THE past decade has seen the smartphone become a portal for managing daily life. Consumers use their pocket computers to bank, buy and befriend. Now this array of activities is expanding into an even more vital sphere. Apple has spent three years preparing its devices and software to process medical data, offering products to researchers and clinical-care teams. On January 24th it announced the result. The next big software update for its iPhone will include a feature, Health Records, to allow users to view, manage and share their medical records. Embedded in Apple’s Health app, the new feature will bring together medical data from participating hospitals and clinics, as well as from the iPhone itself, giving millions of Americans direct digital control of their own health information for the first time.
过去十年，智能手机成为管理人们日常生活的一个门户，消费者利用这个袖珍电脑从事金融投资，网购和交友。如今这类活动正在向更加重要的领域延伸。苹果公司用了三年时间做准备，要将其设备和软件处理医疗数据，将产品提供给研究人员和临床护理人员。1月24日，苹果宣布他们的准备结果。iPhone未来一次的主要软件升级将包括一项功能，即健康记录，用户可以查看管理和分享个人病历。这个新功能整合用户在医院诊所的诊疗数据和苹果手机上所得的数据，最后，数百万的美国人民能第一时间直接掌控自身健康状况数字信息。
Apple’s fellow tech giants are also on the march into medical services. On January 30th Amazon announced a partnership with Berkshire Hathaway and JPMorgan Chase to create a not-for-profit health-care company for their own employees that promises to employ technology to provide cheaper care than conventional health insurers offer. For the past year, the e-commerce giant has also been exploring a venture to use its logistical prowess to start selling drugs online.
与苹果一样的科技巨头也在进军医疗服务行业。1月30日，亚马逊公司宣布与伯克希尔·哈撒韦（Berkshire Hathaway）和摩根大通（JPMorgan Chase）合作，成立一家专为自家员工服务的非盈利医疗机构。该机构承诺用科技手段提供比传统保险公司的服务价格更低的医疗服务。过去一年，这家电子商业巨头也在探索投资企业，用其物流能力进行线上销售药物。
Alphabet, Google’s parent, has just launched a third health-care firm, Cityblock Health, to operate alongside Verily, a subsidiary based in San Francisco, and DeepMind Health, an arm of its London-based artificial-intelligence (AI) firm (a fourth company, Calico, is working to extend human lifespans, but does not provide health-care services). Alphabet already claims to be able to use AI to predict possible deaths of hospitalised patients two days earlier than current methods, for instance, allowing more time for doctors to intervene. Facebook and Microsoft are preparing to add health care to their core businesses of social networking and software.
谷歌母公司Alphabet刚开始成立第三家医疗企业城区健康（Cityblock health），另外两家分别是美国旧金山的Verily和英国伦敦的人工智能子公司DeepMind的健康部门（第四家是Calico，正在研究延长人类寿命项目，但不提供医疗健康产品）。Alphabet很早就称要利用人工智能手段预测住院病人的可能死期，相比目前预测手段提前了两天，这样就能给医生更多时间进行安排。Facebook和微软正准备把医疗保健这块纳入他们社交网络和软件的核心业务中去。
Until now the tech giants’ foray into health care has not gone much beyond wearable devices to track fitness or the provision of cloud-computing services to incumbent providers. In future they aim to deliver real medical services that directly affect individual patients. All five firms have secretive health-care skunk works, are hiring medical talent and are buying or backing external health-care startups. Undeterred by recent claims that their own products may be harmful to mental health, they want not only to be indispensable in customers’ lives but to prolong them, too.
到目前为止，科技巨头涉足医疗保健领域无外乎于穿戴设备，用来跟踪健康状况，或用于现有供应商的云计算服务条款。未来，科技巨头的目标是提供实际的医疗服务，直接针对患者。这五家企业都有各自秘密的医疗保健科研重地，招募医学人才，并收购或投资医疗保健创业企业。最近有消息称，这些科技巨头的产品可能对心理健康有害，但是他们并没有因此就被吓倒，他们不仅希望能成为顾客生命中不可或缺的一部分，也希望可以延长消费者寿命。
The revenues of the industries they could disrupt are enormous. Health-care costs make up about a tenth of any country’s GDP on average, worth in total $7trn in 2015, according to Deloitte, a consultancy. Two insurers, UnitedHealth Group and CVS Health, are among America’s largest firms by revenue, bringing in $185bn and $178bn respectively in 2016. That is more than any tech firm except Apple. Shares in the two insurers fell by 4% on the news of the new Amazon-led health venture.
