The new minefield of technology for AI and healthcare delivery

Data is the “new oil”- Source- The Economist

Circa 2017 (The Economist):

A century ago, the resource in question was oil. Now similar concerns are being raised by the giants that deal in data, the oil of the digital era. These titans—Alphabet (Google’s parent company), Amazon, Apple, Facebook and Microsoft—look unstoppable. They are the five most valuable listed firms in the world.
Their profits are surging: they collectively racked up over $25bn in net profit in the first quarter of 2017. But there is cause for concern. Internet companies’ control of data gives them enormous power. Old ways of thinking about competition, devised in the era of oil, look outdated in what has come to be called the “data economy”

The Economist chose to highlight the story around “surging profits” and the ability of the big-tech to commander “God’s eye view”. Acquisitions are made on the basis of “network effects” and understanding how those networks transact, because their financial data is valuable for the rent seekers (or the ones providing the mechanism to facilitate these networks for “free”). For once, I agreed with their viewpoint – the existing mechanisms are lopsided and do nothing to promote competition. Hence, there is an illusion of “progress” without any real progress being made. Start-ups are promising “flying cars” and everything “electric”; better “healthcare” by summoning the digital assistants and the promise of “telemedicine by trying to adapt the collaboration tools meant for some other business transactions at a distance.

The creep of technology companies in our personal lives is beyond measure and privacy/surveillance concerns are valid enough. Hence, there has been a policy push towards trying to “reign them in”. From the Economist:

The first is that antitrust authorities need to move from the industrial era into the 21st century. When considering a merger, for example, they have traditionally used size to determine when to intervene. They now need to take into account the extent of firms’ data assets when assessing the impact of deals.

The purchase price could also be a signal that an incumbent is buying a nascent threat.

Trustbusters must also become more data-savvy in their analysis of market dynamics, for example by using simulations to hunt for algorithms colluding over prices or to determine how best to promote competition

emphasis mine

Consider the potential for the algorithms determining the healthcare provisioning. Assuming we are using geo-spatial “intelligence” to map out the “demand-services”, the data could be skewed for any number of reasons – awareness, proximity to healthcare or simply inertia on behalf of potential consumers to access the services. Consider a healthcare enterprise attempting to determine the outreach facility for the same – it could easily be misled based on the historical patterns of consumption, further dividing the wedge between the potential users and marginalised communities.

Similar arguments can be made for pricing structures and insufficient discovery for price points – because business thrives in asymmetry for information. If you extrapolate the current trends to a larger scope for AI adoption in healthcare (and increasing in the future), the results will only end up in more chaos. Sunlight is the best disinfectant, and it becomes the duty of elected representatives to understand potential implications for AI. Regulation should ensure that it avoids an over-concentration of data. In parallel, I think, we can draw inferences from the evolving role of fin-tech by having universal mandated standards for data sharing between the organisations. I will explore that in the future post.

It is clear lawmakers from either side of the political divide are cognisant of the potential for anti-competitive behaviour of the technology companies. Lina Khan’s appointment to the FTC has cheered up the anti-monopolist’s camp.

Brent Kendall for Wall Street Journal writes:

Ms. Khan, a 32-year-old Columbia University law professor who has been a vocal critic of powerful technology companies, was confirmed on a 69-28 vote. With her confirmation secured, Mr. Biden immediately designated her as FTC chairwoman, a move that caps the ascendancy of a progressive camp that favors far-reaching changes to antitrust enforcement…
The FTC scrutinizes proposed corporate mergers and an array of business practices to determine whether they illegally suppress competition in the marketplace. The commission also has a broad consumer-protection mission, targeting scams and other types of unfair or deceptive business conduct that harm the public.

(emphasis mine)

I am not aware of the ongoing legal challenges and policy frameworks proposed by FTC. I did read up on Lina’s protracted write up on Amazon’s business practices. I can’t reliably comment on the legal nuances involved in the “market-place” and it is not the focus of this blog. However, we do need to be aware of the existential challenges towards healthcare and how these developments will eventually shape up it’s delivery. These legal challenges to influential tech will be watched closely by regulators across the world, because regardless of whatever happens at home, the American geopolitical interests usually align with the expansionist policies; in the name of “foreign direct investments” and buying up influence.

Again from the WSJ:

FTC Democrats have signaled they would like to take a tougher line on mergers and focus more enforcement attention on anticompetitive business conduct, including by issuing first-of-their-kind regulations that would prohibit certain kinds of business practices as unfair methods of competition.

I hope they don’t forget about healthcare.

This gets me to how Apple’s faring in its healthcare ambitions.

Rolfe Winkler for Wall Street Journal writes:

Apple has envisioned an audacious plan for healthcare, offering its own primary-care medical service with Apple-employed doctors at its own clinics, according to people familiar with the plan and documents. To test that and other bold healthcare ideas, it took over clinics that catered to its employees and built a team with scores of clinicians, engineers, product designers and others.

It has also invested heavily in health, autonomous driving and augmented reality, all technically complex, high-stakes areas, meaning that game-changing offerings could be years away or never come.

Apple’s internal effort to run primary care was nicknamed Casper and reportedly (as per the WSJ article) is “struggling”.

In addition to overseeing the clinics, known as AC Wellness, Dr. Desai’s team handles relations with regulators, spearheads research collaborations and provides clinical expertise on other health products at Apple.

While they are trialling mechanisms to measure “hypertension”, these efforts are “long-term”. Anyone aware of Apple’s product cycles knows well – Apple usually brings a “beta version” of its products before updating it iteratively throughout its product cycle. They also own the complete public-relations narrative.

Why should it be concerning? Apple is pushing for the idea of universal identity through Wallets. Here’s what it introduced in the current WDWC- a mechanism to collect “digital licenses”.

Wired reports:

 Beginning in iOS 15 this fall, Apple will enable just that, letting you store your state ID alongside your credit cards, loyalty programs, transit passes, and even door and car keys in Apple Wallet. By doing so, the company won’t just introduce convenience; it may well be the tipping point that forces more states, the US government, and even Android to make digital driver’s licenses the norm.

In general, though, proponents say that digital IDs will ultimately be more secure and private than physical ones. Mobile driver’s licenses can be locked with biometric authentication—FaceID or TouchID in Apple’s case.

This has been the focus of the other companies too. Notably Stripe, which announced its own version of digital identity. There’s an interesting discussion on the Hacker News around this.

Coming soon to a healthcare facility near you!

Combine everything mentioned here: Data+ Conceteration of “power”, FTC’a appointment, legal challenges and how these new brokers will impact healthcare, including payments and digital identity. If you throw in the AI mix, we have a new tinderbox. Besides a new rash of “ransomware” attacks.

Welcome to the new world. Welcome to the new minefield of technology for delivery of healthcare.

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