The Tech Giants’ Turf War – Google, Microsoft, and Amazon’s Battle for Your Health Data.

It started with a handshake and a ten-year contract. In September 2019, Google announced that Mayo Clinic had agreed to hand over a decade’s worth of medical, genetic, and financial data to live inside Google’s cloud. Within weeks, Providence had signed with Microsoft. Cerner, one of the largest electronic health record companies in the country, picked Amazon. The pattern was obvious even then, though most patients had no idea any of it was happening. America’s hospitals were quietly becoming tech customers.

Walk into a big teaching hospital today and you can almost feel the shift, even if you can’t see it. The paper charts are long gone. The monitors hum. Somewhere behind the scenes, patient records are being shipped off to server farms in Virginia, Oregon, or Dublin, processed by algorithms trying to spot a sepsis risk or a billing inefficiency. The doctors mostly trust it. The IT teams mostly worry about it. The patients, for the most part, never even get asked.

Larry Page saw this coming more than a decade ago. At a small CEO summit in 2014, he told the audience that if medical researchers could simply search through the health records of every American, they’d probably save 10,000 lives in the first year. It was a typical Page-sized concept: audacious, a bit conceited, and not wholly incorrect. He didn’t realize how much people would object to Google knowing their cholesterol levels.

Google had to learn that lesson the hard way. A public relations disaster resulted from the 2019 Ascension deal, which transferred tens of millions of patient records into Google’s systems without informing the majority of patients. In the healthcare industry, trust is difficult to rebuild. Observing from the sidelines, Microsoft adopted a more uninteresting strategy, marketing itself as the dependable enterprise partner that wouldn’t make a hospital CIO look foolish at a board meeting. It has paid off to have that reputation. Usually, Amazon simply offers lower prices than everyone else.

Although storage was the original focus of the competition, this is no longer the case. It has to do with what is situated above the storage. OpenAI’s models now incorporate Microsoft’s Azure health tools. Google has Gemini and MedLM integrations. In 2023, AWS released HealthScribe, a tool for summarizing and transcribing doctor-patient conversations. The AI layer that comes after is probably owned by whoever controls the data layer, and that’s a position worth defending. Even a tiny portion of the trillions of dollars in healthcare spending that pass through American hospitals each year is sufficient to support numerous enterprise sales teams.

However, there’s something unsettling about the entire situation. Hospitals were never intended to be large-scale purchasers of technology. Instead of negotiating with the same companies that run streaming services and sell advertisements, their procurement teams are accustomed to dealing with manufacturers of medical devices. At one conference, a CIO for a mid-sized health system compared negotiating with Google to “trying to buy a house from someone who also owns the entire street.” The disparity in power is not going away.

It remains to be seen if any of this truly enhances patient care. Better triage, fewer missed diagnoses, and cleaner billing are some of the early pilots that show promise. However, rather than significantly improving medicine, a large portion of the value is internal, lowering hospital operations costs. It’s possible that Google, Microsoft, or Amazon won’t be the true winners in five years. Whichever of them manages to gain patients’ trust will win. None of them have figured out that part yet. And that could ultimately determine who wins the turf war, more than any cloud contract.