50 things to know about Amazon, Google and Apple in healthcare

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Tech giants Amazon, Google and Apple have all made striking moves in healthcare over the past year.

The companies have enhanced their technology offerings in the healthcare space, from medical records and research data to wearables and consumer applications. Here are 50 things to know about the companies.

Amazon

1. Amazon reached $1 trillion market value on Jan. 31, but then its shares dipped due to negative sentiment that caused a late-day market selloff. The company reported huge revenue growth from Amazon Web Services cloud platform, which saw a 34 percent year-over-year increase in the fourth quarter.

2. Amazon filed to trademark its "Amazon Pharmacy" brand in Canada, the United Kingdom and Australia.

3. Amazon is among the tech giants making the biggest impact on healthcare, and coupled with its vast number of users and sellers, it can be a fertile testing ground for future healthcare applications, according to CBInsights. The company has around 1.2 million employees in Haven, the Amazon-JPMorgan, Berkshire Hathaway partnership. It also has an estimated 5 million sellers and 310 million active users, including 100 million Amazon Prime members.

4. Haven has been relatively quiet in since launching its website on March 6, 2019. JPMorgan Chase Chairman and CEO Jamie Dimon revealed that the company has hired 50 people to begin problem solving, but that their strategy was a "long term effort," according to Geek Wire. He also reported the company aims to use the cloud and artificial intelligence to improve healthcare.

5. In March, Amazon made a $2 million investment in Boston-based Beth Israel Deaconess Medical Center to test artificial intelligence tools. The two have partnered since 2016 when Beth Israel bought AWS's cloud software and reported significant improvements with operating efficiency.

6. Amazon's Alexa became HIPAA compliant in 2019, according to an April 4 Amazon blog post. The company launched software for its voice assistant technology designed to transmit and receive protected health information. The company partnered with Providence in Renton, Wash.; Boston Children's Hospital; and Atrium Health in Charlotte, N.C., as well as Livongo, Express Scripts and Cigna as part of the exclusive program.

7. Amazon Prime users began to receive email marketing about PillPack, an online pharmacy service Amazon acquired in 2018, in April. Then, it was revealed in December that Amazon is attempting to convince more big name insurers to integrate its pharmacy services into their health benefit plans. Blue Cross Blue Shield of Massachusetts is already in line for integration.

8. Amazon's partnership with the National Health Service in the United Kingdom was put under a microscope in 2019. In July, NHS Health Secretary Matt Hancock outlined the benefits of the partnership, saying Amazon Alexa devices could offer health advice to consumers. However, in December it was revealed that Amazon was able to collect health information to develop, advertise and sell its own products as part of the collaboration. The company cannot collect patient information.

9. Cerner partnered with AWS in July, making AWS its preferred cloud provider. Cerner hopes to enhance clinician use of the EHR, lower operational burden for health systems and help improve patient outcomes through the partnership. During its Oct. 24 earnings call, CEO Brent Shafer said Cerner clients can expect to see continued advancement to the overall user experience and financial operations as a result of the partnership, and Cerner plans to continue to move to the AWS platform.

10. The Pittsburgh Health Data Alliance launched a collaboration with AWS to advance innovation in cancer diagnosis, precision medicine, voice-enabled technologies and medical imaging in August. UPMC, University of Pittsburgh and Carnegie Mellon University developed the alliance to transform disease treatment using data. The alliance is using the AWS Machine Learning Research program to boost commercialization for eight projects.

11. Amazon launched its healthcare program, Amazon Care, for employees in Seattle on Sept. 24. The program offers virtual health clinics and in-home follow-up visits. The Virtual services include in-app visits with physicians, nurse practitioners or nurses.

12. In October, Amazon announced it would send employees to California for Cancer Care. The company now pays travel expenses for employees diagnosed with cancer to see physicians at Duarte, Calif.-based City of Hope. Amazon hopes to lower healthcare spending.

13. On Oct. 24, Amazon acquired Health Navigator, a startup to provide technology and services to digital health companies, to help power the primary care program it launched the month before. The company is in the process of integrating Health Navigator into Amazon Care.

14. For the third quarter of 2019, Amazon reported its first earnings decline in two years. However, AWS revenue was up 35 percent, hitting $9 billion. The company reported projected net sales to grow between 11 percent and 20 percent on the full year.

