Now all you need is a remote microphone in the shape of a star trek communicator for your shirt pocket. Tap, "Alexa, three to beam aboard." :-)

Just needs a vocera badge integration and a connection to Coding Insight from Talix to allow for NLP voice access to patient records...

I believe the terms and conditions for the Alexa SDK state you can't activate the Alexa Voice Service via voice, your user has to purposefully interact with something like a button to use it.

EDIT: I'm wondering if this is a legal thing, i.e. they don't want any tom, dick or harry creating "always listening" devices associated with their brand, or they just want to differentiate their Echo product and not have competitors

Confirmed.

This is not always listening app. You've to click "start listening".

Yes, agreed - this is perfectly fine with me. If I wanted the "always listening" feature I'd grab an "official" Alexa device :)