Health Care Is the Next Battleground for Big Tech

Facebook, Google, Apple, and Amazon are all getting involved in your health care. Here’s why.

Photo: stevecoleimages/Getty Images

AsAs U.S. presidential hopefuls put forth policy proposals to fix America’s health care system, tech giants like Google, Amazon, Apple, and Facebook are trying to create their own solutions. The situation is so bad that some think Big Tech’s intervention might be welcome.

“Everyone hates the health care system,” says John Wilbanks, chief commons officer at Sage Bionetworks, a Seattle-based nonprofit that promotes open science and patient engagement in research. “It’s so bad that the vast majority of interventions will make it better from an experience perspective,” he says. “It might not be more effective, but the experience will be better.”

Health care is a $3.6 trillion industry — too lucrative for tech companies to ignore. “Apple makes devices, Amazon sells stuff at margins that can crush national chains, and Google makes predictions. There is money in all these areas,” Wilbanks says.

Silicon Valley has plenty to gain from wading into health care, but whether consumers will benefit remains to be seen. Here’s a rundown of Big Tech’s plans for health care and what they mean for your health.

Google

In November, Google announced its acquisition of Fitbit for $2 billion, a deal that could give Google an edge in the wearables market, which the Apple Watch currently dominates. In a November blog post, Rick Osterloh, Google’s senior vice president of devices and services, said the deal will “help spur innovation in wearables,” but the huge amounts of data Google inherits from Fitbit may prove more valuable than the gadgets. Once the deal closes this year, the company will have access to personal health data collected from Fitbit’s 28 million users, like steps taken, heart rate, hours of sleep, and other metrics. Fitbit’s privacy policy notes that its de-identified data could potentially be used for research.

Google maintains that it won’t sell users’ personal information to anyone. “Fitbit health and wellness data will not be used for Google ads,” Osterloh said. “And we will give Fitbit users the choice to review, move, or delete their data.”

Google’s privacy practices were criticized later in November, when the Wall Street Journal unearthed a secretive Google effort called Project Nightingale, a partnership with Ascension, one of the largest U.S. health care systems. The WSJ reported that Google’s end goal is to “create an omnibus search tool to aggregate disparate patient data and host it all in one place.” Through the initiative, Google has been collecting patients’ diagnoses, lab results, and hospitalization records, and it didn’t notify patients or doctors when it started doing so.

Meanwhile, Google is also developing artificial intelligence tools for the health care industry. A recent paper found that an A.I. system developed by Google Health, Google-owned DeepMind, and several medical centers was better at detecting breast cancer than doctors. One of the promises of A.I. in health care is that automated systems could provide early detection and diagnosis of certain diseases like cancer, and proponents say identifying and treating patients earlier could improve health outcomes and save on health care costs.

But many experts worry about the privacy of consumer data as Google snaps up smaller companies and forges new partnerships with health systems. “Privacy risks have to be balanced against the medical benefit such data collection and analysis would provide,” says Katharina Kopp, deputy director of the Center for Digital Democracy, a nonprofit organization in Washington, D.C.

“My fear is that we’re going to mistake a better experience for actual health benefit.”

Amazon

In 2018, Amazon made a big move into health care when it bought the mail-order pharmacy PillPack. In 2019, Amazon rebranded the business as “PillPack by Amazon Pharmacy” and began talks with health insurers to make its pharmacy services available to more customers. Now, the company has filed trademarks for “Amazon Pharmacy” in places like Canada and Australia, according to CNBC. If Amazon can lower drug costs for millions of Americans like it’s been able to slash the cost of the millions of products it sells, it could be a huge benefit for patients struggling to pay for necessary medications. But independent pharmacy owners have voiced concerns that Amazon is violating patient privacy with unsolicited phone calls urging them to transfer to the service.

Amazon’s Alexa is also poised to become a medical device. Last year, Amazon announced that Alexa became compliant with a major health privacy law, allowing the smart assistant to send and receive personal health information. A handful of companies and health systems are now building voice “skills” for Alexa to allow patients to set medication reminders, get their last blood sugar reading, and find urgent care centers near them, among other things. In a blog post, Amazon said the new skills are “designed to help customers manage a variety of health care needs at home simply using voice.”

