Is “Silicon Valley” – artificial intelligence – disrupting and taking over the health care system?

“For a year and a half — and more urgently for much of the last month — I have warned of the growing economic, social and political power held by the five largest American tech companies: Apple, Amazon, Google, Facebook and Microsoft.
Because these companies control the world’s most important tech platforms, from smartphones to app stores to the map of our social relationships, their power is growing closer to that of governments than of mere corporations….” (A)

“If there is to be a health-care revolution, it will create winners and losers. Andy Richards, an investor in digital health, argues that three groups are fighting a war for control of the “health-care value chain”.
One group comprises “traditional innovators”—pharmaceutical firms, hospitals and medical-technology companies such as GE Healthcare, Siemens, Medtronic and Philips. A second category is made up of “incumbent players”, which include health insurers, pharmacy-benefit managers (which buy drugs in bulk), and as single-payer health-care systems such as Britain’s NHS. The third group are the technology “insurgents”, including Google, Apple, Amazon and a host of hungry entrepreneurs that are creating apps, predictive-diagnostics systems and new devices. These firms may well profit most handsomely from the shift to digital….
Large hospitals, some of which count as both incumbents and traditional innovators, will also be affected. The rise of telemedicine, predictive analytics and earlier diagnoses of illnesses are expected to reduce admissions, particularly of the emergency kind that are most lucrative in commercial systems. The sickest patients can be targeted by specialist services, such as Evolution Health, a firm in Texas that cares for 2m of the most-ill patients across 15 states. It claims to be able to reduce the use of emergency rooms by a fifth, and inpatient stays in hospitals by two-fifths.” (B)

“Why are Google, Apple and others so keen on health care? How are these companies altering the healthcare space? Moreover, what does the future relationship between these players and health care look like? Here is all you need to know about the love affair between tech companies and health care:
Why the Sudden Interest?…Here are a few reasons why an increasing number of tech companies are breaking into the healthcare sector:
Disruption: Health care has always been, and still is, a sensitive and hugely complex universe. This industry is begging for innovative solutions in the marketplace that can make health care easier to navigate—for both patients and providers. As Intel general manager Michael Jackson says, “The opportunity exists because of disruption. There are fewer industries being disrupted more right now than health care.”
Talking about business opportunities in health care, Unity Stoakes, founder of StartUp Health, says, “The companies that are best placed to take advantage of these changes are those that really understand consumers.”
Who knows consumers better than Apple, Nokia, Google and Samsung do?
Affordable Care Act: Obamacare has given an impetus to data-driven medicine. In fact, the Affordable Care Act requires that data on cost and quality should be made freely available. The focus on big data, as well as consumers’ growing comfort with tracking their daily habits, has cleared the way for the introduction of wearable technology, mobile apps and other high-tech digital applications.” (C)

“So what do we get for these extravagant private and public costs? A system where it takes weeks to see a doctor face-to-face, where more than 6,500 locales are officially deemed to have too few medical professionals to meet patients’ needs, and where U.S. health outcomes are consistently mediocre compared with those of many of our developed-nation peers (and even some of the less developed ones).
This status quo is ripe for disruption. And while true reform will require all the relevant parties—government, industry, and health care consumers themselves—to make major adjustments, an insurgent group of digital health companies is doing its best to drag American medicine into the 21st century kicking and screaming.
That means superseding physical constraints like having an actual hospital by harnessing the power of mobile technology, making the act of taking your medicine less of a hassle, and peering into our very biological building blocks to wage war on the most intractable maladies….
Welcome to the digital health revolution.” (D)

“The prospect of the giant Internet retailer entering the business is beginning to cause far-reaching reverberations for a range of companies, roiling the shares of drugstore chains, drug distributors and pharmacy-benefit managers, and potentially precipitating one of the biggest corporate merger deals this year.
On Thursday, the pressure was plain to see. A report that Amazon had received pharmacy-wholesaler licenses in a dozen states triggered a fast and steep selloff that wounded the likes of McKesson Corp., AmerisourceBergen Corp. and Cardinal Health Inc….
Executives in the drug industry say that Amazon could use its expansive online reach and its logistical muscle to threaten companies that ship and sell medicines to consumers and cut pricing deals with drug makers.
“Size and scale-wise, they can disrupt anywhere they want to disrupt,” said Chip Davis, president of the Association for Accessible Medicines, a trade group for generic medication, in an interview Thursday.” (E)

“Drugstore operator CVS is in talks to buy health insurer Aetna for a proposed $200 per share or more, sources familiar said. The $66 billion or greater deal would be the largest ever in health insurance history, according to an analysis of Thomson Reuters data….
“They needed to defend the business from encroachment by Amazon,” RBC Capital Markets analyst George Hill told CNBC. “Amazon’s ability to impact the business over the near to mid term is low, but the ability to impact the stock is high.”
CVS would lose the ability to control its own destiny if it didn’t do something, Hill added. “This could be $260 billion in revenue [in 2019].”…
CVS has already been trying to establish greater control in its corner of the health care industry. In 2007, the company acquired Caremark pharmacy benefit manager, which has more than 75 million plan members.” (F)

