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Despite its advantages, experts have ‘grave concerns’ about big tech in health care
Google recently began working with Ascension — one of the nation’s largest health care systems — to collect the health information of roughly 50 million Americans, initially without their knowledge, according to reporting by The Wall Street Journal.
A lawsuit alleging that patient data had been mishandled in a similar partnership between Google the University of Chicago has left physicians torn about the idea of big tech wading into health care. Potential advantages include improvements in diagnosis and the treatment of diseases facilitated by artificial intelligence, but there are also concerns about data breaches and Google and/or Ascension using the data for reasons unrelated to improving health care.
Transforming health care
In a press release, Google touted the benefits of its partnership with Ascension, called “Project Nightingale.”
“We hope to transform the delivery of health care through the power of the cloud, data analytics, machine learning and modern productivity tools — ultimately improving outcomes, reducing costs and saving lives,” said Tariq Shaukat, Google Cloud’s president.
Ascension and Google referred Healio Primary Care’s requests for comment to blogs on their websites. In one Ascension post, Joseph Cacchione, MD, FACC, the company’s executive vice president of clinical and network services, further elaborated on how the partnership will improve physicians’ workflows and patients’ health.
“Ascension is collaborating with Google to make health records more useful, accessible and searchable by pulling them into a single, easy-to-use interface for our clinicians,” he said, adding “the work ... will dramatically improve the quality of care we can provide to our patients. It also has the potential to reduce overall health care costs as we use the power of data to help guide us to the most affordable and beneficial treatment for the patients and communities we serve.”
Shaun Grannis, MD, vice president of data and analytics at the Regenstrief Institute in Indiana, pointed to a 2016 JAMA study that illustrated the promise of AI — which is the basis of Google’s partnership with Ascension. In the study, researchers applied an algorithm based on deep machine learning to detect diabetic retinopathy and diabetic macular edema in retinal fundus photographs, and they compared its performance with those of ophthalmologists who were specially trained to detect the conditions. After reviewing 10,000 eye images, researchers determined that the diagnostic accuracy between AI and the specialists was nearly identical.
“In 2 years, we could have similar studies that contain 1 million, or maybe even 10 million images,” Grannis told Healio Primary Care. “When we get to 10 million, the deep machine learning algorithm will likely beat the human every time.”
Grannis also said that AI can also be used to upgrade payment policies and reimbursement schemes. Edmondo Robinson, MD, chief digital innovation officer at Moffitt Cancer Center in Florida, said AI can streamline operations to reduce waste and allow physicians to guide their support staff.
“Imagine a physician whose job is less about seeing a patient every 8 to 10 minutes and more about managing the data that comes in and mentoring their nurse practitioners and physician assistants on the tasks the PCP used to do,” he told Healio Primary Care. “AI won’t eliminate PCPs — it simply shifts their role within a practice.”
Tradeoffs
Grannis and Robinson, who have been part of initiatives similar to the Google/Ascension partnership, warned that they can also negatively impact patient care.
“Some of the companies that are newly entering the health care space are aiming to disrupt the status quo without fully understanding the potential consequences,” Robinson said. “Those consequences may include worsening health outcomes.” Grannis added that “there is always a radeoff between sensitivity, specificity and bias when using AI to predict disease. You need to decide whether you want to make the right prediction every time or never cause a false alarm. And any time you accumulate patient data electronically, you run the risk of data breaches.”
Michael D. Williams, MD, FACS, director of the University of Virginia Center for Health Policy, told Healio Primary Care that he is in favor of using population data to improve patient’s lives, but not without their permission.
“With population data, you’re manipulating with people’s lives. So, I am also in favor of asking people if they want to participate in that collection process first.”
He said this is especially relevant because most patients do not realize the extent of the data that they are sharing when they use smart technology.
“When we give Apple our info from our watches, there are a lot of data we are giving them that most of us don’t know about,” Williams said. “Many people click the ‘I agree’ box on user agreements without realizing that they just gave Apple the right to collect anything it wants.”
Google stated that the data it collects “will not be combined with any Google consumer data.” But Andrew Boyd, MD, acting associate vice chancellor for research in computing and data initiatives at the University of Illinois at Chicago, said that still leaves open numerous opportunities for patient data to be shared.
“Will Google add the metadata or search history to the health records from Ascension?” he asked during an interview.
Mari Rockenstein, JD, an adjunct professor at the California State University Channel Islands, told Healio Primary Care that she has “grave concerns” about these types of partnerships, particularly because companies often place profit before the patient.
“Insurance companies will use the emergent health data that they glean from these conglomerations to assess risk and calculate insurance premiums,” she said. “Advertisers will use the data to deliver ads tailored to a person’s health condition. Companies love this data because it can be used for consumer profiling and marketing, Health care providers and businesses will develop and market health care products. Instead of healing people, emergent health data can be used to control and exploit individuals.”
Rockenstein added that there are currently no laws to prevent any of this from happening.
Ensuring privacy rights
Several sources told Healio Primary Care that the class-action lawsuit filed last year against the University of Chicago and Google underscores their concerns.
According to reporting by The New York Times, the lawsuit alleges that the medical center shared hundreds of thousands of patients’ records with Google “without stripping identifiable date stamps or doctor’s notes.” The newspaper also reported that University of Chicago denied any wrongdoing, and Google stated that it followed HIPAA guidelines.
However, the lawsuit has doctors and Rockenstein wondering how valid Ascension’s assertion that “all work” under its partnership with Google is HIPAA compliant.
“HIPAA was designed when AI was not even envisioned,” Robinson said. “If these partnerships continue, HIPAA will need an upgrade that focuses on safeguarding the privacy of data but at the same time allowing these partnerships to accelerate and innovate the way we improve health.”
Rockenstein agreed that HIPAA has become outdated.
“Parameters must be put in place to safeguard the rights of the consumer and to define the digital boundaries between security and exploitation,” she said. “Consumers should have the right to consent to the use of their data and if they do, they should share in the monetization of their personal health data. Collaboratively developed regulations, policies and laws for privacy from relevant stakeholders will ensure that privacy rights are protected while providing opportunities to improve health care and monetizing big tech investments.”
Cacchione said in one of Ascension’s blogs that the cloud being used for its partnership with Google is “private and secure.”
Robinson stressed that in order for tech companies to get involved in patient health data, they must agree to be more transparent.
“It is possible that the Googles, Amazons and Apples of the world have not been held to this type of transparency in the past,” he told Healio Primary Care. “But if they are going to play in this space, they’re going to have to.” – by Janel Miller
References:
Copeland R. Google’s ‘Project Nightingale’ gathers personal health data on millions of Americans. https://www.wsj.com/articles/google-s-secret-project-nightingale-gathers-personal-health-data-on-millions-of-americans-11573496790?mod=article_inline. Accessed Dec. 19, 2019.
Gulshan V, et al. JAMA. 2016;doi:10.1001/jama2016.17216.
Wakabayashi D. “Google and the University of Chicago are sued over data sharing.” https://www.nytimes.com/2019/06/26/technology/google-university-chicago-data-sharing-lawsuit.html. Accessed Dec. 19, 2019.
Disclosures: Boyd reports receiving funding from the Agency for Healthcare Research and Quality, NIH and the National Science Foundation, and speaking fees from several organizations. Grannis reports receiving research funding from the Agency for Healthcare Research and Quality, CDC and NIH. Robinson, Rockenstein and Williams report no relevant financial disclosures.