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  • Health care is in the midst of a digital revolution

  • And it is generating an ocean of data

  • There's loads of health data out there

  • Patient records that have been digitised, gene sequences...

  • ...medical images, lab tests, and then of course there's the sensors that...

  • ...we're increasingly wearing on our bodies, whether they're Fitbits...

  • ...or ear buds or Apple watches...

  • ...or maybe just your own mobile phone that you carry around with you

  • Now some of the tech companies that made those devices...

  • ...are eyeing up the data they're collecting

  • Microsoft and Walgreens in a seven-year deal...

  • ...and it includes up to 12 digital-health centres

  • Alphabet, the owner of Google, has made an offer to acquire Fitbit

  • These companies have made vast fortunes from processing...

  • ...managing and mining data

  • Today they're turning those talents to health care

  • But will that make you feel better?

  • You need to record at least ten finger movements...

  • ...and combined with those data it will give you the score

  • This app is designed to monitor a patient's Parkinson's disease...

  • ...just by using the camera on a smartphone

  • This is a test that, traditionally, you're doing it in...

  • ...a health-care setting in front of a neurologist

  • It's been created by a tech startup called Medopad

  • Dan Vahdat is its boss

  • With a phone like this, I can measure my resting heart rate

  • I can measure and do a test for Parkinson's, a test for Alzheimer's

  • Can we look at some of the population

  • The app tracks the patient's symptoms...

  • ...so that doctors know when to intervene...

  • ...rather than waiting for the patient to come to them

  • We think there's a new category in medicine...

  • ...which is based on all the data that your body generates

  • And the whole idea and our focus is to see...

  • ...can we find signatures that quantify your health...

  • ...quantify different diseases you might be dealing with

  • These invisible footprints are called digital biomarkers

  • And you're leaving them wherever you go...

  • ...through watches, wearable technology and smartphones

  • There are already thousands of diagnostic and monitoring applications...

  • ...targeting a host of different conditions and diseases

  • Health care is all about the data

  • This digital-biomarker category, probably...

  • ...it will have the biggest impact in medicine...

  • ...because of the amount of data it's going to generate

  • Combined the digital biomarkers produce...

  • ...big and potentially very valuable datasets

  • And that's just the tip of the iceberg

  • Factor in the vast volume of data already generated by health-care systems...

  • ...in the daily effort to look after patients and populations...

  • ...and there's the potential to improve outcomes on a far bigger scale

  • There's a whole bunch of things you can do...

  • ...just with a much broader and deeper view of a patient...

  • ...through digital-health records

  • You can pick up medical errors, for example...

  • ...and you can also figure out which pathways of care are most efficient

  • It's only by assembling lots of patient-health data that you start to see...

  • ...what spending is useful and what spending isn't

  • But in many health systems, what you find is you have pools...

  • ...of medical data in different places. And it's not until you link these up...

  • ...that you can really wring out the power that they have...

  • ...to kind of give you really wonderful insights

  • Digitising and linking this data...

  • ....enables patterns and trends to be spotted

  • But it's a big job

  • ...and the evidence suggests that many countries have a long way to go

  • Health-care systems have been quite slow...

  • ...in using modern technologies to revolutionise themselves

  • Some people say that they're about ten years behind other sectors

  • In 2017 the OECD, a group of mostly rich countries...

  • ...judged how ready its members are for a revolution in health tech

  • It looked at two factors: technological readiness...

  • ...meaning digitised records that can already be used...

  • ...for monitoring and research...

  • ...and policy, the extent to which governments facilitate...

  • ...the use of the data in these digitised records

  • Some countries, like Slovakia, have the technology ready...

  • ...but are held back by government lagging

  • Others, like Poland, have more policy in place but less technology ready

  • And even though many OECD members...

  • ...have a high proportion of health datasets digitised...

  • ...only a small percentage of them are regularly linked...

  • ...with other sources of information

  • Take Singapore. Although all of its key national-health datasets are available...

  • ...just under a third are linked, making vast quantities of data redundant

  • The reason most OECD country health systems don't...

  • ...clean up their datasets, or at least that they haven't so far...

  • ...is really that the data that exists in the health-care system...

  • ...it's not really there for this purpose

  • The point of it is to look after human beings in the moment

  • Inefficiencies in health services, and failure to make full use...

  • ...of digital technologies, mean that rich countries...

  • ...are wasting up to $600bn a year

  • That's around 8% of current health spending...

  • ...and more than the equivalent of the GDP of Sweden

  • At a time when all of the OECD health-care systems...

  • ...are struggling under a burden of increasingly old patients...

  • ...lower amounts of money flowing into the system

  • There's just not a lot of money there to do...

  • ...the kind of digital reorganisation that is needed

  • Enter big tech with its massive computing power...

  • ...and expertise in data analytics

  • And it is very keen to offer its services to overwhelmed health-care systems

  • Microsoft is providing American health-care systems with AI tools...

