Project Nightingale

Purpose of Project Nightingale

Ascension began working with Google to improve its patient care system. The healthcare organization wanted to centralize its electronic record-keeping processes by moving its data to the cloud. Ascension hoped that faster and easier access to patient information and enhanced data mining would help health care providers and benefit patients by, for example, providing additional ways to discover different tests that could help diagnose patients.

Patents filed in 2018 show that Google hopes to use Ascension's collection of medical data to create tools that can identify and predict health concerns before a patient has even visited a doctor using emergent medical data (EMD). EMD is health information gathered by artificial intelligence (AI) from consumer interactions with technology. Organizations are supporting the use of EMD because it can turn nonmedical data into sensitive health information.

Google hopes to use its partnership with Ascension to create the framework for a product which it can sell to other health systems. The corporation claims its end goal is to develop a comprehensive Google search tool that can collect and store a health system's diverse patient data in one place. The tech corporation also hopes to use advancements in AI and machine learning to create tools that focus on individual patients and suggest changes to their care.

Who Project Nightingale affects

The Ascension health system operates more than 2,600 patient care sites -- including more than 50 senior living facilities and 150 hospitals -- and the organization includes approximately 150,000 associates and 40,000 aligned providers. Ascension currently has branches in 20 U.S. states and the District of Columbia. The records of over 50 million Ascension patients have been released to Google through Project Nightingale. At least 150 Google employees have gained access to these medical records.

How Project Nightingale works

Through Project Nightingale, Google is allowed access to the data of the Ascension healthcare network. In return, Ascension is provided access to any new software and services created by Google, such as its developing, centralized search tool that collects all PHI into one place and can be integrated into electronic health record (EHR) systems.

When Ascension patients check into their doctor's office, hospital or senior care center, their examination results are entered into a computer by a doctor or nurse and then uploaded to Google's cloud servers. This data is then used by Google to create new tools and software.

The access that Google has been granted amounts to the complete health records of over 50 million patients. The shared data includes the following:

• patient names
• patient birthdates
• patient and family member addresses
• lab results
• diagnoses
• hospitalization records
• allergies
• immunizations
• medications
• existing medical conditions
• radiology scans

Concerns

Most of the concerns that have been raised about Project Nightingale focus on patient privacy. Ascension health care providers were not informed that the medical records of their patients were being distributed, and the patients never provided consent. Doubts have been raised regarding the security of the initiative and concerned individuals have questioned what precautions have been put in place to protect patients.

The lack of transparency creates the biggest ethical challenge for the Google-Ascension partnership. Some people don't believe Google will use the collected PHI to cure diseases or improve the healthcare industry, and patients are upset by the inability to refuse involvement if they do not want their information shared.

This is not the first time Google has drawn criticism for failing to protect user and data privacy. Google has previously addressed user data leaks in their now-obsolete Google+ networking website and with YouTube -- a subsidiary of Google.

Other concerns have been raised in relation to the Health Insurance Portability and Accountability Act (HIPAA). While many people believe HIPAA prevents health care providers from sharing their PHI, it can, in fact, do the opposite. Business associate agreements are contracts that allow organizations covered by HIPAA to share their patients' medical records with third parties to improve processes closely related to health care -- for example, to enhance practice management or quality assurance (QA).

While the business associate agreement should prohibit Google from proceeding to use Ascension's medical records for marketing and other purposes outside of research and development (R&D), some people are concerned that the contract's rules are too vague and out of date. Worry is rising over whether business associate agreements can still be applied to the current data-focused tech landscape.

Benefits

Google and Ascension have expressed end goals that can benefit health systems, improve clinical quality and increase patient safety. Using the massive amount of medical data it has access to, Google can train AI to comb through patient records to identify phrases, words and other variables that might indicate the early onset or presence of a specific disease.

A concept that is gaining popularity in health IT is the learning healthcare system (LHS). LHS is a system that captures new knowledge and aligns science, incentives, culture and health informatics with continuous improvement and innovation, while also embedding best practices into delivery processes. LHSes have the potential to quickly learn from patient care data and use the gathered knowledge to improve future care. LHSes require sophisticated IT platforms that can pull knowledge from existing evidence and countless treatment records.

The expressed goals of Project Nightingale seem to align with the LHS concept. Therefore, tech advancements made through Project Nightingale could ultimately improve LHSes and advance overall patient care.

Another benefit of Project Nightingale is its potential to improve health equity. Minorities and pregnant women are often underrepresented in research studies. This has led to the concern that medical knowledge might not be as pertinent to these patients. Since Project Nightingale receives unfiltered data from a variety of Ascension patients, it has the potential to improve the knowledge of what treatments and procedures are most effective and safe for minority patient populations.

History of Project Nightingale

Healthcare has always been a focus for Google. In 2008, it introduced Google Health -- a PHI digitization and centralization service. The tool was discontinued in 2011 after three years of minimal adoption, but the Google Health division continues to remain active.

In 2018, Google and Ascension began work on Project Nightingale. The secret project remained hidden until Nov. 11, 2019, when The Wall Street Journal published an article revealing the existence of Project Nightingale. This exposure came just 12 days after Google announced its acquisition of Fitbit -- a company that produces wearable devices for tracking activity and health data, like sleep schedules, heart rates and diets.

News of the Fitbit acquisition had already started to raise concerns about the extent of information Google had access to. Soon after publication of the Wall Street Journal article, the U.S. Department of Health and Human Services' (HHS) Office for Civil Rights (OCR) opened an investigation into the Google-Ascension partnership to learn more about the mass collection of personal health records and to ensure that the project is fully in compliance with HIPAA regulations. Several prominent U.S. legislators also issued statements criticizing the actions of both Google and Ascension.

A whistleblower also came forward soon after the Wall Street Journal article to warn that Project Nightingale gave Google employees access to confidential patient data. The whistleblower revealed that several Google employees involved in the project had already raised concerns about patient privacy.

As recently as January 2020, Google Health Vice President Daniel Feinberg continues to publicly support the company and defend the initiatives it's taking with Project Nightingale.