Author: Jeff Greene, VP Digital Strategy & Insights

It's Demo Day at the Alexa Diabetes Challenge - a Merck-sponsored hackathon to find the best voice-enabled solution for diabetes management. At stake: a $125,000 prize, invaluable exposure to a major pharma company, and, perhaps, a technology breakthrough for a disease that affects more than 422 million people globally.

From an initial universe of 96 start-ups that entered the challenge, only five remain in orbit:

Tony Alvarez, Merck's head of primary care and customer strategy, sets the stage in front of a full house here at Amazon's hipster industrial loft in Soho. "Historically, the pharma industry has discovered from within," he says. "Today, open innovations create opportunities to work with stakeholders across the entire ecosystem."

Then it's on to the presentations. Rachma Dhamija, from Ejenta, talks about the use of intelligent agents, which are essentially customized bots that learn the more you tell them. Her company's solution is called "Pia" (personal intelligent agent), which she says is based on technology NASA uses to monitor astronauts in space. Say "Good morning Pia" and the tool will start your day with a helpful, motivating tip.

Abhishek Shankar, senior director of digital health and commercial platforms from HCL, gives a joint presentation, it seems, with Alexa herself. HCL and Ayogo partnered to create My GluCoach, which is meant to be a voice-activated teacher, personal assistant, and life coach. He asks Alexa how this will work. She responds: "Through personalized responses and anticipating needs in the patient journey, which I follow every step of the way." It's either cool or scary, depending on your comfort-level with technology.

Next up is T2D2, from a team of researchers at Columbia University. Elliott Mitchell explains T2D2 is a menu-planning and recipe solution that collects data by voice: you simply tell Alexa what you eat. The solution remembers how each food combination impacts your blood sugar, enabling better recommendations in the future. Cleverly, the presentation offers a nod to Amazon Fresh, which could potentially be the delivery source for T2D2's healthy meal ingredients.

Diabetty, whose name is meant to create a personal connection, uses sentiment and text analysis to recognize when diabetes patients are depressed, based on changes to their vocal patterns. Sugarpod, from Wellpepper, leverages Alexa to offer tailored activities for patients and includes a foot scanner. It monitors for ulcers, a typical comorbidity of the disease.

While each solution has its pros and cons, all share one commonality: a focus on behavior change. Technology is nearly an after-thought as presenters discuss "extrinsic vs. intrinsic motivators" and how behavioral "nudges" can encourage patients to exercise. The judges, understandably, are interested in data privacy and business models. One asks Dhamija what piece of the care system she hopes her solution will displace. She hedges, noting that nurses, for example, are critical to the diabetes care team. "We're kind of helping her with her workflow," she says, "we're not really displacing her."

Key takeaways:

Voice For Health initiatives are moving quickly now that Alexa, Siri, and Google Home are becoming more commonplace - not just for patients, but for physicians as well. Two key challenges stand in the way of widespread utility by patients:

Technology limitations: Voice-activated assistants don't always work. Alexa choked during Sethi's presentation, garbling responses down the stretch. A judge voiced his concern that Diabetty could misinterpret a depressed person's voice as being "normal"; it was revealed the tool's sentiment-mining engine still needs some work. (A $125,000 grant would help speed things along.) Keep in mind developers faced similar obstacles in the mid-1990s, when the first web browsers debuted. They were slow, clunky, and - once the technology matured - game-changers.

Customer interest: Cybercitizen Health, our multi-region consumer research study, found 29% of U.S. online diabetes patients want a voice assistant to act as their personal health coach.  While 29% is not an insignificant number, it's also not mass acceptance. Many diabetes patients are from lower socio-economic backgrounds; they may not have access to healthy food, let alone a $150 Amazon Echo device. Commercializing Voice For Health initiatives won't necessarily be easy, but if the packed house is any clue, I'm not betting against Alexa and her fellow bots.

Neither is Amazon. Oxana Pickeral, Global Segment Leader for Amazon Web Services, puts it this way: "Introducing voice in this equation has great potential to impact patient behavior, because it's making interactions with technology simpler and smoother."

The grand prize winner will be announced in October.

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