What If Amazon Ran Hospitals?

What if Dr. Alexa offered you the next appointment with your doctor in the Amazon Clinic? What if you could buy your prescription drugs in Amazon’s online pharmacy? What if you could get your personalized plaster cast from the 3D Printing Department? In light of the recent moves of Amazon and other tech giants in the healthcare field, we imagined what it would look like if Amazon operated an entire hospital.

Tech giants move into healthcare

Facebook, Google, and Amazon are aiming for new horizons. The playfield must be too small for them solely on the technology markets. They certainly have the capacity to move into new fields. As The Economist writes, their huge stock market valuations suggest that investors are counting on them to double or even triple in size in the next decade.

So, where do they want to utilize their power? Recent moves show they have ambitions in healthcare. Google has made steps forward in the field with Calico. Human Longevity Inc. joined forces with Cleveland Clinic for a human genomics collaboration aimed at disease discovery and making aging a chronic condition. In September 2017, Microsoft announced the launch of its new healthcare division at its Cambridge research facility, to use its artificial intelligence software to enter the health market. Its research plans include monitoring systems that can help keep patients out of hospitals and large studies into conditions such as diabetes.

And what about Amazon?

According to CNBC’s news in January 2018, the Seattle-based giant hired one of Amazon's most high-profile hires to date in health, Martin Levine. He has been working for Iora Health, which focuses on Medicare patients in six US markets. He could be joining Amazon's internal healthcare group known as 1492, which is testing a variety of secretive projects. Many analysts suspect that Amazon is considering selling prescription drugs online as rumor said in autumn 2017 or that it might be opening drug stores in its Whole Foods chains. Some analysts even considered Amazon’s popular digital assistant, Alexa as the future’s possible digital doctor. Amazon, Berkshire Hathaway, and JPMorgan Chase also announced a partnership to cut health-care costs and improve services for their US employees.

So, US consumers might one day find themselves logging in to Amazon Healthcare Prime, or asking Dr. Alexa what they should do about their cold. But what if we go even further than that? Let’s do a thought experiment. What if Amazon decided to open a clinic in the future?

Hi Ann! Your prescription drugs from Amazon Clinic just arrived!

Your phone buzzes with the above message. As a reaction, you go to your door and notice the tiny medical drone with your package in your backyard. In the neatly wrapped box, you find all the medication the GP prescribed for your pneumonia. The order is fairly easy to make on Amazon’s website with a special code that your GP gave you to allow the purchase of the drugs from Amazon Clinic’s own online pharmacy.

The scene is not that far away from reality considering Amazon’s recent moves in pharma. The tech giant might have been considering selling drugs online. In 2017, it received wholesale licenses in several US states and induced a lot of fear in big pharma players about disrupting the industry. Besides, drone delivery is already on the palette of services offered by Amazon. In December 2016, it delivered the first packages with popcorn and fire TV to its customers in the UK. The US’ airspace watchdog, the FFA, also started to set out rules for drone delivery. Thus, selling pharmaceuticals and delivering medication by drones seems like a natural combination for the future Amazon Clinic.

Moreover, medical drones have a great potential to respond to medical emergencies or disasters. Google already patented a device that can call for a drone in emergency situations to fly in with life-saving medical equipment on board. You would push a button, and a drone would appear on the spot. How amazing would that sound? And what about drones deliver automatic external defibrillators (AEDs) directly to people who have just suffered a heart attack? Researchers from the University of Toronto are already experimenting with the idea based on their inspiration from ambulance drones in the Netherlands. It goes without saying that a future Amazon Clinic would have a swarm of medical drones for drug and blood transportation or medical emergencies.

Artificial Intelligence-based support system in the Amazon Clinic

There is incredible growth in computers’ ability to understand images, text, and video in the form of Artificial Narrow Intelligence (ANI), a field called computer vision and natural language processing. The former is used as a primary technology for self-driving cars, Google image search, automatic photo-tagging on Facebook, and it is extensively utilized now in healthcare, for example in the field of medical imaging.

In December 2017, Amazon also announced a couple of services based on ANI. Amazon Rekognition Video uses smart algorithms to detect objects and faces in customers’ video content; the tech giant's Amazon Transcribe turns audio into text; Amazon Translate (what a surprise) translates text, and last but not least, Amazon Comprehend analyses text for sentiment and key phrases. How could all these services support the work of medical professionals in a hospital?

The Amazon Clinic might deploy smart algorithms to aid doctors’ work in making decisions about treatment paths. Amazon might build its own deep learning algorithm just like IBM Watson, that is able to find the latest scientific studies and sift through millions of options in seconds to find the best solutions. Amazon Rekognition Video might not only detect objects in customers’ video content, but also in medical imaging helping the work of radiology departments. Moreover, Amazon Transcribe might spare the time of making medical notes for doctors by transcribing patients’ account of their conditions as well as medical professionals’ recommendations. As administration puts a high burden on doctors and considerably lowers job satisfaction, tools for easing this hideous task would be more than welcome in future hospitals.

