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The Voice of Healthcare - Episode 4

Co-hosts: Dr. Matt Cybulsky (Principal, Ionia) and Bradley Metrock (CEO, Score Publishing)

Guest: Cathy Pearl, VP of User Experience at Sensely

[Ms. Pearl is now Head of Conversation Design Outreach at Google ]

Duration: 24 minutes, 37 seconds

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Bradley Metrock: [00:00:00] In Episode 4 of The Voice of Healthcare we interviewed Cathy Pearl, VP of User Experience for, a company that is revolutionizing health care by bringing it in into the home. Enjoy!


Bradley Metrock: [00:00:24] Hi! And welcome back to Episode 4 of The Voice of Healthcare. My name is Bradley Metrock and I'm CEO of a company called Score Publishing, based here in Nashville, Tennessee.


Bradley Metrock: [00:00:34] I'm joined by my co-host Dr. Matt Cybulsky - Matt, say hello!


Dr. Matt Cybulsky: [00:00:38] Hello everyone. Glad everyone is back listening to us and we're really excited about today's show.


Bradley Metrock: [00:00:42] Yeah, this is going to be awesome. Our guest today is Cathy Pearl. Cathy, say hello!


Cathy Pearl: [00:00:47] Hello!


Bradley Metrock: [00:00:48] Cathy, thank you very, very much for joining us and setting some of your time aside. We greatly appreciate that.


Cathy Pearl: [00:00:56] Sure. Thanks very much for having me today.


Cathy Pearl: [00:00:59] My company is called, and I'm the Vice President of User Experience. And the main purpose of is to help people engage better with their own health. We have a mobile app with an Avatar, a virtual nurse, and the Avatar helps people with chronic health conditions, general health. And there's a whole lot of ways we think that the Avatar is more engaging than just a regular push button app. And we think that helps people take care of themselves better.


Bradley Metrock: [00:01:33] You have a tremendous amount of experience in voice, voice user interface design. How did you get into it? What made you interested in learning about that and having a career along those lines?


Cathy Pearl: [00:01:48] Well, it kind of started a long time ago. When I was about 10, our family had a Commodore VIC 20 (which is showing my age) but I have been interested in getting the computer talk back to me since then. And I wrote a very primitive chatbot which - even though it had very limited responses and of course I knew everything that it was going to say because I programmed it - I got a real thrill any time I typed something like how are you and it responded back to me. So I've always been fascinated by the concept, but of course back then there was no such thing as voice user interfaces or career in that. Fast forward to college, I went to UC San Diego where I discovered cognitive science which was a great Major, a great combination of things like neuroscience and mystics psychology, artificial intelligence, which turned out to be a great background for voice user interface design although I didn't know it at the time.


Cathy Pearl: [00:02:43] Fast forward again to grad school and I took my first human computer interaction class which kind of blew my mind. This whole idea of designing not just designing new features and new software that perform things, but designing for the way people would actually understand how to use it and use it naturally. I moved back to California after school. I was working on writing software for a human machine interaction for helicopter pilot simulators and I saw an ad for a company called Nuance, which was a speech recognition company and at the time I thought well that stuff doesn't work. But they had a demo line, you'd call on the phone and I called that up and they had a very simple demo where you could pretend to move money from your savings account to your checking account. And I was absolutely amazed that the technology worked. And I went and worked at Nuance for eight years where I learned how to design IVRs, sound systems.


Bradley Metrock: [00:03:37] For people who are listening to this podcast who are interested in getting into voice design, getting into different aspects of creating voice experiences, what do you think is the - what's the most important thing that students or people looking to transition careers can go and learn? What are the most important skills that someone needs to bring to the table?


Cathy Pearl: [00:04:01] I think one of the most important skills is what I would call conversational principles and there's not exactly a college major for that. But things like psychology definitely play into it. It's really about paying attention to how people speak to each other. What are these basic principles that we all learn at a very young age. And then the second part of it is really understanding the constraints of the technology. So understanding how do people communicate and then taking that and applying it to a real world way, knowing that you can't do everything yet, even though speech recognition technology has gotten tremendously better, but understanding how to put that into today's technology.


