Health system CIOs predict the EHR interface of the future will be voice-activated, with exam rooms filled with listening devices, cameras and sensors.
But what happens to patient privacy in that scenario?
IT executives told Becker’s they’re working to assure patients that these technologies are being designed with confidentiality and data security in mind. At the same time, they anticipate patients will inevitably accept them, like they have so many seemingly invasive modern technologies, from Alexa and Ring doorbells to ambient AI scribes in healthcare.
“I believe that, like ambient listening, which went from a novelty to the standard of care in an ambulatory setting, this tech will be deployed and dealt with in a broad consent-to-treat process, since it will be how care is delivered,” said Jeff Gautney, senior vice president and CIO of Chicago-based Rush University System for Health. “And I believe that like our current safety cameras, E-ZPass tracking or the famous ‘eye in the sky’ tech that the gaming industry uses, these sensors will be always on and a background infrastructure that just exists.”
He noted that “people give up their privacy in the name of convenience every day, perhaps unwittingly, but they do,” pointing to smart glasses that record people and conversations without consent.
So he asks: Will patients’ desire for convenience trump their privacy concerns? And will healthcare’s privacy touchstone — which is stronger than the consumer standard — cause the industry to forego technology that removes friction for patients and caregivers alike?
Mr. Gautney said he is watching Amazon Health AI, an assistant that people can upload their medical records to, for insights. Besides, the technology is already here, with many hospitals and health systems deploying telesitters and virtual nurses. Healthcare settings have for years been a mass of sensors and smart devices — this is just rationalizing the use cases.
“I think we will need to convince people that we are prepared with the proper safeguards for their data, and not keeping data that’s not pertinent,” Mr. Gautney said. “But I also think given current and future staff shortages, and increasing use of AI-enabled robotics to support care, there are few alternatives.”
Clearwater, Fla.-based BayCare Health System has Alexa smart speakers in all its hospital rooms, with consent and education part of the in-room welcoming process. Patients can talk to nurses through the devices rather than hitting a call button, and use Alexa to adjust the air conditioning and lighting and access entertainment options.
“I believe our patients and team will see the value of this new technology like they do at home — it will be a bell curve of acceptance,” said BayCare CIO Lynnette Clinton.
But the 16-hospital system has long offered low-tech alternatives to patients — cameras and recording devices will be no different.
“Many people will embrace them and the value they bring — as long as we can communicate the benefits well — and some will not,” Ms. Clinton said. “For those, we will have options to turn off devices not required for their care or choose devices where you can visibly see the device is turned off or not listening.”
Still, she predicted, “over time, I suspect these devices will become the new normal.”
For these technologies to succeed, trust has to be paramount and privacy a deliberate design choice, said Tom Gordon, senior vice president and CIO of Marlton, N.J.-based Virtua Health.
In the five-hospital network’s smart rooms, cameras are turned off outside of virtual visits while discussions aren’t recorded. The technology, from Care.ai, includes a “doorbell” functionality where a prompt appears on patients’ TV and they choose whether or not to connect with the virtual caregiver.
“Just as a bedside nurse knocks before entering, our virtual colleagues do the same digitally,” Mr. Gordon said. “If the patient is resting or has visitors, they can decline and the virtual colleague can try again later. That autonomy matters enormously, both ethically and practically.”
But doesn’t the technology always have to be on? For videos and cameras, no, Mr. Gordon said. For sensors, yes.
Virtua Health’s smart care platform includes “always-aware” ambient sensors that monitor for patient movement, falls and safety events. That’s also by design. “A sensor that only activates when you ask it to won’t catch a patient at risk of falling at 3 a.m.,” Mr. Gordon noted.
“The key is being transparent with patients about what each layer of the technology does and doesn’t do,” he said. “Video requires active consent and patient control. Ambient sensing is explained clearly at admission as a safety tool, no different in principle from the monitoring equipment already present in every hospital room.”
IT works with legal, compliance and privacy teams to ensure the technology meets HIPAA requirements.
At Virtua Health, early feedback from patients has been positive, particularly the ability to have family members join visits virtually. Mr. Gordon prefers framing the technology as “connection,” not “surveillance.”
“My advice to other health system leaders: start with use cases that are unambiguously beneficial — virtual nursing, virtual intensivists, fall prevention, family inclusion in care,” he said. “Build the trust account first. The organizations that win in this space will be the ones that treat transparency and consent not as legal minimums, but as genuine expressions of their mission.”
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