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Alan Stolier, MD/

Project Nightingale: Google deals with Ascension, obtains medical records

google ascention pictureGoogle accumulates data from search, email, and maps and clearly knows how people live. One treasure trove of data has eluded Google, healthcare information. Ascension, the second-largest healthcare system has given Google access to records of 50 million patients. How did they get access and what do they plan to do with it? Larry Page, co-founder of Google, said a few years ago that people don’t understand how much good can come from Google having this information. Google thinks that they can come in and fix this 3.5 trillion-dollar industry, which is essentially broken. They believe that they can improve patient care and at the same time, make money. 

This was not Google’s first venture into the healthcare universe. In 2008, Google Health was founded. Doctors and patients could use Google Health to organize medical records.  It required doctors and patients to opt-in to the system. However, it got little traction and closed 3 years later, in 2011. Now however, by partnering with a hospital system as opposed to doctors and patients, they were not required to have patients or doctors opt-in. Ascension is in 21 states and DC; 2600 hospitals, urgent care centers, senior centers, and doctors’ offices.  Google was given access to patient records that were deanonymized. This included all patient data as well as insurance billing information. It started collecting information in 2018. Millions of patients’ data were shared with Google. Neither wanted much information made public so they assigned it a code name, Project Nightingale.  Of these 50 million patients in Ascension, tens of millions of records have already been shared. Google said they were modernizing Ascension infrastructure while exploring artificial intelligence (AI) and machine learning applications for patient care.

So, what does Ascension get out of this deal with Google? Certainly, data could be exponentially easier to access for both patients and doctors. Financially and likely most important to Ascension, both Ascension and Google could explore methods to increase billing. Google is doing this work for free. But on Google’s side of the ledger, they could eventually sell this data to other healthcare providers for a significant pile of cash. The fact that Google is doing this for free shows just how big the healthcare pie really is. Apple is also currently involved in a healthcare data deal with  the Veterans administration. However, the deal includes mainly an app and website allowing veterans to easily access their own electronic medical record. Moreover, there are only 9 million veterans in the system compared to 50 million in Ascension.  Similarly, Google has a deal with the Mayo Clinic but it is with anonymized data. 

Ascension patients and doctors were not informed that their medical data has been shared with
Google. Have privacy laws been breached? There are two ways to look at this, legally and ethically. On the legal side, a HIPPA provider can share patients’ medical data if done so to improve patient care. So in theory, it is legal. But the HIPPA law was written in 1996 at a time that there was no artificial intelligence (machine learning) and no huge computerized databases.  Ethically, in 2019, patients want to be told about these things. Allowing Google to obtain your medical data, requires a great leap of faith that data won’t be misused. Great things may come of it, but this requires great trust in Google and in the hospital systems. 

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