
Mayo Clinic to partner with Google - somerandomness
https://cloud.google.com/blog/topics/customers/how-google-and-mayo-clinic-will-transform-the-future-of-healthcare
======
elpakal
Sorry for the cynicism, but this worries me.

> This strategic partnership will combine Google’s cloud and AI capabilities
> and Mayo’s world-leading clinical expertise to improve the health of
> people—and entire communities—through the transformative impact of
> understanding insights at scale. Ultimately, we will work together to solve
> humanity’s most serious and complex medical challenges.

I'm sorry but this is just pure silicon valley speak. Are Mayo's patients
really going to know what Google is doing with their clinical data? When I
hear "partnering with Google to create machine-learning models for serious and
complex disease", I have a hard time believing Mayo patients know what they
are signing away when they consent to this (if at all, which is not
mentioned?)

~~~
disabled
They have no idea. Even data from continuous glucose monitors (most commonly
used in type 1 diabetes) are directly shared with insurance companies, where
certain patients with diabetes are "flagged" as "problem patients":
[https://type1tennis.blogspot.com/2016/05/when-data-fluxes-
co...](https://type1tennis.blogspot.com/2016/05/when-data-fluxes-collide-
random.html)

I have 2 rare diseases, and one of which was discovered via NIH funds at the
Mayo Clinic in the early 2000s. I also have type 1 diabetes, and I can attest
to the veracity of the claims made on the blog post.

For somebody like me, the situation is unwinnable, if I want to live. HIPAA is
a joke because it is perfectly legal to combine other data with the HIPAA
anonymized source to identify the individual. Every day, leaving the US looks
better.

~~~
opsiprogram
How would you combine HIPAA with another data source to identify the
individual? Not suggesting it can't be done, just wondering how one might do
that? Being able to link data that can identify a person to some de-identified
would only be possible if the original data was not properly de-identified
right?

~~~
TeMPOraL
There is no such thing as "proper de-identification" in general; it's all the
matter of what other data sets the re-identifying party has at its disposal.

Consider the following de-identified data sets:

\- [date, time, clinic, procedure or test being done, insurer] - as collected
by the clinic chain so that it can get money from insurers

\- [month, clinic, test name, test result] - for all tests made in the last
year, collected for statistical purposes

\- [date, time, latitude, longitude, phone number] - because AFAIR telcos sell
this data

\- [name, surname, phone number, ...] - some insurance company's list of
customers

If you can get your hands on these datasets, you can trivially de-identify
patients and even assign test results to them with high probability (that
depends on how many tests of a given type are made in any given clinic per the
unit of time used to group the second data set).

Real-world data sets may be less clear-cut than this, but there is more of it,
and you can apply statistical methods to find correlations. You don't need to
be 100% sure customer X has diabetes for the information to be useful to you;
70% or 60% is useful too.

~~~
paulddraper
Section 164.514(b)

"The following identifiers of the individual or of relatives, employers, or
household members of the individual, are removed:

...

(B) All geographic subdivisions smaller than a state, including street
address, city, county, precinct, ZIP code, and their equivalent geocodes,
except for the initial three digits of the ZIP code

(C) All elements of dates (except year) for dates that are directly related to
an individual, including birth date, admission date, discharge date, death
date, and all ages over 89 and all elements of dates (including year)
indicative of such age, except that such ages and elements may be aggregated
into a single category of age 90 or older

... "

This the "Safe Harbor" method.

You could use the "Expert Determination" method. However, date + time +
location attached to health information in your first data set _definitely_
doesn't meet the criteria. I'll eat my hat if you find a supposed "non-PHI"
data set with those.

In fact, the criteria for expert determination is literally that re-
identification cannot be performed (without already having PHI-type
information).

~~~
opsiprogram
Yea this was my impression too. I've worked with HIPAA data and usually I had
to remove far more than just like a "name" for it to be de-identified.

------
disabled
I "love" how Google just throws in "rare diseases" in to this, via their press
release, as somebody who lives with 2 rare diseases that affect my peripheral
nervous system. Actually, one of the diseases I have was discovered in the
early 2000s on NIH grant funds at the Mayo Clinic.

This sounds wild, but it is true: Rare diseases are an absolute cash cow, and
everyone should watch this. Our healthcare system in the US will be
unsustainable if orphan drugs are not regulated (Which is why I naturalized as
an European Union citizen, in addition to being American. I fret and worry
about getting proper access to medical care every single day.):
[https://www.nytimes.com/2019/08/23/the-weekly/rare-
diseases-...](https://www.nytimes.com/2019/08/23/the-weekly/rare-diseases-
orphan-drugs.html)

(I do not believe that healthcare for all is unsustainable, but an unregulated
free market will make it unsustainable.)

Just in case anyone was wondering, it is common to have a rare disease, and
they are unfathomly expensive to have. In the US, the definition of rare
disease (which really should be called "orphan conditions" based on the law)
is tied to "orphan drugs" which in theory can collectively benefit 10% of the
general population. There are a ton of orphan drugs being approved at the
moment, which cost between hundreds of thousands of dollars per year to
millions per year, in the US. The European estimate on rare diseases is more
realistic and 6-8% of the general population has a rare disease.

So, do not think think that it cannot happen to you. You are naive to believe
otherwise.

