A client recently asked our thoughts on using Alexa in the operating room. Presumably, the tasks Alexa would be charged with doing would be basic. Turn the lights on. Turn the lights off. Make a call. And so on.
For those of you unfamiliar with Alexa, it is a product sold by Amazon which serves as your virtual assistant. It takes your verbal commands and turns them into action. Here’s Alexa at its most basic.
Alexa, what’s on my calendar today?
Alexa, remind me to check on my patient at 3PM?
No surprise, you can buy stuff with Alexa.
Alexa, buy a package of double AA batteries.
Alexa, order package of size 7 ½ gloves.
And there are Internet of Things devices that will respond to verbal commands; for example, to turn on the lights.
Now for the down side.
Security.
Such devices already pose a risk in the general consumer space without even touching on the more stringent security requirements an operating room would demand.
A recent article detailed “researchers can now send secret audio signals undetectable to the human ear to Apple’s Siri, Amazon’s Alexa, and Google’s Assistant.”
So, your dog may hear your device being hacked while you are blissfully unaware. (Actually, I have no idea if your dog would be able to hear the attacking frequency.)
This year, another group of Chinese and American researchers from China’s Academy of Sciences and other institutions, demonstrated they could control voice-activated devices with commands embedded in songs that can be broadcast over the radio or played on services like YouTube.
More recently, [Nicholas Carlini] and his colleagues at Berkeley have incorporated commands into audio recognized by Mozilla’s DeepSpeech voice-to-text translation software, an open-source platform. They were able to hide the command, “O.K. Google, browse to evil.com” in a recording of the spoken phrase, “Without the data set, the article is useless.” Humans cannot discern the command…..
“Companies have to ensure user-friendliness of their devices, because that’s their major selling point,” said Tavish Vaidya, a researcher at Georgetown. He wrote one of the first papers on audio attacks, which he titled “Cocaine Noodles” because devices interpreted the phrase “cocaine noodles” as “O.K., Google.”
Mr. Carlini said he was confident that in time he and his colleagues could mount successful adversarial attacks against any smart device system on the market.
I do think we will reach a point where such devices are usable in the operating suite. But, I would not be the first on the block to use them. Such devices will need to be made commercial grade, taking into account reasonable security concerns.
It is easy to imagine a hacked device recording operating room banter. Think that poses no risk? In 2015, a patient successfully sued an anesthesiologist for $500,000 for insults (about the patient) that were recorded during the procedure. Here, the patient’s phone was recording all operating room conversations while stored in a clothes bag on the bottom of the gurney.
The patient said he had his phone set to record the post-operation instructions given to him before he was put to sleep. He forgot to turn off his phone during the procedure, though, and when he listened back to what the operating team had said about him, he was shocked.
So, my two cents worth.
“Alexa, stay out of the operating suite for now.”
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1) Alexa is notoriously unreliable at actually getting commands correct. It’s voice recognition at this point is not much better than Dragon’s was in the late 1990’s. Therefore having it in the OR is more of a distraction and a hindrance then a help.
2) Even assuming that the voice recognition technology was as good as Dragon’s is now, which is to say still not perfect, the ability of Alexa to actually get to useful information is very limited. It has difficulty understanding syntax and often returns wildly absurd results. That severely limits its usefulness. Assuming in the future that it is fully able to perform up to its hyped promises it might become a useful tool.
3) This gets to the central question as to whether it should be in the OR.
If it is in the OR to access a calendar that can wait until the end of the procedure. The focus should be on the patient.
If there is a need for the physician to be reminded about something, his office can be called or the OR nurse can write a note to him and he can be handed the note at the end of the procedure.
4) As for ordering supplies in the OR, that should be done under ideal circumstances by data entry into the hospital’s material management system and come up on the next supply cart. Having Alexa doesn’t help because it cannot interface into that system.
5) I fail to understand the attraction for this rudimentary device that has been oversold on its capabilities. I would not have purchased such a unit. I was gifted with one. As a result I have had the opportunity to become acquainted with its shortfalls and there are many. It is a best for now a toy, that doesn’t work well.
6) Why would we want a device to be constantly listening in on conversations? Do we wish to be recorded 24/7, if so, why don’t we just use digital recording devices that have been around for 20 years. At least those are obviously recording. With Alexa they are not. Alexa listens whether its light is on or not. Why do we want or need that? What is so all fired important that it has to be done instantly by a digital assistant/ spy?
I was gifted an Alexa device the size of a hockey puck, and I unplugged it after a week. She’s spooky. There is no reason she should get OR privileges. #savecirculatingnurses
Agreed: not ready for prime time….
I would not want this in a dental operatory, let alone an operating room. Especially since it recently sent a recorded private conversation to everyone on one of the party’s contact list. Oops.