I'm Praveen Suthrum. After 13 years of building and running NextServices, a healthcare technology/management company, the challenges and opportunities in the industry leap out at me. I also get early access to industry trends and changes.

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Amazon's secretive foray into healthcare. But will it disrupt the industry?

Amazon's secretive foray into healthcare. But will it disrupt the industry?

Every time a big boy enters healthcare, there's nervous excitement in the market.

Google entered with Verily. Apple did with HealthKit. Microsoft's always been there. With Watson, IBM makes big promises of healthcare applications. Even Facebook, I learn, has healthcare ambitions.

How can Amazon resist?

Amazon's secretive team is called 1492. The year Columbus entered America. Team 1492 supposedly is working on legacy electronic medical records and telemedicine.

Goldman Sachs took the cue and put together a 30-page report. Here are the highlightsfrom the report as reported by CNBC:

  1. Rather than replacing pharmacies right away, Amazon might start by partnering with a pharmacy benefits manager (PBM), which acts as an intermediary between payers, like health insurers, and the rest of the health system. That would provide "access to patient data and the potential to cross-sell related products."
  2. Amazon could ultimately improve price transparency for the consumer and reduce out-of-pocket drug costs. But it would likely start by speeding up the drug delivery process and facilitating at-home delivery.
  3. Amazon could also become an online pharmacy, retail and online pharmacy, integrated PBM and online pharmacy, or handle drug distribution to pharmacies.
  4. One potential -- and overlooked -- challenge for Amazon might be the so-called "age gap." Amazon's customers tend to be younger and healthier than people who typically take prescription drugs.
  5. Amazon could move into digital health by using the Echo in clinical settings and developing tools for telemedicine and remote patient monitoring. "Imagine seeing a virtual doctor on your Amazon app, having it prescribe you a certain medication, and then tapping a 'buy now' button -- all without leaving your home."

What are the obvious signals?

Let's think like Amazon for a moment. Here are at least 3 obvious signals.

#1: World's largest distribution platform (to patients). The company has one of the largest distribution networks on the planet. Connected to both consumers and businesses. Selling toys, books, and some more.

What could it mean? Think about it. Consumers are patients. Businesses are employers. They've already started selling medical supplies and equipment online. They hired a general manager to sell drugs online. Why not figure out a plan to save health insurance expenses for employers?

#2: Expanding cloud infrastructure (plugging hospitals in). Amazon Web Services (AWS) is the original cloud-platform, making over $14billion in revenues. AWS's vision is to connect millions of smart devices at home and elsewhere. They expect enterprises to collect data and analyze them on AWS.

What could it mean? Medical devices and equipment are on the path to be smart. That means, they will each have an IP address. Plugged into the cloud. Most modern EHRs are already on the cloud. (We run ours on AWS!). Imagine getting all the data in one place.

#3: Learning devices that listen and talk (to patients). With Echo and Alexa, Amazon is rapidly changing how we engage with machines. Using artificial intelligence and machine learning. Jeff Bezos says much of the innovation will happen beneath the surface. Making forecasting more accurate.

What could it mean? Today, Amazon Echo doubles up as a home healthcare assistantKidsMD is a 'skill' on Alexa developed by Boston Children's Hospital. It answers questions on common ailments and medication dosages. It's only a matter of time when we have more such examples.

# Reply and tell me about other signals that you spot...

Let's amplify these signals

Alexa applications will get more sophisticated (like airline voice-response systems). Amazon will even launch newer AI-run hardware. Machines will begin to understand patients and doctors better.

Data from these devices and systems will find their way into electronic health records. Systems become more dynamic. Predicting disease before it occurs. Making care more proactive.

Doctors will transcribe medical records by speaking into Alexa. Completely doing away with the problem of dealing with old EHRs. (For now, Alexa is not HIPAA compliant.)

Hospital infrastructure will largely migrate to the cloud. Making it accessible from anywhere. AWS will make it easier for device makers to AI-enable themselves. Which would make medical devices understand patients even better. Possibly predicting the course of care.

AWS may even solve the interoperability problem by making systems and devices talk to each other.

But healthcare is different...

EVEN IF...drones drop off drugs at people's homes after they chat with Alexa. Healthcarewill have many problems to solve.

In healthcare, the old and new co-exist. IBM Watson (invented in 2010) and stethoscope (invented in 1815) live side-by-side. You can't simply pluck legacy systems out.

Everything takes a little longer. It's been a couple of years since GE Healthcare launched its cloud to connect 500K imaging machines. It's only now they are hiring more engineersto build an "app store".

Policy that's meant to fix problems itself becomes a burden. A new law called MACRA has the whole industry losing balance. Even 7 months after start.

Doctors and their staff are over-burdened by insurance companies. On an average, doctors spend over 20 hours/week to complete prior authorizations. For procedures they are about to perform.

From breast cancer to hypertension to cholesterol, medical guidelines keep changing every few years. Disorienting both patients and doctors.

More important, trust amongst the industry's chief participants - doctors and patients - is low. Medicine has become a transaction beyond control.

Patients have changed into customers. From people needing sympathetic treatment to care buyers with high demands. Doctors are pressured by new needs of ROI in the medical business. 

I know what you are thinking. But those can't become Amazon's problems.

Amazon can't possibly be expected to fix broken policies. Processes. Overblown cost of drugs. Distrusting patients and doctors. Rapid rise in disease, like diabetes among teenagers. Excessive medicine. Unreliable guidelines. Opioid crisis.


There in lies the scope for disrupting the industry.

Before technology comes mindset.

And to redo healthcare, we need a mindset fix. Amen.

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