Google, Amazon, Microsoft and others have a long road ahead in healthcare

As tech giants start to forge paths into healthcare, they stand to put pressure on established healthcare IT firms to open up their systems and adopt data standards.

But change won't happen overnight, and these outsiders will need to adjust too, gaining access to healthcare data and making it useful while potentially moving at a slower pace than they're used to.

"They're not the first to try to solve this problem of interoperability, and to date, no one's had a lot of success," said Daniel Farris, a partner and chair of the technology group at the law firm Fox Rothschild. "But clearly, they're better positioned than most to solve the problem."

To succeed, these six companies will need to learn a whole new industry. Meanwhile, they'll bring a whole new mindset to that industry, one based on the widespread availability and sharing of data, Farris said.

"The tech companies tend to think about how else they can use the data, how they can use it for convenience and for cross-sales," Farris said. "That's just not something healthcare organizations or healthcare tech tends to look at."

Healthcare organizations tend to focus instead of more traditional business models that involve owning data but not necessarily moving it around. "These new companies are more platform business models where they create value by facilitating transactions which requires data to move with less friction," said Dr. James Woodson, CEO of Pulsara, which makes healthcare communication software.

Data is both a boon and a sticking point for outside tech companies. While they have experience moving around large amounts of data, they lack a lot of the specific healthcare data that healthcare companies like Epic and Cerner already have.

And they lack experience handling that data according to regulations, like HIPAA.

"Interoperability is about data more than apps, so that's a major challenge for them to actually be effective in bringing about this change," Farris said. "The way healthcare organizations address these things is almost completely opposite from the way the tech companies address these things."

While big tech companies happily share data—and sometimes share that data with nefarious actors, as with Facebook and Cambridge Analytica—healthcare companies are less generous. That's in part because they haven't had many incentives to open up their architectures to more easily share information, said Bob Fuller, managing partner with data consulting firm Clarity Insights.

"The big tech companies are stepping up in a big way to fill that void," Fuller said.

Healthcare companies and tech giants do have one major commonality in how they treat data transfers: standards. In their pledge, the six companies pointed specifically to open standards, such as FHIR, as a way to more easily exchange data.

Though the standard is much touted in the healthcare industry, many have yet to fully adopt it as a way to move data. The six tech companies are "sort of back-handedly saying the EHR companies are not moving fast enough and their APIs are not as robust as we need," said Nick Hatt, a senior developer at Redox, an interoperability-focused software company.

The entrance of these big tech companies could steer traditional vendors towards standards and more capable APIs.

"These big companies are happy to agree on something for a standard and then they can compete on implementation," Hatt said. "They're saying, 'we all agree that we're going to do it this way, so we can push the competition to the right place, which is actually on the AI models and cloud services."

FHIR is a way to get there. Once they have access to healthcare data, these companies could then use it for machine learning and AI models, including models for profiling patients, according to Dr. Shafiq Rab, CIO of Rush University Medical Center.

"If I can profile you, I can sell to you," Rab said.

Most of the companies were mum about their specific plans and did not provide comments. Oracle, though, said it would draw on its data management and healthcare software to drive change in the industry. "Our one unique differentiator is that we combine clinical, financial, genomics and administrative data in a single platform," said Andy Alasso, vice president of product management for Oracle Health Sciences.

Regardless of what they end up doing, as these six companies dive deeper into healthcare, they must be careful not to succumb to the woes IBM is facing with Watson Health, Fuller said. "Their marketing was way too far ahead of their capability," he said. "You should be visionary in where you're going but also pragmatic in what it takes to get there."

That means these companies might have to move slower than they're used to. "I think nothing dramatic is going to change in the next three to four years," Hatt said. "IBM got out ahead with Watson Health, and by all accounts it's been a disaster. The fail cycle for health systems is really long."

There's a big gap between healthcare developers and developers in the rest of tech, Hatt added. Because of that gap, the pledge plays an important part in showing that healthcare can act more like the tech industry, he said.

The pledge's impact will depend on how these six companies interact with existing healthcare firms, which still mostly rely on closed, on-premise systems.

"Healthcare vendors are in a much better position now based on the current technology to be able to focus on interoperability issues," Fuller said. "Legacy vendors need to come to grips with the fact that keeping closed systems is not going to be to their advantage."