about privacy and commercialisation are the same as those that apply to all search providers.

3. Why are we giving this away for free?

The content is already freely available on the NHS website and over 1,500 organisations are signed up to our APIs. The Alexa partnership is a mutually beneficial one that will enable more people to access information accredited by the NHS and which helps people get control of their own healthcare. It will also improve accessibility for people who are less confident with written material, those with lower levels of computer literacy and with physical mobility issues that can affect access to a website. Amazon is obviously not the only operator in the voice market, and we are discussing opportunities with others, too.