Imagine a future when you order your prescription drugs with your Amazon Health Prime account, when your smart glasses from Microsft tell you that a heart attack is imminent, when you order Google’s Alexa to call an Uber instead of a regular ambulance and then go to the emergency room at the Apple Clinic. What may sound slightly odd today, may become reality sooner than one might think as step by step Alphabet, Amazon, Apple and Microsoft are making their way into healthcare industry. Here are a few examples of the TechGiants plans to disrupt the healthcare market – some ventures have already been launched, others are still in the planning stage.
Report: Sascha Keutel
Alphabet’s interest in the healthcare industry is not new. Since 2009 the company’s venture capital arm, GV has invested in nearly 60 healthcare-related companies which include 23andme, a direct-to-consumer genetic testing company; Doctor on Demand, which allows a patient to consult an urgent care doctor or psychologist via telemedicine. And just a few days ago, it was announced that Alphabet would invest another $375 million in Oscar Health, the next-gen health insurance company.
Earlier this year, Google also launched its new Cloud Healthcare API. According to Gregory J. Moore MD, PhD, Vice President of Healthcare, “Google Cloud’s goal for healthcare is very much a reflection of Google’s overall mission: to organize the world’s information and make it universally accessible and useful.”
In addition, DeepMind, the artificial intelligence company that is owned by Alphabet, works on mining medical records to provide better and faster health services. It also uses mobile technology to send alerts to clinicians whenever a patient’s condition deteriorates. In August, the company announced its plans to develop a product that could help doctors detect more than 50 sight-threatening conditions from a common eye scan.
With Calico, its research and development biotech company, Alphabet’s ultimate goal is to extend the human lifespan. Verily is Alphabet’s research entity to prevent, detect, and manage diseases and to analyze what makes people healthy. According to reports Verily is also moving into the health insurance industry.
Alphabet has also shown an increased interest in building collaborations. In 2014, it struck a deal with pharmaceutical firm Novartis to develop “smart“ lenses targeted towards people with diabetes. [Update: On November 16th, Brian Otis, PhD, Chief Technical Officer of Verily,announced in a blog post, that Verily would “put the glucose-sensing lens work on hold, while continuing to focus on the smart accommodating contact lens and smart intraocular lens projects.” He explained, that “Our clinical work on the glucose-sensing lens demonstrated that there was insufficient consistency in our measurements of the correlation between tear glucose and blood glucose concentrations to support the requirements of a medical device.”]
In 2015, Alphabet formed Verb Surgical with Johnson&Johnson to build new digital surgery platforms as well as robotic-assisted surgical products. In 2017, the company launched a “digital scribe” study together with Stanford Medicine to use speech recognition and machine learning tools to help doctors automatically fill out electronic health record (EHR).
In spring, researchers from Google, UC San Francisco, Stanford Medicine, and The University of Chicago Medicine showed that an AI outperformed traditional statistical models at predicting a range of clinical outcomes from a patient’s entire raw EHR.
And just a few months ago, in April 2018, Alphabet and Fitbit announced a collaboration to accelerate innovation in digital health and wearables. According to a press release, Fitbit intends to use Google’s new Cloud Healthcare API to help the company integrate further into the healthcare system, such as by connecting user data with EHRs. Moreover, they are collaborating to bring together the strengths of both companies to transform the future of wearables. “Working together provides an exciting opportunity to leverage Fitbit’s leading wearables brand, community, data, and popular devices alongside Google’s expertise in building platforms, software and services,” they stated in the press release.
Like Alphabet, Amazon, or rather its CEO Jeff Bezos, has a long history of investing in healthcare companies.
In 1999, he purchased a 40 percent stake in Drugstore.com which didn’t turn out as successful as Bezos may have hoped as the company’s shares tanked during the dot-com bust. It was finally shut down in 2016 after being purchased by Walgreens.
