This is nothing new. MSFT, Alphabet, AMZN, Oracle have all been making plays for years trying to get into the healthcare industry. It's a huge, bloated industry
This is also an heavily regulated industry in terms of patient data protection, software quality, part availability, etc. It will be interesting to see how big tech will deal with having an overbearing regulator breathing down their neck.
I'm not against data mining at all, just handing it out to agencies without my say so. I'd be happy for it to be used for this purpose entirely within the NHS but that's not what was assured.
I don't like the approach that you have to opt out, not opt in.
I others may have different tradeoffs, that's fine. This is my view and urge people not to follow what I've done but to decide for themselves. It's your data, if you're in the UK, you can make a choice (not making a choice IS making a choice: for it to be shared).
Edit: and please don't respond with "just you wait..." or "it's going to happen anyway" defeatist juvenile posts.
In Australia we have a similar mechanism, I opted out of sharing my health data. However down under when you opt out, this applies not only to private companies but also to State and Federal health providers. Source https://www.digitalhealth.gov.au/initiatives-and-programs/my...
I disagree. Alphabet values human life. Sure they may kill products constantly but I trust the company to uphold certain values, especially around humanistic principles.
Step 1) Allow Gov to build up regulations so complex that it requires a force of nature to over come. Step 2) Big Tech builds technology around those regulations and sells it to people. Step 3) Viola! we have a giant massive ocean-like moat that surrounds the Big Gov + Big Tech castle. Never to be breached by the likes of Silicon Valley startups or otherwise.
A merger of technology privacy invading, ai-guiding, rip off processes AND the ability to direct your health for profit. With government lobbyists in both pockets.
Assuming by free you mean universal coverage that is (almost) free at the point of usage then this is a solved problem. What the United States lacks in order to realize a solution is political willpower and an electorate that is savvy enough to know that wanting such a system does not make one a communist. (And that being a communist does not make one an evil person.)
> Google is also giving health records another whirl. The new initiative, called Care Studio, is aimed at doctors rather than patients. Google’s earlier efforts in this area were derailed in part by hospitals’ sluggishness in digitising their patient records.
Not just digitizing but also in sharing them. Hospital systems are very very reluctant to send out a copy of their records, or even to let you query their system. Especially in the early days of EHRs there was very much a sense that it was their data and they didn't want to let data out because interoperability was a threat to their data moats.
That's good in a privacy sense, but it really did slow down adoption of interoperability initiatives. Finally Medicare/Medicaid basically forced it iirc... if you want Medicare dollars you will send Medicare your encounter data. So now you have to code your records at least good enough to at least get your medicare reimbursements.
> That problem has mostly gone away but another has emerged, says Karen deSalvo, Google’s health chief—the inability of different providers’ records to talk to each other. Dr de Salvo has been vocal about the need for greater interoperability since her days in the Obama administration, where she was in charge of co-ordinating American health information technology. Until that happens, Care Studio is meant to act as both translator and repository (which is, naturally, searchable).
Dead on. It's a hard hard problem though because during the early days we went through a Cambrian explosion in data diversity. Data is often coded very inconsistently or in ways that make it "invalid" to modern schemas. The "miracle of HL7" is basically just a fancy text format, and like the on-table records or XML documents it's still possible to code things in ways that still won't be parseable even if they're syntactially/lexically correct.
There are standardized schemas (f.ex NEDSS schema) available, but they are super over-engineered for a lot of use-cases and can perform quite poorly due to excessive "anything can map to anything" design and field-table-value formats. And again, they suffer from the "there's multiple ways you could code this" thing, just using NEDSS doesn't mean you interoperate with anyone, not close. Not sure what EHRs typically have underneath but it wouldn't surprise me if they all had their own solutions too, EHR software is universally dogshit.
Handling poorly-validated/normalized data from tens of thousands of facilities all doing their own things is a very tough problem, and honestly the only solution is to decentralize it a little bit, facilities have to look at their own data and see if it makes sense the way they're sending it or even if they're storing it wrong. Once it's just another record in a database, if it's not consistent and accurate it likely never will be. It'll just be yet another System-Specific-Record-Identifier in the list for that record, and since it's not coded right nobody will ever be able to read it unless it's patched by someone/some layer.
Data clearinghouses are uniquely positioned to gatekeep that a little bit, and over time there are tools getting written to help various facilities validate their data and see whether it's semantically reasonable. Almost everybody has errors especially if this is their first integration, but they can be brought up to speed on their ongoing record submissions, at least.
