Tech Brew Ride Home - (Bonus) Health Tech Checkin With CNBC's Christina Farr

Episode Date: January 11, 2020

Checkin on the health-tech space with the only reporter I follow religiously around this space: Christina Farr. Why are hospitals suddenly in the middle of a health data gold rush? Why are you more likely to have your health records hacked then every be able to get them in your own hands? Sponsors: Tiny Capital DoubleUp.agency Learn more about your ad choices. Visit megaphone.fm/adchoices

On April 4th, 2023, around 2 in the morning, a man was found stabbed multiple times on a sidewalk in downtown San Francisco. Hey, who did this to you? What happened next turned the story into a political firestorm. Reports have identified the victim as Bob Lee, the founder of Cash App. From Bloomberg Podcasts, this is Foundering, the Killing of Bob Lee, beginning April 16. Welcome to the first weekend bonus episode of the TechMeme Right Home for 2020. I'm Brian McCullough. Christina Farr is the one reporter I follow religiously to keep up on the health tech space.

Christina was one of our first ever weekend bonus episode guests, almost exactly a year ago. So I thought we'd check in a year later to find out how things are going in health tech. Why are all the big tech companies so obsessed with health data all of the sudden? Why are you more likely to have your health record hacked than ever actually get your health records in your hands? What is the legality around hospitals selling your health data? All of this and more. Christina, thanks for coming to talk to us again. Yeah, thanks for having me.

So when we spoke a year ago, we talked a lot about things like wearables and AI in health tech. And I kind of hate to start off with one of those, one of these sort of like broad questions right off the bat. But did those, a lot of those trends bear out over the course of the year? Because I kind of stopped hearing about it a lot. Like, what were the, what were some of the biggest stories that we saw in health tech over the last year, the things that you found yourself writing about over and over again? Yeah, I mean, it's a really good question. And, you know, an important time to kind of look back as we get into a new decade.

It's crazy. So, you know, it's funny. I think at the beginning of the beginning of that. the year, a lot of folks were talking about the AI and machine learning and kind of bringing these tools to bear in health. But one of the things that you need when you're trying to do this kind of work is a massive amount of data. And so we saw a lot of deals get done through the year between health systems that have that information typically in the form of patient records and the tech companies like Amazon and Google. So, you know, in some of the health systems, you know,

ways you wouldn't be surprised to hear that in the second half of the year, the big story was privacy. Because I think, you know, consumers were at large, kind of got the case for what it really means to, you know, give up this information without consent. And we got into some really interesting discussions about what it means to be identified according to kind of privacy rules and regulations. And is that the same thing as being anonymous? And it turns out, of course, that it isn't. So now, you know, there's a lot of talk about potentially revising the privacy policies for this new age that we're living in. And I think the tech companies are at the center of that. Well, you know, it's almost as if you were reading my notes because I want to talk about

all these things. So let me back up for a second. Let's start with the whole idea of the tech companies and getting into this data and stuff. Like, I mean, for 30 years, we've been hearing that, you know, this is the next frontier for 10. tech, that we're going to make everything more efficient and digitize everything. But, like, especially Google's, like, Project Nightingale, to some degree, I wonder if, you know, if it's what I just said, that this is something that tech has always wanted to get into. Is there something that has changed that now, like, someone like Google has gotten so much religion? Like, is it that they have built up all this cloud infrastructure now that they need to show something for that?

For Google being number three in cloud after Microsoft and Amazon, you think that they would be looking at areas like health, which I think compared to other sectors, is sort of relatively intact by these cloud providers, and it's a huge industry. So there are still a bunch of customers that you can sell on kind of migrating to the cloud, which explains their interest. And I think the other way they want to differentiate themselves is by saying that they're better at AI and machine. that they can build all these cool applications on top of these health systems and healthcare customers' data sets. That's kind of been part of the pitch. But then, you know, the drawback is that nobody really trusts Google. And as they try to do, you know, what is essentially kind of some of the same things that healthcare companies have always done. Like, they're not doing anything new here.

And Project Nightingale kind of follows a very long tradition of these sorts of. agreements being made between healthcare companies. Well, yeah. And there's nothing to do you about it. Maybe that's what I'm asking. Like, how, just from your perspective, how serious do you think this is? Is this something new or is this, as you're saying, just something that we've been hearing for years and years?

