Google Health has grown to 500 employees

Google and its parent company, Alphabet, are counting on new businesses as growth slows in its core digital advertising business.

What will these mean as we go forward in health IT and health reform? In the past, Google struggled with Health Vault which was a major fail at the time electronic health records were going mainstream.

It's led by former Geisinger CEO David Feinberg, who reports to Google AI chief Jeff Dean, and key players include Google veteran Paul Muret, who runs product, and Chief Health Officer Karen DeSalvo.  Google and its Alphabet holding company are becoming a landing page and exit strategy for former HHS employees of high rank.

Google Health, which represents the first major new product area at Google since hardware, began to organize in 2018, and now numbers more than 500 people working under David Feinberg, who joined the company in early 2019. Most of these people were reassigned from other groups within Google, although the company has been hiring and currently has over a dozen open roles.

Google and its parent company, Alphabet, are counting on new businesses as growth slows in its core digital advertising business. Alphabet CEO Sundar Pichai, who was recently promoted from Google's CEO to run the whole conglomerate, has said health care offers the biggest potential for Alphabet to use artificial intelligence to improve outcomes over the next 5 to ten years.

Google's health efforts date back more than a decade to 2006 when it attempted to create a repository of health records and data. Back then, it aimed to connect doctors and hospitals and help consumers aggregate their medical data. However, those early attempts failed in the market and the company terminated this first "Google Health" product in 2012. Google then spent several years developing artificial intelligence to analyze imaging scans and other patient documents and identify diseases with the intent of predicting outcomes and reducing costs. It also experimented with other ideas, like adding an option for people searching for medical information to talk to a doctor.

Google is already harnessing many of its strengths to be used or integrated into electronic health records either as a patch, plug-in or API. When HIPAA became law many of entities such as Google were not included in the law.  There is a stipulation for health care entities to sign business associate agreement with subcontractors which details HIPAA's regulations. It is unknown whether this is being enforced.  The author will investigate this in the coming month, and the results will be published here.

Google AI  already created algorithms to analyze images of the retina, CT, and MRI images.

On the left is a fundus image graded as having proliferative (vision-threatening) DR by an adjudication panel of ophthalmologists (ground truth). On the top right is an illustration of our deep learning model’s predicted scores (“P” = proliferative, the most severe form of DR). On the bottom right is the set of grades given by physicians without assistance (“Unassisted”) and those who saw the model’s predictions (“Grades Only”).

In our latest study, to be published today in Ophthalmology, we demonstrate methods by which explanations of deep learning algorithms can be shown to ophthalmologists to increase both the accuracy and confidence of their grading for diabetic eye disease. Using the results of the model trained and validated on high-quality labels from our earlier study, we generated different forms of potential assistance for general ophthalmologists. We presented to the physicians the algorithm’s predicted scores for different DR severity levels as well as heatmaps highlighting image regions that most strongly drove its predictions. Using this assistance, we saw a significant increase in physicians’ diagnostic accuracy, as well as improved confidence in their diagnosis.

We saw clear evidence that showing model predictions could help physicians catch pathology they otherwise might have missed. In the retinal image below, our adjudication panel found signs of vision-threatening DR. This was missed by 2 of 3 doctors who graded it without assistance; but caught by all 3 doctors who graded it when they saw the model predictions (which accurately detected the pathology).

Jeffrey Dean co-founded Google Brain in 2010, which catapulted the company's deep learning technology into the medical analysis. Some of the first health-related projects out of Google Brain included a new computer-based model to screen for signs of diabetic retinopathy in eye scans, and an algorithm to detect breast cancer in X-rays. In 2019, Dean took the helm of the company's AI unit, reporting to Pichai. 

Researchers found that the AI system reduced false positives by 5.7 percent for US women — a significant improvement when you consider how distressing it would be to be told you have cancer when you actually do not. It also reduced false negatives by 9.4 percent, meaning it caught instances of cancer that would’ve otherwise gone undetected.

And it did this by “looking” at mammograms alone, without access to any of the other health data that human doctors have on their patients.

