Kindly Care scores $5.4 million to vet and place caregivers, then help families pay them correctly

There are roughly 45 million unpaid eldercare providers in the United States, according to the 2016 U.S. Census Bureau. It’s tough on these family caregivers, many of whom are working women who are also raising their own children.

There are alternatives. For example, there is no shortage of agencies willing to place a rotating cast of caregivers into the homes of the elderly, though they can be prohibitively expensive for many families. There are also upstarts trying to address the challenge — and opportunity — that an aging American population presents. One startup, Honor, places full-time employees in the homes of seniors with an eye on maintaining a consistent experience for the seniors with whom they work. Another, HomeHero, partners with hospitals to connect home care providers to patients. (It also has a mobile app that helps family members monitor the health of those under HomeHero’s care.)

Now, another startup in the space, three-year-old San Francisco-based Kindly Care, is taking more of a marketplace approach, pairing vetted caregivers with families who need them, then helping both sides manage their financial and tax arrangements by acting as their back-office provider.

The company, as with many similar companies, was born largely out of the need of its founder and CEO Igor Lebovic, a native of Croatia who’d moved to the U.S. to nab two aerospace engineering degrees, and never moved home, instead starting a company with a college co-founder. They later sold their startup to About.com, then a property of The New York Times. But while it was a happy outcome for Lebovic, he worried about his parents, thousands of miles away, as the realization set in that he would likely never again be as available to them as he was when they lived in close proximity.

“Like a lot of people who leave their parents behind, it’s one of those things that I’ve wondered about over time. We don’t have a lot of plans for our parents, and there’s this guilt.”

Whether the 12-person company eventually expands into Europe at some point is a distant unknown, but Kindly Care seems to be resonating with caregivers in the U.S. According to Lebovic, more than 100,000 caregivers have registered with the platform in hopes of finding an assignment through it, and 20,000 people have been fully vetted and are now available to contact through the platform, ranging from people who specialize in memory care; to specialized nursing; to dressing, bathing and personal care; to transportation and more.

Based on their specific needs, families can then scan interviews and videos of caregivers in their area, and  settle on an hourly wage that’s acceptable on both sides. (Most families pay between $15 and $18 an hour, says Lebovic.) After that, Kindly Care essentially sets up a payroll for the family that ensures that payments and tax withholdings are compliant based on the state of operation.

What Kindly Care gets in exchange is a commission based on the dollars spent on its platform. Families who pay for live-in help are essentially paying the company 20 percent of the hourly wages they provide their caregivers; for caregivers who don’t live with their clients, Kindly Care takes a 25 percent cut.

It may sound steep, but Lebovic argues that it has to do a lot of heavy lifting on the front end to ensure that caregivers are who they say they are, and that they operate in a way that’s compliant with local labor laws. (All that help it provides on the administrative front is presumably pretty sticky, too.) Kindly Care is also more affordable than traditional live-in-care, he says, and it’s a much better alternative to posting an ad on Craigslist and hoping for the best.

Investors agree. Kindly Care just completed a $5.4 million Series A funding round led by Javelin Venture Partners, with participation from MHS Capital and Jackson Square Ventures . Altogether, the company has now raised $9.5 million.

Asked what Kindly Care will do with its fresh capital, Lebovic is clear. “Right now we’re geographically spread out across five states,” including California and Ohio. “Now, with the help of our new funding, we plan to expand to all 50.”

Gear for making outdoor fitness more enjoyable

Editor’s note: This post was done in partnership with Wirecutter. When readers choose to buy Wirecutter’s independently chosen editorial picks, Wirecutter and TechCrunch earn affiliate commissions.     

Exercising outdoors comes with space, terrain and, if you’re lucky, a nice breeze that you don’t get in a gym. While fitness fanatics care most about completing a good workout, having the right gear to help with keeping track of progress — and getting on with your day when you’re done — makes a big difference.

We’ve gathered some of our favorite fitness wearables, headphones and accessories that improve and make outdoor workout routines more enjoyable.

Running headphones: Plantronics BackBeat Fit

We’ve tested 31 pairs of running headphones and for two years the Plantronics BackBeat Fit has remained our top recommendation. The ergonomics and comfort that the BackBeat Fit offer is impressive and they’re built to combat sweat, dust and rain. The cable that connects the earbuds is accommodating for heads of all sizes and it won’t bounce around or be an annoyance while you work out. Jogging at night or in a busy neighborhood will be a bit safer and easier to navigate as the BackBeat Fit has unsealed earbuds that are designed to allow you to hear your surroundings.