Bradley Metrock: [00:04:42] Interesting. Let me transition a little bit into asking about So the tag line is the future of healthcare because it's time for the doctor to come to you. I'm really fascinated by that. I think that anybody would be. How does work? So did approach hospitals and partner with them? Does approach insurers and partner with them? What's the business model for the company?


Cathy Pearl: [00:05:15] Yeah, basically you said a lot of it. We definitely work closely with hospitals, clinics and insurance companies. We also work closely in the UK with the National Health Service, you know the health service there. And so we are not currently going directly to consumers, but we work through a clinic, a hospital, a doctor practice, that kind of thing to have them invite their patients to use our app within the constraints of whatever health issue or strategy they'd like to use.


Bradley Metrock: [00:05:51] With voice technology there is the sense that it's arrived. This has been a decade or two or longer in the making, and thanks to many different things happening, including big tech companies doing the necessary marketing, the technology has simply improved. The general sentiment is that voice technology is not going anywhere. It's here and it's here to stay. But I think voice in healthcare, it's not as clear. And perhaps it's here to stay. And if it's good enough, it's here to stay. Do you feel like the time is right just as much for voice in healthcare right now as it is for just voice in the general population?


Cathy Pearl: [00:06:36] Yeah absolutely. I think although there's been a lot of hype that I think isn't necessarily true about speech recognition; you know there's claims that it's 97 percent accurate and things like that. There's also of course the natural language component. Maybe the recognition is really good, but you still have to determine what someone is actually saying. But I think it's a wonderful time to apply it to healthcare and I love seeing a lot of creative solutions out there that are starting to happen. For example, I saw recently an assisted living place was using the Amazon Echo to help its residents, and they were setting up really interesting skills like you could say, "Alexa tell me messages from my family" and it would read out messages that people could leave for their let's say their grandparent. And the person can also send their own messages out, you know send a message to Cathy to have her call me. I think there's so many ways like that, especially with our older community who maybe isn't interested in using really complicated apps or fitness trackers or things like that. But if you use voice, and this is what we found at, the first thing that one of our Avatars, Molly, will say to the patient, in certain cases, is "how are you today?" You know that's the beginning of a conversation. It's not get on a scale or press this button or whatever.


Cathy Pearl: [00:07:51] And we were wondering you know with some of our older patients who maybe in their 70s or even 80s, how are they going to deal with this Avatar you know? Are they going to be able to use this app? And what we found is that overwhelmingly if you design well and you use the basic principles of conversational design, everybody gets it. It's not hard for people to know what to do. They just say I'm fine or I'm stressed or whatever it is and you just go ahead and move on and it's just a great way to get people into some of these helpful areas of technology through voice.


Dr. Matt Cybulsky: [00:08:25] Have patience been interacting with before the Avatar was available, and do you see a market difference between just the voice interaction and the voice interaction with an Avatar? When you think about you know cognitive processing and facial processing when it comes to communication, sometimes it's not what we say it's how we say it. I have a gut feeling that perhaps the Avatar adds an element that is statistically significant than just voice alone. But what has been your experience with the interactions with patients there?


Cathy Pearl: [00:08:59] Yeah for sure. I mean the sensory app always had the Avatar. But research has shown that, there's some great you shoot research out of USC, comparing people answering questions in an app to just you know no Avatar, a still picture, or an Avatar, and people were much more willing to answer more questions for example when it was with an Avatar rather than just a list of questions. And we've found a similar thing ourselves which is that people start to get very engaged with the Avatar and they get a bit attached to the Avatar, going so far as sometimes they'll apologize to Molly when they miss their daily check in.


Dr. Matt Cybulsky: [00:09:39] That's actually a good sign.


Cathy Pearl: [00:09:40] Yeah exactly and they'll start saying you know have a good weekend. There was one patient who insisted on taking her whole set up, her scale, her blood pressure cuff on a cruise because she wanted to talk to Molly everyday even though the doctor said you don't have to do that.