Like, how serious do you think someone like Google is about getting into this sort of health data stuff with both feet? I mean, I think it's both. You know, it is, they are definitely serious about getting into space. And you've seen them kind of higher a lot of. healthcare people in the past year, including somebody called David Feinberg, to kind of lead their division in health, and that they are really serious about doing something in space. And then, you know, Project Nightingale, I think, got that reaction because it's Google.

But I recently tweeted out this whole thread of just kind of similar things that have been done between healthcare companies for years that really no one has particularly cared about because it's not Google. But, you know, for instance, if you look at the de-identified data that that Project Nightingale, in part, was collecting and that involved, you know, that being shared between ascension, the health system and Google, these sorts of agreements happen all the time in health. I mean, if patient data didn't flow freely like it does now, I mean, I've heard folks say that the industry would basically grind to a screeching halt. So that's kind of, sorry, go ahead. That's kind of a tricky part of it. Yeah, it's sort of like it's eerie, but it's legal.

Okay, I want to dive into that. Like, you just, you had a recent tweet thread where you, you kind of outlined all the ways that health care companies have, are already and have for years been taking advantage of your data or there's already like brokers selling your health data in the same way that, you know, you can buy my browsing history or my location history and stuff like that. So this is, that isn't new. is new is that now there's this market to sell to the big tech companies, is what you're saying? Absolutely. I mean, you know, one of the craziest statistics I've had, which, you know, seems to be

true. I don't know how much access do you have to your health information or use in no way your, you know, blood test results or x-ray imaging is. Most people don't have access to that. Turns out that you're 10 times more likely to have that information be hacked than to ever view it. I'm more likely to have my health information be hacked than to actually ever see it with my own eyes. More likely. Ten times more likely. So that's like the piece of it that's illegal. But the piece of it that's legal is that there are also data brokers,

these companies that just buy up this information from health systems and sell it into pharma, mostly for marketing purposes, which is, you know, another way in which your data is being activated and leveraged. without you ever really having had access to it yourself. What about, we've seen all these stories about these genetic testing companies and, you know, it's not only crimes are being solved by them and stuff, but there's, I think, like, 23 and me cut some sort of deal with a drug maker to mine customer data. So is that something that's new on the horizon too, that you're, 23 and me is not just making $200 or whatever off the kit, they're also going to be selling the

this data down the road? Yeah, I mean, isn't it kind of like it's sort of a brilliantly scary business model that you can charge people for these tests and then also, you know, once you have that information, and of course you have to get consent, but somebody says, yes, you can also have a business model on the other side of it by, you know, aggregating into that information and selling it to some of your pharma customers. I think for 23 and me, there's kind of the third wheel of this, which is that they can become a drug maker themselves, which they are currently trying to do.

Wow. Yeah, they have a whole therapeutics on. So they're trying to use some of this information to see if they can develop better drugs. And I think for that reason, there are definitely calls among patient advocates that I talk to you to see if there's a way to compensate patients. Like imagine if you had something really unique and cool about your genome, and that led to some great discovery that a bunch of drug makers, you know, were able to, you know, monetize, why wouldn't you ultimately then get some kind of payment from that?

That's what I've been... So this is something that's been discussed. I've been going on and on about that, about all of our data. How come... But even forget about if they make some sort of cool new drug based off of my medical history or whatever, but it's still my medical history that they're selling. So wait, let's back up a second. So this is all legal, even though we have things like HIPAA and all those sorts of laws.

Is it legal because it can... can be de-identified or anonymized? Yeah, so it's certainly fine to sell anonymized data under HIPAA. And then let's be clear, like HIPAA doesn't, you know, if you share your data, say you give your health information to Facebook, like that's, HIPAA wouldn't even cover that. It's really just cases where it's some kind of health care provider sharing data to a business associate. So that might be a health system sharing information with a company like Google.

would be HIPAA. But it's not all circumstances that involve any sharing of health information. And under HIPAA, it's basically okay to form an agreement to share this data that is considered de-identified. And there are a couple ways that HIPAA sort of just finds the identified. But I think that's the piece of it where people are saying HIPA needs an update. Because these days, I think you can take very slight small amounts of information, even when it's been de-identified, you can find a way to correlate that to some other piece of information.