Everything I fit into my Arkel Bug for a day of working away from home. (Photo: Eve O’Neill)

Backpack pannier: Arkel Bug Pannier Backpack

Bike riding is a form of exercise that’s enjoyable for many. A bike is also a convenient mode of transportation, and equipping it with gear like a bike lock, rear rack and pannier can make heading out on the trail even more worthwhile. If in-between or after your ride you’d prefer to run errands, hang out or work, we recommend carrying your belongings in the Arkel Bug Pannier Backpack.

It’s spacious and has mesh material that repels water. We like that it’s durable enough to hold heavier items and it has a deep back pocket that’s big enough for a road or urban style helmet.                                                                                                                 

The Forerunner 235 (front) is thinner and sits more evenly on your wrist than its predecessor, the Forerunner 225.

GPS Running Watch: Garmin Forerunner 235

The ease of operating the Garmin Forerunner 235 makes it a great GPS running watch for beginners. Its optional apps and ability to track advanced metrics makes it great for experienced runners. You’ll be able to use data to create and follow customized workouts, as well as review details about intensity and volume.

The FR 235 delivers heart-rate tracking without the use of a chest strap and it isn’t as bulky as previous generations. Its Auto Pause feature helps with accurately tracking pace and running data when you make stops (i.e. at an intersection) during runs.

The Garmin Vivosport is the most versatile and accurate tracker we’ve found. (Photo: Michael Hession)

Fitness tracker: Garmin Vivosport

For a simple rundown of your heart rate, the number of steps you’ve taken and the distance you’ve traveled, a fitness tracker will do the trick. Our top pick, the Garmin Vivosport, has optional GPS tracking capabilities, accurate stats and overall solid performance that places it above a standard fitness tracker.

If keeping your phone on you for listening to music is a must, you can use the Vivosport to control playback and receive notifications. It measures stress levels, tracks sleep and automatically detects activity. When you’re lifting weights without a buddy, its strength-training mode can be enabled to do rep counting for you.

Photo: Kyle Fitzgerald

Water bottle: Klean Kanteen Classic 27-ounce stainless-steel bottle with 3.0 Sport Cap

Whether your workout consists of high-intensity cardio or a casual walk in the park, it’s important to stay hydrated. Bringing along a light, durable water bottle means you won’t have to find a place to grab a drink and you’ll have a handy go-to when you need a refresher.

The Klean Kanteen Classic 27-Ounce Stainless Steel Bottle with 3.0 Sport Cap is our top pick for a steel water bottle because it’s easy to clean, has swappable caps and, more importantly, less than favorable tastes and smells don’t linger around. Its 1¾-inch mouth is big enough to fit ice cubes but not so big that water will spill on your new shoes if you take a sip while running.

This guide may have been updated by WirecutterNote from Wirecutter: When readers choose to buy our independently chosen editorial picks, we may earn affiliate commissions that support our work.

Facebook tests 30-day keyword snoozing to fight spoilers, triggers

Don’t want to know the ending to a World Cup game or Avengers movie until you’ve watched it, or just need to quiet an exhausting political topic like “Trump”? Facebook is now testing the option to “snooze” specific keywords so you won’t see them for 30 days in News Feed or Groups. The feature is rolling out to a small percentage of users today. It could make people both more comfortable browsing the social network when they’re trying to avoid something, and not feel guilty posting about sensitive topics.

The feature was first spotted in the Facebook’s app’s code by Chris Messina on Sunday, who told TechCrunch he found a string for “snooze keywords for 30 days”. We reached out to Facebook on Monday, which didn’t initially respond, but last night provided details we could publish at 5am this morning ahead of an official announcement later today. The test follows the roll out of snoozing people, Pages, and Groups from last December.

To snooze a keyword, you first have to find a post that includes it. That kind of defeats the whole purpose since you might run into the spoiler you didn’t want to see. But when asked about that problem, a Facebook spokesperson told me the company is looking into adding a preemptive snooze option in the next few weeks, potentially in News Feed Preferences. It’s also considering a recurring snooze list so you could easily re-enable hiding your favorite sports team before any game you’ll have to watch on delay.

For now, though, when you see the word you can hit the drop-down arrow on the post which will reveal an option to “snooze keywords in this post”. Tapping that reveals a list of nouns from the post you might want to nix, without common words like “the” in the way. So if you used the feature on a post that said “England won its World Cup game against Tunisia! Yes!”, the feature would pull out “World Cup”, “England”, and “Tunisia”. Select all that you want to snooze, and posts containing them will be hidden for a month. Currently, the feature only works on text, not images, and won’t suggest synonyms you might want to snooze as well.

The spokesperson says the feature “was something that kept coming up” in Facebook interviews with users. The option applies to any organic content, but you can’t block ads with it, so if you snoozed “Deadpool” you wouldn’t see posts from friends about the movie but still might see ads to buy tickets. Facebook’s excuse for this is that ads belong to a “a separate team, separate algorithm” but surely it just doesn’t want to open itself up to users mass-blocking its revenue driver. The spokesperson also said that snoozing isn’t currently being used for other content and ad targeting purposes.

We asked why users can’t permanently mute keywords like Twitter launched in November 2016, or the way Instagram launched keyword blocking for your posts’ comments in September 2016. Facebook says “If we’re hearing from people that they want more or less time” that might get added as the feature rolls out beyond a test. There is some sense to defaulting to only temporary muting, as users might simply forget they blocked their favorite sports team before a big game, and then wouldn’t see it mentioned forever after.

But when it comes to abuse, permanent muting is something Facebook really should offer. Instead it’s relied on users flagging abuse like racial slurs, and it recently revealed its content moderation guidelines. Some topics that are fine for others could be tough for certain people to see, though, and helping users prevent trauma probably deserves to be prioritized above stopping reality TV spoilers.

This smart prosthetic ankle adjusts to rough terrain

Prosthetic limbs are getting better and more personalized, but useful as they are, they’re still a far cry from the real thing. This new prosthetic ankle is a little closer than others, though: it moves on its own, adapting to its user’s gait and the surface on which it lands.

Your ankle does a lot of work when you walk: lifting your toe out of the way so you don’t scuff it on the ground, controlling the tilt of your foot to minimize the shock when it lands or as you adjust your weight, all while conforming to bumps and other irregularities it encounters. Few prostheses attempt to replicate these motions, meaning all that work is done in a more basic way, like the bending of a spring or compression of padding.

But this prototype ankle from Michael Goldfarb, a mechanical engineering professor at Vanderbilt, goes much further than passive shock absorption. Inside the joint are a motor and actuator, controlled by a chip that senses and classifies motion and determines how each step should look.

“This device first and foremost adapts to what’s around it,” Goldfarb said in a video documenting the prosthesis.

“You can walk up slopes, down slopes, up stairs and down stairs, and the device figures out what you’re doing and functions the way it should,” He added in a news release from the university.

When it senses that the foot has lifted up for a step, it can lift the toe up to keep it clear, also exposing the heel so that when the limb comes down, it can roll into the next step. And by reading the pressure both from above (indicating how the person is using that foot) and below (indicating the slope and irregularities of the surface) it can make that step feel much more like a natural one.

One veteran of many prostheses, Mike Sasser, tested the device and had good things to say: “I’ve tried hydraulic ankles that had no sort of microprocessors, and they’ve been clunky, heavy and unforgiving for an active person. This isn’t that.”

Right now the device is still very lab-bound, and it runs on wired power — not exactly convenient if someone wants to go for a walk. But if the joint works as designed, as it certainly seems to, then powering it is a secondary issue. The plan is to commercialize the prosthesis in the next couple years once all that is figured out. You can learn a bit more about Goldfarb’s research at the Center for Intelligent Mechatronics.

With CBD, marijuana-based medicine gets its first greenlight from the FDA

In a news release today, the FDA announced its approval of a marijuana-derived drug called Epidiolex for the treatment of seizures in a subset of patients suffering from severe epilepsy. Epidiolex contains CBD, a cannabis chemical compound skyrocketing in popularity and driving what is estimated to have doubled into a $200 million market in 2018.

CBD is the common abbreviation for cannabidiol, a chemical derived from cannabis. In contrast to THC, the far more popular cannabinoid CBD does not produce strong psychoactive effects when consumed. The chemical’s use in seizure prevention is well-documented in reputable research, and now, after conducting its own trials, the FDA is on board.

As the FDA itself notes, “this is the first FDA-approved drug that contains a purified drug substance derived from marijuana.” Epidiolex, produced by GW Research Ltd., is now approved to treat the conditions known as Lennox-Gastaut syndrome and Dravet syndrome.

The FDA news signals that the DEA will likely adjust its scheduling for CBD, which is currently a Schedule I substance, denoting high potential for abuse and no medical applications.

“The FDA prepares and transmits… a medical and scientific analysis of substances subject to scheduling, like CBD, and provides recommendations to the Drug Enforcement Administration (DEA) regarding controls under the [Controlled Substances Act],” the FDA stated, indicating that it will recommend that CBD be rescheduled but the act of shifting the substance’s legality is ultimately in the DEA’s hands.

Prior to the FDA decision, a press officer for the DEA confirmed to Leafly that the FDA decision will prompt action from the DEA. “If they on June 27 announce that they’re approving Epidiolex, absolutely we’ll go into a different schedule. There’s no ifs, ands, or buts about it.”

The FDA notes that it will still “take action” against illegal CBD products making “serious, unproven medical claims.”

The medicinal acknowledgment of CBD should come as good news to marijuana startups eyeing the compound for consumer and medical consumption. Cannabis-derived CBD products are available where recreational marijuana is sold, though CBD derived from industrial hemp faces fewer regulations and is even stocked by some grocery stores.

By some measures, consumer interest appears to be moving away from traditional high-potency THC-based products and toward CBD. In February, even Bon Appétit magazine got in on the trend with a story titled “What Is CBD, and Why Is It in Everything Right Now?” Cannabis startups are likely tuned into that fact and keeping an ear to the ground for the DEA decision on what by most accounts is the next big thing in cannabis.

AARP commits $60 million to a fund backing new treatments for dementia

Dementia, the syndrome caused by several brain illnesses affecting memory, motor skills, thinking and behavior, affects 47 million people around the world and is projected to afflict 75 million by 2030, according to the World Health Organization.

It’s a syndrome that’s not only debilitating for the people who live with it but also for their families and caregivers. According to statistics from WHO the economic cost of dementia is roughly $818 billion.

Yet, it’s also one that’s the most poorly understood by researchers. Now, thanks to a $60 million commitment from the US AARP, a London-based fund has closed with $350 million to invest in new medicines to combat dementia and its underlying illnesses.

Initially formed by the UK Department of Health and Social Care and the charity Alzheimer’s Research UK (ARUK) alongside a consortium of pharmaceutical companies, including Biogen, Eli Lilly and Company, GSK, Johnson & Johnson, Otsuka (Astex), Pfizer and Takeda, the Dementia Discovery Fund had initially targeted $200 million to invest in new treatments.

Commitments from other wealthy individuals (like Bill Gates) and interested organizations like (ahem) the NFL Players Association, and UnitedHealth Group helped round out the commitments to get the fund closed at its $350 million hard cap.

Founded in October, 2015 by SV Health Investors, a venture capital and growth equity firm with offices in London and Boston and roughly $2.5 billion under management, the Dementia Discovery Fund has already invested in 16 companies in the U.S. and the U.K. focused on microglial biology and inflammation, mitochondrial dynamics, trafficking and membrane biology and synaptic physiology and functions.

“At the DDF, we are focused on scientific approaches that look beyond the amyloid beta pathway into other areas, such as inflammation, mitochondrial function and the preservation and enhancement of healthy brain cells,” said Kate Bingham, managing partner of SV Health Investors, in a statement. “These areas are highly likely to be important to chronic traumatic encephalopathy or traumatic brain injury, leading to renewed hope for treatment of these terrible disorders.”

For the AARP, the investment in finding cures for dementia is central to the nonprofit’s mission going forward, according to chief executive Jo Ann Jenkins. “Dementia doesn’t just affect those with the disease. It takes a devastating emotional, physical and financial toll on families and caregivers. The projected doubling of the size of the 65+ population over the next generation makes finding new ways to treat dementia, including Alzheimer’s, even more critical,” she said.

Facebook prototypes tool to show how many minutes you spend on it

Are you ready for some scary numbers? After months of Mark Zuckerberg talking about how “Protecting our community is more important than maximizing our profits,” Facebook is preparing to turn that commitment into a Time Well Spent product.

Buried in Facebook’s Android app is an unreleased “Your Time on Facebook” feature. It shows the tally of how much time you spent on the Facebook app on your phone on each of the last seven days, and your average time spent per day. It lets you set a daily reminder that alerts you when you’ve reached your self-imposed limit, plus a shortcut to change your Facebook notification settings.

Facebook confirmed the feature development to TechCrunch, with a spokesperson telling us, “We’re always working on new ways to help make sure people’s time on Facebook is time well spent.”

The feature could help Facebook users stay mindful of how long they’re staring at the social network. This self-policing could be important since both iOS and Android are launching their own screen time monitoring dashboards that reveal which apps are dominating your attention and can alert you or lock you out of apps when you hit your time limit. When Apple demoed the feature at WWDC, it used Facebook as an example of an app you might use too much.

Images of Facebook’s digital wellbeing tool come courtesy of our favorite tipster and app investigator Jane Manchun Wong. She previously helped TechCrunch scoop the development of features like Facebook Avatars, Twitter encrypted DMs and Instagram Usage Insights — a Time Well Spent feature that looks very similar to this one on Facebook.

Our report on Instagram Usage Insights led the sub-company’s CEO Kevin Systrom to confirm the upcoming feature, saying “It’s true . . . We’re building tools that will help the IG community know more about the time they spend on Instagram – any time should be positive and intentional . . . Understanding how time online impacts people is important, and it’s the responsibility of all companies to be honest about this. We want to be part of the solution. I take that responsibility seriously.”

Facebook has already made changes to its News Feed algorithm designed to reduce the presence of low-quality but eye-catching viral videos. That led to Facebook’s first-ever usage decline in North America in Q4 2017, with a loss of 700,000 daily active users in the region. Zuckerberg said on an earnings call that this change “reduced time spent on Facebook by roughly 50 million hours every day.”

Zuckerberg has been adamant that all time spent on Facebook isn’t bad. Instead, as we argued in our piece “The difference between good and bad Facebooking,” its asocial, zombie-like passive browsing and video watching that’s harmful to people’s wellbeing, while active sharing, commenting and chatting can make users feel more connected and supported.

But that distinction isn’t visible in this prototype of the “Your Time on Facebook” tool, which appears to treat all time spent the same. If Facebook was able to measure our active versus passive time on its app and impress the health difference, it could start to encourage us to either put down the app or use it to communicate directly with friends when we find ourselves mindlessly scrolling the feed or enviously viewing people’s photos.

‘Gaming disorder’ is officially recognized by the World Health Organization

Honestly, “gaming disorder” sounds like a phrase tossed around by irritated parents and significant others. After much back and forth, however, the term was just granted validity, as the World Health Organization opted to include it in the latest edition of its Internal Classification of Diseases.

The volume, out this week, diagnoses the newly minted disorder with three key telltale signs:

  1. Impaired control over gaming (e.g. onset, frequency, intensity, duration, termination, context)
  2. Increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities
  3. Continuation or escalation of gaming despite the occurrence of negative consequences

I can hear the collective sound of many of my friends gulping at the sound of eerily familiar symptoms. Of course, the disorder has been criticized from a number of corners, including health professionals who have written it off as being overly broad and subjective. And, of course, the potential impact greatly differs from person to person and game to game.

The effects as specified above share common ground with other similar addictive activities defined by the WHO, including gambling disorder:

“Disorders due to addictive behaviours are recognizable and clinically significant syndromes associated with distress or interference with personal functions that develop as a result of repetitive rewarding behaviours other than the use of dependence-producing substances,” writes the WHO. “Disorders due to addictive behaviors include gambling disorder and gaming disorder, which may involve both online and offline behaviour.”

In spite of what may appear to be universal symptoms, however, the organization is quick to note that the prevalence of gaming disorder, as defined by the WHO, is actually “very low.” WHO member Dr. Vladimir Poznyak tells CNN, “Millions of gamers around the world, even when it comes to the intense gaming, would never qualify as people suffering from gaming disorder.”

First look at Instagram’s self-policing Time Well Spent tool

Are you Overgramming? Instagram is stepping up to help you manage overuse rather than leaving it to iOS and Android’s new screen time dashboards. Last month after TechCrunch first reported Instagram was prototyping a Usage Insights feature, the Facebook sub-company’s CEO Kevin System confirmed its forthcoming launch.

Tweeting our article, Systrom wrote “It’s true . . . We’re building tools that will help the IG community know more about the time they spend on Instagram – any time should be positive and intentional . . . Understanding how time online impacts people is important, and it’s the responsibility of all companies to be honest about this. We want to be part of the solution. I take that responsibility seriously.”

Now we have our first look at the tool via Jane Manchun Wong, who’s recently become one of TechCrunch’s favorite sources thanks to her skills at digging new features out of apps’ Android APK code. Though Usage Insights might change before an official launch, these screenshots give us an idea of what Instagram will include. We’ve reached out to Instagram for comment, and will update if we hear back.

This unlaunched version of Instagram’s Usage Insights tool offers users a daily tally of their minutes spent on the app. They’ll be able to set a time spent daily limit, and get a reminder once they exceed that. There’s also a shortcut to manage Instagram’s notifications so the app is less interruptive. Instagram has been spotted testing a new hamburger button that opens a slide-out navigation menu on the profile. That might be where the link for Usage Insights shows up, judging by this screenshot.

Instagram doesn’t appear to be going so far as to lock you out of the app after your limit, or fading it to grayscale which might annoy advertisers and businesses. But offering a handy way to monitor your usage that isn’t buried in your operating system’s settings could make users more mindful.

Instagram has an opportunity to be a role model here, especially if it gives its Usage Insights feature sharper teeth. For example,  rather than a single notification when you hit your daily limit, it could remind you every 15 minutes after, or create some persistent visual flag so you know you’ve broken your self-imposed rule.

Instagram has already started to push users towards healthier behavior with a “You’re all caught up” notice when you’ve seen everything in your feed and should stop scrolling.

I expect more apps to attempt to self-police with tools like these rather than leaving themselves at the mercy of iOS’s Screen Time and Android’s Digital Wellbeing features that offer more drastic ways to enforce your own good intentions.

Both let you see overall usage of your phone and stats about individual apps. iOS lets you easily dismiss alerts about hitting your daily limit in an app but delivers a weekly usage report (ironically via notification), while Android will gray out an app’s icon and force you to go to your settings to unlock an app once you exceed your limit.

For Android users especially, Instagram wants to avoid looking like such a time sink that you put one of those hard limits on your use. In that sense, self-policing shows both empathy for its users’ mental health, but is also a self-preservation strategy. With Instagram slated to launch a long-form video hub that could drive even longer session times this week, Usage Insights could be seen as either hypocritical or more necessary than ever.

New time management tools coming to iOS (left) and Android (right). Images via The VergeInstagram is one of the world’s most beloved apps, but also one of the most easily abused. From envy spiraling as you watch the highlights of your friends’ lives to body image issues propelled by its endless legions of models, there are plenty of ways to make yourself feel bad scrolling the Insta feed. And since there’s so little text, no links, and few calls for participation, it’s easy to zombie-browse in the passive way research shows is most dangerous.

We’re in a crisis of attention. Mobile app business models often rely on maximizing our time spent to maximize their ad or in-app purchase revenue. But carrying the bottomless temptation of the Internet in our pockets threatens to leave us distracted, less educated, and depressed. We’ve evolved to crave dopamine hits from blinking lights and novel information, but never had such an endless supply.

There’s value to connecting with friends by watching their days unfold through Instagram and other apps. But tech giants are thankfully starting to be held responsible for helping us balance that with living our own lives.

UK report warns DeepMind Health could gain ‘excessive monopoly power’

DeepMind’s foray into digital health services continues to raise concerns. The latest worries are voiced by a panel of external reviewers appointed by the Google-owned AI company to report on its operations after its initial data-sharing arrangements with the U.K.’s National Health Service (NHS) ran into a major public controversy in 2016.

The DeepMind Health Independent Reviewers’ 2018 report flags a series of risks and concerns, as they see it, including the potential for DeepMind Health to be able to “exert excessive monopoly power” as a result of the data access and streaming infrastructure that’s bundled with provision of the Streams app — and which, contractually, positions DeepMind as the access-controlling intermediary between the structured health data and any other third parties that might, in the future, want to offer their own digital assistance solutions to the Trust.

While the underlying FHIR (aka, fast healthcare interoperability resource) deployed by DeepMind for Streams uses an open API, the contract between the company and the Royal Free Trust funnels connections via DeepMind’s own servers, and prohibits connections to other FHIR servers. A commercial structure that seemingly works against the openness and interoperability DeepMind’s co-founder Mustafa Suleyman has claimed to support.

There are many examples in the IT arena where companies lock their customers into systems that are difficult to change or replace. Such arrangements are not in the interests of the public. And we do not want to see DeepMind Health putting itself in a position where clients, such as hospitals, find themselves forced to stay with DeepMind Health even if it is no longer financially or clinically sensible to do so; we want DeepMind Health to compete on quality and price, not by entrenching legacy position,” the reviewers write.

Though they point to DeepMind’s “stated commitment to interoperability of systems,” and “their adoption of the FHIR open API” as positive indications, writing: “This means that there is potential for many other SMEs to become involved, creating a diverse and innovative marketplace which works to the benefit of consumers, innovation and the economy.”

“We also note DeepMind Health’s intention to implement many of the features of Streams as modules which could be easily swapped, meaning that they will have to rely on being the best to stay in business,” they add. 

However, stated intentions and future potentials are clearly not the same as on-the-ground reality. And, as it stands, a technically interoperable app-delivery infrastructure is being encumbered by prohibitive clauses in a commercial contract — and by a lack of regulatory pushback against such behavior.

The reviewers also raise concerns about an ongoing lack of clarity around DeepMind Health’s business model — writing: “Given the current environment, and with no clarity about DeepMind Health’s business model, people are likely to suspect that there must be an undisclosed profit motive or a hidden agenda. We do not believe this to be the case, but would urge DeepMind Health to be transparent about their business model, and their ability to stick to that without being overridden by Alphabet. For once an idea of hidden agendas is fixed in people’s mind, it is hard to shift, no matter how much a company is motivated by the public good.”

We have had detailed conversations about DeepMind Health’s evolving thoughts in this area, and are aware that some of these questions have not yet been finalised. However, we would urge DeepMind Health to set out publicly what they are proposing,” they add. 

DeepMind has suggested it wants to build healthcare AIs that are capable of charging by results. But Streams does not involve any AI. The service is also being provided to NHS Trusts for free, at least for the first five years — raising the question of how exactly the Google-owned company intends to recoup its investment.

Google of course monetizes a large suite of free-at-the-point-of-use consumer products — such as the Android mobile operating system; its cloud email service Gmail; and the YouTube video sharing platform, to name three — by harvesting people’s personal data and using that information to inform its ad targeting platforms.

Hence the reviewers’ recommendation for DeepMind to set out its thinking on its business model to avoid its intentions vis-a-vis people’s medical data being viewed with suspicion.

The company’s historical modus operandi also underlines the potential monopoly risks if DeepMind is allowed to carve out a dominant platform position in digital healthcare provision — given how effectively its parent has been able to turn a free-for-OEMs mobile OS (Android) into global smartphone market OS dominance, for example.

So, while DeepMind only has a handful of contracts with NHS Trusts for the Streams app and delivery infrastructure at this stage, the reviewers’ concerns over the risk of the company gaining “excessive monopoly power” do not seem overblown.

They are also worried about DeepMind’s ongoing vagueness about how exactly it works with its parent Alphabet, and what data could ever be transferred to the ad giant — an inevitably queasy combination when stacked against DeepMind’s handling of people’s medical records.

“To what extent can DeepMind Health insulate itself against Alphabet instructing them in the future to do something which it has promised not to do today? Or, if DeepMind Health’s current management were to leave DeepMind Health, how much could a new CEO alter what has been agreed today?” they write.

“We appreciate that DeepMind Health would continue to be bound by the legal and regulatory framework, but much of our attention is on the steps that DeepMind Health have taken to take a more ethical stance than the law requires; could this all be ended? We encourage DeepMind Health to look at ways of entrenching its separation from Alphabet and DeepMind more robustly, so that it can have enduring force to the commitments it makes.”

Responding to the report’s publication on its website, DeepMind writes that it’s “developing our longer-term business model and roadmap.”

“Rather than charging for the early stages of our work, our first priority has been to prove that our technologies can help improve patient care and reduce costs. We believe that our business model should flow from the positive impact we create, and will continue to explore outcomes-based elements so that costs are at least in part related to the benefits we deliver,” it continues.

So it has nothing to say to defuse the reviewers’ concerns about making its intentions for monetizing health data plain — beyond deploying a few choice PR soundbites.

On its links with Alphabet, DeepMind also has little to say, writing only that: “We will explore further ways to ensure there is clarity about the binding legal frameworks that govern all our NHS partnerships.”

“Trusts remain in full control of the data at all times,” it adds. “We are legally and contractually bound to only using patient data under the instructions of our partners. We will continue to make our legal agreements with Trusts publicly available to allow scrutiny of this important point.”

“There is nothing in our legal agreements with our partners that prevents them from working with any other data processor, should they wish to seek the services of another provider,” it also claims in response to additional questions we put to it.

We hope that Streams can help unlock the next wave of innovation in the NHS. The infrastructure that powers Streams is built on state-of-the-art open and interoperable standards, known as FHIR. The FHIR standard is supported in the UK by NHS Digital, NHS England and the INTEROPen group. This should allow our partner trusts to work more easily with other developers, helping them bring many more new innovations to the clinical frontlines,” it adds in additional comments to us.

“Under our contractual agreements with relevant partner trusts, we have committed to building FHIR API infrastructure within the five year terms of the agreements.”

Asked about the progress it’s made on a technical audit infrastructure for verifying access to health data, which it announced last year, it reiterated the wording on its blog, saying: “We will remain vigilant about setting the highest possible standards of information governance. At the beginning of this year, we appointed a full time Information Governance Manager to oversee our use of data in all areas of our work. We are also continuing to build our Verifiable Data Audit and other tools to clearly show how we’re using data.”

So developments on that front look as slow as we expected.

The Google-owned U.K. AI company began its push into digital healthcare services in 2015, quietly signing an information-sharing arrangement with a London-based NHS Trust that gave it access to around 1.6 million people’s medical records for developing an alerts app for a condition called Acute Kidney Injury.

It also inked an MoU with the Trust where the pair set out their ambition to apply AI to NHS data sets. (They even went so far as to get ethical signs-off for an AI project — but have consistently claimed the Royal Free data was not fed to any AIs.)

However, the data-sharing collaboration ran into trouble in May 2016 when the scope of patient data being shared by the Royal Free with DeepMind was revealed (via investigative journalism, rather than by disclosures from the Trust or DeepMind).

None of the ~1.6 million people whose non-anonymized medical records had been passed to the Google-owned company had been informed or asked for their consent. And questions were raised about the legal basis for the data-sharing arrangement.

Last summer the U.K.’s privacy regulator concluded an investigation of the project — finding that the Royal Free NHS Trust had broken data protection rules during the app’s development.

Yet despite ethical questions and regulatory disquiet about the legality of the data sharing, the Streams project steamrollered on. And the Royal Free Trust went on to implement the app for use by clinicians in its hospitals, while DeepMind has also signed several additional contracts to deploy Streams to other NHS Trusts.

More recently, the law firm Linklaters completed an audit of the Royal Free Streams project, after being commissioned by the Trust as part of its settlement with the ICO. Though this audit only examined the current functioning of Streams. (There has been no historical audit of the lawfulness of people’s medical records being shared during the build and test phase of the project.)

Linklaters did recommend the Royal Free terminates its wider MoU with DeepMind — and the Trust has confirmed to us that it will be following the firm’s advice.

“The audit recommends we terminate the historic memorandum of understanding with DeepMind which was signed in January 2016. The MOU is no longer relevant to the partnership and we are in the process of terminating it,” a Royal Free spokesperson told us.

So DeepMind, probably the world’s most famous AI company, is in the curious position of being involved in providing digital healthcare services to U.K. hospitals that don’t actually involve any AI at all. (Though it does have some ongoing AI research projects with NHS Trusts too.)

In mid 2016, at the height of the Royal Free DeepMind data scandal — and in a bid to foster greater public trust — the company appointed the panel of external reviewers who have now produced their second report looking at how the division is operating.

And it’s fair to say that much has happened in the tech industry since the panel was appointed to further undermine public trust in tech platforms and algorithmic promises — including the ICO’s finding that the initial data-sharing arrangement between the Royal Free and DeepMind broke U.K. privacy laws.

The eight members of the panel for the 2018 report are: Martin Bromiley OBE; Elisabeth Buggins CBE; Eileen Burbidge MBE; Richard Horton; Dr. Julian Huppert; Professor Donal O’Donoghue; Matthew Taylor; and Professor Sir John Tooke.

In their latest report the external reviewers warn that the public’s view of tech giants has “shifted substantially” versus where it was even a year ago — asserting that “issues of privacy in a digital age are if anything, of greater concern.”

At the same time politicians are also gazing rather more critically on the works and social impacts of tech giants.

Although the U.K. government has also been keen to position itself as a supporter of AI, providing public funds for the sector and, in its Industrial Strategy white paper, identifying AI and data as one of four so-called “Grand Challenges” where it believes the U.K. can “lead the world for years to come” — including specifically name-checking DeepMind as one of a handful of leading-edge homegrown AI businesses for the country to be proud of.

Still, questions over how to manage and regulate public sector data and AI deployments — especially in highly sensitive areas such as healthcare — remain to be clearly addressed by the government.

Meanwhile, the encroaching ingress of digital technologies into the healthcare space — even when the techs don’t even involve any AI — are already presenting major challenges by putting pressure on existing information governance rules and structures, and raising the specter of monopolistic risk.

Asked whether it offers any guidance to NHS Trusts around digital assistance for clinicians, including specifically whether it requires multiple options be offered by different providers, the NHS’ digital services provider, NHS Digital, referred our question on to the Department of Health (DoH), saying it’s a matter of health policy.

The DoH in turn referred the question to NHS England, the executive non-departmental body which commissions contracts and sets priorities and directions for the health service in England.

And at the time of writing, we’re still waiting for a response from the steering body.

Ultimately it looks like it will be up to the health service to put in place a clear and robust structure for AI and digital decision services that fosters competition by design by baking in a requirement for Trusts to support multiple independent options when procuring apps and services.

Without that important check and balance, the risk is that platform dynamics will quickly dominate and control the emergent digital health assistance space — just as big tech has dominated consumer tech.

But publicly funded healthcare decisions and data sets should not simply be handed to the single market-dominating entity that’s willing and able to burn the most resource to own the space.

Nor should government stand by and do nothing when there’s a clear risk that a vital area of digital innovation is at risk of being closed down by a tech giant muscling in and positioning itself as a gatekeeper before others have had a chance to show what their ideas are made of, and before even a market has had the chance to form.