Although healthcare tech is booming, it’s given major incumbents little to worry about so far. That will soon change.
The industry as a whole is expected to be worth about $150 billion in value by 2025, with a lot of the surge driven by improvements to care and government expenditures on healthcare infrastructure. The invasion of big tech players will only accelerate the growth.
Tech monopolies like Apple, Google, and Amazon have gotten in on the game, in everything from extending the capabilities of wearables like the Apple Watch, to Haven Healthcare, a joint venture between Amazon, JP Morgan Chase, and Berkshire Hathaway to bring tech-enabled improvements to insurance, diagnostics, and other aspects of patient care.
Alphabet has been jumping on opportunities in healthcare tech for a long time. Just take the strides made under Verily Life Sciences in placebo-controlled clinical trials and drug development, and the fact that the health division of DeepMind, the Google-acquired British AI firm, is officially joining Google Health. But Google is now is planting the most promising seeds of transformation to date in the electronic medical records (EHR) space.
Through Alphabet’s Google Health division, the tech giant is gaining access to millions of US patient health records in a deal with nonprofit healthcare provider Ascension, a move that may revolutionize how doctors work with patient data. It could lead to vastly better health outcomes and lower costs than the EHR SaaS systems clinicians are dealing with today. Google also has a similar deal with Intermountain Healthcare and has pursued a deal with Cerner.
With these initiatives, Google seems to be laying the groundwork for a new open development platform, in a healthcare tech subsector that desperately needs one.
The EHR industry is dominated by mega-vendors Epic and Cerner, which together command almost 60% of market share in terms of U.S. hospital usage. But the current state of affairs in managing patient data is not good.
The HITECH Act of 2009 was supposed to bring change to health record management in the US. The law effectively mandated that mountains of patient charts containing lab test results, patient diagnoses, and prescriptions be converted from paper into electronic data that can be securely stored and shared among a patient’s care team.
But while it brought some necessary digitization to the way things were done, it unleashed a whole new slew of problems. Clinicians of all stripes are forced to navigate the unwieldy, inconvenient, dangerously error-prone proprietary EHR systems that their institutions mandate.
A damning exposé of the EMR/EHR scene in Fortune reveals how bad things have gotten. Current solutions are clunky and frustrating to use, causing doctors to spend precious minutes staring at a screen and typing during their ever-shrinking appointment time with patients, and even to log overtime hours correcting and updating records.
Different solutions have been riddled with failures in updating prescriptions, transmitting lab orders, and even alerting users of hazardous drug interactions. Doctors often have to scroll through long lists and click a mouse dozens of times just to order the right drug, along with the right dosage and form.
These aren’t innocuous problems. Aside from contributing to doctor burnout and improperly managed patient care, EHR errors and usability issues have been implicated in serious patient injuries and deaths, and have led to large out-of-court settlements.
Another key problem with the proprietary systems is that they relentlessly silo patient data. If a person goes to a clinic for a checkup, then shortly thereafter has to get treated at an unaffiliated hospital (given that the two establishments use different EHRs), it can be a hassle to integrate that patient’s treatment info.
This is the crux of the oft-cited “non-interoperability” problem with incumbent EHR solutions. They can’t communicate with each other very well as-is, so simply trying to move everyone onto one traditional, linear EHR system won’t solve the problem.
But the industry does desperately need a more reliable system that democratizes patient data for care teams, while making it more complete, easier to manage, and easier to draw useful insights from. This kind of upgrade to healthcare tech wouldn’t only cut costs, but would likely save lives.
Google’s actions through Project Nightingale carry huge implications for the revamping of EHR across the board. With millions of patient health records, Google will be uniquely positioned to create a much-improved user experience for doctors. Its deep expertise in AI also enables it to provide a suite of clinical diagnostic tools that can make caregivers more effective.
However, the move has been controversial. In an age where personal data security concerns are on the minds of many, there’s been increasing scutiny about how this will impact patient privacy. But even health data transactions this big are considered broadly permissible under federal HIPAA law.
Google has also deployed a demo of an attractive clinical EHR “operating system” complete with a clean, familiar interface. It’s slated to be a big improvement to the experience doctors currently face in using multiple logins to pull patient data from different systems.
Dr. David Feinberg, head of Google Health, puts it this way: “What we thought we could accomplish is take the functionality that we know from organizing information, and put it on top of your [health] record,” letting a doctor see with quick keyword searches or in clear charts and graphs how a patient is doing, what tests they’ve done, and what medications they’re taking.
The most exciting possibilities here lie in the potential for Google to create an EHR platform that builds a network of third-party developers creating new tools for caregivers. In this scenario, third parties would develop useful apps, perhaps through later iterations of the Fast Healthcare Interoperability Resources (FHIR) API standard.
These apps, for example, could pull together discrete pieces of patient data from numerous sources, run predictive analyses that uncover lifetime risks, and create helpful UI elements that instantly show how patients are declining or improving along various health metrics.
The $2.1 billion acquisition of FitBit just secures Google’s spot as the leading modern monopoly that can create the EHR development platform to rule them all. By integrating patient-generated health records (PGHR) with traditional EHR and other data such as genetic profiles, practitioners can get even more sensible 360-degree views of their patients.
That could be a key differentiator for a Google-backed EHR platform. Rather than relying solely on its homegrown algorithms to analyze patient data, Google could augment its AI superpowers by partnering with various healthcare tech startups and developers, while leveraging user-generated data from devices like smartphones and the FitBit.
This could make a new platform sticky and valuable enough for both developers and end users (physicians) to keep coming back, and for network effects to quickly take off.
Against the backdrop of the public outcry over Google’s recent moves, it’s important to remember two things.
One, the large incumbent EHR players certainly do have something to worry about and strike out against.
Two, Google isn’t the only company grabbing up EHR data, not by a long shot. As long as health data is anonymized, collecting, selling and reselling it appears to be fair game under HIPAA rules.
Other tech behemoths like Amazon, Microsoft, and Apple are accessing and sourcing troves of patient data for analytics and other purposes. Many pharmaceutical corporations and other businesses in the healthcare trenches are doing the same.
But right now, Google seems to be in the lead in building an operating system and development platform for healthcare, or what would practically amount to an Android for doctors. Just like Android has given millions of developers open access to a global community of tuned-in, engaged mobile consumers, Google could spark a similarly big movement within healthcare.
After some more obligatory testing and validation of the new, exciting EHR operating system, all that will remain for Google is to open things up to outside developers. We’ll have to wait and see what it looks like, but big things are clearly on the horizon.
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