Where The Streets Have No Name

Looking back at Amazon's celebrated 2019 partnership with major healthcare organizations to create HIPAA-compliant Alexa skills

Where The Streets Have No Name is an extraordinary idea.

Do you want to go there? Because if you do, I'm ready to go there with you, to that other place.

Call it what you like, a place of imagination, where there are no limitations.


The prospect of voice in healthcare, over the past two to three decades but especially after Amazon brought Alexa to the masses, has been the stuff of dreams.

One of the major roadblocks standing in the way, at least theoretically, has been HIPAA compliance. Back in 2017 and 2018, I remember having entire shows on This Week In Voice where HIPAA was discussed, and the idea was that if big tech could move that hurdle out of the way, a lot of innovation and success would follow.

In 2019, Amazon struck first with the news that they had partnered with six major healthcare organizations within the United States to create the first HIPAA-compliant Alexa skills.

One of these organizations was Livongo. Here was the press release quote from Dr. Jennifer Schneider, who had first served as the organization’s Chief Medical Officer before becoming Livongo’s President:

Livongo’s goal is to leverage innovative technologies to create a world-class Member experience.

We believe that voice technology will have an impactful role in helping our Members better manage their chronic conditions, and health in general. Speaking and listening are natural communication channels, and voice-based capabilities also allow us to reach people who prefer other modes of communication.

Our Members now have the ability to hear their last blood glucose check by simply asking Alexa. In providing seamless health insights while our Members are preparing meals or about to exercise, Livongo can more effectively drive positive behavior change.

After enduring a barrage of bad reviews, Livongo made the decision last month to quietly pull their Alexa skill, and currently have no presence on Amazon Alexa at all. Dr. Schneider departed from her role as President in October 2020.

The six HIPAA-compliant Alexa skills released back in April 2019 were Livongo’s Blood Sugar Lookup (no longer available), Express Scripts, Cigna Health Today (no longer available), My Children’s Enhanced Recovery After Surgery, Atrium Health, and Swedish Health Connect.

Of the four Alexa skills still available, the most recent review left by a user was from June 2020 - the only user review for the Atrium Health skill. It’s a fun one, highlighting an entirely different problem the Alexa ecosystem has with user reviews in general:

I could tell you about how there’s a total of 5 reviews left across these 4 remaining Alexa skills, cumulatively, over the course of these two years. (For reference, the NPR skill on Alexa has 27,351 user reviews, of which 7 have been left in April 2021 so far.)

But it’s more telling that Amazon’s own August 2020 press release - announcing this HIPAA-compliance program is now open to all third-party developers - ignores this previous cohort of healthcare skills almost completely, only mentioning Boston Children’s Hospital in passing.

Amazon’s challenges in bringing voice to healthcare doesn’t mean others aren’t having success.

Florida-based Constant Companion - a company I have previously praised in this space - was making serious strides prior to the pandemic, and over the last twelve months, has absolutely surged to become an unquestioned leader in this space.

The company is owned by Ways Security and does something you rarely see voice companies do: leads with security in talking about their voice/AI product.

According to company CEO Mark Gray, who I first met when the company participated in our annual Voice of Healthcare Summit at Harvard Medical School, Constant Companion has developed the only HIPAA-compliant voice technology platform for healthcare.

The result has been a massive new contract with Vikor Scientific which has almost overnight given the company $25 million in annual recurring revenue, alongside significant growth in home healthcare systems and assisted living facilities.

Constant Companion has cultivated strategic partnerships with the likes of Best Buy and Samsung, and has succeeded already to such an extent, it is actually helping to create success for other voice/healthcare companies, such as another favorite of mine, Canary Speech. (The two companies entered into a master distribution agreement earlier this year.)

If you look down the road, the combination of increased money supply with growing hostility toward big tech has an inevitable conclusion: increased M&A activity.

Microsoft’s acquisition of Nuance made all the headlines, for 19.7 billion good reasons, but it was actually Peloton’s acquisition of Aiqudo, which took place just a month or so before, that is more telling.

The latter was an example of a voice/AI company with no particular healthcare background that got acquired to play a role in a larger healthcare-oriented operation.

With voice’s inherent privacy concerns and significant potential regulatory issues, it may very well be the case that large organizations are much better off acquiring voice/AI expertise and capabilities rather than developing them internally.

It’s going to be a good year for a lot of companies working in this space.

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