15. On Oct. 30, AWS, University of Texas Health Science Center at Houston and Cardinal Health announced a partnership with digital health company Virtusa to use artificial intelligence in medical research. Virtusa's cloud platform is available through AWS' marketplace.

16. On Dec. 2, AWS launched Amazon Transcribe Medical, a voice transcription service for physicians that inputs text directly into medical records. The program is associated with Amazon Comprehend Medical, which allows developers to understand medical text and identify patient information. The transcription service can integrate into device or apps, but it is only available to cloud customers.

17. Amazon Web Services deepened its Next Gen Stats partnership with the NFL in December to advance player health. The partnership plans to use AWS artificial intelligence and machine learning to provide insights into player injuries and how equipment, game rules and rehabilitation strategies can affect player health.

Google

19. Google reports that around 7 percent of its daily searches are health related, and it receives around 1 billion health questions every day, or 70,000 health-related searches each minute.

20. Google, Microsoft and Tencent are responsible for more than 70 percent of the deals made for digital health startups, according to CB Insights. Google is No. 1, with 57 digital health startups in its portfolio. The company's investments have focused on genomics, clinical research, insurance and benefits.

21. Google's revenues were up in 2018, jumping 23 percent to $136.2 billion. Google Health now has more than 500 employees.

22. In February, Google Cloud partnered with Flywheel, a provider of cloud-based tools for biomedical research. The partners aim to provide clinical researchers with cloud technology for medical imaging research.

23. Google partnered with its sister company Verily in February to for a program to screen medical images for diabetic retinopathy and diabetic macular edema, installing the technology at a hospital in India.

24. In April, The Wall Street Journal reported Google was dismantling its AI advisory board, which reviewed its artificial intelligence solutions in healthcare. WSJ reported the board disbanded over disagreements about how to govern itself. The company also canceled its artificial intelligence global advisory council.

25. On June 26, a former University of Chicago Medical Center patient filed a lawsuit claiming the hospital's partnership with Google violated HIPAA. The two initially partnered in 2017 to improve predictive analysis in data from patient records. The records had date stamps of when patients checked in and out of the hospital, which the lawsuit claims violated HIPAA; otherwise, the data was de-identified. In August, the partners moved to dismiss the lawsuit.

26. Google Health completed its acquisition of U.K. startup DeepMind, which was initiated for $500 million in 2014. DeepMind focuses on artificial intelligence research and mobile tools to improve patient care and clinical workflows. DeepMind now has access to Google's app development, data security and cloud-storage expertise.

27. EHR company Meditech and Google Cloud partnered on Oct. 2. Meditech EHRs will now be available through the cloud as a service subscription. The partners hope this move will help Meditech users avoid ransomware attacks. Meditech also plans to develop native cloud products and application programming interfaces.

28. Google appointed former ONC national coordinator Karen DeSalvo, MD, as the chief health officer in October. She will advise Google on providers, physicians and nurses, working within Alphabet's cloud computing and life sciences sector.

29. Google Cloud added an EHR voice assistant in October. Suki, the artificial intelligence, voice-enabled digital assistant, aims to help clinicians complete administrative tasks including documentation or EHR information retrieval. Physicians have reported the time spent on each note dropped 76 percent on average over the past year, from 13 minutes to 3 minutes.

30. On Nov. 1, Alphabet reported it will acquire Fitbit for around $2.1 billion. Fitbit said its consumers' health and wellness data wouldn't be used for Google ads, and Google hopes the acquisition will boost its wearables division. The DOJ received clearance to review the acquisition in December.

31. Google Health head David Feinberg, MD, presented the company's new health-related search ideas at the HLTH healthcare conference in Las Vegas in late October, revealing that Google doesn't plan to compete with existing EHR vendors, but rather aims to provide search functions that integrate with the EHR to help with data entry, charting and billing. He also said Google search and YouTube teams are working on strategies to reduce false information and advice on their platform, which may include developing a separate search site.

32. On Nov. 5, The Washington Post revealed Google had planned to post more than 100,000 X-ray images online before the National Institutes of Health stepped in. NIH and Google partnered in 2017 to store patient X-ray scans on the cloud. The two collaborated to clean images of patient data on July 21, but two days before launching, NIH told Google that dozens of images still included the patient information and Google immediately deleted all of the information from its servers. The partners ended the project.

