21–30 of 57 posts
Earlier quoted context omitted.
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.
Earlier quoted context omitted.
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 writ…
> Google exposed the private data of hundreds of thousands of users of the Google+ social network and then opted not to disclose the issue this past spring, in part because of fears that doing so would draw regulatory scrutiny and cause reputational damage, according to people briefed on the incident and documents reviewed by The Wall Street Journal.
https://www.wsj.com/articles/google-exposed-user-data-feared...
The Google reputation is so bad that my previous company was actually asked by customers if we used Google Cloud, with the implication that they wouldn't work with us if we did.
"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 se…
Compare this to for-profit clinics like One Medical, where your appointment typically starts exactly on time and front desk staff are courteous, helpful, and responsive to calls and emails. This holds true to every location of theirs I've used across major US metros (NYC, SF, PHX, CHI) [1].
Anecdotally, one time I forgot my eyedrops on a trip to SF. I tried to get a hold of my ophthalmologist's office back in NYC so they could send a prescription to a pharmacy in SF. On hold for 25 minutes, disconnected, tried one more time then gave up. Opened One Medical app, requested a virtual visit, had a Dr on a video call in 3 minutes who confirmed my eye drops and submitted the prescription to the pharmacy I was sitting in.
I'm not sure how much of it is down to profit motive and I'm sure there are tons of other confounding factors, but it's hard to not notice the huge difference in experience.
[1] I work in the healthcare industry and I'm a happy One Medical customer; I initially got it as a perk thru work but upon leaving I coughed up the money to continue using them.
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.
"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 se…
Earlier quoted context omitted.
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 writ…
Earlier quoted context omitted.
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 writ…
My experience has been that Google's internal culture has always been extremely serious about restricting access to privacy-relevant data. On top of that, there's recently been a big push to defend against malicious internal actors, things like engineers intentionally creating backdoors or the like. You'd have to work to specifically and intentionally override defaults to mislabel the data and every piece of code that works with it, actively defeat multiple layers of access-control tech, get the code to accomplish that past privacy-and-security review by engineers from the privacy and security team, lie continuously and fake a bunch of supporting evidence when requesting about four different kinds of quota, hide your column names and API definitions from infrastructure engineers doing migrations and routine load-management stuff, lie to a bunch of lawyers and general Search+Ads PMs during launch reviews, and more. It's just not going to happen.
It's also not going to happen because "someone at the top told everyone to do it and nobody complained", either. Googlers pitch shitfits like no employee body I have ever seen, and using health data to drive ads would instantly cause internal messaging to explode into a tornado of hatred. I've seen it happen for less.
Like QuercusMax said, using totally-aboveboard anonymized-and-aggregated-and-scrubbed query logs is already hard enough, enough so that my team has a policy of just plain not doing it. I have a coworker whose account is irrevocably tainted because he used to work on a project that used data from the "This result is wrong" button on search results with biographical information about public figures. Misusing health data like this would be so obnoxious and difficult as to be unbelievable.
https://nvlpubs.nist.gov/nistpubs/ir/2015/NIST.IR.8053.pdf
Additional helpful works:
Anonymizing Health Data by Khaled El Emam, Luk Arbuckle
Building an Anonymization Pipeline by Luk Arbuckle, Khaled El Emam
Practical Synthetic Data Generation by Khaled El Emam, Lucy Mosquera, Richard Hoptroff
Accelerating AI with Synthetic Data by Khaled El Emam
Khaled El Emam's website: http://www.ehealthinformation.ca/
Earlier quoted context omitted.
> 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.
Earlier quoted context omitted.
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 se…
so let's clarify a few things. All the things you described that suck (e.g. preauth, drug renewal, etc) are made to suck, on purpose, by ... drumroll ... you insurance company which, believe it or not is usually a for profit entity (USA USA USA) and therefore is incentivized to take your money and not pay any out in premium. Paying for your care to them is a loss, and what they do is try to minimize loss ratio. (reme…
Responding to what you have written, however:
1. I provided a direct explanatory mechanism for how physician reimbursement caps lead to low-quality auxiliary services - by pointing out that investing in an activity or service that provides no marginal revenue is a strictly money-losing proposition. You assert, without mechanism or evidence, that this is strictly due to "for profit insurance." You need to clarify how the insurer, and their profit motive, creates this result - as the mechanism I put forward simply requires that the physician is has a fixed fee schedule and is at capacity volume. I won't go so far as to assert you should take my word on it, but you could do worse than listening to a doctor say "this is exactly what's going on in my and my friends' practices."
2. The majority of healthcare dollars in the United States flow through Medicare and Medicaid. Given that these services reimburse quite a bit lower in dollars/service than for-profit insurers, they actually make up a larger volume of total services rendered. I can't argue with a statement as vague as "usually a for-profit entity," but I can state more precisely that it "will be a non-profit entity for more than 50% of services and more than 50% of reimbursed dollars."
3. Minimizing loss ratio has nothing to do with what I said at all. If you can put forward a mechanism that translates my front desk expenses into reduced MLR for the payor, I'm listening with open ears. Look at this thought experiment: let's say my insurer's MLR stays flat, and I can accept a 100$/yr subscription fee from all of my patients to improve front-desk service, with the caveat that I'm taking a profit off the top. Would the insurer care? No? Is there anything the insurer's payment processes would do to affect this? No? Then the issue is my profit motive, not the insurer.
4. The convoluted payment processes are there to aid the insurer in sorting through their giant piles of paperwork (you didn't think that administering a health insurance network was low in bureaucracy, did you?) and, more cynically, to create pitholes for us to step into so patient care is denied reimbursement. You're going to have actually, again, provide a mechanism by which that translates into "Doctor doesn't improve services offered." Because I can tell you that if the bureaucratic hurdle that is insurance billing doesn't step me from billing in the current environment, then it's not going to stop me from billing for higher amounts if I could get them.