Amazon is also working with Accenture and pharmaceutical giant Merck to create a drug development platform on Amazon Web Services, the company’s cloud-computing platform.

Apple

The Apple Watch is massively popular as a smart watch, outselling other wearables on the market, but Apple long wanted it to be a medical device too. Apple took its first big step in 2018, when it got clearance from the U.S. Food and Drug Administration to market an Apple Watch embedded with an electrocardiogram to measure a wearer’s heart rate. According to CNET, Apple also holds patents for blood oxygen reporting — a feature that Fitbit has just rolled out that could be useful for detecting sleep apnea — but hasn’t introduced that feature on any of its devices.

The Apple Watch Series 4 or later is also able to detect a hard fall while users are wearing the watch. At an event last September, the company touted it as a life-saving feature. In one instance, an Apple Watch detected a man’s fall and automatically called 911.

The company is working on an Apple Watch feature that detects a heart rhythm condition called atrial fibrillation, which is a leading cause of stroke and hospitalization in the United States. It’s still under development: Recently published results from a massive study of 400,000 people who used the app identified a small number of people with heart rhythm abnormalities, but when that group used electrocardiogram patches to confirm the findings, only about 34% of them actually had atrial fibrillation, raising concerns about false positives. Nevertheless, at an event this month, CEO Tim Cook hinted at future detection capabilities that go beyond heart problems.

In November, Apple also launched three major research studies that will use the Apple Watch to track menstrual cycles, noise exposure, and heart rate and mobility.

Apple’s foray into health care also includes an electronic health records business. The company debuted Apple Health Records in 2018 at a few dozen partner hospitals. Last year, it made the feature available to any U.S. health care provider that uses electronic medical records. It now allows patients with iPhones or iPods to download and view their medical records — including medications, immunizations, lab results, and more — in one place.

Facebook

Last October, Facebook revealed a new tool called Preventive Health, which recommends certain health screenings based on data it has previously collected on a user’s age, sex, and other demographic criteria. Through the tool, users can set reminders for upcoming appointments, mark tests as complete, and find nearby clinics and health care providers. For now, it provides screening recommendations for only cancer, heart disease, and flu, but Facebook plans to add more capabilities.

The tool represents an expansion into health for Facebook, which dipped its toes in the space in 2017 when it rolled out a blood donation feature that allowed users to sign up to become blood donors and locate blood banks nearby. The feature first became available to users in Bangladesh, Brazil, India, and Pakistan, and so far, more than 35 million people in those countries have signed up to be blood donors. Last year, Facebook expanded the tool to U.S. users.

Sherry Pagoto, director of the UConn Center for mHealth and Social Media, says the new Preventive Health tool is exciting because it could help close gaps in preventive care. Through Facebook notifications, the platform could remind people to get flu shots and age-appropriate health screenings. “Tech companies have enormous potential to solve some of the problems that have affected public health, things like access to care or cost or awareness of preventive services, because they have such big reach and they may be able to do things more efficiently.”

Facebook says it won’t have access to any testing results and the information users enter into the tool won’t be shared with third parties and advertisers. But there are still reasons for users to be concerned about the privacy of the health data they share in the tool.

Looking Ahead

Uber Health, which launched in 2018 to allow health care providers to schedule rides for their patients to get to and from appointments, plans to double in size this year.

Microsoft has also been trying to make moves into health care but hasn’t been as successful as other tech companies. A big upset came in November, when Microsoft pulled the plug on HealthVault, its attempt at a web-based personal health record system. A new seven-year partnership between Microsoft and health insurer Humana will use cloud, A.I., and voice technologies to help aging seniors navigate their care.

Tech companies’ health initiatives could very well improve Americans’ experiences with health care, but Wilbanks wonders if these efforts will actually translate into better health outcomes for people or just serve tech companies’ bottom lines.

“My fear,” he says, “is that we’re going to mistake a better experience for actual health benefit.”

Former staff writer at Medium, where I covered biotech, genetics, and Covid-19 for OneZero, Future Human, Elemental, and the Coronavirus Blog.

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