Amazon healthcare package deals and Dr. Alexa

No matter whether you are looking for blood glucose monitors, otoscopes or blood pressure cuffs, snoring aids or defibrillators, you can find everything on Amazon. The tech giant is already selling medical equipment, first aid kits, and non-prescription drugs online, so jumping into more serious healthcare business is truly not so far away.

Now, imagine the Amazon Clinic going some steps further. What if you could have special package deals on Amazon Healthcare Prime? The doctors prescribed you medication for high blood pressure, and you could get blood pressure cuffs or mobile apps helping you measure your medical state at a reduced price – when getting everything in a bundle.

Dr. Alexa might even help you choose from the selection based on your personal history. For example, based on your known allergies to drugs. The digital assistant might also act as the first line in primary care by answering basic medical questions and helping patients with simpler conditions. The concept is already moving into reality. UK’s National Health Service (NHS) started to use a chatbot app for dispensing medical advice for a trial period in 2017, with the aim of reducing the burden on its 111 non-emergency helplines. Moreover, Dr. Alexa could also ease the administrative burden on medical staff by patient management and organizing doctors’ schedules.

3D printing drugs and medical equipment in the Amazon Clinic

Imagine that the future Amazon Clinic would apply disruptive technologies such as surgical robots, tiny robot companions or TUG robots for carrying medication and equipment. Imagine that doctors would use 3D printers to create finger splints and other personalized plaster casts, tumor or organ models or low-cost prosthetic parts inside the Amazon Clinic. The 3D Printing Department would be responsible for all medical equipment necessary in other parts of the hospital.

And what if the Amazon pharmacy could even use 3D printing to make drugs in any color or shape you choose online? This is closer than you think. In August 2015, the FDA approved an epilepsy drug called Spritam that is made by 3D printers. It prints out the powdered drug layer by layer to make it dissolve faster than average pills. In June 2015, the UK’s Daily Mail reported that scientists from University College of London are experimenting with 3D printing drugs in odd shapes; such as dinosaurs or octopuses in order to make it easier for kids to take pills.

 The possible downsides of a future Amazon Clinic – Recommendations and Black Fridays!

Imagine that you would receive recommendations for treatments, hospitals and even doctors based on your own habits. Just as the algorithms of Amazon, Google and Facebook show you ads based on your browsing history. So, if you suffer from diabetes, every content you receive will have something to do with the condition. Or if you do your grocery shopping and Amazon saw you buy some liqueur you might get some recommendations for healthy living from Amazon Health Prime. That would be an annoying nag as well as a scary connection between parts of your personal data.

Imagine that you had a Black Friday in medicine, too! On certain days of the year, treatments and drugs would be less expensive, and even doctors would get paid less – but could get easier better reviews. At first, it could sound like a good idea but think about it. What if patients did not buy medical equipment or drugs that they actually needed in order to wait for some discount? It could cost their health, or in extreme cases their life!

The entire medical history of you

It is not a coincidence that Black Mirror comes into your mind when reading the section title. The creators of the dystopic series already imagined what could happen when people would be evaluated solely based on their social media profiles and interactions. Imagine what would happen when reviews would determine the future of doctors and treatments? What if you could review doctors and treatments just as you do with books on Amazon? If many patients were dissatisfied with a treatment due to its side effects, it would go out of the window. This is not how evidence-based medicine works. Moreover, the power of the masses could sweep away great professionals with fewer charms – which should never happen.

Not only medical professionals but also patients might be reviewed and evaluated like that. Patients would have a profile on Amazon with their entire medical documentation, genetic information – and the evaluation they received from their doctors. If someone has bad reviews, treatment might become more expensive for them. Very scary prospects there!

Should Amazon run a hospital?

Some ideas sound funny and promising; others sound just like script lines from Black Mirror. Anyhow, healthcare would definitely look different with Amazon running hospitals. Perhaps more patient-centered and more business-oriented.

But healthcare should not be pure business. Medical evidence, empathy, and caregivers dedicated to their jobs make healthcare unique. Thus, a lot of techniques which Amazon, Google, Microsoft, Apple or Facebook apply in their businesses would not work or would have catastrophic consequences in healthcare. Especially in direct patient care.

No wonder that Apple, Google, and all the other tech giants move rather forward on the market for medical equipment, wearables or artificial intelligence solutions that indirectly affect patients. The fact that Amazon decided not yet to sell drugs online but rather concentrate on the medical equipment might also have something to do with that. So, there is no question that tech giants want to take a leap of faith in healthcare, but they still have a lot to learn to get into the industry successfully.

Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.

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