This does not mean AI will soon replace radiologists — that’s a common but false narrative. While AI systems catch things that doctors miss, doctors also catch things that AI systems miss. Their abilities are complementary, best used together.o build the AI system, researchers got anonymized mammograms from some 76,000 women in the UK and 15,000 women in the US. They used that data to train the system. Then they tested it on the X-rays of a different group — 25,000 UK women and 3,000 US women — analyzing how often the AI was right about whether the woman actually ended up having cancer, as determined by biopsies and follow-ups.

In both the UK and the US, the AI outperformed a single radiologist.

In the UK, the standard of care is to have two radiologists read the X-rays, which can be tricky to analyze. The AI didn’t do better than two radiologists combined, but it didn’t do worse than them, either — and it reduced the workload of the second reader by 88 percent.

Ten things we should demand from AI companies: The Algorithmic Bill of Rights

In the near future, I predict there will be an additional disclosure that AI is used by the entity to diagnose and/or treat the patient.

Google (Alphabet) has also dabbled with Verily and Calico Labs a company that focuses on aging.   Verily has since been shuttered.

Poll Shows Eroding Support for Health Reform

By Karen Pallarito
HealthDay Reporter

THURSDAY, Feb. 11 (HealthDay News) -- While half of Americans want some kind of health reform in the next two years, nearly 40% say it would be a good thing if the legislation proposed by the Democrats and President Barack Obama never materializes. And one-quarter aren't sure if health reform would be good or bad for the country, a new Harris Interactive/HealthDay poll finds.

"Essentially what they're saying is we want reform but we don't trust or like what we're seeing now," said Humphrey Taylor, chairman of The Harris Poll, a service of Harris Interactive.

While reforming health care is still important for many Americans, the most pressing issue is fixing the troubled economy, the poll found.

When asked to pick two top priorities for the President and Congress, about 8 out of 10 of respondents, regardless of their political persuasion, picked reducing unemployment and creating new jobs as a top priority over the next few months. Among Democrats, health reform came next (59%), while among Republicans preventing a terrorist attack in the United States (64%) took second place.

The Harris Interactive/HealthDay poll, conducted online Feb. 3-5, included a national cross-section of 2,075 adults 18 and older. Respondents represented all three major political affiliations: Democrats (35%), Republicans (27%) and Independents (28%).

John C. Goodman, president of the National Center for Policy Analysis in Dallas, which supports free-market health-care solutions, said the poll findings suggest that Americans have lost confidence in Congress and the White House.

When half of the public thinks no major reform is not a bad thing, "that's because they've been soured on this," said Goodman, asserting that much of the focus on health-care reform has been on its more painful aspects, such as how to pay for it, whose taxes to raise and what benefits to cut, rather than what people would gain from it.

"Eighty percent or more of people who have health insurance like the plan they're in, and when they read about the government dithering with their plan, they get apprehensive," he said.

Voters still want health reform, "but they don't trust this legislation," added Mark C. Blum, executive director of America's Agenda: Health Care for All, a coalition of business, labor union and government leaders. The process wasn't transparent enough, it was fraught with deals with special interests and, ultimately, consumers had very little understanding of the details of the reform proposals, he said.

"That's a big hurdle to climb when time is slipping away very quickly to pass legislation this year," Blum said.

According to the poll, only 13% of Republicans believe the President should keep trying now to pass health reform, while 68% say he should wait another year. Among Democrats, the opposite is true: 66% say he should keep pushing now and 18% prefer holding off for a year.

"The public is clearly split, with Republicans on one side and Democrats on the other, as to how hard the president should push for health-care reform," Taylor observed. "The president's stated intention to push ahead is likely to be popular with most Democrats, but will probably remain so only if he and Congress can deliver significant legislation. Failure to do so could be very damaging."

Independents are somewhat more inclined to wait for reform (45%) than forge ahead (39%).

While Independents helped elect Obama to the White House in 2008, the political winds are shifting, Taylor said. "That support has been eroding and eroded, so that actually on many issues the Independents look a bit more like Republicans than they do like Democrats," he observed.