~~~
jiveturkey
> The European estimate on rare diseases is more realistic and 6-8% of the
> general population has a rare disease.

But not _the same_ rare disease.

Orphan drugs collectively may benefit 10% of the population, but not
individually.

Not that I disagree with what I think is your main point: a profit driven
medical industry hurts those at the extremes, _relative to_ those in the
median. I don't know how awful that is or isn't. 100 years ago, those folks
would just have suffered. It's a profit motive, in some part at least, which
has fueled advanced treatments. If all healthcare and healthcare research were
socialized, maybe the expensive treatments wouldn't exist at all.

What I'm not sure about is if you are critical of, or in favor of, this
collaboration. Bringing "commercial-grade" AI to healthcare sounds like a good
thing to me on its face. I've read here and there (perhaps it's sensational,
but still) how some AI can be order or orders of magnitude more accurate than
doctors when evaluating x-rays, or scans, or other diagnostics.

My worry here is in the profit motive of Google and the fact that, well, they
suck these days in that they do not care about user privacy.

~~~
disabled
> But not the same rare disease.

Obviously. Clearly you do not understand what it means to have a rare disease
and that rare diseases play by a totally different set of rules than common
health conditions.

> AI can be order or orders of magnitude more accurate than doctors when
> evaluating x-rays, or scans, or other diagnostics

Rare diseases manifest much more dynamically than something that can be
trained to an objective via AI.

There are huge ethical issues involved.

> If all healthcare and healthcare research were socialized, maybe the
> expensive treatments wouldn't exist at all.

I do not know what you mean by socialized. Most of the groundbreaking research
in general occurs via grants from governments. If that is what you mean by
socialized, then I support that.

------
musicale
Glad to see the companies we know and love getting into healthcare:

Amazon: People who shopped for MRIs also shopped for...

Facebook: You have been tagged in this x-ray...

Apple: Glucose Monitor Pro, starting at $999/$42 monthly (gold/64GB, Apple
Pencil and iCloud storage sold separately...)

Google/YouTube: Dr. Oz, Stephen Fry, and Ben Shapiro DESTROY healthcare in
amazing TEDx talk...

------
sjg007
I’m pretty excited about this. Although it’s in Rochester it will boost the MN
tech scene. There’s a lot of opportunity here for Google to learn about
healthcare as well. Their AI tools should help improve outcomes. I can think
of half a dozen promising projects just based on the current scientific
literature. I don’t think google is going after EHRs here. Epic is too
dominate. Also google could just buy an EHR company if they really wanted to
get into that space. Interestingly Epic is pitching AI tools as well.

------
Forge36
The article is a PR announcement without much substance.

What AI projects? What part of the cloud platform will they use? What will it
be used for?

It sounds like a nice partnership, but it's not clear what Mayo will be doing
with it

------
Angostura
Just in case anyone didn't spot it, yesterday Apple announced Research.app
that will let Apple Watch users opt in to supplying data to research projects

[https://www.apple.com/uk/newsroom/2019/09/apple-announces-
th...](https://www.apple.com/uk/newsroom/2019/09/apple-announces-three-
groundbreaking-health-studies/)

Three projects announced at the moment.

I feel fairly comfortable with these, since they are opt in and not aimed at
users who are suffering a healthcare crisis while deciding whether to share
their data.

------
aazaa
Buzzwords aplenty, but not one word about what this does for patients. Count
me skeptical.

------
en-us
Interesting decision considering Mayo is an Epic customer, and Epic has their
own cloud AI product. I guess Mayo doesn't have much confidence in them to
deliver?

~~~
throw78153081
UC San Diego Health’s CIO spoke his mind about Epic’s core offerings in 2017.

[https://healthitanalytics.com/features/epic-systems-
machine-...](https://healthitanalytics.com/features/epic-systems-machine-
learning-is-the-ehr-usability-solution)

Epic sat on its hands too long and missed whatever calling it had in this
space.

------
ProAm
This doesn't seem good for anyone but Google.

~~~
dzader
curious why you say that - wouldn't doctors (and thus patients by extension)
using these tools stand to benefit as well? (in addition to Google who is
definitely getting the most upside here)

------
mark_l_watson
I have worked on medical/improving patient outcomes consulting projects three
or four times - enough to get a feeling for how difficult it is to accomplish
all of: keep patient data private, convince data partners to spend the
resources to sanitize data, share benefit of research amount partners, and
work with different data formats.

I heard a keynote at NACL a few years ago that was a call to arms to solve
these problems.