33. On Nov. 11, The Wall Street Journal published an article outlining how the partnership between Google and St. Louis-based Ascension has raised concerns about the privacy of patients' personal health information. The collaboration, dubbed Project Nightingale, entailed gathering patient information to create healthcare solutions. Google received data on lab results, diagnostics and hospitalization records, which at least 150 employees had access to. Ascension hoped to modernize its infrastructure through the collaboration and explore ways to improve clinical quality.

34. On Nov. 13, the Office of Civil Rights of HHS asked for more information about Project Nightingale to ensure HIPAA was implemented appropriately within the partnership.

35. Google Health's artificial intelligence team reported that the deep learning models they developed to detect complications in chest radiographs did so with the same accuracy as radiologists. The results were published in Radiology, and the study's authors published a blog post cautioning that their findings didn't mean AI should replace radiologists.

36. Google recruited Jacqueline Shreibati, MD, CMO of wearables startup AliveCor, to its team in December. Dr. Shreibati joined Google's clinical research group and will assist with its research efforts.

Apple

37. Apple dominated the wearables market, shipping 46.2 million wearable devices in 2018, and its health recrods application also made progress in the past year. Hundreds of providers utilize Apple Health Records, including Amita Health in Illinois, Baylor Scott & White Health in Texas and Boston-based Partners HealthCare.

38. Morgan Stanley analysts projected Apple's healthcare revenues could hit $15 billion to $313 billion by 2027, according to a report in Bloomberg. The analysts believe Apple would have a competitive advantage over Google and Amazon because it has a loyal consumer base.

39. In June, Livongo Health, a digital health startup, integrated its mobile app with Apple, Fitbit and Samsung smartwatches.

40. Apple and Eli Lilly partnered in August on new research to determine whether health data from the iPhone and Apple Watch can detect early signs of dementia. During the 12-week study, researchers found that people with cognitive decline typed slower, sent fewer messages and relied more on support apps than the control group.

41. Apple has made several notable hires in the past year, including poaching the CIO of AstraZeneca David Smoley in September to fill a vice president role. Then in October, the company hired New York city-based Columbia University Medical Center cardiologist David Tsay, MD.

42. In August, Apple Health partnered with Allscripts to make Apple Health Records available on Allscripts Sunrise, TouchWorks and Professional EHR. Meditech also partnered with Apple Health Records in October.

43. Apple Health Records became available for veterans after a November partnership with the Department of Veterans Affairs.

44. On Nov. 14, Apple opened enrollment for three health studies conducted in partnership with academic and research institutions, including a women's health study with Boston-based Harvard T.H. Chan School of Public Health and the National Institute of Environmental Health Sciences. Another study includes one designed with Boston-based Brigham and Women's Hospital and the American Heart Association, and the third is a hearing study in collaboration with Ann Arbor-based University of Michigan and the World Health Organization.

45. Apple partnered with genetic testing company Color to provide employees with free genetic screenings at Apple's onsite health clinics. The clinics were launched in 2018 with clinicians who are not Apple employs but treat Apple employees.

46. On Dec. 27, NYU Langone Health cardiologist Joseph Wiesel, MD, sued Apple, claiming the company's irregular heartbeat monitoring tool infringed on his patents, which takes steps to create a system for atrial fibrillation detection. He claims Apple is using a copycat technology and filed a lawsuit to receive royalties.

47. Medical technology company Masimo sued Apple for allegedly stealing non-invasive health monitoring technology. Masimo and Cercacor Laboratories, its spinoff, said Apple infringed on 10 patents, including technology to measure blood oxygen levels, for the Apple Watch.

48. Apple Insider reported that Apple is expanding its health sensor technology to create preventative care solutions, according to a Jan. 21 report. While Apple CEO Tim Cook didn't reveal what the initiatives are, the company is involved in health tracking and filed a patent that suggests it is creating a capability to detect Parkinson's disease and diagnose tremor syndrome.

49. Apple reported $91.8 billion in revenue for the first quarter of 2020, representing a 9 percent increase year over year. The company reported record-high earnings in Apple's wearables and services segment, which includes Apple Health Records. Mr. Cook highlighted the company's moves into healthcare, discussing the company's success in the space.

50. Apple was among the 30 organizations to sign a letter backing the HHS proposed interoperability rules to make the flow of patient data easier between technology systems.

More articles on health IT:
55 things to know about Epic, Cerner, Meditech, Allscripts and Athenahealth
SSM Health CIO Sony Jacob: The tech investments to solve healthcare's 'wicked problems'
Providence's Aaron Martin on how a recent digital health investment is boosting patient engagement

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