科技巨头要颠覆的医疗行业的收益巨大。据咨询机构德勤的统计，任何一个国家的医疗保健费用平均每年占全国GDP的十分之一，2015年医疗保健费用总计有7万亿美元。联合健康集团（UnitedHealth Group）和CVS健康（CVS Health）两家保险公司是美国医疗保健收益最大的两家，在2016年的收入分别是1850亿美元和1780亿美元。除了苹果公司外，这两家公司的收入超过了所有科技公司。然而，亚马逊控股的健康企业发布的报告显示，这两家保险企业的股价下跌了4%。
Apple and Alphabet, however, are likely to have the biggest impact in the near term. Amazon’s three-headed health-care venture will cover roughly 1m employees in the first instance, whereas Apple and Alphabet have the potential to generate or enable valuable health insights for hundreds of millions of users, collecting a small slice of that value in return.
苹果和Alphabet近期内可能会产生最大的影响。亚马逊三家医疗保健机构起初涵盖有近100万名员工，而苹果和Alphabet则有能力给成百用户提供有价值的健康数据，并从中获得小部分利益。
There are two broad routes into health care. The first is doing business with hospitals and health-care companies in the existing system. Alphabet provides software services to hospitals, for example; Apple sells smartphones, tablet computers and wearables to medical professionals and hospitals. A second route is for tech firms to use their various platforms to create entirely new channels through which medical care can be delivered to patients. Such channels include watches that use machine-learning algorithms to monitor the wearer’s health, phones through which clinical trials can be run and apps that provide medical-grade care to people managing chronic conditions such as diabetes.
要进入医疗保健行业，有两种主要方式。一种是与医院和医疗机构合作，比如Alphabet就给医院提供软件服务；苹果向医务人员和医院销售智能手机、平板电脑和穿戴设备。另一种方式是科技公司利用他们丰富多样的平台开创全新渠道，病人可以通过这些渠道得到医疗护理。这样的渠道有手表（利用机器学习算法检测戴表人的健康状况），手机（用于临床实验），还有应用软件（给人们提供医学级护理以控制糖尿病这类慢性疾病）。
Deploying bedside manner
采取医生对待病人的态度
Start with the existing system. Alphabet’s business here comes through Verily and DeepMind, and has focused on Britain’s National Health Service, which offers a single, standardised market. DeepMind has partnerships with four large hospital groups, to which it provides an app called Streams. This uses the hospitals’ data to generate alerts that draw doctors’ attention to the potential deterioration of patients. In May, meanwhile, Verily switched on data processing for a hospital—the NHS Heywood, Middleton and Rochdale Clinical Commissioning Group, near Manchester. It crunches through the hospital’s pseudonymised patient records, looking for patterns that suggest the emergence of long-term diseases like diabetes and alerting doctors if they are found. (In September Microsoft started a health-care division in Cambridge, which will devise medical algorithms of its own.)
与现有的医疗体系开始合作。Alphabet的业务来自Verily和DeepMind，重点放在有单一标准市场的英国国民保健制度上。DeepMind与英国四家大型医院集团合作，提供应用Steams。这款应用利用医院的病人数据发布提示，提醒医生注意病人可能存在的病情恶化。与此同时，Verily在五月给一家医院开始处理数据。这家医院是曼彻斯特附近国民保健署海伍德，米德尔顿和罗奇代尔临床调试集团（the NHS Heywood, Middleton and Rochdale Clinical Commissioning Group）。数据处理功能可以处理医院假名病历，找到表明糖尿病这类慢性疾病的突发情况的规律，并提醒医生进行处理。（九月，微软在剑桥设立了一个医疗保健学院，并研发独有的医学算法。）
None of this is straightforward. Health records generated in conventional clinical settings are immensely valuable—no amount of smartwatch accelerometer data is going to take the place of an MRI or an X-ray. Such records are increasingly available in digital form (see chart) but they are often messy and hard to process. DeepMind has had to spend months cleaning up data flows from a British hospital, the Royal Free, for instance, and has not yet delivered any AI-driven insights.
