Amazon 1492, Amazon 2018

"In 1492, Columbus sailed the Ocean Blue".

A nice little rhyme to help us remember the story of Christopher Columbus, and his "discovery" of America?

Perhaps. 

But what the number 1492 represents in 2018 may be a much bigger deal—for better or worse—than what ol' Chris did back in the day. 

Why? Because in 2018, “1492,” or Amazon’s not-so-secret health care initiative, came out of the closet.

Now, when I think of Amazon's entry into the health care market, I am not referring to the Amazon-Berkshire-Hathaway-JP Morgan initiative led by Dr. Atul Gawande

As smart as Jeff Bezos, Warren Buffett, and Jamie Diamond may be, and as talented as Dr. Gawande is as a writer, physician, and health care thought leader, I just can't take any effort to reform all of the health care too seriously when the CEO intends to continue his surgical practice and Harvard professorship. I just don't see changing health care as a part-time CEO job, but I do wish him well.

Rather, when I think of Amazon's most significant entry into the health care market in 2018, I am referring to the much less touted news release in November about its EHR-mining application called Amazon Comprehend Medical

Simply put, Amazon's new EHR data mining software allows medical records to be uploaded and mined to yield insightful information for health care organizations. 

Is this a good thing?

Maybe.

On the upside, the data locked away in our organizations' EHRs are a treasure trove of information, and the AI-guided mining by smart algorithms developed by even smarter Amazon programmers will likely yield results that could benefit both our patients’ health and our organizations’ profitability. 

So far, so good.

But, on the downside (and if you are a skeptic), you could see this as the ultimate data-grab by one of the Big Five tech companies (Amazon, Apple, Facebook, Google, and Microsoft). 

Just think of what it could mean to one of these five companies to have a person's health record data and potentially combining it with their own data sets: In Amazon's case, possibly their Prime membership data; in Google's case it means a person's search history; in Apple’s case it's an individual's iTunes account; in Microsoft’s case it's the use of Windows, Explorer, and video game data; and finally in Facebook’s case it's every post a person has written or liked.

Just think what these companies could learn by combining hard medical data points (i.e. labs, vital signs, diagnosis codes, prescription history, etc.) and subjective medical notes (chief complaints, history of present illness, nursing notes, etc.) contained in a person's EHR with, let’s say, a person’s purchasing behavior?

In essence, these companies will have the ability to combine our medical record with our "in the wild" behavior, presumptively to come up with significant new insights about our health. 

Wow.

Now look, every doctor reading this knows that personal behavior—although not necessarily the cause of every disease—is the keystone for good health (and there are very few things more important to a person's health than the personal behaviors involving diet, activity, sleep, and stress).

Without question, gaining a better understanding of how a person's behavior can be understood and modified to improve health by accessing and combining massive data sets is undoubtedly part of what companies like Amazon want to do.

A noble goal? Perhaps.

A profitable goal? Definitely.

But consider this: When you went for your last physical, or got an ear infection treated, or had a yeast prescription called in—all through your EHR—did you also at that moment and on that specific day give explicit consent to be part of Amazon's grand data mining experiment. As noble as it may be, it’s doubtful. 

Without question, all of these companies will be conscious of HIPPA compliance, which protects the security of our medical data as its uploaded to Amazon’s or Google’s or Microsoft's respective clouds.

And I have no doubt that somewhere along the way, we gave legal consent for our health care organization to analyze the data locked in our medical records.

But to what extent did we really give informed consent for third-party vendors (the Amazons, the Googles, etc.) to use our data using AI tools which didn't even exist two years ago?

Does giving informed consent to analyze your EHR data in one place, and giving informed consent to analyze your Amazon Prime data in another place, assume that you gave consent to combine datasets to analyze then together?

Anyway, I am not sure, but one thing I am sure about is 2018 is the year the EHR mines opened for business. And guess what? You aren't the customer getting the diamond; you are the mine.

Or, to mix metaphors, and bring everyone back around to sailing: Amazon isn't sailing to Ocean Blue to find some undiscovered country; rather the Ocean Blue is your data, and in 2018, Amazon left port to sail in it.

Dr. Matthew Rehrl is a physician who has served in a C-Suite advisory role on social media within healthcare for over a decade. His current focus is the ethics of AI in healthcare. He reports no conflict of interest.

Dr. Rehrl is a 2018–19 Doximity Author. He can be found on matthewrehrl.com and @matthewrehrl.

Image: Nongkran_ch / Who_I_am / gettyimages



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