Some other key findings from the poll:

Forty-two percent of all adults -- and roughly equal proportions of Republicans, Democrats and Independents -- say it's important to control out-of-pocket health-care costs and health insurance expenses paid for by the public and patients.

Sixty-one percent of Republicans say they don't want to see an increase in taxes to pay for health reform, compared to 21% of Democrats and 36% of Independents.

Fifty-two percent of Democrats say their top priority is ensuring that many more people have health insurance, compared to 30% of Independents and 16% of Republicans.

"Eighteen months ago, coverage tended to be as high or a higher priority than controlling costs, and now the two top items are both about controlling costs," Taylor noted.

Blum applauded Obama for trying to "reset" the health-care debate in recent weeks. The president has called for a bipartisan summit on health care that would be televised nationally on Feb. 25. But, Blum added, Republicans and Democrats are also positioning for the November elections, making true bipartisanship unlikely.

The best solution, Blum said, maybe for an independent bipartisan group to merge their ideas and challenge Congress to react. "Then we could get real constructive debate moving into the November mid-terms," he said.

Copyright © 2010 HealthDay. All rights reserved.












Poll Shows Eroding Support for Health Reform: Poll Shows Eroding Support for Health Reform

Predictions for 2020: Big tech's here to stay, digital health moves through Gartner hype cycle and more |

Our second edition on Digital Health Prospects for 2020

How HIPAA, investor funding, digital health commercialization, and other focus areas will be changing over the course of the new year.

Big tech isn’t going away — and its healthcare moves will only get bolder

This has become a perennial prediction, but it’s still an important one. Few people believe at this point that Amazon’s Amazon Care program will stay an employee experiment for long. We’re convinced it’s headed for a wider rollout that will see Amazon offering, or at least facilitating, telemedicine services, disrupting the supply chain for care the same way it has with so many other things. Exactly what form that will take remains to be seen, but healthcare is a market ripe for disruption and Amazon is well-positioned to get more involved in disrupting it, as indeed they already have with mail-order prescription delivery. We’ve heard surprisingly little out of Haven, Amazon’s joint venture with JP Morgan Chase and Berkshire Hathaway, but we suspect Haven and Amazon Care are pieces of the same puzzle. Some idea how Amazon intends to grow and dominate the market is the fact they have purchased the domain  (.care).  A visit to the Amazon Care Program Website reveals the comprehensive plan which is enabled by digital health apps.

Apple and Google may not be taking as direct a role, but we expect to see them slowly expanding their role as well. Apple continues to invest in a whole ecosystem of hardware and software around both health monitoring and mobile-enabled health research. Recent signals by Google that it may want to compete — including a new 510(k) clearance for the Verily Study Watch and the company’s acquisition of Fitbit — should only heat up Apple’s efforts.

As for Google, we had the opportunity to hear Google Health VP David Feinberg speak last week at the Startup Health Festival. After sharing several interesting AI projects the company is involved in around mammography and eye health, this is how he described the company’s vision:

“Fundamentally in 10 years, I feel like we'll be successful if we have helped the health care system in communities redesign health care. So it's actually centered around patients and families. I think we fundamentally have built the wrong system. And I think these tools can help us achieve that. How that looks, I'm not sure. But it will be more affordable. It will be much easier. The quality will be better. There'll be joy in being a caregiver. And health will be something that you don't have to worry about, because when bad stuff happens or if we can predict bad stuff, we can get you in the right direction.

Data privacy will remain in the spotlight, and HIPAA won’t cut it

The limits of HIPAA are a double-edged sword for big tech, something Google learned the hard way this year when news broke of its Ascensia partnership in a less-than-flattering way. The company was operating within the letter of the decades-old law, but that was cold comfort to patients alarmed that (A) Google had access to their data and (B) they weren’t notified.

At events like the HIMSS Security Forum in December, a growing chorus of voices saying that we need a new law — some kind of fusion of HIPAA and GDPR that protects patient data even if it didn’t originate in the health system (for instance, if it came from a direct-to-consumer wearable).

These concerns aren’t new, but that chorus is getting louder. We need something that gives patients more transparency into the hundreds of business associates agreements that permit hospital partners to use that data in increasingly novel and varied ways. We need a law that acknowledges the limits of de-identification.