Say, like, you know, if you knew a person's location or where they're going every day, then you might be able to figure out ultimately who that person is. So, you know, that's kind of an interesting thing that, you know, HIPAA wasn't, when it was, when it was, the law was first formed,

wasn't really considering. And then you can also share some data that is protected under HIPAA. form an agreement and we sign what's called the BAA or a business associates agreement. And that allows for some sharing of information for the purposes of, say, research or for a company building a tool for a health system. But they're not supposed to then turn that into a commercial business and sell it to another health system. So it's kind of complex, but that's sort of how, generally how the framework of HIPAA works. And you can already tell that there

limitations. Is there a difference between de-identified and anonymized, or are they essentially the same thing? No. So they are not the same thing. Okay. So like I said, you can, you know, when something's been de-identified, it's under HIPAA, it's because you've taken, stripped it of certain kinds of information that, you know, HIPAA would say, are identifying, or under HIPA is identifying, and met certain requirements. Or you've hired a statistician who's agreed. that it's sufficiently de-identified. But nowadays, people, you know, there's been lots of studies that have shown

that even de-identified data can be traced back to an individual. So it is definitely not the same thing as anonymized. Coming back to this idea that it's these healthcare providers that are getting inundated by requests from tech companies for their data, like you did a piece recently where, like, apparently hospitals, which are generally, you know, like nonprofits and things like that and are kind of in dire financial straits, are sort of not looking askance at these tech companies knocking on their door offering to buy this data. And so that's legal, too. If I go to a hospital, like, I don't have

to consent for them to sell, you know, the records of my surgery or things like that. Yeah, I mean, if they were able to, you know, if they determined that they wanted to form an agreement with, say, Google and they decided to either sign that agreement, do a BAA or they decided to make the data set be identified, they don't ask you, notify you as a patient. They should, but, you know, they don't necessarily, depending on what the agreement is, they don't, they may not have to ask for consent. And that's what happened in the case of Project 19-Gale that you mentioned between Google and Ascension. I think, you know, it was shocking when some of those, we learned that some of the clinicians, the doctors didn't even know about this, let alone the patient. So you see a lot of this happening under this sort of, you know, secrecy. And I think that is my kind of, you know, biggest takeaway from all this is that I think that if there had been more transparency around this, it probably wouldn't have been a big deal.

But these tech companies like to do everything in this highly secretive kind of project with code name sort of way for everything they do. And they haven't really adapted that for the healthcare industry, which I think they should. Now, the tech companies, like Google,

when they're trying to get their hands on this corpus of data, is it just to train their, say, machine learning systems and things like that? Or is there a way that, Are these new revenue streams? Is there a way that this data is already being monetized by the tech companies?

A big part of it is to build those AI and machine learning streams, and I think that's a pathway for them to monetization, because they can kind of make the case that they've got an edge as a cloud provider. It helps them sell more cloud. But I also see them kind of thinking about using this data to build new tools, and those could be monetized potentially on their own. And one thing Google has definitely said that it is trying to do is do this sort of idea, you know, they're very good at search.

That's their core competency. So could you apply search to the medical field and specifically to the medical record? So if a doctor was in a medical record type system, they could just use this Google search bar to find some patient record whenever they needed it or to look for patterns among the, you know, sort of patients within that record. So, you know, it's just, it's apparently a very difficult to search the record now.

And so I think that's kind of one of the things they're looking to build. And if they could do that, I'm sure that that would actually be a successful business for them. I know we talked last year, because there had been news around it right at that moment about, you know, Google's not alone. This Amazon is serious about getting into healthcare.

Actually, in a ton of ways, like even on the insurance the selling prescription side. So how has Amazon's efforts progressed this year? Are they basically, of all the tech companies, are they maybe the most serious about getting into health in all sorts of ways right now? Yeah, I personally am most interested in Amazon right now over any of the other tech companies,

because I think they've got this discipline. And, you know, that discipline is sort of born from this being a really thin kind of margin business across the board that they're in an e-commerce. So they could apply that to health in a way that, you know, you've seen other companies in the space that have tried to do a million things, but then not get any of them right. I think Amazon might be able to hone in on a few things and really do well.

