If there has been one thing I have been consistent about both during the thirty-five years I was a healthcare system CEO and continuing on to my tenure now on the beach, it has been my view that the information collected during the patient care process belongs to the patient and no one else. As a provider of care we maintain custody of that information but it is not ours to give away or sell.

That was the focus of a blog I published in November (Unholy Alliance) which discussed the arrangement which Ascension Health had with Google to share patient data (“Project Nightingale”). The Wall Street Journal ran an article exposing this arrangement and raised questions about it appropriateness, particularly since it was a secret endeavor done without patients’ knowledge.

The Wall Street Journal in a more recent article again explored this subject. WSJ related how some prominent healthcare organizations like Intermountain Health and the Mayo Clinic were considering or have struck deals to provide patient data, some of which might with a little effort allow individual patients to be identify. Kaiser apparently also did some consideration of a similar data sharing arrangement.

It is not just healthcare providers who see patient data as a desirable asset. Health plans think such information belongs to them to use as they see fit. There are no uniform safeguards to protect patient confidentiality.

Its gets more dismaying. Cerner, a major provider of electronic medical records to providers, seems to think that the information which flows through its servers is its data to use or exploit as it deems appropriate. Apparently they had second and third thoughts about such data monetization and decided–for now–not to allow access to their data trove to outside organizations. Cerner would better serve its clients by providing a more efficient and less expensive suite of software. That would be a major achievement to crow about.

Google and Amazon seem to be the most active in attempting to entice healthcare providers to allow them to aggregate such data and in the process provide addtional revenue to the providers. The sale of this patient data is always couched in language which suggest that the common good will be enhanced. Disease processes will be better defined and the efficacy of treatment modalities better understood. I have no doubt that is true but do not believe Google, Amazon or any of the nerd herd are trustworthy recipients of this data. Nothing in their past history is a confidence builder in this regard.

Google, whose self proclaimed mission is “to organize the world’s information and make it universally accessible and useful”, has a dismaying tendency to take action and then beg for forgiveness later. I get the impression sometimes that they would like to be the “University of Google” with the prestige that would give them. If so, hopefully they will have a football team which will be smart enough to keep their helmets on at all times.

All of this is beside the point if you accept the thesis that your personal health record belongs to you and no one else. It is not for sale to others. We in healthcare forfeit our patients’ trust if we enter into such arrangements with the likes of Google or Amazon or Apple or Microsoft—make your own list. Healthcare organizations need to be more forthright about this matter and assure those it serves that their data will not be sold to others.

This is an area which continues to attract the attention of politicians which can be a mixed blessing. Bottom line though is that my healthcare record is my business and it is not for sale without my permission. Take my information off the market.

Amazon, the slayer of dinosaurs like WalMart and Target, is suddenly finding that the dinosaurs are biting back and it hurts. That was the subject of several articles in the business press at the end of 2019. I believe this revival of the erstwhile retail dinosaurs has some parallels to healthcare.

Until recently, Amazon has been a devastating competitor in the retail space. Online ordering and the absence of costly stores has allowed Amazon to grow very quickly. Free or low cost delivery made purchasing from Amazon even more attractive. WalMart and Target with their many stores found competing against Amazon difficult. A new paradigm was rising.

That is until WalMart and Target took a look at their business and how Amazon was leveraging online ordering to their disadvantage. Amazon, they realized, did its order fulfilment from massive warehouses located around the country. Could that seemingly insurmountable strength be a weakness?

WalMart in particular and Target to a lesser extent began online order fulfilment using the inventory in their thousands of stores. If necessary, orders could be shipped from the store or, even better from a cost viewpoint, customers could pick up their online purchases at local stores. This past holiday season, both WalMart and Target made it very easy to do such pickups. These dinosaurs had in effect mini-warehouses much closer to the customer than did Amazon. The dinosaurs suddenly became more formidable.

Amazon is now beginning to open stores to assert its presence. I frequently visit a bookstore they have in Walnut Creek, CA. I also visit another Amazon store in Berkeley which only stocks the best selling items in a number of categories. Amazon also owns Whole Earth Food stores (better know as “Whole Paycheck” due to their high prices and air of genteel nonsense— they make you feel good as they shamelessly pick your pocket). Amazon is looking more and more like the dinosaurs it thought it had replaced.

So what is the parallel with healthcare? For years the mantra has been that hospitals are dying. The first book on that subject that I can recall dates to the early 1980s. The author of that book is now a senior citizen pundit who no longer necessarily believes in the death of hospitals. The thesis underlying the hospital death notices was that technology would reduce the need for hospitals and services would be provided in less costly outpatient locations. Outpatient locations with their lower cost were to be the Amazons of that healthcare era.

Except, all the hospital doomsayers were wrong. First of all, technological advances also led to increased use of hospitals for some diseases. More to the point, like Walmart and Target, hospitals did not roll over and bow to the pundits’ outpatient gods. Hospitals big and small morphed into healthcare systems. In many locations, hospitals are the central focus of a campus and are surrounded on their sites or nearby by various outpatient centers they own.

Hospitals are like WalMart Super Centers. Easy to find with all that a customer (or patient) may need. That convenience plays a huge role in allowing hospitals to adapt to changing circumstances. Hospitals did not die. They evolved and in the process made care more accessible.

This reality is hard for many to accept. There are entrepreneurs still trying to form urgent care companies and imaging center companies. The economics work fine as long as they can find venture capital companies dumb enough to fund them. The dumb guys do exist. The fact is, though, that none of these companies have amounted to much or moved the needle in terms of healthcare cost.

Hospitals in their new form, like WalMart and Target in retail, have become effective competitors with self-proclaimed disrupters. The lesson here is to never underestimate the ability of dinosaurs to evolve.