November 13, 2019

Google and Ascension, the second-largest U.S. health system, on Monday announced the companies are teaming up on a project to store and analyze the personal health data of tens of millions of patients to improve services across the continuum of care.

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Other consumer tech companies such as Amazon, Apple, and Microsoft have made similar moves to partner with providers and store patient data on their cloud platforms.

Project details

The non-profit, Catholic health system Ascension said the project aims to improve care by analyzing patient data to determine how the health system, which operates 2,600 doctors' offices, hospitals, and other facilities in 20 states and Washington D.C., can better serve its patients by identifying medically necessary tests or other ways to help patients.

Tariq Shaukat, president of Google Cloud, which is leading the project, said the project, called "Project Nightingale," will move Ascension's "infrastructure" to Google's cloud, allow Ascension employees to use Google's tools, and offer providers new tools aimed at advancing patient treatment.

Under the project, which Google and Ascension began last year, patient data inputted by nurses and doctors "instantly flows" from Ascension's computers to Google's Project Nightingale system, the Wall Street Journal reports. The Nightingale system processes hospitalization records, lab results, medications, medical conditions, medical diagnoses, radiology scans, patient names, and other patient health data, which "amounts to a complete health history," the Journal reports.

Google's system then analyzes the data, using artificial intelligence and machine learning, to suggest changes to an individual patient's care. For instance, the system can recommend the addition of a provider to a patient's team, enforcement of narcotics policies, a flag for an unusual deviation in care, or a suggested treatment plan. The system also allows providers to search a patient's EHRs by data categories and graph the information, such as blood test results, over time, according to internal documents obtained by the New York Times.

Google's cloud division has assigned dozens of engineers to develop the software without charging for the work as they hope to offer similar products to other health systems, according to the Journal. Google's ultimate goal is to develop an omnibus search tool to aggregate and host patient data in a single place, according to internal documents, the Journal reports.

Shaukat said the company's goal for health care centers on "improving outcomes, reducing costs, and saving lives."

Eduardo Conrado, an executive vice president at Ascension, said, "As the health care environment continues to rapidly evolve, we must transform to better meet the needs and expectations of those we serve as well as our own caregivers and health-care providers." Ascension noted the partnership provides the health system with a faster form of electronic recordkeeping than the health system's current decentralized EHR system.

Ascension did not respond to questions about how many of Ascension's patient records have already been transferred to Google Cloud, according to the Times.

Privacy questions prompt HHS investigation

According to the Journal, which reviewed internal documents regarding the project and spoke with an unnamed person familiar with the project, patients have not been directly notified that their data are being shared with Google. The Journal reports that employees across Google's parent company, Alphabet, already have access to the data, including employees at Google Brain, the company's research science division.

The practice, and Google's history with federal privacy law violations, has caused some patient privacy advocates to raise questions about the project and whether patients will trust Google with their personal health data, according to the Times. Internal documents reviewed by the Times also show some Ascension employees have raised concerns that Google employees have been able to download the data.

Another concern stems from the amount of consumer data Google already has access to from the company's advertising business, which allows them to know people's interests, where they are located, what they search on Google, and what they watch on YouTube, according to the Times.   

HHS' Office for Civil Rights (OCR) this week said it will look into the project to determine if there are any HIPAA concerns.

In addition, several Democratic and Republican lawmakers on Tuesday voiced concern over the program, the Journal reports. For instance, Sen. Mark Warner (D-Va.) said the program should stop while OCR conducts its investigation, noting that Google is already under a consent-decree for privacy violations.

In response to the OCR investigation, a Google spokesperson in a statement said, "We are happy to cooperate with any questions about the project. We believe Google's work with Ascension adheres to industry-wide regulations (including HIPAA) regarding patient data, and comes with strict guidance on data privacy, security, and usage."

Privacy experts say project appears in line with HIPAA

Privacy experts also have said the project appears to comply with HIPAA. Under HIPAA, hospitals are generally allowed to share patient data with business partners as long as the data is used only for health care purposes.

Ascension in a release said, "All work related to Ascension's engagement with Google is HIPAA compliant and underpinned by a robust data security and protection effort and adherence to Ascension’s strict requirements for data handling."

Google said the patient data is being stored in a private space within Google's cloud platform and the company is only allowed to use the data to offer tools to Ascension's providers. Shaukat in a blog post wrote, "To be clear: under this arrangement, Ascension's data cannot be used for any other purpose than for providing these services we're offering under the agreement, and patient data cannot and will not be combined with any Google consumer data" (Copeland, Wall Street Journal, 11/11; Owens, "Vitals," Axios, 11/12; Singer/Wakabayashi, New York Times, 11/11; Coleman, The Hill, 11/11; Miliard, Healthcare IT News, 11/11; Copeland/Needleman, Wall Street Journal, 11/12).

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