所有这些方法都不简单。传统临床的病历价值巨大——即使有再多的智能手表加速度计数据也不能取代核磁共振成像（MRI）和X射线。MRI和X射线结果越来越多地数字化（见表），但通常很凌乱，不好处理。比如，DeepMind花了数月的时间整理英国皇家自由医院的数据，到现今也没有提出通过 人工智能来处理的办法。
Apple’s approach is more focused on hardware. It is working to make its devices into trusted, secure channels through which medical data can flow. Third parties, rather than Apple itself, then build useful health services on top. Putting patients’ health records on iPhones will make these far more effective.
苹果则更加专注于硬件。它正在让自家的设备进入有信任度和安全的数据流动渠道。随后，第三方，非苹果自己，能在顶层创建有效的医疗服务。用iPhone手机记录病人的病历，会更为有效地利用这些数据。
Millions of people around the world have already joined medical studies using this infrastructure, participating through iPhones. Hints are emerging of the power of the approach. An app called mPower, built by Sage Bionetworks, a non-profit research organisation, studies Parkinson’s disease by getting iPhone users to perform tasks and measuring the tremor in their hands using the phone’s internal accelerometer. The data so far suggest that Apple’s platform may soon enable medics to spot Parkinson’s digitally, over the internet, before it is symptomatic in a patient.
全世界有数百万人通过iPhone加入一些医学研究来使用这些数据病历，而这种方式的强大之处正在渐渐显现。非赢利性研究机构赛智生物网络（Sage Bionetworks）开发出一款名为mPower的应用，让苹果手机用户执行任务，利用手机内的加速器计来测算在用户手中震动情况研究帕金森氏病。截至目前所得数据表明，苹果的平台可能很快就能通过互联网络让医务人员在发病前以数字方式发现帕金森氏病。
All this makes money for Apple by increasing the perceived value of its devices, says Anurag Gupta, a health-care analyst at Gartner, an IT research firm. The firm also hopes that clinicians and insurers will buy and use Apple devices in their work.
IT研究机构高德纳（Gartner）的医疗行业分析师阿努拉格·古普塔（Anurag Gupta）表示，苹果公司通过提高其设备的感知价值来赚钱。苹果希望临床人员和保险机构能购买使用苹果设备当作工作设备。
Algorithms v arrhythmia
算法Vs心律失常
Delivering medical services through brand-new channels—the second route into the industry—holds equal promise. The new non-profit venture from Amazon, Berkshire Hathaway and JPMorgan Chase fits into this category. Details are scarce, but the three firms might, for instance, use Amazon’s data-processing skills to build tools to monitor and care for patients outside hospitals and surgeries. Some speculate that the firms might build an app that makes booking a doctor’s appointment as easy as reserving a table at a restaurant. Whatever is built for their own employees, it seems likely that the services will end up being made available to the public, too.
进入医疗行业的第二种方式——用最新渠道模式同行有希望。亚马逊、伯克希尔·哈撒韦公司和摩根大通集团合作建立的非盈利性企业就属于此类。现在没有详细的内容，但是这三家企业可能会利用亚马逊的数据处理技术，创建一些工具，用心跟踪和看护院外病人或术后病人。有猜测称这几家企业可能会开发一款移动应用，用于预约医生，就如餐馆订座一样容易。无论为他们自己员工提供什么样的服务，普通大众最终都有可能享受到这种服务。
Another recent innovation is Alphabet’s Cityblock Health. Its mission to care for low-income city-dwellers in their own homes does not rely on existing health infrastructure at all. It plans to send its own health-care professionals to the homes of people needing care, with the visits paid for by insurance, often Medicaid, the social-insurance system that covers America’s poorest. Cityblock Health will trawl data to spot where care is needed. It plans to hire some 55 people over the next six months, including data scientists, software engineers and a lead physician, as well as a team to interact directly with patients.
