To the casual viewer, the smart-speaker tech space—and specifically healthcare voice tech—appears dominated by Amazon’s Alexa and Google Home, which are essentially now household names in 20% of American homes (, March 2018). As of August 2018, “total worldwide smart speaker sales volume expanded 187% between Q2 2017 and Q2 2018,” according to

It was this year now closing, 2018, when voice technology firmly took hold—what voice-design agency Marvee calls the “Voice First Revolution”—with Google sitting firmly upon the largest market share. But the global voice-tech market may be headed for a shakeup that in time could dramatically alter the voice healthcare landscape, could downgrade Alexa’s importance, and could surprise many Americans.

A shakeup aided by Chinese innovation.

The healthcare voice-tech space

The startup landscape in healthcare voice tech is roiling with action. (a publication of HIMMS) sorted 37 startups building products at the intersection of voice and healthcare by seven market sectors:

  1. Aging in place,
  2. Patient-provider communication,
  3. Physician notes,
  4. Speech and hearing difficulty,
  5. Development platforms,
  6. Vocal biomarkers, and
  7. Patient engagement.

Integral to many voice-tech innovations is the smartphone. And that sector of the virtual-assistant (VA) market appears to be a small and potentially diminishing world for Alexa. Google Assistant currently controls 51% of global VA market share on smartphones, while Alexa has less than 0.1% market share.

Now, Google isn’t the only competitor that Alexa has to worry about outdistancing it. According to Strategy Analytics (as reported by, “The fastest rising assistant comes from China where Baidu Duer (…) will capture second place within the next few years.”

It seems entirely feasible that, as more of voice tech migrates to smartphones, Google and Baidu DuerOS will eventually dominate the voice healthcare space.

A look at AI acquisition reflects the trend. Google is today’s most active investor and acquirer of AI companies, according to CB Insights, 29). Meanwhile, in H1’18, China surpassed the United Kingdom to become the second most active country for healthcare AI deals (CB Insights).

Healthcare appears to be the field on which the battle for voice-tech dominance will largely play out. According to Savina van der Straten at Purple Orange Ventures, writing in Medium, 47% of vertical startups that were focused on a single sector of voice tech in 2017 were focused on healthcare.

From “Voice Tech Landscape: 150+ Infrastructure, Horizontal and Vertical Startups Mapped and Analysed”, Savina van der Straten, Dec 13, 2017. Accessed via

Part of the reason for that intensity could be the promise and potential of voice tech in synergizing healthcare provider relationships. Voice-tech and AI developer PullString asserts three ways that voice assistance can improve those relationships:

  1. Adherence—through conversational interactions like adding prescription reminders, logging medication taken, and emailing a summary to patients,
  2. Lifestyle/Medical Condition Assessments enabling patients to check in with their doctors and help doctors to assess their patients’ conditions.
  3. Clinical Trial Interactions “can engage patients throughout the entire lifecycle of clinical trials by enabling in-home support for surveys, feedback, and updates through conversation with smart speakers” (PullString).

Screening for certain diseases via Q&A, or helping with adherence and lifestyle management of disease are, in fact, some of the uses that CB Insights cited in a research report for the Google Home device (Google in Healthcare, 97).

Meanwhile, Amazon had dominated the smart-speaker market for nearly four years and marked a new era of home automation after it released its Alexa-powered Echo in 2014. But “Amazon is losing its market share — not only to its rival Google, but to newer players emerging in China” (CB Insights, 27 June 2018).

CB Insights has observed that “the biggest tech companies in China — Baidu, Alibaba, and Tencent — are positioning themselves to become global leaders in AI across a range of industries, from healthcare to autonomous vehicles. Smart voice is a common area of focus for all three companies.”

Like their US tech counterparts, their biggest global challenge today, CB Insights says, “is the lack of foreign language user data compared to what Facebook, Amazon, Microsoft, Google, and Apple (FAMGA) have access to.”

A dramatic year-over-year reversal

Tech-market analyst firm Canalys reported in August 2018 that “Google Home sold 5.43 million smart speakers worldwide in the second quarter of 2018. Those sales gave Google nearly one-third of global smart speaker sales compared to 24.5% and 4.12 million units for the Amazon Echo product line. In Q2 2017, the market share breakdown was very different. Amazon Echo commanded 82.3% market share whereas Google Home only captured 16.9%” (

Three factors are driving Google’s faster growth compared to Amazon:

  1. Google already had a number of localized language models built-out to support Android smartphone use cases ranging from navigation to voice search.
  2. That library of partially or fully built-out language models has helped Google Assistant be ready to enter many countries much earlier than Amazon Alexa. As of July 2018, Google Home was already available in 14 countries compared to just 11 for Amazon Echo.
  3. Global growth has shifted outside the U.S. where Amazon Echo is strongest. Only 16% of the new volume growth came from the U.S. in Q2 2018. Canalys reports that 68% of Amazon Echo shipments were in the U.S. compared to just 58% for Google Home. Google’s lower dependence on the domestic market offers it better growth prospects as smart speaker volume rises outside the U.S. (, 16 Aug 2018).

The momentum behind healthcare voice tech is a tidal force spanning the globe. It may be challenging to imagine a voice-tech landscape in which one of the erstwhile leaders in it—a household name—has lost preeminence in lieu of a Chinese rival. This evolving shift, like all other developments in tech innovation and entrepreneurship, is something we at tekMountain will continue to monitor.

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