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This is the future of bugs and viruses in the era of voice assistants.

By Christina Bonnington

Photo illustration by Slate. Photos by Thinkstock and Guillermo Fernandes/Flickr.

As Amazon Echo Dot owner Gavin Hightower was heading to bed the other week, he encountered a disturbing Alexa bug. For no apparent reason, the device uttered a “very loud and creepy laugh.”

“There’s a good chance I’m getting murdered tonight,” Hightower tweeted after the incident.

Hightower isn’t alone: Numerous Echo device owners have reported their Alexas laughing spontaneously, unprovoked by their wake word (“Alexa”) or any other command. For other users , it’s more than just laughter. Some report their Alexa devices failing to fulfill their spoken requests, performing random other actions instead, and then capping it off with a guffaw.

Of all the bugs your smart assistant could encounter, uttering a high-pitched “ Modal Scarf Design scarf Purple by VIDA VIDA Gkx57C
” laugh ranks among the creepiest possibilities. (Other podium contenders: Saying “I’m watching you” or actually making a threat.) The issue has now evolved into a Grey Leather HighTop Sneakers Santoni ueCc2R7
on Twitter, and Amazon has responded to the phenomenon, telling the Verge on Wednesday that the company is “aware of this and flat top sun hat Nude amp; Neutrals Loro Piana zscnqc
.”

The whole scenario reminds me of Mat Honan’s delightfully dystopian view of Leila Womens PeepToe Menbur sg4Ho9S9
for Wired in mid-2014:

I wake up at four to some old-timey dubstep spewing from my pillows. The lights are flashing. My alarm clock is blasting Skrillex or Deadmau5 or something, I don’t know. I never listened to dubstep, and in fact the entire genre is on my banned list. You see, my house has a virus again.

Honan’s four-year-old imagined future seems eerily on point. However, at the time, Amazon had not yet launched its revolutionary ; it and other digital assistants are now poised to permeate Baseball Cap In Lilac Velour With Composure Embroidery Lilac Asos zbJN6LTm3Q
of our existence.

While they’ve had a remarkably good run, it was inevitable that our digital assistants would crack. Friday delivered a tremor of foreshadowing: Amazon’s virtual assistant briefly “ Skinny DB Suit Trousers Navy Heart amp; Dagger sccDW3CB
” due to issues with Amazon Web Services. (It’s unclear if these reported issues are related to that downtime.)

Whatever the reason for the laughter—and hopefully Amazon will tell us whether this is some sort of software malfunction, a hack, or the work of a disgruntled software programmer—this isn’t going to be a one-off scenario. Amazon is adding capabilities to its assistant on a near-daily basis and so are its competitors, like Google Home. As it gets more bloated with code, the possibility a strange bug could slip through also increases. Consider Apple’s iOS. In November, a strange bug cropped up that Mens Brooklyn Comfort Straight Leg Jeans Lee ax2C0ZqiVz
on iOS devices. Over the years, the operating system has suffered from numerous other bugs: The alarm clock not working , apps becoming V Star sneakers Blue Golden Goose aN4HWaZ
, and the phone crashing when it encounters a certain character.

At least 1 of the authors visited each of 21 sites ( Table 1 ), shadowing physicians and their teams for a day and meeting with administrative and clinical leaders. We made virtual visits to 2 additional practices with a telephone interview and follow-up e-mail communication with leaders or practitioners. A semistructured site visit questionnaire (Supplemental Appendix 2, available online-only at http://annfammed.org/content/11/3/272/suppl/DC1 ) guided observations and interviews.

View this table:
Table 1

Specialty, Setting, and Clinicians at Study Sites

Although a description of how these practices made their changes, as well as quantitative data as to whether these changes directly and independently improved patient care, is beyond the scope of this report, a narrative summary describing in greater depth the care model and in some cases the change process, along with the investigators’ personal reflections on the model’s strengths and weaknesses, was composed for each site (a full report is available at http://www.abimfoundation.org ).

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During our site visits, we observed a number of solutions to problems commonly faced in primary care; these solutions include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping ( Table 2 ). Below we organize our findings as solutions to common problems in primary care.

View this table:
Table 2

Problems and Innovations

Primary care visits are often disorganized and rushed.

Many high-functioning sites have learned that previsit planning and previsit laboratory tests can reduce the total volume of work to be done, save time, and improve care.

Example

At Mayo Red Cedar Medical Center patients have their laboratory tests done a few days before their appointments and are able to discuss results and engage in shared decision making at the time of the visit. This system eliminates an hour or more per day of post-appointment results reporting. David Eitrheim, MD, reported (e-mail, July 9, 2012):

Patients like to discuss the results of their lab work at the time of their office visit. I can’t imagine going back to the day when I used to send out letters to patients with results of HbA and lipid profiles and not use those results as an opportunity for motivational interviewing, goal setting and developing an action plan.

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