/Behind Google’s ‘Project Nightingale’: A Health Data Gold Mine of 50 Million Patients

Behind Google’s ‘Project Nightingale’: A Health Data Gold Mine of 50 Million Patients


The detailed health information of millions of Ascension patients is scattered across 40 data centers in more than a dozen U.S. states. In an ambitious, all-in bet, Google and the nonprofit health system are putting all of that data into the cloud—with potentially big changes on tap for doctors and patients.

As part of “Project Nightingale,” first reported by The Wall Street Journal on Monday, Ascension is attempting to store its far-flung patient information in one place, hoping to provide better care. The effort covers the personal health records of around 50 million patients of Ascension, the country’s second-largest health system, people familiar with the matter say.

In the past few months, tens of millions of records have been shared with Google, according to the people and documents. The rest are on their way.

The data’s new destination is Google’s “cloud,” essentially software storage able to be accessed remotely, including by some of the search giant’s employees.

Paging Nurse Google

The tech giant is teaming with Ascension on an ambitious project to crunch patient data for treatment and administrative purposes.

How ‘Project Nightingale’ intends to use data

1. Patient checks into hospital, doctor’s office or senior care center.

2. Doctors/nurses examine the patient, input data into computers.

Data that is

shared includes:

Name

Date of Birth

Address

Family members

Allergies

Immunizations

Radiology scans

Hospitalization

records

Lab tests

Medications

Medical conditions

3. Data instantly flows to Google’s ‘Project Nightingale’ system. The system may suggest the following outcomes, among others:

Replacement or addition of doctors

to patient’s team.

Additional enforcement of narcotics policies.

Ascension may bill more or for different procedures.

Treatment plans, suggests tests, flags unusual deviations in care.

How ‘Project Nightingale’ intends to use data

1. Patient checks into hospital, doctor’s office or senior care center.

2. Doctors/nurses examine the patient, input data into computers.

Data that is

shared includes:

Name

Date of Birth

Address

Family members

Allergies

Immunizations

Radiology scans

Hospitalization

records

Lab tests

Medications

Medical conditions

3. Data instantly flows to Google’s ‘Project Nightingale’ system. The system may suggest the following outcomes, among others:

Additional enforcement of narcotics policies.

Replacement or addition of doctors

to patient’s team.

Ascension may bill more or for different procedures.

Treatment plans, suggests tests, flags unusual deviations in care.

How ‘Project Nightingale’ intends to use data

1. Patient checks into hospital, doctor’s office or senior care center.

2. Doctors/nurses examine the patient, input data into computers.

Data that is

shared includes:

Name

Date of Birth

Address

Family members

Allergies

Immunizations

Radiology scans

Hospitalization

records

Lab tests

Medications

Medical conditions

3. Data instantly flows to Google’s ‘Project Nightingale’ system. The system may suggest the following outcomes, among others:

Replacement or addition of doctors to patient’s team.

Additional enforcement of narcotics policies.

Ascension may bill more or for different procedures.

Treatment plans, suggests tests, flags unusual deviations in care.

How ‘Project Nightingale’ intends to use data

1. Patient checks into hospital, doctor’s office or senior care center.

2. Doctors/nurses examine the patient, input data into computers.

Data that is

shared includes:

Name

Date of Birth

Address

Family members

Allergies

Immunizations

Radiology scans

Hospitalization

records

Lab tests

Medications

Medical conditions

3. Data instantly flows to Google’s ‘Project Nightingale’ system. The system may suggest the following outcomes, among others:

Treatment plans, suggests tests, flags unusual deviations in care.

Replacement or addition of doctors

to patient’s team.

Additional enforcement of narcotics policies.

Ascension may bill more or for different procedures.

The data includes personally identifiable information like names and dates of birth; lab tests; doctor diagnoses; medication and hospitalization history; and some billing claims and other clinical records.

Neither doctors nor patients have been formally notified of the arrangement. Ascension, a Catholic nonprofit, has more than 2,600 facilities like hospitals and nursing homes in 21 states and Washington, D.C.

The arrangement is permitted under federal health laws, according to the companies and some privacy experts. Still, it has attracted criticism amid heightened attention to data privacy.

“The optics are bad. The legal argument is tenuous. Ethically, this is a bad strategy. They need to tell people what they are doing,” said

Ellen Wright Clayton,

a professor of biomedical ethics at Vanderbilt University.

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The federal Health Insurance Portability and Accountability Act of 1996 generally allows hospitals to share data with business partners without telling patients, as long as the information is used “only to help the covered entity carry out its health-care functions.”

Ms. Clayton said Google risks running afoul of the rules if it uses the health data to perform independent research outside the direct scope of patient care.

Google declined to comment on whether it would conduct research. People familiar with the project say the company’s staffers are still parsing through Ascension’s unwieldy patchwork of data collections, and aren’t yet positive what insights might be found or eventually produced.

Down the line, experts say, Google could reap tens of millions of dollars—if not more—by repeating its Ascension work for other health-care clients.

Google cloud President

Tariq Shaukat,

in a blog post late Monday, said the company aimed to help “modernize Ascension’s infrastructure,” as well as give Ascension staffers tools to communicate and build functions that the health system could use to improve care.

In meetings and presentations reviewed by the Journal, Google has laid out deep ambitions for the project. Google executives describe the goal as a “layer” of patient information that is essentially an entire personal health record. Artificial intelligence would immediately jump in with suggested questions, and its own answers, such as risks of a given treatment plan. Project Nightingale would then automatically predict and map the outcome of certain procedures or medications.

Doctors and other Ascension medical staff, as well as Google employees, would be able to pull up far-flung patient data faster than under Ascension’s current system.

Conceptual images of the software under construction show an interface much like Google’s flagship search engine. Begin to type in a first name, and Google will produce a drop-down menu featuring other patients with similar names. A single click reveals metabolic data, medications, phone numbers and even the patient’s temperature.

Tech giants like Amazon and Apple are expanding their businesses to include electronic health records — which contain data on diagnoses, prescriptions and other medical information. That’s creating both opportunities and spurring privacy concerns. Here’s what to know. Photo Composite: Heather Seidel/ The Wall Street Journal (Originally published Jan. 9, 2019)

Project Nightingale software would be able to automatically read scanned images such as MRIs and upload related data to a central network accessible to Ascension and some Google employees.

The concept gave some Ascension patients pause.

“Google is not doing this out of the goodness of their heart,” said

Tim Weiesner,

a 63-year-old retired nurse and Ascension patient in Wichita, Kan. He said he was disappointed not to have been notified of the data sharing directly by his doctor. “It just seems deceitful. I’m sure they are going to make money off our information.”

Google declined to comment on any profit-making plans. It isn’t being paid for the work for now, but Ascension is incurring costs as it trains its staff in the search giant’s systems, people familiar say.

Google and St. Louis-based Ascension have signed what is known as a business associate arrangement, which specifies when a health-care vendor can access patient data. Ascension retains ownership of the data, people familiar with the matter said. Neither Google nor Ascension would give details on who at the search giant can access data.

The breadth of the project has angered some politicians.

“Blatant disregard for privacy, public well-being, & basic norms is now core to Google’s business model. This abuse is beyond shameful,” tweeted

Sen. Richard Blumenthal

(D., Conn.), a frequent critic of the technology giants.

“Some of the solutions we are working on with Ascension are not yet in active clinical deployment, but rather are in early testing,” Mr. Shaukat said. “This is one of the reasons we used a code name for the work—in this case, ‘Nightingale.’”

Write to Rob Copeland at rob.copeland@wsj.com

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