“Apple appears to be preparing a major move into the health care industry, expanding from its platform of fitness and clinical trial enrollment apps into an area that could include FDA-regulated sensors, advanced clinical decision support and even electronic health records.
The tech giant is cementing partnerships with big health systems and hiring scores of health care professionals. While the company is keeping mum about its plans, techie fans hope Apple will become the agent of transformation that makes patients, rather than providers or EHR vendors, the guardians of health data.” (G)

“Now Microsoft is joining the ranks of tech companies working to take on healthcare’s thorniest issues with its ambitious Healthcare NExT initiative. Launched this week, the program aims to leverage Microsoft tools like the cloud and artificial intelligence to solve a slew of issues in the health system.
It’s a departure from the company’s previous healthcare projects, which have focused on data-based patient programs like Microsoft Health.
The new initiative will set up partnerships between Microsoft’s AI and Research organization and players in the healthcare industry, starting with a huge collaboration with the University of Pittsburgh Medical Center.
The idea is that Microsoft’s research and technology expertise will work with UPMC’s product development experts to build tech solutions that are shaped by the needs they are serving. This kind of synergy between the realities of everyday healthcare and the products designed to solve them has long been a stumbling block in healthcare tech initiatives.” (H)

“Wal-Mart Stores and Quest Diagnostics announced a partnership Monday that will bring Quest’s laboratory testing services to 15 Walmart locations in Florida and Texas by the end of the year.
The centers will initially provide testing services, but they may expand to include other “basic” healthcare services over time, the companies said.
“By providing laboratory testing and healthcare services where people also shop, we will make it easier for Walmart customers and their associates to get the quality diagnostic insights they need in convenient locations,” Steve Rusckowski, Quest Diagnostics’ CEO, said in a statement.
George Riedl, president of Walmart Health and Wellness, described Walmart as a “one-stop shop” for everyday health and wellness needs.
The partnership signals Walmart’s continued expansion in the healthcare space and a comprehensive patient-centered focus on healthcare delivery that strives to keep broader populations healthy. The company expanded its efforts to place retail clinics at its stores in 2014 through a collaboration with QuadMed, with a focus on preventive care and management of chronic conditions—some of the biggest drivers of rising healthcare costs.” (I)

“Google announced expanded partnerships with three blue-chip academic medical centers this past week, where bioinformaticians will explore how its machine learning technology can be deployed in clinical settings to mine EHR data for improved outcomes.
“Machine learning is mature enough to start accurately predicting medical events – such as whether patients will be hospitalized, how long they will stay, and whether their health is deteriorating despite treatment for conditions such as urinary tract infections, pneumonia, or heart failure,” said Google Brain Team researcher Katherine Chou in a blog post.
“Advanced machine learning can discover patterns in de-identified medical records to predict what is likely to happen next, and thus, anticipate the needs of the patients before they arise,” she added.
Google Brain is especially interested in putting machine learning to work predicting and preventing healthcare-associated infections, medication errors and hospital readmissions.” (J)

“On Thursday, the (Facebook) New York-based health unit hosted an invitation-only breakfast for pharmaceutical marketers to learn about targeting users for their clinical trials.
CNBC viewed a copy of the invitation, which asked participants to attend a presentation on the company’s “new clinical trials strategy.”
Facebook is already widely used by clinical trial recruiters. The sector is a massive revenue opportunity for the company. Research firm eMarketer estimates that pharma and health-care marketers will spend $3.1 billion on digital advertising by 2020, up from $1.9 billion last year.
According to a person who attended Thursday’s event, Facebook detailed how drug marketers can and can’t target users. The source requested anonymity because Facebook did not make the details public.
Facebook’s health team explained that users can’t be targeted based on health conditions like insomnia. This is not limited to clinical trials.
Marketers can target people by demographics and their expressed interests, or likes. Millions of health groups have organically popped up on Facebook for people with a variety of health conditions, though marketers can’t use that data in their outreach.” (K)

“One of IBM’s tentpole program within health care is the Watson for Oncology application developed in partnership with New York’s Memorial Sloan Kettering Cancer Center (MSK).
Some MSK oncologists have a highly specific expertise in certain cancers. By training Watson to think like they do, that knowledge expands from one specialist to any doctor who is querying Watson. That means that a patient can get the same top-tier care as if they traveled directly to the center’s offices in Manhattan. IBM’s Watson provides the framework to learn, connect, and store the data, while MSK is imparting its knowledge to train the computer.
The app, which can be run on an iPad or other tablet, is able to pack in all the expertise of MSK oncologists into one place so that any doctor anywhere is able to provide elite cancer care. This is significant for patients who live in areas without world-class medical services, like lower-income countries or rural America.” (L)