Dr. Matt Cybulsky: [00:09:53] I love that, that's fantastic.


Cathy Pearl: [00:09:55] And so we feel that you know as we know voice adds an element of intimacy and engagement. But the Avatar on top of the voice for something like this where we're trying to encourage someone to do something, let's say on a daily basis, makes it even more engaging and more likely that they will continue to do this thing.


Dr. Matt Cybulsky: [00:10:11] Yeah that's fascinating when it comes to getting people to make action and influencing and persuading them, the idea that what you're telling us is that you've created an emotional connection, a bond between the patient and the Avatar is really telling about the success of these technologies and specifically


Dr. Matt Cybulsky: [00:10:29] Now I was at a talk at UAB Medical School the last two days discussing this very topic of how do you work with a population of people, and how do you work with patients when there are five thousand hours out of the year they're not in a clinic, especially when you look at current statistics of providers coming out of school compared to the amount of patients that are needed. Bradley asked the question earlier, and I think Cathy responded, that "no you do think it's here to stay." Well from a pragmatic perspective that's absolutely the case, it has to be. So Cathy as you see the evolution of these technologies continue with ostensibly a shortage of practitioners, where does go when you get to a deeper place of clinical involvement and emotional connection with the patient? Where is the next version, what's the next step here?


Cathy Pearl: [00:11:20] We're definitely not out to replace any clinicians, any nurses, any doctors. Our whole main mission is to assist with this huge gap we have. I mean if you got somebody with chronic heart failure you can't have someone come visit them every day, or even call them every day, necessarily to check in on them. So makes this bridge between the patient and the clinicians. For example in this chronic heart failure case every day the Avatar asks the patient to take their weight and blood pressure with a Bluetooth enabled scale and cuff and answer some questions. And this information is triaged, and based on the responses and the values we might send an alert to their nurse or their doctor. And so as the clinician you're checking in on your patients via a dashboard that we have and you might see oh, Ms. Pearl has a rapid weight gain, which for chronic heart failure, can be a sign that maybe a medication needs to be adjusted. And so then the nurse could make a phone call to me and ask me to you know how I'm doing and things like that and basically it triages you know, if you're monitoring 1000 patients you can't check up on all of them. So makes that bridge where it's like no just concentrate on these 10 patients today because these are the ones who need a little assistance. And so it really is filling in what we know is an issue, which is we just don't have enough people to do all the health care that's needed. Really try to fill that gap.


Dr. Matt Cybulsky: [00:12:44] It sounds like there's a portal that me as a provider would use to get in to review patient interaction with, or and/or do you have integration into major EMRs like McKesson, Cerner, Epic etc.


Cathy Pearl: [00:13:01] Yes so both. So we have the clinician portal which is a portal, but we also do integrate with several large medical record providers.


Dr. Matt Cybulsky: [00:13:09] Is there a sense from some practitioners or a feeling of being threatened by this kind of technology and/or replaced because of things like IBM Watson and the processing and AI with medicine, or do they see it more like a tool to really expand their effect over a population?


Cathy Pearl: [00:13:26] Well it's interesting because we've kind of learned some lessons in the healthcare industry where when we go in and we introduce the program to a clinical group things like that, we do have to introduce it in sort of a cautious way in the sense that we need to build the trust, especially let's say the nurses you know, nurses on the ground, the one interacting with patients on a daily basis. And they might be a little suspicious at first, not necessarily they're being replaced but maybe it's like is this going to be actual work for me? Why do we need to do this? I'm doing it you know, I already have a system. And so we are cognizant of that. And so when we introduce the tool and introduce the process, we make sure to say look you know give it a try see what it's like and what happens is over time they realize what the value is and that it's not a replacement. It's not adding extra work. It's hopefully streamlining their work, but we understand we can't just throw it at them and be like here use this. You know you have to say well this is why it's going to be useful to you, this is what other people have said about it and realize there may be sort of a ramp up time where the trust has to be built in the medical community.


