Google Shutters Streams UK Clinician Support App

Google's Pattern of Product Discontinuation and its Impact on Healthcare

Google has gained a reputation for initiating projects and subsequently discontinuing them, often within a relatively short timeframe. While this practice is noticeable with consumer-facing applications like messaging apps and games, the company’s extensive reach now extends into critical areas impacting people’s lives.

This includes a significant presence within the healthcare sector. Unfortunately, Google’s tendency to abandon products extends to those previously promoted as potentially “life saving” by its public relations department.

Decommissioning of the Streams Clinician Support App

Recent restructuring within Google’s health division, as initially reported by Business Insider, has led to the confirmation that the Streams app is being decommissioned. This information was conveyed to TechCrunch by Google itself.

Developed in 2015 by DeepMind, Google’s artificial intelligence division, Streams was classified as a “mobile medical device”. It has been utilized by the U.K.’s National Health Service (NHS) for several years.

Numerous NHS Trusts entered into agreements with DeepMind Health to implement Streams for use by their clinical staff.

Current Usage and Previous Deployments

As of this writing, London’s Royal Free NHS Trust remains the sole organization still actively employing the app within its hospital network.

However, its continued use is likely limited, as Google is proceeding with the app’s termination – adding it to a growing list of discontinued Alphabet/Google products, including Google+ and Loon.

Other NHS Trusts previously utilizing Streams have already ceased its operation.

Trusts Ending Their Agreements

University College London NHS Trust confirmed to TechCrunch that their partnership with Google Health concluded earlier in 2021.

A spokesperson for UCL NHS Trust stated that Google Health removed all data in their possession upon the completion of the Streams project.

Imperial College Healthcare NHS Trust also reported ceasing Streams usage this past summer (July), with patient data currently undergoing deletion.

According to a spokesperson, the data deletion process will commence following the termination of the agreement, with Google contractually obligated to complete the deletion within six months.

Taunton & Somerset NHS Foundation Trust also verified that their involvement with Streams had already concluded.

Contractual Considerations and Potential Factors

The initial contracts between DeepMind and the NHS Trusts were established for a five-year period, suggesting that many were nearing their natural expiration.

Any extensions would have required mutual agreement. Google’s decision to discontinue Streams may reflect a lack of interest from the Trusts in continuing the software’s use.

Conversely, this disinterest could stem from perceptions of Google’s limited long-term commitment to the project.

Public statements from both parties remain scarce.

Currently, the Royal Free NHS Trust appears to be the last remaining entity utilizing the clinician support application as Google prepares to end its support.

The Complex History of Streams

The narrative surrounding Streams is, to say the least, multifaceted and filled with unexpected turns.

Despite originating from Google’s artificial intelligence division, and initial statements from DeepMind’s Mustafa Suleyman regarding integrating AI for predictive healthcare alerts, the Streams application did not initially incorporate any artificial intelligence technology.

The app utilized an existing acute kidney injury (AKI) algorithm developed by the National Health Service (NHS) to alert physicians to potential risks. Essentially, Streams digitized and mobilized established clinical practices.

Consequently, it appeared unusual for an AI-focused division of an advertising technology company to be so invested in the long-term development and maintenance of clinician support software.

However, as events unfolded, neither DeepMind nor Google intended a sustained presence at the patient’s bedside.

Early ambitions for the partnership between DeepMind and the Royal Free NHS Trust—outlined in a 2016 memo—encompassed a five-year plan to integrate AI into healthcare. Furthermore, Suleyman consistently advocated for this integration, stating in 2019 that Streams aimed to incorporate predictive AI models to provide clinicians with valuable patient deterioration insights.

A significant setback occurred in 2017, triggered by a data scandal revealed through press reports. New Scientist, utilizing a freedom of information request, published details of the extensive data-sharing agreement between the Royal Free and DeepMind.

The U.K.’s data protection authority determined that the Royal Free lacked a valid legal basis for sharing data on millions of patients with DeepMind during Streams’ development phase.

This finding potentially clarifies DeepMind’s diminishing enthusiasm for a project initially perceived—with a cooperative NHS partner—as a means to gain free access to substantial patient data for training healthcare AIs.

These AIs could then be sold back to the same service, with pricing to be determined later.

It became apparent that those involved had not thoroughly examined U.K. healthcare data regulations.

More crucially, they failed to adequately consider fundamental patient expectations regarding the privacy of their personal information.

Therefore, it wasn’t entirely unexpected when DeepMind announced its withdrawal from Streams in 2018, transferring the app—and all associated data—to Google Health.

Google Health subsequently completed its acquisition of DeepMind Health in 2019. Suleyman suggested that the combined resources would facilitate the development of mobile tools to support clinicians, address patient safety concerns, and potentially save lives globally.

A notable irony arose from this transfer, as DeepMind had previously assured the public that its advertising technology parent company would not access patient medical information.

This assurance was contradicted when the entire project was handed over to Google, with the transfer being presented as positive news for both clinicians and patients.

Google’s acquisition of Streams necessitated new contracts between NHS Trusts and Google Health for continued app usage. All Trusts that had implemented the app complied, having limited alternatives.

Subsequently, Google Health underwent a significant reorganization, placing Streams at risk of being discontinued as part of Google’s ongoing project prioritization adjustments.

This represents a rather disappointing conclusion to an already controversial project.

The U.K. government had previously highlighted DeepMind’s collaboration with the NHS, with former health secretary Matt Hancock citing a research partnership between the company and Moorfield’s Eye Hospital as a model for data-driven innovation in healthcare.

Fortunately for Hancock, he did not select Streams as an example of successful “healthtech” innovation. (Moorfields has confirmed that its research partnership with Google Health remains active.)

The primary takeaway appears to be the risk of relying on an advertising technology company with a questionable approach to data privacy and a tendency to abandon digital medical devices based on internal restructuring.

MedConfidential, a patient data privacy advocacy group instrumental in raising concerns about the Royal Free’s data-sharing agreement with DeepMind, urged Google to be transparent about the Streams situation.

“Streams is the Windows Vista of Google—a project it would prefer to forget,” stated Sam Smith of MedConfidential. “The NHS requires dependable suppliers, but companies that abandon projects after causing issues create lasting problems for the NHS, as seen with WannaCry. Google should acknowledge the decision, delete the data, and recognize that experimenting on patients is subject to regulation.”

Inquiries Arise Regarding the Royal Free’s Continued Application Usage

Despite the Information Commissioner’s Office determining in 2017 that the Royal Free’s initial data-sharing agreement with DeepMind was inappropriate, the London Trust notably maintained its use of Streams – consistently transmitting data to DeepMind.

The original patient database shared with DeepMind lacked a legitimate legal foundation and was never mandated for deletion. It is presumed that it has not been deleted to date, thus bolstering the current demand for Google to remove the data.

Ironically, the improperly obtained data is theoretically scheduled for deletion once contractual timeframes for final backup purges are fulfilled. However, this deletion is contingent upon Google’s own decision to discontinue Streams.

The Royal Free has affirmed to us that it continues to utilize Streams, even as Google re-evaluates its commercial priorities and deems this specific clinician support tool no longer a focus.

We submitted several inquiries to the Trust, including questions concerning patient data deletion, but received no response.

Instead, two days later, we received a single-sentence statement that generated further questions: “The Streams app has not been decommissioned for the Royal Free London, and our clinicians continue to use it to benefit patients in our hospitals.”

The duration of the Trust’s access to an app Google is phasing out remains unclear. Furthermore, the potential impact on patient safety – such as a lack of essential security updates – raises concerns.

We have also requested information from Google regarding the length of their continued support for the Royal Free’s usage and the planned service shutdown date. We are awaiting a response regarding which internal team will manage Service Level Agreement (SLA) requests from the Royal Free as Google Health discontinues the software, and will update this report accordingly. (Previously, a Google spokesperson indicated the Royal Free would continue using Streams for the “near future,” but did not specify an end date.)

Recent press coverage regarding the Google Health reorganization – based on an internal memo initially obtained by Business Insider – reported that teams working on various Google health projects are being redistributed to other divisions, including those reporting to Google’s search and AI teams.

Determining which Google division will assume responsibility for the Royal Free’s SLA, following the Google Health restructuring, presents a significant question.

Google’s spokesperson previously stated that the new structure for its reorganized health initiatives – still branded “Google Health” – will encompass all its work in health and wellness, including Fitbit, AI health research, Google Cloud, and more.

Specifically regarding Streams, the spokesperson explained that the app was not selected for continuation because, following the acquisition of DeepMind Health, Google decided to concentrate its efforts on another digital offering for clinicians – called Care Studio – which is currently being piloted with two U.S. health systems (Ascension & Beth Israel Deaconess Medical Center).

Those familiar with Google’s messaging applications may experience a sense of familiarity with this development.

DeepMind’s co-founder, however, seemingly was unaware of Google’s plans to discontinue Streams in favor of Care Studio. He tweeted in 2019, upon Google’s completion of the DeepMind Health takeover, expressing pride in the journey and highlighting “huge progress delivered already, and so much more to come for this incredible team.”

Ultimately, Streams is not being “supercharged” – to use current terminology – as his 2019 blog post suggested. Google is simply discontinuing it, similar to its previous actions with Reader, Allo, Tango, Google Play Music, and numerous other projects.

Suleyman’s personal narrative also contains complexities.

He is no longer with DeepMind, having transitioned to Google as a VP of artificial intelligence policy, following an initial period of extended leave from DeepMind.

In January, allegations of bullying behavior were reported by the WSJ. Business Insider subsequently expanded on these allegations earlier this month, reporting on confidential settlements between DeepMind and former employees who had worked under Suleyman and voiced complaints about his conduct (though DeepMind denied knowledge of these settlements).

In a statement to Business Insider, Suleyman apologized for his past behavior, stating that in 2019 he had “accepted feedback that, as a co-founder at DeepMind, I drove people too hard and at times my management style was not constructive.” He added that he had engaged in coaching to “reflect, grow and learn personally and professionally.”

We inquired with Google whether Suleyman would like to comment on the discontinuation of Streams and Google’s decision to end the app, given his initial enthusiasm for the project and the years of effort invested. However, the company did not respond to this request.

We also extended an opportunity for direct comment to Suleyman. This story will be updated if he provides a response.