I'm sure google would love to be in charge of everyone's health data, or at least to get to see it. Commercial activity isn't notionally allowed but I wonder if HIPAA applies to aggregated data like that, they can probably set up The Business-Purpose Side with a firewall from the Gets To Make Money Querying Anonymized Data side.
It's true that this is a thing where there are intellectual economies-of-scale though. If you can get to One Standard To Rule Them All and actually make it work and not suck, that's useful, everyone just agrees to adopt Google Validation Rules and a shit-ton of terrible mapping/correcting labor gets saved once people get on board. There's just also not really anyone trustworthy enough to handle being the One Giant Repository Of Health Data, Google owning it eventually ends up in massive data mining of sensitive PHI.
it's much easier to get hospitals to share EHR data than you think. Both from the anecdote level (when switching health care provider companies, my doctor was able to export my EHR from Kaiser and import it to Sutter with a single click. Two completely different systems (which happen to both be running the same underlying software).
At the generalization level, many companies make deals with health providers to get various forms of access to EHRs.
There is another aspect to this. Treating all hospital records as an infallible and comprehensive record of truth, carving them in stone and having them follow you for the rest of your life is plain dangerous. They are to be interpreted in a complex context, and their relevancy fades over time as well.
So, if you thought it was shitty when your Gmail service abruptly gets suspended for no clear reason or means of recourse, imagine how wonderful it's going to be when your entire range of cloud based medical services and remotely updated internal gizmos goes down the drain because some algorithm decided so....
I really wish Google would just accept it's a dumb advertising company and forget about these moonshots. It's just to stroke the founders ego. They are big enough. Pay out a huge dividend or something.
As somebody who's been blacklisted by Google for no particular reason I can even discover, this terrifies me. I'm not saying they'd hire a hit man and kill me, but tweaking some doses of medicines? This isn't impossible if they get their claws into health care. It's free and easy. And Google is terrible for privacy and has major security problems which are endemic.
I don’t understand these drives. The US is the only developed country without state control of healthcare. How is Google hoping to grow their market outside the US when it’s such a difficult space to navigate?
Medicare, which is under state control, is larger than many other developed country's state-run medical systems. Before criticizing the US system, make a strong attempt to understand the underlying structure.
How incredible would it be if Alphabet spent, say 1% of their total healthcare venture budget, just running models on all of the different ways that the cost of healthcare could be reduced and access to care could increase. And maybe they do this already (we have no idea if they do, it might be nice to share that information if they did). It's just become so clear that many people believe the anti-science stuff that gets thrown around these days because they can't even afford to participate in the healthcare system anymore. And who can blame them? Figuring out how to get medical records systems to talk to each other isn't going to solve this problem.
But no, let's throw billions of dollars at anti-aging instead...
>> anti-science stuff that gets thrown around these days
It wasn't just anti-science but deliberate attempts to stop Obamacare, the ONLY initiative ever attempted to fix the US healthcare system. Then came the Republicans to stop it.
IMO, the Pacific coast states need to reject national health care, create a health-care pact between states that slowly grows larger by adding new states. If another state doesn't want to join, then, so be it.
Enough of splintered policies that change across state lines. Reduce health care insurance costs by allowing continued and universal care to states that elect this policy. The strength of change is in the states themselves, not the federal level.
"Running models" can't fix problems that are political conflicts between competing interests. You don't need DeepMind to tell you Certificate of Need laws reduce access and increase price; you need a political coalition that can overturn them.
Healthcare isn't expensive because there are huge swaths of spending unexamined by human intelligence that might become tractable with an automated process. On the contrary, it's one of the sectors that has the most eyes and brains pointed at costs and extracting as most money as possible.
On the topic of EMR systems in particular, they suck because the people using them hate them and because the people purchasing them, building them, and mandating them aren't the people using them. If it were just a matter of having enough money to throw at the problem, Epic would have done so already.
IMo, The ballooning costs in healthcare are not from not knowing how to reduce the costs or make the system more efficient. There is entrenched interests/ businesses that will lose 100s of billions if it were replaced or shifted. They absolutely will not let it happen. Spending a few billions to buy politicians is justifiable for them. That is the main reason we are in this mess and will always be. May be I am too pessimistic, but Google, Amazon put together is not enough to change it
[+] [-] Apocryphon|3 years ago|reply
And there’s even more giants:
https://www.theverge.com/2022/6/10/23162503/oracle-cerner-he...
https://www.fiercehealthcare.com/health-tech/oracle-cerner-p...