Dr. Matt Cybulsky: [00:14:33] Yeah I totally agree with that. I think that there has to be a trust that these things are useful and good. Practitioners have an amazing sense of responsibility for the care they deliver, most of them; a healthy, well-trained practitioner, a nurse, physician or whoever will. And I often wonder you know walking through hallways of medical schools across the country, is there going to be a section in the future of medical training, and nursing training, and other technical skill sets, where voice language processing tools are taught to them on a day to day basis and what that might look like.


Cathy Pearl: [00:15:04] Perhaps, although my dream is that if we're using voice people won't have to have so much training because it'll will be more obvious on what to do.


Dr. Matt Cybulsky: [00:15:12] That's true, a little bit of a segue here. I was in a talk recently at a consulting firm in Tennessee and he was telling the crowd, and actually lamenting, of Medicaid populations and "those people" and how they need to be a lot more accountable for their health care and how they're not, and they're costing us all this money. Cathy you have studied human behavior and you actually worked with a product that touches human behavior. When you hear that from somebody and they say we need more carrots or we need more sticks to make people "accountable," when you look at that in terms of something like stenciling and population health management what comes to mind? How would you answer that in a more substantive and academically and maybe scientifically correct manner?


Cathy Pearl: [00:15:55] I just think it's more complicated than that. I mean people understand you know we all know I should eat better, I should exercise more. It's not a mystery. But why don't we? Because we're human and there's so much about you know - like that book Nudge - where to really change behavior, you can't just tell someone what to do as we all know this. Using tools like where we're not trying to fool anyone into thinking they're actually talking to a human or anything like that. We're just saying look here's an here's a way to get the things done that you know you need to do but maybe you don't want to do. No one wants to wake up every morning and take their blood pressure and their weight and the same five questions about do they have shortness of breath things like that. But if you give them a little bit of help, you make it a little bit more fun, a little bit more interesting, it's a little nicer to talk to Molly let's say than just write on a piece of paper and e-mail your doctor later. And we try to take away as much of the effort as possible like rather than having to write it down and email your doctor, Molly automatically reads the weight from the Bluetooth scale and sends it off.


Cathy Pearl: [00:16:54] So trying to remove even the smallest barriers just you know little things like you put your running clothes out the night before so when you get up in the morning you put them on first thing, you're more likely to go for your run. There's all those little things like that sure I could tell myself to go for a run anyway, but if I put my shoes out I'm going to be just a little bit more likely to do it. So why not take advantage of those types of nudges and just help people help themselves.


Dr. Matt Cybulsky: [00:17:19] Right. I think it's a myopic and artificial position to say it's enough to tell someone that you're not going to be healthy if you don't do X, or we're going to withdraw your benefits if you don't eat right. What you describe is setting up a system around people to guide human behavior. I mean humans you know we respond to reciprocity and we also kind of abide by this universal law of least effort. If we can create a game, we can create a system, we can create a prompt with something like or even an emotional connection which voice definitely allows us to do that. If you look at our evolution as people, and tones, and viewing others, and facial expressions, and how we bond to others, that's the real answer in my mind about how you help people help themselves or at least create a system around them that doesn't cause them harm. is doing that now. Can you give us a sense of some of the features that you really like with, as far as setting up a system around people that help them live better, healthier lives and work with their practitioners to do so.


Cathy Pearl: [00:18:27] Yes I think there's a few elements. One is the fact that you can use the app at any time. Any time you want to talk to Molly or one of our other Avatars, all you have to do is pull out your smartphone or tablet. You don't have to have you know office hours and things like that. You can share information even with your doctor that way, so you can sort of in a way leave a message for the doctor via Molly by telling her this is what my new symptom is and she'll say "OK I'll pass that on to the doctor.".


