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St. Louis Metropolitan Medical Society

The Greater St. Louis Medical Group Management Association is pleased to launch a partnership with the St. Louis Metropolitan Medical Society (SLMMS).  This partnership will feature the sharing of information in publications and on our websites.  

Thanks to Kevin K. Peek and Killian R. Walsh, for sharing the following article.

The Budding Friendship of HIPAA and Virtual Assistants
Amazon introduces six Alexa skills involving protected health information. 

Earlier this year, Amazon proudly announced to the world that its virtual assistant, Alexa, possesses new skills in the realm of health care that abide by the ever-formidable Health Insurance Portability and Accountability Act of 1996, also known as HIPAA.  The popular voice assistant is best known for residing in Amazon’s hefty army of Echo devices.  However, winning over HIPAA is not a popularity contest.  The well-known goal of HIPAA is to guard protected health information (PHI), a task the enforcers of HIPAA do not take lightly as evidenced by the many multi-million-dollar fines handed out to healthcare professionals found to be in violation each year.  

Health care is a field into which many top technology companies, including Apple and Google, are attempting to establish a larger presence.  While small steps have been taken, none have been able to enter the health market with their most ideal product – their respective voice assistants.  Their attempts are often thwarted (understandably so) by HIPAA and the need to protect patients’ individual health information.  However, that changed in April with Amazon’s announcement.  

Amazon introduced six new Alexa health skills in April.  These skills allow users to ask questions such as “Alexa, pull up my blood glucose readings” or “Alexa, find me a doctor.”  Amazon partnered with six different companies – including St. Louis-based pharmacy benefits manager Express Scripts along with the health insurer Cigna – for the development of these specific skills in an early effort to test the waters of merging healthcare with the growing availability of smart technology.  The new skills also allow users to schedule appointments with health care providers, find urgent care centers, receive updates from their health care providers, access their latest blood sugar reading, and check the status of their prescription deliveries. 

Straight from Amazon, below is a detailed listing of the new skills:

  • Express Scripts: Members can check the status of a home delivery prescription and can request Alexa notifications when their prescription orders are shipped.
  •  Cigna Health Today: Eligible employees with one of Cigna's large national accounts can now manage their health improvement goals and increase opportunities for earning personalized wellness incentives.
  • My Children's Enhanced Recovery After Surgery (ERAS): Parents and caregivers of children in the ERAS program at Boston Children's Hospital can provide their care teams with updates on recovery progress and receive information regarding their post-op appointments.
  • Swedish Health Connect (by Providence St. Joseph Health, a health care system with 51 hospitals across 7 states and 829 clinics): Customers can find an urgent care center near them and schedule a same-day appointment.
  • Atrium Health (a healthcare system with more than 40 hospitals and 900 care locations throughout North and South Carolina and Georgia): Customers in North and South Carolina can find an urgent care location near them and schedule a same-day appointment.
  • Livongo (a leading consumer digital health company that creates new and different experiences for people with chronic conditions): Members can query their last blood sugar reading, blood sugar measurement trends, and receive insights and Health Nudges that are personalized to them.

Amazon stated that it plans to work with other companies on an invitation-only basis.  Amazon, along with the companies it invites, will work together to develop new skills that are HIPAA-compliant by offering business associate agreements to meet HIPAA requirements.  So what does this mean? How do these skills get around HIPAA and ensure patient information is protected?

Navigating HIPAA

Typically, health care workers can only share a patient’s health information with the patient and others in the health care system. Amazon, and other businesses like it that are not healthcare companies, would not be able to handle this data.  However, there is no hard and fast rule for becoming HIPAA compliant.  Rather, it is a self-implemented process, generated by a company’s ability to follow various HIPAA requirements like the Privacy Rule, the Breach Notification Rule, and the Security Rule.

Amazon is leading the charge in becoming a sort of “middle man” company that has access to healthcare information by transmitting it only.  The way they are getting around the notion that only providers can access information is by entering into agreements with health care companies related to data.  For example, with one of the skill partners, Livongo, their agreement provides for Livongo to store the information and Alexa only to transmit the information.  Alexa is not able to store any information and therefore is not able to do anything further with the data, theoretically.

While there are numerous details left to hash out, the obvious merging of health care and virtual assistants will undeniably provide ample benefits to consumers.  However, providing that same level of privacy protection for patients, while also allowing such a merger, is a significant complication. 

The task of creating the ability for a virtual assistant to protect and utilize PHI is no small feat.  While these new available skills are a great step, virtual assistants are still not approved to provide any other kind of assistance for medical personnel related to PHI.  Tasks not yet ready include note taking by doctors about a patient visit, reminders about patient appointments, and sending prescriptions to pharmacies.  However, with the never-ending advances in technology and the brilliant minds behind these early steps to work with HIPAA, patients’ protected health information will continue to remain in good hands, whether they be real or virtual.

Kevin K. Peek, JD, is an associate in the St. Louis office of Sandberg Phoenix & von Gontard P.C. and focuses on his practice on cases involving medical malpractice defense and the defense of providers in correctional health care.  He can be reached at


Killian R. Walsh, JD, is an associate with Stanton Barton, LLC in St. Louis.  Her experience and practice includes medical malpractice defense, defense of transportation and trucking companies, and complex products liability litigation.  She can be reached at 

The following articles also appeared in the St. Louis Metropolitan Medical Society's newsletter:


Prevention Is the Best Medicine: Taking A Proactive Approach to Your Medical Practice’s Cybersecurity by Ryan Haislar, Computerease


Help Wanted on the Dark Web by Derrick Weisbrod, Healthcare Technology Advisors

Take Two and (Video) Call Me in the Morning by Kevin K. Peek, Sandberg Phoenix & von Gontard P.C.

Leaders - Born or Made? by Julie Guethler, Transform Healthcare Strategies

Health Care Innovation in St. Louis by Melony Tanko, Kypher and Michael Tan, Kypher Intern

Navigating MIPS in 2018 by Derrick Weisbrod, Greater St. Louis MGMA Director at Large

Surviving the Stress: Malpractice Risk Reduction by Diane Robben, Greater St. Louis MGMA VP Business Partners

View from the Inside by Kathleen McCarry, Greater St. Louis MGMA VP Advocacy

Filling the Gap: How Physicians and Aspiring Medical Students Learn from Each Other by Julie Guethler, Greater St. Louis MGMA Past President

What the "Soft Market" Means for Physicians by Monte Shields, The Keane Insurance Group

A Tale of Two Practices by Julie Guethler, MGMA of Greater St. Louis President

Physicians Beware of Referrals for Home Care and Potential Fraud Charges by Diane Robben, JD, MGMA of Greater St. Louis VP Business Partners and Denise Bloch, JD

MGMA of Greater St. Louis: Committed to Developing Strong Practice Managers by John Marshall, MGMA of Greater St. Louis Director at Large

Finding Good Employees by Chris Keefe, CPA, CMPE, MGMA of Greater St. Louis President-Elect

Workplace Wellness: Start Small to Improve the Health of Your Employees  by Chris Keefe, MGMA of Greater St. Louis President-Elect

Carrots and Sticks in Coding: Why Good Documentation Matters by Kathleen McCarry, MGMA of Greater St. Louis VP Advocacy

 Introduction to MGMA: Can Your Practice Afford to be "Left in the Cold?"  by Jim Kidd, MGMA of Greater St. Louis President






Greater St. Louis MGMA
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