In accordance with this previous investment, Amazon’s roughly $1 billion acquisition of PillPack is a logical follow-up to try and push into the healthcare market. PillPack delivers medications in pre-sorted dose packaging, coordinates refills and renewals and ensures that shipments are delivered on time – a service that with the exception of Hawaii is currently available in every U.S. state. This deal may be a very successful foray into the healthcare industry as it enables Amazon to ship prescriptions overnight to its customers making it a strong contender in the $400 billion U.S. pharmacy industry.
This acquisition came only a few months after forming an alliance with Berkshire Hathaway and JPMorgan Chase. The goal of this joint-venture is to tackle the problem of skyrocketing employee healthcare costs while also improving treatment outcomes. Not much is known about the project, other than surgeon and bestselling author Atul Gawande was selected to lead the partnership. [Update: On September 5th, it was announced, that Jack Stoddard, former general manager for digital health at Comcast, would serve as chief operations officer.]
Another step forward into healthcare emerged in August when reports broke that Amazon is planning to build primary care clinics for its Seattle employees. This could be a part of the joint-venture, as primary care is an area of focus for Atul Gawande.
In addition there continue to be rumors about the project team called ‘1492’ that is supposed to be working on a variety of secretive health projects such as creating platforms for EHRs data, health apps and telemedicine to make virtual doctor-patient consultations a reality.
There are also reports that suggest that Amazon is interested in building healthcare applications directly into its virtual assistant, Alexa. According to CNBC, Amazon built a team within its Alexa voice-assistant division called “health & wellness” that aims to ensure that Alexas functionality is compliant with health privacy laws. Using Alexa in a healthcare setting makes sense, as it could be programmed to remind a user to take his or her medications on time, keep track of upcoming doctor’s appointments or coordinate with various other health apps to log glucose or blood pressure levels. This could be helpful especially in management of chronic diseases such as diabetes or it could act as a lifeline for elderly in the case of falls or injuries.
Update: On 27th November, Amazon announced Amazon Comprehend Medical, a new software service that uses machine learning and natural language processing to extract relevant medical information from doctors’ notes, clinical trial reports and patient health records. “Comprehend Medical helps health care providers, insurers, researchers, and clinical trial investigators as well as health care IT, biotech, and pharmaceutical companies to improve clinical decision support, streamline revenue cycle and clinical trials management, and better address data privacy and protected health information (PHI) requirements,” the company wrote in a blog post.
Like Amazon, Apple has plans to launch “multiple, stunning state-of-the-art medical centers,” in Santa Clara just a few miles north of Apple’s headquarters in Cupertino. “AC Wellness is an independent medical practice dedicated to delivering compassionate, effective healthcare to the Apple employee population,” the website states. “AC Wellness Network believes that having trusting, accessible relationships with our patients, enabled by technology, promotes high-quality care and a unique patient experience. This is fostered by an environment of continuous learning and teamwork, which in turn allows us to work with our patients to achieve exceptional health outcomes.”
It seems that Apple’s initial goal is to drive down its financial burden by helping its staff and their families to stay healthy in the first place rather than treating them once they get sick. Job listings showed that Apple was looking to hire population health “designers” and clinical program design leads whose job would be to implement a program focused on preventing disease and promoting healthy behavior. According to the website, “Candidates must have an appreciation for the patient experience and passion for wellness and population health — integrating best clinical practices and technology in a manner that drives patient engagement.”
Apple has filed more than 50 patents to turn its consumer products such as iPhone and Apple Watch into medical devices that can monitor biometric data, e.g. as blood pressure and body fat levels, as well as to develop algorithms to detect heart arrhythmia. In August, the U.S. Patent and Trademark Office granted Apple a patent that covers a wearable that one can wear on the wrist or on either ankle That device will collect the wearers electrocardiogram (ECG) readings.
In January 2018, Apple reported that it will provide its users with the ability to view their EHRs on iOS devices. Thanks to Apple Health Records patients at the participating hospitals and clinics – such as Johns Hopkins Medicine, Cedars-Sinai and Penn Medicine – can view their medical data from multiple providers at any time. They can access several types of data, including their allergies, immunizations, lab results, as well as medications and procedures from various healthcare organizations.