Cathy Pearl: [00:18:55] And the other part of it is just we have for example something called a symptom checker, which let's say you have back pain and you're wondering what should I do? Should I go to the doctor, you know how serious is it? And we have an algorithm that guides the patient through a series of questions to decide what to do. And you might say well why not. What's different between doing and googling it. The feedback we get is that people say well you know when I google it I just get a million responses back, it tells me I'm going to you know it's probably cancer. It's always the worst thing. And the nice thing about using is that it's more guided. And so rather than just this flood of information like what do I do with that, it narrows it down to your more specific case by going through this conversation. The questions that are necessary to find out you know what you should do and that can a little bit less stressful for example for people because by the end they think OK this is specific to me. This isn't just me googling something and trying to figure it out on my own. This is tailored to me and I'm going to trust a little more about what I should do next.


Bradley Metrock: [00:19:56] It's funny that you would mention Google because it makes me recall my my brother has a two year old. That two year old started walking with a limp one day. This is fairly recent. And you know so I just happened to Google, I was on the road traveling and had heard that this was happening, and so I googled two year old limp. And you just immediately get confronted with a lot of different pretty negative possibilities.


Cathy Pearl: [00:20:26] It's scary.


Bradley Metrock: [00:20:27] Yeah. And so I understand the reluctance, the sentiment out there to move away from that. Let me ask you a question about your technology Cathy. So you've got the app as it is now that lives in the smartphone and tablet world. But really to me something like what y'all are doing, it's so perfect for something like the Echo Show. Is that something that you're looking at or do you, based on different healthcare perhaps related reasons, need to stay on the smartphone?


Cathy Pearl: [00:21:02] We are definitely looking into that. I made a demo scale in fact that simulates our daily check-in on my Amazon Echo, but the Amazon Echo is not currently HIPPA compliant, and so there are some issues there. On the other hand, you can still do things. For example, we can do a handoff. So you could start with the app and set everything up and then later the Amazon Echo could for example remind you like OK it's time for you daily check-in, or maybe ask you a simple question like how did you sleep last night or something like that. And I think there could be a real shared kind of situation where you do some things on the smartphone, maybe that are longer conversations or things like that, and also use the you know the Echo or the Show. It's definitely something we're looking into.


Bradley Metrock: [00:21:48] The other aspect of that too is news that has come out, and it's not really news yet, but there's a lot of smoke around the impending new feature with the Echo ecosystem of being able to have all of your speakers linked to one another. So you could have an Echo Show in the kitchen. You could have a regular Echo in the bedroom. You can have an Echo Tap in the bathroom and you could have a Dot in the basement, and all of those know that the other ones are there. And this has been talked about and talked about and apparently Amazon just finished testing of this a week or so ago and it's about to be rolled out. And it's being talked about in the context of audio which is logical, but in the realm of healthcare man you've got a potential game changer there. Have you seen that?


Cathy Pearl: [00:22:49] No I haven't heard about that.


Bradley Metrock: [00:22:51] Yeah. So from the standpoint of or any voice assistant that aspires to help people be healthier, that's a really potentially interesting new feature that they're adding.


Dr. Matt Cybulsky: [00:23:05] You know Bradley also as a addendum to that, there are some really fantastic technology they've got going on with their mikes and I don't see it not being able to be implemented in other tools that is, their sensitive enough where they can determine the flushing of a toilet or how many gallons of water went through a pipe, and the kinds of bags you're opening, whether the seal on the fridge has been broken, when all the lights in the house have gone out. All based on sound, which gives a bunch of secondary data that someone like, or other products, could easily use and say here's a really interesting host of behaviors that are probably occurring in that household.


Bradley Metrock: [00:23:43] Cathy, we greatly appreciate you. I greatly appreciate you joining us and setting your time aside and sharing your experience with us, your insights and your expertise.


Cathy Pearl: [00:23:56] Yeah my pleasure. I love talking about this stuff. Thank you very much for having me.


Dr. Matt Cybulsky: [00:23:59] Thanks again Cathy, that was a wonderful, really bright conversation. Thank you for your time.


Cathy Pearl: [00:24:03] Thank you.


Bradley Metrock: [00:24:04] For the Voice Of Healthcare. Episode 4, thank you for listening and until next time.

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