~~~
tootie
They mention "digital transformation" at the end and man Google is not the
right partner for that. They are a software company, not business consultants.
I'm sure they have no respect for what it takes to make non-tech people change
their way of thinking.

------
bt848
Pure word salad. This is what you get when you import executives from
Hell^WOracle.

------
mjevans
Healthcare has many forces driving less than optimal outcomes.

The for profit status of treatment in "western" medicine.

Laws like HIPPA that are well intention-ed, but written by lobbyists and out
of field and out of date lawyers/politicians who don't understand the actual
nature of data protection or the need for a patient to be in control of their
medical records in meaningful ways.

There's also the lack of a national / international identity and legal / data
security infrastructure: this makes it very difficult to associate government
issued IDs to patient records and requests / authorizations for limited
sharing of those records.

In a less crazy world the outcome might look something like this:

Everyone has a Digital ID; this is a government issued or signed PKI based
contract approval key. It would be stored in a dedicated, open hardware,
firmware and software, wallet that is used only for making strong signatures.

The Digital ID allows the patient to log in to government websites and
associate their healthcare coverage (ideally single payer, but if they're rich
and have a luxury plan that could be linked as well) at various medical
centers to their (emergency) care records. They can also actively choose to,
or passively allow, the sharing of specific records from one provider to
anyone else, as well as obtain personal copies of all of their records from
all of their providers. Any time a provider is no longer covering a given
patient stewardship of those records transfers to the government agency
providing this service (and is paid for out of a general fund based on taxing
providers so they don't have to deal with this).

A management matrix might also allow for general records access approval, in
the case that the patient just wants their entire medical history and ongoing
updates to be provided to their pool of physicians.

Through that framework outside entities can also obtain access keys and links
for the records at other providers which they are authorized to view the
records at.

Also; of course, all of the records would be required to be in "open, patent
free, free to implement record formats as standardized by the medical industry
software and equipment providers"; a specific format wouldn't be legally
mandated, but the use of formats that are intended to be interchangeable would
be.

~~~
elpakal
open records, tied to a uniquely identifiable data point? what if those
digital ids were _leaked_?

~~~
mjevans
What if a "patient" happened to grab the records that were faxed from one
office to another, or worse, someone intentionally got a common transposition
of fax number for an office and captured medical records transferred by
exemption?

There are many what-ifs. The intent of the system I outlined is to make good
data-hygiene practices easier and thus more likely.

I'll also point out that most EHR systems aren't 'airgapped' like paper
records of old, but are still connected to the internet at least loosely for
security updates if not limited remote access.

If there's some specific attack scenario that you feel is worthy of discussing
as a topic that positively enhances knowledge and the exchange of information
please outline such a concern in a proper venue; which might or might not be
this comments thread depending on the specific concerns. I merely provided a
back-of-napkin idea to start from.

------
java-man
Is google going to sell data obtained from this collaboration to the
advertizers? Insurance companies?

~~~
randcraw
Trusting Mayo a bit to do the right thing here, I believe they will rein in
Google's lust for reselling personal data, and limit the partnership to
providing labeled data Google will use to train their latest pattern
recognizers.

I suspect Mayo also hopes Google can break some new ground in analytics beyond
munging mere patterns. No doubt Mayo would love to explore all kinds of
advances in medical practice using novel monitoring and instrumentation, esp.
in the clinic.

No telling what Google has proposed: maybe a lot, maybe only a little. Their
announcement says nought.

------
gkolli
Hopefully, we get specific information about what Google Cloud will be doing
with Mayo Clinic to better patient outcomes - the article is filled with
handwaving.

------
wheelerwj
Please don't.

------
Ancalagon
And here I was hoping for cost-reduction plans. Undoubtedly the cloud service
provisioning will do the exact opposite.

~~~
nraynaud
Yeah, what force exactly would bring the cost down?

------
isaacyes
Google Deepmind x The Royal Free hospital didn't quite go as planned,
Information Governance wise.

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vchak1
Maybe start with transforming the "present" of marketing, and avoid hyperbole?

------
tempodox
Sheesh. “All your data are belong to us” gets more toxic every day.

------
MrZongle2
Color me cynical, but 20-25 years ago companies were touting what the "future
of healthcare" looked like.

They, and the people they were marketing to, would have been appalled if at
the time they could have seen at what it became. At least in the United
States.

------
roywiggins
Well they could hardly change the _past_ of healthcare....

------
a_imho
tldr; US clinic hands over millions of patients records.

