Cloud players in health: how can telcos compete?
In this article we explore what the cloud players are doing in health, and identify where telecoms operators can look to compete or collaborate in the digital health market.
The digital health opportunity has never been better
The healthcare industry presents a vast opportunity, comprising roughly 10% of the world’s GDP. Although it’s an industry that has traditionally lagged behind others in terms of digitalisation, it is now undergoing a transformation. This is being accelerated by the COVID pandemic, which has highlighted the importance of technology in society, particularly in healthcare. Finally, some big regulatory and cultural barriers to digital health adoption have fallen and the healthcare sector is ready to change.
The healthcare opportunity has not gone unnoticed by the cloud players and internet giants. Over the past decade, Facebook, Amazon, Microsoft, Apple and Google (FAMGA) have gradually been building up their healthcare portfolios through partnerships, acquisitions, investments and internal development. With their huge in-built customer base and vast budget and resources, they are well positioned to succeed in the digital health space.
However, this leads to the question – do FAMGA post a competitive threat to telcos building digital health businesses in their local markets? How can operators hope to achieve success, when they are up against players that have a significantly greater reach and abundance of resources?
In this article we explore what the cloud players and technology giants are doing today in healthcare, then assess the strategic implications for telecoms operators considering or actively developing digital health businesses.
What are FAMGA doing today in healthcare?
Facebook has a wealth of diverse users who use its apps regularly and share a great deal of personal information on them. Accordingly, its healthcare offerings look to leverage these unique data sets to detect potential health threats for individuals and encourage them to adopt a healthy lifestyle. Their health play includes:
- A preventive health tool integrated into the Facebook mobile app, that considers a user’s age and gender and reminds them to get check-ups when required. It also connects them to relevant local medical service providers.
- A suicide prevention tool, where AI analyses users’ activity on Facebook and detects when they express suicidal tendencies. It then prioritises the severity of the case, and trained staff determine what help to offer the user.
For many people Amazon is the first port of call for an online purchase, and AWS is currently the leading provider of cloud computing services. Amazon is looking to leverage this loyal user base, as well as its extensive distribution network to address healthcare pain points in the US. While this includes leveraging its cloud computing and AI capabilities in health, Amazon is equally focused on cutting the fat in the US’ care and prescription drug delivery systems.
- Amazon joined the online pharmacy business in 2018 with a $753 million acquisition of PillPack, an online pharmacy with licenses to distribute in almost every state. Two years later customers can still order their prescriptions directly through PillPack, but it is now also possible to buy prescription medicine on Amazon’s main website, with free two-day delivery for Prime members. Amazon is integrated with most health insurance plans in the US.
- Haven was a joint venture launched in 2018 between Amazon, JPMorgan Chase, and Berkshire Hathaway that aimed to provide low-cost and accessible healthcare solutions for the three companies’ employees. Its ambition to disrupt the healthcare market was ultimately not realised, and It will shut down at the end of February 2021, though the three companies aim to continue collaborating informally.
- In late 2019 Amazon acquired Health Navigator, which uses analytics and AI to improve patient diagnosis and care. It offers clinical content in the form of APIs, and Amazon plans to integrate it into its Amazon Care offering.
- Amazon Care launched for Amazon employees in September 2020. It is a virtual and in-person offering, that includes telemedicine via app/chat/video, prescription medication delivery and follow-up visits by a nurse to the employee’s office or home.
- Amazon has designed software for the voice assistant Alexa that enables it to handle and communicate confidential patient information. It is HIPAA compliant and it has partnered with three hospitals as part of the program.
- Amazon’s work in the AI space includes a speech recognition service called ‘Amazon Transcribe Medical’ that takes physician’s speech and inputs it directly into medical records in text form. They also have a partnership with University of Texas Health Science Centre, Cardinal Health and Virtusa to use AI in medical research, and a Next Gen Stats partnership with the NFL that is investigating AI/ML to improve player health.
Microsoft is a highly trusted technology and cloud computing company that owns the world’s most popular workplace apps, and popularity has continued to grow over the last year with daily users of its Teams platform jumping from 20 million in November 2019 to 115 million in October 2020 as a result of COVID-19. Its healthcare initiatives are primarily focused on supporting the healthcare sector’s transition to cloud computing/cloud based infrastructure and adoption of machine learning and AI. They include:
- AI for health, which is a five-year, $60 million philanthropic program to help healthcare organisations fight global health challenges and use AI/ML to boost patient health.
- Microsoft Cloud for Healthcare is their first industry-specific cloud offering. It brings together cloud computing capabilities (including Azure, Dynamics 365 and Microsoft 365) to ‘enhance patient engagement, empower health team collaboration, and improve clinical and operational data insights’.
- Microsoft has also partnered with various companies including:
- Providence – AI to improve electronic health records (EHRs). They are also building a high-tech hospital together.