For new entities entering the health care market, it will do well to have their legal counsel study the HIPAA rules regarding business associate agreements.  The health IT culture is very different from ordinary offerings in the way of apps

“Everyone’s concerned about what’s happening to their data,” Salesforce CMO Ash Zenooz told MobiHealthNews in an interview on the sidelines of JP Morgan. “And this is a global thing. GDPR tried to address that. But our healthcare data for our interactions with our providers and insurance companies lives in a place, but there’s a ton of other data about us that’s living outside that’s not protected by HIPAA. … Most of our data is sitting outside and that’s the data that a good part of that is going to predict what’s happening to a person’s health, and I think people are appropriately concerned about where that’s being utilized.”







MobiHealthNews' predictions for 2020: Big tech's here to stay, digital health moves through Gartner hype cycle and more | MobiHealthNews:

There is now a number, that you can't see, that follows you wherever you go.

Your Poorly Secured Medical Credit Score Could Deny You Care

Private hospitals are now consulting a secret medical credit score from Experian before you even see a doctor. As a patient you do not have access to this score, nor can you see how it is generated. All you know is that you may be denied care, or receive different care, because of it.  

In our backward health care system, neither the hospitals nor Experian see any potential issue with this. It helps a hospital's bottom line and that's what counts. They're actually pretty excited about it:

I spoke with Ashley Reede, information systems and privacy consultant, who worked with a private hospital in California as they were onboarding Experian's 'Financial Clearance' system. What she saw was quite upsetting and she wants people to know what's happening with their data.

"The revenue department came to me and said they were going to start sharing data with Experian," she says. "They wanted approval to send data from reception/patient admittance to Experian to check a medical credit score that's generated and assigned by Experian. Then Experian would send that score back to the hospital."

The Financial Clearance system combines medical records along with the financial records Experian already has on you to calculate the score. Since they have a network of hospitals reporting this kind of data, separate visits to different hospitals by a patient are no longer siloed. There is now a number, that you can't see, that follows you wherever you go.

"The central issue is that we don't have any actual transparency on what's in the record," says Reede. "I can't see what this is being evaluated on."

And have you ever found anything inaccurate on your credit report? The process to get it expunged is so onerous that many people just leave the false item on the report. But at least in that case you can see what other people see. With this new, arguably more important score, it's secret.

"What if you paid a medical bill and now it's reported that you didn't?" says Reede. "You'd be totally unaware that you have medical delinquency on your report. You have no recourse and you don't know what you don't know."

The Worst of a Bad Situation

Let's all keep in mind under what circumstances one would be approaching reception at a hospital. There is something wrong with your health, or the health of someone you love, and you're seeking medical care. Under these heightened circumstances, you now have to wait to see if a company thinks you're a good customer for them.

While Reede says this is likely not an issue for larger hospitals that have less financial pressure (although Kaiser Permanente uses this system), it's definitely appealing for smaller hospitals that will notice a hit to their finances if a patient defaults. She also points out that this is for private hospitals, not public.

But without any public pushback, it could conceivably be used for public hospitals as well. In a time where we seem to be burning down any regulation we can find and trying to privatize everything, this is a window into a possible future.

At Least It's Secure, Right?

There are security certifications that most big vendors of Experian's size have. Google, Salesforce, and AWS all have it, and they have dedicated teams that works year-round to get them. As part of her consulting with the hospital in California, Reede had to discuss this certification with Experian.

"Experian had issues with getting their certifications," says Reede. "There were discrepancies. They were having difficulty administering and patching servers within their environment. While that is a common occurrence in IT Security, it does create vulnerabilities and can create opportunities for data loss."

Experian's infrastructure that handles regular credit scores does have these certifications, but the medical score system did not.

We expect our personal data to stay at the hospital. We don't anticipate that it might be shipped to a less secure third-party.

Google reveals ‘Project Nightingale’ after being accused of secretly gathering personal health records

Google secretly gathered millions of patient records across 21 states on behalf of a health care provider, in an effort dubbed “Project Nightingale,” reports The Wall Street Journal. Neither the provider’s doctors nor patients were made aware of the effort, according to the report.