Update: On Sept. 12th, Apple announced that the Apple Watch Series 4 would bring ECG features cleared by the U.S. Food and Drug Administration. “Apple Watch can now screen your heart rhythm in the background and it sends you a notification if it detects an irregular rhythm that appears to be atrial fibrillation. Now it won’t catch every instance of a-fib, but this is going to help a lot of people who didn’t realize they had an issue,” said Apple Chief Operating Officer Jeff Williams.
Update, January 18, 2019: Apple and Johnson & Johnson announced a collobaration on a study to determine whether the latest Apple Watch, in conjunction with an app from the pharmaceutical company, can accelerate the diagnosis of a leading cause of stroke. “We want a deeper understanding about outcomes and prevention associated with early detection. We are excited to work with Johnson & Johnson, which has a long history and expertise in cardiovascular disease,” said Jeff Williams. Paul Stoffels, Johnson & Johnson’s executive vice president and chief scientific officer, said “the goal is to identify early on AFib and prevent stroke by combining the physical know-how from Apple and what we have from the medical and scientific know-how.”
In September 2017, the company announced the launch of its new healthcare division at its Cambridge research facility to use its artificial intelligence software to enter the healthcare market. Its research plans include monitoring devices that can help keep patients out of hospitals and large studies into conditions of chronic diseases such as diabetes.
Although it is not the sole reason for the purchase, the reported acquisition of GitHub may be another step into the healthcare market. Many healthcare organizations use GitHub for health IT-related source code to develop and improve their IT infrastructure, thus the acquisition could impact how organizations access and use healthcare open source code.
Speaking of health IT infrastructure. In August 2018 it was announced that Microsoft would join with Amazon, Google and other IT companies in support of healthcare interoperability. According to a joint statement, they are “committed to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI.”
There are several further health projects Microsoft is working on, such as:
- Azure Security and Compliance Blueprint provides a ready platform-as-a-service (PaaS) environment for ingesting, storing, analyzing, and interacting with personal and non-personal medical records in a secure, multi-tier cloud environment, deployed as an end-to-end solution. In addition together with Microsoft Genomics, Azure provides clinicians and researchers with highly accelerated, cloud-powered genomic processing services.
- AI Network for Healthcare: The company is expanding its Microsoft Intelligent Network for Eyecare to create an AI-focused network in cardiology.
- Project InnerEye is “a research project that uses state of the art machine learning technology to build innovative tools for the automatic, quantitative analysis of three-dimensional radiological images.” The project “turns radiological images into measuring devices.”
- Project Empower MD is a research collaboration that aims to create a system that listens and learns what doctors say and do in given situations. Its goal is to reduce the burden of note-taking for physicians.
In late July 2018, Microsoft filed a patent for an eyeglass monitor capable of tracking blood pressure called Glabella. The glasses are designed to be easier to use and more accurate than a traditional inflatable cuff. “Our wearable glasses prototype Glabella incorporates optical sensors to continuously measure and store the user’s pulse waves at three different sites on their face,” chief designers Christian Holz and Edward Wang reported on the new product.
Update: 5th November: The University of Cambridge announced a partnership with with Microsoft. Together they want to tackle the problem of ‘brain drain’ in AI and machine learning research. The software giant will help increase AI research capacity and capability at Cambridge by supporting visiting researchers, postdoctoral researchers, PhD students and interns from the UK, EU and beyond.
Wait and see
This short overview shows that the efforts of these TechGiants span much of the healthcare food chain – from insurance to distribution to primary care. Some are focusing on their own employees, others partner with or invest in existing healthcare companies. However, they all share the same goal of lowering the costs. As of yet, we don’t know how successful the move of these companies into healthcare will be. However, as history shows, these companies have proven that they are more than capable of disrupting existing business models.
First published on August, 20th 2018.