- AstraZeneca – AI Factory for health (a healthcare AI accelerator)
- Novartis – AI innovation lab to accelerate development of new medicines
- Nuance – building modern healthcare solutions, including speech recognition for clinical use, where AI software listens to physician/patient conversations and converts them to reports
- Rutgers medical school – app to prevent sudden infant death syndrome
Google has a wealth of experience in handling and searching large data sets and stands out from the other hyperscale cloud providers for its strong analytics and AI capabilities, which it is building on in digital health. It has made many moves in healthcare and has 57 digital health startups in its portfolio (as of January 2020).
- Google Health is a branch of Google that was started in 2006. It carries out research, develops clinical tools and partners with healthcare organisations to develop solutions. Its work includes using AI/ML to analyse patient data (e.g. detecting heart disease risk, diabetic retinopathy, cancer), which has resulted in a reduction in false positives and negatives compared to doctors.
- Google partnered with Ascension (a major private healthcare system in the US) in 2019 to move its EHRs to the cloud and create a search tool to improve search capabilities for doctors.
- Google acquired DeepMind, an artificial intelligence company and research laboratory, in 2014. The DeepMind health team joined Google Health in 2019 to work on developing tools and technology to improve patient care and clinical workflows.
- EHR voice assistant Suki helps clinicians complete administrative tasks. Google is also working on a voice recognition solution that will listen to physicians and not only transcribe the patient interaction, but also interpret it and produce notes on the most important and relevant parts of the conversation.
- Google acquired Fitbit in January 2021 for an estimated $2.1Bn, revealing ambitions in the wearables market.
Apple is one of the most trusted technology companies and enjoys a highly brand loyal userbase. Its work in digital health focusses on enabling both consumers and enterprise users to manage data easily across systems.
- The Apple Health app is a dashboard that shows users their health metrics, compiled from compatible apps/devices.
- HealthKit platform is a developer framework that enables sharing of health data between compatible apps and services.
- is a software framework for apps to let people better understand and manage their medical conditions by tracking their day to day health and medications. This data can then be shared with care teams. Johns Hopkins Medicine, Stanford Medicine, and Emory Healthcare are amongst those using CareKit apps.
- ResearchKit is a software framework for apps to help researchers gather data by making it easier to enrol participants for studies (e.g. by recruiting through CareKit or HealthKit users) and gather regular data.
- The Apple smart watches have increasingly advanced healthcare capabilities including:
- Sensors capable of measuring a user’s blood oxygen levels. Users will be able to enter a study on asthma and heart failure, and the role of blood oxygen and heart rate metrics in detecting respiratory illnesses.
- Heart rate sensors to detect unusually low or high heart rates, and an ECG tool that can identify arterial fibrillation
- Sensors that can detect when someone’s taken a hard fall and likely injured themselves
- Sleep tracking
- Medical ID, so first responders in medical emergencies can access critical patient information such as allergies or emergency contacts
Where can telecoms operators compete?
Areas where it’s not worth competing
- Amazon, Microsoft and Google are the leading players in the cloud computing market, and previous attempts by telcos to compete in core cloud have not proven successful. Instead, telcos could look to deliver edge cloud services to healthcare providers to alleviate the data privacy and sovereignty concerns of the industry.
- Personal health records are another area where attempting to compete may be difficult, as Apple already have a significant hold of the personal health market. Even the cloud companies have struggled in this digital health area, with Microsoft and Google’s offerings (HealthVault and Google Health) having both failed – although Google’s acquisition of FitBit shows renewed ambitions.
Areas where telcos could compete
- When it comes to remote care delivery, FAMGA have good ties to organisations in the US but may lack local partners in other countries, therefore telcos with regional relationships and expertise can have an advantage in telehealth and remote care services.
- Public distrust of large technology companies and their use of consumer data is growing (particularly for Facebook and Google), while telcos are generally quite well trusted. Telcos could therefore leverage this brand to have more success in working with EMR/EHRs and supporting healthcare providers in their transformation of legacy systems. They will also be better placed to deal with regional-specific forms of patient data and hospital information systems (HIS), whereas the cloud players (who have a more global offering) will likely not have the regional knowledge or bespoke offerings by geography.
Areas where telcos could collaborate
- In some of these areas, telcos could collaborate to implement FAMGA’s tech at a national level. Areas where this could be successful include SaaS, AI, personal health records, HER/EMRs, telehealth and potentially on-premise edge computing.
- EMR/EHRs are an attractive area for this because while the cloud and internet players can produce solutions to optimise sharing of patient information across the US, this won’t directly translate to other countries which will have different needs. Telcos will be able to leverage their national or regional relationships and know-how.
- Telehealth is also a good area to collaborate in, as telcos can provide the relationships with consumers, healthcare providers and solutions providers in countries where FAMGA do not already have them.
Telcos could leverage the strong AI capabilities of cloud players like Google to deliver AI-based analytics, diagnostics, and triage services to healthcare providers – an opportunity area which STL Partners forecasts will grow significantly over the next few years.
Author: Miran Gilmore, Consultant and member of the Digital Health Practice
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