另一项最新创新成果是Alphabet的Cityblock Health，旨在为给低收入城市居民提供医疗护理，而且完全不依赖当地医疗基础保障。该公司计划派送他们的医疗保健专业人士到需要医疗护理人员家里进行服务，费用通常由在美国专为穷人设立的社保体系医疗补助制度（Medicaid）支付。Cityblock Health通过数据检索，找到需要医疗服务的人，并计划接下来的半年内要雇用55人左右，其中包括 数据科学家，软件工程师和一名主治医生，以及一支直接看病的医疗团队。
Smartphones and watches are channels for new services in their own right. In this realm, Apple would become a direct provider of actual care to patients. It holds patents to turn its phones into full medical devices, using a bundle of sensors around the camera to let users measure their blood pressure, body fat and heart function by pressing a finger to the screen, for instance. Other patent filings envisage putting sensors into both phones and smartwatches to collect electrocardiograms to monitor heart health more precisely, and even doing biometric monitoring through AirPods, the firm’s wireless headphones.
智能手机和智能手表本身就是新的医疗服务渠道。在这个领域，苹果会成为直接供应商，为病人提供真实的医务护理。苹果拥有将手机变成医疗设备的专利，比如，通过利用相机周围的一组传感器，用户手指按在屏幕上，可以测量血压、体脂肪和心脏功能。其他申请的专利可以是将传感器放入手机和智能手表里面，采集用户的心电图以便更加准确地监控心脏健康状况，甚至可以是通过苹果的无线耳机Airpod进行人体生物特征监测。
Apple has also tinkered with sensors which gauge stress or measure blood oxygenation, and is reportedly working on ways to measure blood glucose through its watch, helping it get a handle on diabetes. Late last year it said it would join up with Stanford University to develop algorithms to spot irregular patterns in heartbeat data gathered by its watch. This research could produce what is known as a “digital therapeutic”, which goes through a full regulatory approval process (see article).
苹果公司也利用传感器来测量人的压力或血氧含量。有报导称苹果在想办法用手表测量血糖含量，让用户掌控好自己的糖尿病情况。去年年底，苹果声称要与斯坦福大*联学**手开发一种算法，用以发现手表采集到的心跳数据中不规则部分数据。这项研究可能会形成一种名为“数字治疗”方式，并经过全面的审查批准的方式。
Verily’s eclectic range of ventures includes building new kinds of surgical robots in a joint venture with Johnson & Johnson, a drug firm. It is also working on cutlery containing self-stabilisation technology, to help those with tremors to eat. The firm has two joint ventures to try to tackle diabetes, one with Dexcom, a medical-device-maker, and another with Sanofi, a drugs company. Verily also seeks to organise health information so that it can be queried for useful insights. Project Baseline, a research study, will gather data from 10,000 people over four years to do this.
Verily投资的众多企业中包括要与强生制药公司合资建立新型外科机器人。Verily还在生产含自稳定性技术的餐具，帮助手抖的人吃饭。Verily有两家合资企业，一家是医疗设备制造商德康医疗（Dexcome），另一家是制药公司赛诺菲（Sanofi），他们都在尝试解决糖尿病问题。Verily还试图整理出人们的健康信息，以便查询解决问题的独到见解。基线项目（Project Baseline） 就是这样一项研究性研究，将收集10,000人的健康数据做这项整理。
Facebook’s work in the field has been discreet and focused on two areas—mental health and clinical trials. In November the firm said it had started to use AI to monitor its users’ online behaviour for patterns which indicate depression, and to reach out in an effort to prevent suicide. The photos a user posts on Instagram may signal depression, for example, depending on the colours they contain, the times at which they are posted and whether they show faces. Google is trying something similar.
Facebook在这一领域很谨小慎微，主要集中在两个领域：心理健康和临床试验。Facebook在11月称开始启用人工智能监视用户的线上行为，总结出表明用户消极情绪的模式，从而制止人们出现自杀行为。比如，用户在图片分享应用Instagram上发布的图片，根据图片内含的颜色，发布的时间和用户是否呈现出脸，可能表示该用户心情抑郁的状态。谷歌也在做着类似的工作。
Facebook is also hoping to formalise and monetise an activity which is already common on its platform—namely, groups of patients discussing their symptoms. One plan is to help drug companies recruit people from these online gatherings for clinical trials, and to manage groups of patients who sign up, presumably in return for payment from the drug firms.
