December 16, 2019

The United Kingdom's National Health Service (NHS) has a contract that will grant Amazon access to health data on the NHS website—and newly available information about the contract is raising concerns among privacy advocates.

Slide deck: What 'Amazon health care' could look like in 5 years

Amazon's increasing presence in health care

Amazon has steadily increased its presence in health care in recent years. For instance, it bought online pharmacy PillPack in 2018 and has launched a joint venture with Berkshire Hathaway and JPMorgan Chase aimed at improving health care quality and costs for the three employers.

But earlier this year, news broke that Amazon had entered into a contract with NHS that would allow UK residents to get vetted health advice from NHS' website on Amazon's Alexa voice assistant devices. The UK's Department of Health and Social Care (DHSC) at the time said the move was designed to reduce strain on general practitioners in the country by giving people a reliable way to get advice for their low-acuity needs. But few other details were provided.

New details about NHS contract come to light

In response to FOI requests submitted by the Sunday Times, NHS recently released more details on the contract.

The newly available information shows that the contract will give Amazon access to all of the health care information that NHS, using taxpayer funds, has gathered and published, including information on health care-related "symptoms, causes, and definitions," as well as "all related copyrightable content and data and other materials" held by DHSC, the Sunday Times reports. 

Amazon can use the information in ways other than to directly benefit NHS patients, according to Forbes. The contract gives Amazon permission to use NHS information to create, advertise, and sell "new products, applications, cloud-based services and/or distributed software," according to the Sunday Times.  

Under the contract, Amazon also can share the information with third parties, the Sunday Times reports.

The contract shows that Amazon has not paid NHS for access to the information, the Sunday Times reports.

Privacy advocates take issue

NHS quickly came under scrutiny for the deal, with activists claiming the contract could pose a threat to patient and consumer privacy, the Sunday Times reports. However, NHS and Amazon have pushed back against the criticism. 

According to Wired, privacy advocates believe the deal will result in people sharing more information with Amazon by way of Alexa.

Privacy International, a group that obtained the contract, said, "While this particular contract may sound harmless at first … we should not be naive about the intentions of big companies that are preying over the NHS."

Another area of contention, according to Privacy International, is the lack of "transparency" surrounding the contract. When DHSC released the contract it redacted large amounts of the contract, claiming "the release of the redacted clauses would be likely to prejudice the commercial interests of Amazon," according to DHCS.

"This particular partnership also raises questions when it comes to competition regulation of dominant players in the digital era," Privacy International said. "With their business model relying increasingly on the availability of consumers' data, dominant online platforms can engage in various forms of data exploitation or even impose unfair terms for consumers."

Separately, a commercial lawyer who analyzed the contract told the Sunday Times, "The most alarming thing is that Amazon isn't paying anything for this and the data is very valuable. The NHS is one of the leaders in the world in collecting this data, so it's incredible really that it is not charging for it."

NHS, Amazon respond

A spokesperson for NHS said, "No patient data is being provided to [Amazon] by the NHS, which takes data privacy extremely seriously and has put appropriate safeguards in place to ensure information is used correctly."

Amazon similarly stated that the contract only gives them access to information that is already available on the NHS website, adding that it "does not build customer health profiles based on interactions with nhs.uk content or use such requests for marketing purposes."

A spokesperson for Amazon reiterated the purpose of the deal is to allow UK residents to get answers to general health questions from NHS' website through Alexa, which could reduce strain on general practitioners (Walker, The Guardian, 12/8; Woollacott, Forbes, 12/9; Bernal, Wired, 12/10; Das/Gregory, Sunday Times, 12/8).

What 'Amazon health care' could look like in 5 years

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