  • ...to analyse health data relating to surgery outcomes and cancer therapies

  • Google is working with Ascension, one of the largest American health firms...

  • ...to create an online tool so that its doctors can more easily search patient data

  • And in the UK, Google has been working with the Royal Free...

  • ...a London Hospital, to identify patients who are most at risk...

  • ...of falling seriously ill in hospital

  • When big-tech companies work with hospitals....

  • ...you can start to see the potential for some really big wins

  • But at the same time, there are also risks

  • Just because a tech company says that...

  • ...it can do amazing things with your data...

  • ...it doesn't mean that it's going to work

  • Health systems really have to think hard about...

  • ...patient privacy and security of the data

  • For example, Google got into hot water when the Royal Free...

  • ...shared patient data with it in a way that it shouldn't have done

  • This tension goes beyond big tech's access to existing patient data

  • The aspirations of some of these companies continue to grow...

  • ...fuelled in part by their ability to collect health data directly from the public

  • It's now the private sector trying to show the government how to do it

  • Amazon finally making that big foray into the health-care industry...

  • ...announcing earlier its partnership with Berkshire Hathaway and JPMorgan...

  • ...to form a health-care company

  • Apple is using the Research app on its iPhone and Watch...

  • ...to conduct medical studies with academic institutions

  • The ambitions of Verily, Google's sister company, seem even greater

  • Its goal is to become the central repository for health data worldwide...

  • ...a kind of medical Google Maps

  • If you think about Google Maps, it was an effort...

  • ...to really understand all of the roads, not just in your backyard...

  • ...but really in the whole world

  • And in many ways health care has some similarities

  • We have to understand the system but also as a patient...

  • ...you have to understand your health at a very deep level

  • And so when we think about projects, for example like Project Baseline...

  • ...where we're trying to map human health...

  • ...this is going to be a new ground truth to understand...

  • ...comprehensive health data

  • Project Baseline analyses health data...

  • ...to discover clues that can predict disease...

  • ...creating a research platform that Verily hopes will enhance clinical care

  • Camilo Barcenas is one of its volunteers...

  • ...paid to undergo a broad range of tests over a four-year period

  • There are a lot of reasons why to do this

  • I've got two children and one of the ways I've thought about it...

  • ...if something happens to me in the next five years...

  • ...then there will be this real-time log of information about me

  • The first test is call the forced vital capacity

  • What we are measuring is how much air you can take in...

  • ...and how fast you can blast it out

  • Deep, deep, deep, deep, blast it out...

  • ...blow, blow, blow, keep going, keep going, don't stop

  • Deep breath in

  • Many of these tests would be familiar to anyone who has had a health check

  • The difference is what Verily does with the results

  • The data the company is collecting...

  • ...clinical, behavioural, psychological and even molecular...

  • ...will be analysed in an effort to build a comprehensive baseline of good health

  • This data will be anything from genomics to patients' experiences

  • But having this information hopefully will do two main things

  • One, it helps us as a community to create...

  • ...an infrastructure to actually handle all that data

  • And then secondarily, the idea is to try to look for signals...

  • ...of changes in health before disease actually happens

  • The end result could be an invaluable asset for humanity...

  • ...but also a pretty valuable one to license...

  • ...in the multi-trillion dollar health-care market

  • It's this mix of idealism and opportunity that makes many people uneasy

  • Especially when the prospect is raised of these same companies...

  • ...having access to the data in their own medical records

  • The issue that all of the tech companies face...

  • ...is that they're now, so big and so prevalent...

  • ...that they've kind of taken on this negative, scary connotation

  • The idea that any of them might have my patient data...

  • ...does not play well with the public

  • A survey from 2019 looked at how willing Americans are...

  • ...to share their information

  • It found that unsurprisingly people are most happy...

  • ...to share health data with their doctor

  • ...but far less willing to share with pharmaceutical companies...

  • ...or the government

  • And least of all with tech companies

  • Privacy is contextual. It's about the expectations...

  • ...that the user has over the data that they provide

  • And in a health-care context, what it usually means is that...

  • ...I'm happy to share this with my doctor...

  • ...but I'm not happy to share this with advertising companies...

  • ...that my doctor wants to make a bit of money on the side...

  • ...from by selling my patient profile to them

  • Health systems and governments eyeing the benefits of...

  • ...partnering with big tech have a delicate balance to strike

  • To reap the rewards they'll need to ease public fears...

  • ...about what happens to their data

  • That means taking the lead to ensure patient privacy is protected...

  • ...and demanding greater transparency about the use of data

  • There are potentially huge rewards for health systems...

  • ...that welcome technology companies in

  • They can improve care. They can save lives. They can save money

  • You also need to think about what happens if tech companies...

  • ...aren't welcomed; are the health systems...

  • ...going to develop this technology for themselves?

  • And if they don't, what is the cost in human life...

  • ...to those things not happening?

Health care is in the midst of a digital revolution

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Is big tech good for your health? | The Economist

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    李柏毅 posted on 2020/07/15
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