Probably the most important thing we saw them do this year was they launched clinics for their own employees called Amazon Care. And that might not sound big because, you know, obviously it is for important. But what I suspect is that they are going to, if they meet certain metrics and they, I'm sure they have a ROI that they need to hit just to improve the health of their own employees, if they're able to drive down health care costs, you could see them then saying, why not scale this to the population at large to all of our customers? And you've seen them do that before. If a product, you know, is eventually going to be scaled out, they decide to test it first on that smaller employee base. just get it right before they move out to the logic group. So I think that's what's happening within Amazon care.

And I like the virtual, the digital-fass approach that they're taking with it, too. So Google, Amazon, everybody knows that Apple's messing around with this with Apple Watch stuff. We haven't mentioned Facebook so far, but Fitbit just got acquired by Google. and it came out that Facebook was apparently bidding against Google to acquire Fitbit. What do you make of that? I know, right? Certainly Facebook is interested. I mean, we actually had a story on SanBC about, you know, these final weeks before the Fitbit acquisition.

And it came out in the story that the Fitbit CEO, James Park, had dinner with Mark Zuckerberg, you know, a few weeks before. when they were talking about Facebook and how the company could have a whole wearables play. So it's probably not that surprising if you've been following Facebook pretty closely. I mean, they've talked about stuff like that for years, and they're really interested in sort of the brain computing interfaces as well. But, you know, it's just kind of scary to think in a way that Facebook may have access to this new amount of data, which I think, you know, for the wearables opportunity, represents a way to, to kind of find out what people are doing as they're on the go.

Facebook probably doesn't have that information now. You know, so this could be a way for them to figure out what you're doing all day or every day. How much you're moving, you know, where, you know, do you go to, do you work in an office? Like, all these questions, which would be potentially lucrative for them as they look at, you know, more ways to sort of target advertising to you. Yeah, I can see that, that, you know, they don't know what I'm doing unless I interact with. them and so obviously having a wearable or they've never been able to have their own phone so they can't track my data direct my location directly. But I'm wondering is there some, I mean, obviously there is, but there's some sort of play that they could make where you combine all

of the personal stuff that Facebook knows about us with like health data stuff and then all the sudden, man, insurance companies, whoever would be interested in that sort of stuff. Oh yeah. I mean, we actually did a story about this. I think it was a may have been earlier this year, but Facebook at one point had hired this cardiologist called Freddie of Newsy, who was working out of building eight, which is kind of their R&D group. And we had heard that Freddie's team had been approaching hospitals to talk about this kind of data set that is being referred to as the social determinants of health. It's kind of a joggingy term, but it basically means, you know, all the things about a patient that might impact their health outcomes.

that isn't strictly medical. So if you send a patient home who doesn't have adequate housing or doesn't have social support or doesn't have access to clean water or healthy food, all of those things could be social determinants. So Facebook was trying to approach these hospitals and saying, you know, if you share your medical data with us in a de-identified fashion,

then we can share back with you all this information about the social determinants. And then together we can have this full picture. of people's health. But I think for some of the health systems, the prospect of working with Facebook was just too scary. And I don't think that, you know, that project progressed. Final question. And you might not have anything on this. And if not, I'll just cut it out. This is totally out of left field. But this year is going to supposedly be the year that, you know, 5G finally becomes real for everybody. And one of the use cases that every time people are hyping

5G, they always bring up as sort of like the telemedicine aspect of doing remote surgeries and things like that. I'm just curious, is any of that right around the corner where my doctor can be in Hungary or something and do heart surgery on me here in New York or something? I mean, it's a kind of science fiction idea, but, you know, this idea of kind of remote health and remote surgery and all of this. I mean, I think that you don't necessarily need 5G. Some of the most, like, effective stuff I've seen

has just been people in remote areas uploading just, like, still photographs. There's an app called Figure 1 where you can just, where you can do that. And then, you know, physicians from around the world will weigh in and say, well, I think I know what this is, and I think that you should treat it with X, Y, and Z. And you can get to a diagnosis much faster.

And, you know, we've also seen a good. experiments in VR and those sorts of tools within the operating room. But I think people kind of tend to focus more on this 5G and really high tech that's coming down the pipe. But oftentimes the most effective stuff is the most simple. Well, yes, 5G is a lot of hype right now, as we know. Okay, that answers my curiosity. Thank you, Christina, for talking to us again.

Thank you for having me. It's been a real block.