The Wall Street Journal’s Rob Copeland wrote that the data amassed in the program include “lab results, doctor diagnoses and hospitalization records, among other categories, and amounts to a complete health history, complete with patient names and dates of birth,” and that as many as 150 Google employees may have had access to the data.

The New York Times corroborated much of the report later in the day, writing that “dozens of Google employees” may have access to sensitive patient data, and that there are concerns that some Google employees may have downloaded some of that data

Standard Industry Practices, according to But Google tells The Verge that despite the surprise, it’s standard industry practice for a health care provider to share highly sensitive health records with tech workers under an agreement like the kind it signed — one that narrowly allows Google to build tools for that health care provider by using the private medical data of its patients, and one that doesn’t require patients to be notified, the company claims.

Many of health care entities attempt to partner with Google in order to use tools such as search, artificial intelligence as an API to harness tools not present in their EHR. This may well be all good in other industries however it is akin to opening Pandora's Box which contains your medical records.

It is doubtful that all the details have been carefully examined by HHS and HIPAA.

There is no more security than a file locked in a steel cabinet. The more complex a system is the more likely it won't work. To get at a file in the office the intruder breaks the door, jimmies the file cabinet and your records are exposed Once your data is digitized, sent to the cloud and many other entities the risks escalate enormously.

You do own your private data, BUT so do many other entities and hackers

Your Poorly Secured Medical Credit Score Could Deny You Care:

Healthcare - USAFacts

Our nation, in numbers:

Government data from over 70 sources organized to show how the money flows, the impact, and who "the people" are.

From health insurance to prescription drug prices, the cost of healthcare has been a political issue for decades. There’s a good reason for that: In 2018, $3.7 trillion was spent on healthcare-related goods and services, 18% of the nation’s gross domestic product. The issue encompasses several government programs, with Medicare (which primarily serves the 65+ population) and Medicaid (for low-income people) being the best known. Beyond government healthcare programs, private insurance is also an important aspect of this issue.

Covered by public or private health insurance

(%)National spending on healthcare goods and services

Healthcare Expenditures as % of GDP

Share of uninsured Americans increases for the first time since ACA went into effect, Census data shows

The number of uninsured Americans increased by 1.8 million between 2017 to 2018, increasing the percentage of Americans without health insurance by 0.6 percentage points.

The uptick represents the first increase in the percentage of uninsured Americans since 2014, when the bulk of the provisions of the Affordable Care Act went into effect.

The data was released by the Census Bureau Tuesday in its annual Health Insurance Coverage in the United States report.

How Americans get insurance

The individual mandate, a provision of the Affordable Care Act, was still in effect in 2018 requiring health insurance in lieu of paying a tax penalty. For 2019, the tax penalty was lowered to $0, effectively ending the individual mandate.

At the state level, 25 states had a higher share of uninsured in 2018 compared with 2017, with Hawaii and Idaho experiencing increases by more than 1 percentage point.

The share of those uninsured increased across age groups, excluding slight decreases for those 26 to 34 years old and those 65 and older.

The share of those uninsured, by age

Age group	% uninsured in 2016	% uninsured in 2017
Under 65	9.2%	10.0%
Under 19	5.0%	5.5%
19 to 64	11.0%	11.7%
19 to 25	13.7%	14.3%
26 to 34	14.0%	13.9%
35 to 44	11.4%	12.5%
45 to 64	8.3%	9.3%
65 and over	1.0%	0.9%

How does the census compile health insurance data

The US Census Bureau releases data on health insurance rates using two different measures. Its Current Population Survey Annual Social and Economic Supplement (CPS ASEC) is conducted between every February and April, asking respondents if they had health insurance at any point during the previous calendar year. Data used in this report from prior to 2016 had a different data processing approach to the post-2017 statistics.

The agency also asks about health insurance coverage in its American Community Survey. Unlike the CPS ASEC, that survey asks respondents if they are covered at the time of questioning. This data is used to provide estimates at the state and local levels.




Healthcare - USAFacts: