Author: Sara Yip Edited by: Jun Hon Pang
The healthtech industry is booming; exciting digital health start-ups are piquing the interest of doctors and patients alike because of their potential to improve healthcare. On the other end of the spectrum, we are already seeing large tech companies becoming more involved in healthcare, with IBM Watson Health and Alphabet's DeepMind Health coming to mind. This was only to be expected, as these large companies have considerable technical expertise they can leverage, which can easily be applied to their health endeavours. In addition, influential companies such as Apple, Google and Amazon are able to partner with pharmaceutical companies, healthcare providers and start-ups, thus bridging the gap between the biosciences and the vast amounts of computing that will be required to store and process increasing amounts of healthcare data.
When asked about how tech giants are innovating in this space, many may think of the Apple Health app, but they are providing much more than just a pedometer. Their open source framework, ResearchKit, is providing a platform for clinicians and researchers to widen their patient reach for recruitment into studies, while apps developed with CareKit enable patients to become more involved in monitoring their conditions. This means that software developers will be able to more easily create apps for the iPhone or Apple Watch that can track a patient’s medical status. Current apps that have been created with CareKit can address chronic conditions such as epilepsy, depression and diabetes.
In December 2017, Apple launched the first medical study with the Apple Heart Study app in the US, which was developed in conjunction with Stanford Medicine. It utilises the Apple Watch’s heart rate sensor to identify signs of arrhythmia, which is associated with atrial fibrillation, in those who have been accepted onto the study. If an irregular rhythm is found, the individual then receives a free consultation with a doctor and an electrocardiogram (EKG) patch for further monitoring. This tool is intended to be used for screening rather than diagnosis, directing individuals who may not otherwise have been alerted to healthcare professionals. Further to this, the US Food and Drug Administration (FDA) has approved the first add-on medical device for the Apple Watch, which has been developed by AliveCor. The device, named KardiaBand, is a medically approved EKG-recording device that can be strapped onto the watch, and uses neural networks to determine unusual heart activity.
Besides facilitating research across a wider patient base, Apple revealed a major development in their new iOS update for iPhones earlier last month (Jan 2018). A new beta feature allows on-demand patient access to their own medical records from separate health institutions, integrated within the Health app. This will make it as easy to view health data, including allergy information, medications and laboratory records, as it is to read a text message. Apple’s medical records are based on Fast Healthcare Interoperability Resources (FHIR) standards, which are compliant with various frameworks, hence enabling easy implementation and consistent sharing of health records. Several top hospitals in the U.S., such as Johns Hopkins Medicine and Cedars-Sinai, are in the forefront, placing their patients in control of their own health data; thus, empowering patients and improving data sharing between patients and health providers.
It is unsurprising that Alphabet (of which Google and DeepMind are subsidiaries) is also playing a pivotal role in this, and their artificial intelligence (AI) and healthcare research cannot go unmentioned. They have received much positive media attention recently, especially with the chess-playing AlphaZero (developed by DeepMind). Google aims to develop various technologies to empower healthcare professionals, with functions such as aiding diagnosis, assisting with tracking trends over time and improving patient-caregiver interactions. Currently, Google is collaborating with clinicians and researchers to develop image classification algorithms that can detect diabetic retinopathy from retinal images, with high sensitivity and specificity achieved for multi-ethnic diabetic patients. With the use of deep learning systems, such preventable conditions can be screened and addressed before the onset of irreversible symptoms. Similar progress has been made for the identification of breast cancer metastasis, which is currently a very complex and laborious task taken on by pathologists. Neural networks recently developed in this field have the potential for a high level of detection of tumours, with lower error rates compared to the previous best automated system as well as human attempts.
Google’s dedication to and involvement in healthcare can be observed by searching for ‘post-traumatic stress disorder’ or ‘PTSD’ on Google’s mobile search engine within the U.S. As a result of their partnership with the National Alliance on Mental Illness and the National Center for PTSD, the search engine now provides an option which allows the viewer to access a clinically-validated questionnaire to screen for PTSD, providing a starting point for individuals affected to seek professional treatment. In addition, Google’s sister company, Verily, which focuses on life science research, formed a joint venture with Sanofi last year to create Onduo, a mobile app that enables diabetic patients to receive personalised care more frequently than they would with conventional doctor visits, making diabetes treatment more accessible to patients worldwide. Each patient will be assigned a personal contact within the diabetes clinical care team, who will provide guidance between physician visits. The patient can also receive wireless glucose sensors to monitor their glucose levels via the app.
However, DeepMind's progress can also be seen in a negative light, with a recent incident involving the Royal Free NHS Foundation Trust only highlighting complex issues surrounding health data security and ownership. DeepMind initially announced that it was collaborating with the Trust to build Streams, an app that helps physicians monitor and detect early signs of kidney failure. It was then revealed that not only kidney data was being shared, but also complete health records for 1.6 million patients from the last 5 years without their full consent. This incident has sparked DeepMind’s push for transparency within data, security and compliance.
It also appears that Amazon may be getting involved in the healthcare domain. At the end of October 2017, Amazon obtained wholesale pharmacy distributor licenses in 12 U.S. states. Amazon’s motives are relatively unclear, as these licenses also cover the distribution of medical and surgical equipment, which Amazon already undertakes. To become a pharmaceutical distributor, Amazon will require further certification in the U.S.; however, due to their expanse and capabilities, it would be relatively easy for them to achieve this. Furthermore, Amazon has invested in a cancer-testing start-up called Grail, which aims to use genetic sequencing of circulating tumour DNA in blood for early cancer diagnosis. Genetic sequencing at this scale will require a vast amount of data processing and storage, and they could benefit from employing Amazon Web Services in this mission.
The tech giants’ progresses in healthcare have the capacity to facilitate health data sharing and earlier diagnosis, directly benefitting patients, and thus alleviating current pressures on healthcare systems. However, stringent medical and regulatory review procedures are important for the implementation of such developments. If not sufficiently scrutinised before approval, any advancements would be negated, with consequences such as false-positives putting more stress on hospital systems. In fact, the FDA has allowed certain companies in the digital health industry, including Apple and Verily, into their Software Precertification Pilot Program. The programme aims to set standards and determine the necessary information to be provided by a digital health technology developer for certification of their product. This allows a modified approach towards software certification based on the software developer instead of the product, compared with the traditional approach used for medical devices. The implications of this are that the pilot companies will benefit from faster approval from the FDA and have their technologies pre-cleared before the formal programme is in place.
In the near future, we are likely to continue to see Apple, Google, Amazon and other tech giants in the healthcare and pharmaceutical domain. Their increased involvement inevitably comes hand in hand with further debates in terms of ethics and privacy; however, it is certain that they will provide many enhancements in a progressively patient-empowered world.