Artificial intelligence already found several areas in healthcare to revolutionize starting from the design of treatment plans through the assistance in repetitive jobs to medication management or drug creation. And it is only the beginning.
Mining medical records: The most obvious application of artificial intelligence in healthcare is data management….
Designing treatment plans: Watson for Oncology has an advanced ability to analyze the meaning and context of structured and unstructured data in clinical notes and reports that may be critical to selecting a treatment pathway. ..
Precision medicine: …Deep Genomics aims at identifying patterns in huge data sets of genetic information and medical records, looking for mutations and linkages to disease.
Drug creation:…Atomwise uses supercomputers that root out therapies from a database of molecular structures. “ (M)

Just six months after El Camino Hospital in Silicon Valley implemented artificial intelligence technology, the rate at which patients suffered dangerous falls dropped 39 percent. The key, alongside additional fall prevention strategies, was a software program that predicts which individuals are most likely to fall by combing over electronic health records for risk factors and merging the data discovered there with real-time tracking of patients.
“Every time a patient pushes a call light or hits a bathroom or bed alarm, it’s recorded,” says Cheryl Reinking, chief nursing officer at El Camino. The software takes that information and compares the rate at which a patient is requesting assistance to data such as what surgeries he’s had or which medications have been prescribed.
These data are all processed through “machine learning” – a form of artificial intelligence whereby computers take in new information and perform tasks based on it without being reprogrammed to do so. In this case, the program “learns” if a person may be more likely to fall based on his behavior and treatments. “Then it pushes an alert to the nurse saying ‘your patient in room 2308 is at risk right now for falling,'” Reinking says, after which that individual might be moved closer to the nursing station or monitored via video.” (N)

President Trump, “Nobody knew that health care could be so complicated.”

(A) The Upside of Being Ruled by the Five Tech Giants, by Farhad Manjoo, https://www.nytimes.com/2017/11/01/technology/five-tech-giants-upside.html?_r=0
(B) A digital revolution in health care is speeding up, https://www.economist.com/news/business/21717990-telemedicine-predictive-diagnostics-wearable-sensors-and-host-new-apps-will-transform-how
(C) Why Tech Giants Like Google and Apple Are Moving into the Healthcare Space, http://ventureclash.com/2016/06/29/why-tech-giants-like-google-and-apple-are-moving-into-the-healthcare-space/
(D) Prepare for the Digital Health Revolution, by Sy Mukherjee, http://fortune.com/2017/04/20/digital-health-revolution/
(E) Amazon Threat Causes Shakeout in the Health-Care Industry, by Robert Langreth , Jared S Hopkins , and Spencer Soper, https://www.bloomberg.com/news/articles/2017-10-26/drug-wholesalers-slump-after-amazon-com-obtains-state-licenses
(F) CVS Health’s surprising deal for Aetna? It’s all about Amazon, by Evelyn Cheng and Thomas Franck, https://www.cnbc.com/2017/10/26/cvs-deal-for-aetna-would-be-biggest-in-history-of-health-insurance.html
(G) Rumors, expectations surround Apple expansion into health care, by DARIUS TAHIR, https://www.politico.com/story/2016/10/apple-expansion-health-care-229111
(H) Microsoft’s new healthcare initiative, and the challenges of bridging tech and health, by CLARE MCGRANE, https://www.geekwire.com/2017/microsofts-new-healthcare-initiative-challenges-bridging-tech-health/
(I) Quest Diagnostics, Walmart partner to offer lab testing services in stores, by Alex Kacik, http://www.modernhealthcare.com/article/20170626/news/170629919
(J) Google strikes several hospital partnerships for machine learning research. Stanford Medicine, UC San Francisco and University of Chicago Medicine to help Google Brain fine-tune predictive analytics to spot patterns in EHRs, by Mike Miliard, http://www.healthcareitnews.com/news/google-strikes-several-hospital-partnerships-machine-learning-research
(K) Facebook brought drug marketers together to educate them on targeting consumers, by Christina Farr, https://www.cnbc.com/2017/09/07/facebook-held-a-breakfast-to-promote-clinical-trials-strategy.html
(L) MING THE HEALTH CARE INDUSTRY, by Laura Lorenzetti, http://fortune.com/ibm-watson-health-business-strategy/
(M) Artificial Intelligence Will Redesign Healthcare, by Arlene Weintraub, https://www.usnews.com/news/healthcare-of-tomorrow/articles/2017-10-31/hospitals-utilize-artificial-intelligence-to-treat-patients
(N) Hospitals Utilize Artificial Intelligence to Treat Patients, by Arlene Weintraub, https://www.usnews.com/news/healthcare-of-tomorrow/articles/2017-10-31/hospitals-utilize-artificial-intelligence-to-treat-patients

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