[+] [-] metadat|3 years ago|reply
[+] [-] m15i|3 years ago|reply
[+] [-] 1024core|3 years ago|reply
[+] [-] Finnucane|3 years ago|reply
[+] [-] airza|3 years ago|reply
[+] [-] pg_1234|3 years ago|reply
[+] [-] dontcare007|3 years ago|reply
[+] [-] bluetrolliage|3 years ago|reply
[+] [-] skywal_l|3 years ago|reply
[+] [-] zasdffaa|3 years ago|reply
Link is here if you want
https://www.nhs.uk/using-the-nhs/about-the-nhs/sharing-your-...
A few points:
I'm not against data mining at all, just handing it out to agencies without my say so. I'd be happy for it to be used for this purpose entirely within the NHS but that's not what was assured.
I don't like the approach that you have to opt out, not opt in.
I others may have different tradeoffs, that's fine. This is my view and urge people not to follow what I've done but to decide for themselves. It's your data, if you're in the UK, you can make a choice (not making a choice IS making a choice: for it to be shared).
Edit: and please don't respond with "just you wait..." or "it's going to happen anyway" defeatist juvenile posts.
[+] [-] mastazi|3 years ago|reply
[+] [-] na85|3 years ago|reply
Sarcasm aside I can't think of a company I'd trust less than Alphabet (maybe Meta) with managing healthcare.
[+] [-] unrealhoang|3 years ago|reply
[+] [-] bergenty|3 years ago|reply
[+] [-] GoOnThenDoTell|3 years ago|reply
[+] [-] Gehlitio|3 years ago|reply
Because I do and you know how scattered the field of medicine is?
There is one realistic way of getting more people with chronic issues new threatments and it's data. Lots and lots of it.
IF someone can pull that of while protecting the individuals I believe it's alphabet. Together with deep mind and all the other research they do.
[+] [-] systemvoltage|3 years ago|reply
We are already in a dystopian time.
[+] [-] verisimi|3 years ago|reply
A merger of technology privacy invading, ai-guiding, rip off processes AND the ability to direct your health for profit. With government lobbyists in both pockets.
What could go right?!?
[+] [-] glglwty|3 years ago|reply
[+] [-] cardosof|3 years ago|reply
[+] [-] AtlasBarfed|3 years ago|reply
AFAIK, crickets.
... at least it isn't facebook. Oh, sorry """Meta"""
[+] [-] zxexz|3 years ago|reply
[0] https://hbr.org/2021/01/why-haven-healthcare-failed
[+] [-] scifibestfi|3 years ago|reply
[+] [-] hericium|3 years ago|reply
Google offers services that you don't pay for in cash.
[+] [-] whyenot|3 years ago|reply
[+] [-] klyrs|3 years ago|reply
[+] [-] UkrainianJew|3 years ago|reply
[+] [-] suture|3 years ago|reply
[+] [-] unknown|3 years ago|reply
[deleted]
[+] [-] paulmd|3 years ago|reply
> Google is also giving health records another whirl. The new initiative, called Care Studio, is aimed at doctors rather than patients. Google’s earlier efforts in this area were derailed in part by hospitals’ sluggishness in digitising their patient records.
Not just digitizing but also in sharing them. Hospital systems are very very reluctant to send out a copy of their records, or even to let you query their system. Especially in the early days of EHRs there was very much a sense that it was their data and they didn't want to let data out because interoperability was a threat to their data moats.
That's good in a privacy sense, but it really did slow down adoption of interoperability initiatives. Finally Medicare/Medicaid basically forced it iirc... if you want Medicare dollars you will send Medicare your encounter data. So now you have to code your records at least good enough to at least get your medicare reimbursements.
> That problem has mostly gone away but another has emerged, says Karen deSalvo, Google’s health chief—the inability of different providers’ records to talk to each other. Dr de Salvo has been vocal about the need for greater interoperability since her days in the Obama administration, where she was in charge of co-ordinating American health information technology. Until that happens, Care Studio is meant to act as both translator and repository (which is, naturally, searchable).
