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Google to use patient data to develop healthcare algorithms for hospital chain

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Re: Google to use patient data to develop healthcare algorithms for hospital chain

#11

Post by doggodaddo78 »

clusterhacks wrote: post #6

I work as a data engineer in an academic medical research institution. Most electronic medical records (EMR) systems are really about billing. Yes, there are clinically relevant data fields available but a large amount of what we were after as researchers was only available in free-text. Data abstraction is still mostly a human-expert driven activity. It would be fun if that could be better automated but there is sig…

Yep.

tl;dr :

EHR are mostly about charts.

EMR are mostly about billing.

The risks of unfettered access to EMR is that conditions can be inferred and future profitabilit of patients predicted so that they can be steered to different types and qualities of care (for good or for evil).

For-profit healthcare will overall optimize for profits before patient outcomes. It's as certain as gravity. FPH should be illegal.

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#12

Post by mfer »

clusterhacks wrote: post #6

I work as a data engineer in an academic medical research institution. Most electronic medical records (EMR) systems are really about billing. Yes, there are clinically relevant data fields available but a large amount of what we were after as researchers was only available in free-text. Data abstraction is still mostly a human-expert driven activity. It would be fun if that could be better automated but there is sig…

The US is a money and capitalism first culture. This is before things like privacy. I'm not suggesting what is right or should be but rather an observation of what is the case.

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#13

Post by tedivm »

wins32767 wrote: post #7
tedivm wrote: post #5

Earlier quoted context omitted.

HIPAA lets companies share data with other companies as long as it meets two requirements- 1. The company that collects the data (the covered entity) has to have a Business Associate Agreement in place with the company they're sharing it with. This basically affirms that the other company is aware of their HIPAA requirements and intends to follow them. 2. The Business Associate needs to access the data to do the job…

That's true if the data is PHI, which means that it's personally identifiable. Per TFA, Google is using anonymized data. There are a bunch of companies that do this already, for example my last startup had anonymized health records from ~240 million Americans.

My last startup does this as well, but in our experience deidentification is not nearly as robust as the companies using it claim it is.

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#14

Post by tedivm »

mfer wrote: post #8
tedivm wrote: post #5

Earlier quoted context omitted.

HIPAA lets companies share data with other companies as long as it meets two requirements- 1. The company that collects the data (the covered entity) has to have a Business Associate Agreement in place with the company they're sharing it with. This basically affirms that the other company is aware of their HIPAA requirements and intends to follow them. 2. The Business Associate needs to access the data to do the job…

Even though this happens... Google still makes me nervous because... - Other large companies with other big agendas have violated rules on data sharing to improve performance in other areas. Amazon comes to mind with how they used markeplace data on vendors to produce their own competitive products. Rules are regularly broken. - Will Google let auditors really have enough insight to make sure data is kept in a contro…

I 100% agree- I'd rather see a small company with various security policies than see a company like Google with the data.

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#15

Post by matheusmoreira »

clusterhacks wrote: post #6

I work as a data engineer in an academic medical research institution. Most electronic medical records (EMR) systems are really about billing. Yes, there are clinically relevant data fields available but a large amount of what we were after as researchers was only available in free-text. Data abstraction is still mostly a human-expert driven activity. It would be fun if that could be better automated but there is sig…

> a large amount of what we were after as researchers was only available in free-text

Is there no way to parse this? Surely the EMR systems could have a simple key-value syntax. Patient history is too complex to be expressed that way but there is a lot of other valuable data that could. Blood pressure, for example. Ideally, things like lab results would already be stored as structured data.

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#16

Post by drknownuffin »

matheusmoreira wrote: post #15
clusterhacks wrote: post #6

I work as a data engineer in an academic medical research institution. Most electronic medical records (EMR) systems are really about billing. Yes, there are clinically relevant data fields available but a large amount of what we were after as researchers was only available in free-text. Data abstraction is still mostly a human-expert driven activity. It would be fun if that could be better automated but there is sig…

> a large amount of what we were after as researchers was only available in free-text Is there no way to parse this? Surely the EMR systems could have a simple key-value syntax. Patient history is too complex to be expressed that way but there is a lot of other valuable data that could. Blood pressure, for example. Ideally, things like lab results would already be stored as structured data.

With existing tech? No, not really.

Most of those lab values are more or less worthless outside of context - which is why so much time is spent on training docs on physio, pathophys, and history taking. I know that it's frustrating to hear, but it's why every "helpful" tech solution to date has resulted in increasing doc griping and burnout.

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#17

Post by drknownuffin »

doggodaddo78 wrote: post #9

"Don't be evil." For-profit healthcare is evil. https://www.pbs.org/video/the-healthcare-divide-rv6npd/

Way to oversimplify.

Some healthcare is vital (emergency intervention for heart attacks), some healthcare is grey-area quality of life (do I need glasses vs. LASIK?), and some healthcare is pure luxury (cosmetic). These are not all created equal.

Additionally, removing the profit motive has its own consequences. Ever notice how the front-desk staff that serves as your docs' connection to the rest of the healthcare sector generally suck? Try to get a preauth, or a drug renewal, or an etc. There's a reason they suck: if your doc is working with a price ceiling (as most are, due to health insurance if not due to socialized medicine), they have a hard cap on their annual income for the year. The difference between a 2/10 and a 10/10 service staff doesn't make a single extra cent of income for the doc, but they have to pay the difference in salary straight out of their annual take-home. How many docs are going to get an 80K/yr front desk vs. a 40k/yr front desk just out of charity?

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#18

Post by QuercusMax »

mfer wrote: post #8
tedivm wrote: post #5

Earlier quoted context omitted.

HIPAA lets companies share data with other companies as long as it meets two requirements- 1. The company that collects the data (the covered entity) has to have a Business Associate Agreement in place with the company they're sharing it with. This basically affirms that the other company is aware of their HIPAA requirements and intends to follow them. 2. The Business Associate needs to access the data to do the job…

Even though this happens... Google still makes me nervous because... - Other large companies with other big agendas have violated rules on data sharing to improve performance in other areas. Amazon comes to mind with how they used markeplace data on vendors to produce their own competitive products. Rules are regularly broken. - Will Google let auditors really have enough insight to make sure data is kept in a contro…

As someone who actually works at Google Health (on an unrelated project), it pains me to see folks suggesting that this type of thing could happen.

I can tell you with 100% certainty that there is no way in hell that any of the health data for a project like this could possibly ever be used for advertising to patients. Someone on an eng team with access to this data (which is VERY tightly controlled) who have to write a data export pipeline and deliberately export that data to Ads, and someone on the Ads side would then have to deidentify that data and join it with advertising data.

Getting someone to write an export pipeline that will be consumed by other folks in Health, and actually get it used in practice is hard enough, when dealing with all the data restrictions. What you're suggesting is just not going to happen.

You shouldn't think of Google as one giant org with a big pot of shared data. It's really dozens of orgs, each with their own sub-orgs, which all have their own databases, file storage, etc. Getting access to data owned by a team the next aisle over is hard. Getting access to data from another org is basically impossible without a ton of oversight.

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#19

Post by wfhbata »

yhoneycomb wrote: post #3

For the unaware - this particular hospital chain (HCA) is super, super shady. It's a for-profit institution, which is alarming in and of itself when the bar for hospitals to be nonprofit is so low (and when most of the "non-profit" hospitals are essentially for profit institutions anyway.)

> when most of the "non-profit" hospitals are essentially for profit institutions anyway

This sounds worse than a for-profit institution declaring itself as a for-profit institution.

What is it about the chain that is “super, super shady”?

Re: Google to use patient data to develop healthcare algorithms for hospital chain

#20

Post by potatoman22 »

matheusmoreira wrote: post #15
clusterhacks wrote: post #6

I work as a data engineer in an academic medical research institution. Most electronic medical records (EMR) systems are really about billing. Yes, there are clinically relevant data fields available but a large amount of what we were after as researchers was only available in free-text. Data abstraction is still mostly a human-expert driven activity. It would be fun if that could be better automated but there is sig…

> a large amount of what we were after as researchers was only available in free-text Is there no way to parse this? Surely the EMR systems could have a simple key-value syntax. Patient history is too complex to be expressed that way but there is a lot of other valuable data that could. Blood pressure, for example. Ideally, things like lab results would already be stored as structured data.

Certain EMRs have lab data and diagnostics stored like this. That data is used in ML algorithms. That data lies outside of free-text.
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