有病人在Facebook平台建群，探讨他们的症状，并变得非常普遍。Facebook希望将这种行为规范化以及从中赚钱。其中一个计划是协助制药公司从这些群里招募人员进行临床试验，并管理注册的病人群。这些方式预计能从制药企业那里获取回报。
This time may be different
这一次或不一样
It is worth remembering that the prospect of technology firms transforming health care has been heralded in the past, only to disappoint. Google started a health-records initiative in 2008, but shut it down by 2011, citing poor adoption. Microsoft made similar efforts with similarly low take-up. Yet ten years on, the centrality of the smartphone, with its potential to give patients access to their data whenever they want and wherever they are, changes the game.
值得注意的是，对科技企业要变革医疗行业的前景，早已有人做过憧憬，结果不尽人如意。谷歌从2008年首次开始建立病例库，但是数据采集不佳，在2011年停止了这个项目。微软也做过类似的工作，效果同样不好。但十年之后，以智能手机为核心的时代改变了这场游戏规则，智能手机可能让病人随时随地都能了解自己的健康数据。
So too does the inexorable logic of the data economy. Data sets that contain information about human health are hugely valuable. At a time when health-care budgets around the world are stretched, payers are desperate for insights that might enable them to cut costs while maintaining quality. The more data the tech firms can handle, the more they will learn about human health, and the better the services they can offer will become.
数据经济内含的必然逻辑也是如此。数据集囊括人们健康的信息，具有非常高的价值。曾经世界各国的医疗预算都处于紧张状态，各家企业都急切想要得到解决问题的办法，帮助他们减少开支，同时又能确保医疗保健质量。科技企业能处理的数据越多，就越了解人们的健康状况，就越能提供好的医疗服务。
That raises some familiar concerns. Privacy is an obvious one: the tech world’s mindset of “move fast and break things” works less well when it comes to health data. And the same competition issues that dog Google’s search business and Facebook’s social-networking service would arise in health care, too, if a particular AI diagnosis platform, say, were to became dominant. DeepMind’s work in Britain is already on the radar of the EU’s competition watchdogs. Meanwhile, Amazon’s partnership with Berkshire Hathaway and JPMorgan Chase will lure in huge quantities of patients’ data, leading to continual improvement of its services and, potentially, fears about dominance.
类似的担忧也随之而来。对隐私的担忧是显而易见的：科技界的“快速行动，破除陈规”思维模式不再适用于健康数据的方面。要说一个特定的人工智能诊断平台会占据主导地位，那谷歌检索业务和Facebook社交网络服务也会随之出现同样的竞争问题。DeepMind在英国的工作，早就在欧盟竞争监管部门的掌控之中。同时，亚马逊与伯克希尔·哈撒韦公司和摩根大通的合作关系将引来大量的病人数据，这就可以做到持续改进服务，但也可能招来主导问题的担心。
Apple’s entry into the field offers some answers to these worries. Its efforts in health so far have been cautious. The only patient data it processes now come from its partnership with Stanford University, and in future the firm is likely only to analyse medical information from those patients whose trust it has fully secured. Its services will be opt-in; patients who find themselves in hospitals working with Alphabet’s DeepMind, by contrast, are offered opt-out consent mechanisms.
苹果的涉足对这些担心提供了一些答案。到目前为止，苹果在保健领域都是在谨慎行进。唯一一项现在处理的病人数据来自与斯坦福大学的合作关系。未来，苹果很可能只会分析它完全信任它的病人的病例。苹果的服务是选择参与的，相比之下，病人在发现自己在医院与DeepMind进行合作时，则拥有选择退出的评价机制。
Earlier attempts by Google and Microsoft to offer patients a home for their digital records obliged people to consider whether they trusted the two companies enough; many decided the answer was no. If they only have to decide whether their own iPhone is sufficiently secure, many will believe that it is. Apple has so far lagged behind other technology giants in earning revenues from the booming market for data. It may yet strike gold in the most sensitive personal-data category of all.
谷歌和微软早前试图给病人提供一个住所进行数字病例采集，让人们思考他们自己是不是真的足够信任这两家公司，很多人觉得是不够信任的。如果他们只是要想他们的iPhone是不是有足够的安全保障，那很多人会相信手机是有足够保障的。目前，苹果从繁荣的数据市场上的盈利落后于其他科技公司巨头，但是它或许在最为敏感的个人数据方面却有丰富的资源。
编译：彭展峰
编辑：翻吧
来源：经济学人（2018.02.03）
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