Dead on. It's a hard hard problem though because during the early days we went through a Cambrian explosion in data diversity. Data is often coded very inconsistently or in ways that make it "invalid" to modern schemas. The "miracle of HL7" is basically just a fancy text format, and like the on-table records or XML documents it's still possible to code things in ways that still won't be parseable even if they're syntactially/lexically correct.
There are standardized schemas (f.ex NEDSS schema) available, but they are super over-engineered for a lot of use-cases and can perform quite poorly due to excessive "anything can map to anything" design and field-table-value formats. And again, they suffer from the "there's multiple ways you could code this" thing, just using NEDSS doesn't mean you interoperate with anyone, not close. Not sure what EHRs typically have underneath but it wouldn't surprise me if they all had their own solutions too, EHR software is universally dogshit.
Handling poorly-validated/normalized data from tens of thousands of facilities all doing their own things is a very tough problem, and honestly the only solution is to decentralize it a little bit, facilities have to look at their own data and see if it makes sense the way they're sending it or even if they're storing it wrong. Once it's just another record in a database, if it's not consistent and accurate it likely never will be. It'll just be yet another System-Specific-Record-Identifier in the list for that record, and since it's not coded right nobody will ever be able to read it unless it's patched by someone/some layer.
Data clearinghouses are uniquely positioned to gatekeep that a little bit, and over time there are tools getting written to help various facilities validate their data and see whether it's semantically reasonable. Almost everybody has errors especially if this is their first integration, but they can be brought up to speed on their ongoing record submissions, at least.
I'm sure google would love to be in charge of everyone's health data, or at least to get to see it. Commercial activity isn't notionally allowed but I wonder if HIPAA applies to aggregated data like that, they can probably set up The Business-Purpose Side with a firewall from the Gets To Make Money Querying Anonymized Data side.
It's true that this is a thing where there are intellectual economies-of-scale though. If you can get to One Standard To Rule Them All and actually make it work and not suck, that's useful, everyone just agrees to adopt Google Validation Rules and a shit-ton of terrible mapping/correcting labor gets saved once people get on board. There's just also not really anyone trustworthy enough to handle being the One Giant Repository Of Health Data, Google owning it eventually ends up in massive data mining of sensitive PHI.
[+] [-] claytongulick|3 years ago|reply
Also, it's complex to implement.
Fortunately, we have HAPI [1] and it's very good, but has deployment complexity only a java developer could love.
There's been a couple false starts on a nodejs based FHIR server, but nothing open source and production ready that I've found.
[1] https://hapifhir.io/
[+] [-] dekhn|3 years ago|reply
At the generalization level, many companies make deals with health providers to get various forms of access to EHRs.
[+] [-] mateo1|3 years ago|reply
[+] [-] helloworld11|3 years ago|reply
[+] [-] nightski|3 years ago|reply
[+] [-] midislack|3 years ago|reply
[+] [-] pottertheotter|3 years ago|reply
[+] [-] jelliclesfarm|3 years ago|reply
[+] [-] philistine|3 years ago|reply
[+] [-] dekhn|3 years ago|reply
[+] [-] thr0wawayf00|3 years ago|reply
But no, let's throw billions of dollars at anti-aging instead...
[+] [-] adamredwoods|3 years ago|reply
It wasn't just anti-science but deliberate attempts to stop Obamacare, the ONLY initiative ever attempted to fix the US healthcare system. Then came the Republicans to stop it.
https://www.heritage.org/health-care-reform/commentary/why-t...
IMO, the Pacific coast states need to reject national health care, create a health-care pact between states that slowly grows larger by adding new states. If another state doesn't want to join, then, so be it.
Enough of splintered policies that change across state lines. Reduce health care insurance costs by allowing continued and universal care to states that elect this policy. The strength of change is in the states themselves, not the federal level.
https://www.gov.ca.gov/2020/04/13/california-oregon-washingt...
[+] [-] jdminhbg|3 years ago|reply
[+] [-] scarmig|3 years ago|reply
On the topic of EMR systems in particular, they suck because the people using them hate them and because the people purchasing them, building them, and mandating them aren't the people using them. If it were just a matter of having enough money to throw at the problem, Epic would have done so already.
[+] [-] yalogin|3 years ago|reply
[+] [-] googlryas|3 years ago|reply
[+] [-] thatfrenchguy|3 years ago|reply
[+] [-] aliswe|3 years ago|reply
[+] [-] bergenty|3 years ago|reply
[deleted]