Editor's Note: This story was updated on June 17th to reflect Facebook's recent moves in health care.

By Jackie Kimmell, Senior Analyst

Several weeks ago, Facebook announced a surprising high-profile hire. Roni Ziegler, a trained internist who served as Google's chief health strategist from 2006 to 2012, was named Facebook's new head of health strategy. He called the job "an opportunity I [couldn't] resist."

The acquisition was striking for a company that's generally believed to have more modest health care ambitions than the other Big Tech companies like Google, Apple, and Amazon. Yet, it reflects the company's renewed forays into health care.

On May 20th, Facebook announced it was expanding efforts with the Harvard School of Public Health, the London School of Hygiene & Tropical Medicine, UNICEF, the World Bank and others to use AI to create real-time global health maps. And just last week, the company announced the U.S. launch of a blood donation feature that will allow users to signal their interest in donation and be contacted by nearby centers on the platform. It's working with partners like the American Red Cross, America's Blood Centers, Inova, and Stanford Blood Center on the effort.

Taken together, these moves indicate that the tech giant likely wants to move more deeply into the health care space—an area they've mostly avoided since the 2017 Cambridge Analytica scandal.

Remember Facebook's patient data-matching plan?

In 2017, Facebook presented an aggressive plan to health care providers: Providers would provide anonymized patient data (on illnesses, prescriptions, etc…) to Facebook which the company would, in turn, match with the patient's social media data. The goal was to provide a greater picture of patients' lives outside of the hospital—informing decisions like, for example, who would benefit from extra outreach after surgery.

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At first, the idea seemed to be gaining traction. According to CNBC, Facebook had spoken to many leading health care organizations, including "major U.S. hospitals," Stanford Medical School, and the American College of Cardiology, about the project.

But momentum on the project fizzled out shortly after the Cambridge Analytica scandal, when the world found out that 87 million users' data had been shared without their knowledge and used for targeting political ads.

Since the scandal, Facebook has been far more quiet about their health care projects—but that doesn't mean the company is done with the industry altogether. Rather, they've been unobtrusively pursuing several health care projects (though they aren't all without their controversies).

How Facebook is slowly moving into health care

Outside of online advertising—which the company has heavily pursued for pharmaceutical companies—Facebook has two main entryways into the health care industry. The first is through its AI capabilities; Facebook in 2018 announced that it planned to double the size of its Artificial Intelligence Research (FAIR) group, which, according to the company, is focusing "on open and foundational research that advances the state of AI."

The other main way is through its easy access to American's social networks—where it can both use social pressure to encourage altruistic moves like blood donation, create channels for access to online health-focused communities, and help researchers recruit for large studies. Here are seven main ways Facebook is leveraging its platform to influence health care:

1. Facilitating blood donation. In 2017, Facebook launched an international blood donation tool on the site in Brazil, India, Pakistan, and Bangladesh. The company said that 35 million people became donors, and studies in India and Brazil had found that 20% of people said Facebook had influenced their decision to donate blood. However, critics argued the tool had made users vulnerable to abuse by black market peddlers. Clearly, this criticism didn't dissuade the company is bringing the effort to the United States, where it plans to launch the blood donation feature for users in Chicago, New York City, San Francisco, Baltimore, and the District of Columbia. Facebook said it plans to expand the feature nationwide in the next few months.

The plan will allow users to sign up in the 'About' section of their profile, then be contacted by donation centers in times of need. Requests and opportunities to donate will be displayed on the Facebook site. Facebook's partners say that they see the site as a tool to reach a new group of potential donors in a personal way. "The number one reason why people don't give blood is because they are not asked," said Cliff Numark, senior VP of blood services at the American Red Cross. "Facebook gives us the opportunity to make the need front and center for someone who is interested."

2. Improving the MRI. In August, the company launched a pilot project with the NYU School of Medicine aimed at using AI to make MRI scans up to 10 times faster. The project, called fastMRI, will test ways to generate an MRI image using less raw MRI data. Scans currently range from 15 minutes to over an hour in order to gather the necessary data in the proper order to create an image. But Facebook believes it can collect less data and train AI to fill in the blanks to accelerate the time it takes to generate a scan.

3. Enhancing facial recognition. One where Facebook seems to have an edge over other tech companies involved in AI is with facial recognition. The company has focused on tools that, for example, can reconstruct partially-hidden human faces, or generate fake eyes that can be edited into an image if the subject has blinked. Obviously, most of these efforts have been aimed at improving photo posting on the site, but the company is also potentially considering health care applications for this technology. For instance, facial recognition software has already been used to accurately predict physiological health, track patients through the hospital, measure their pain or even for hospital security. Facebook could use its AI to offer even more. Still, it will have to overcome privacy hurdles, including a class-action lawsuit over its use of the technology on the site.

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4. Connecting the brain and computer. In more futuristic plans, Facebook CEO Mark Zuckerberg during a recent discussion at Harvard spoke about a brain-computer interface his company has been researching. According to Wired, the technology Zuckerberg described is a "shower-cap-looking device" that aims to identify connection between certain thoughts and brain activity. The end product would allow a person to "type" by thinking. In 2017, Facebook said they were working with scientists at UC San Francisco, UC Berkley, Johns Hopkins Medicine, and Washington University School of Medicine in St. Louis on the telepathic project, which could prove useful in health-related experiments, like connecting brain waves to control prosthetics.

5. Building its own Alexa. Facebook in April confirmed it is working on its own AI-based digital voice assistant to compete with Amazon's Alexa and Google Assistant. Facebook in 2013 acquired the technology company Oculus VR and will work to incorporate voice and AI assistants into Oculus' products. While it's not yet clear whether Facebook will seek to introduce its voice assistant into the health care industry, it could follow Amazon in pursuing HIPAA-compliant uses. 

6. Using AI for suicide prevention. Facebook also has deployed AI for suicide prevention efforts, aiming to build models to predict when someone may commit suicide (and especially to prevent suicides from being streamed on their live video platform). The company's AI mines users' posts and comments for language that may indicate possibly suicidality, and alerts law enforcement if they sense an imminent threat of self-harm. Within the first year of launching this tool, Facebook said they had contacted about 100 local law enforcement officials about users. In November, they said that number had increased to 3,500 over a year—marking about 10 contacts to emergency responders per day—and that they had at least 7,500 community operations staffers reviewing cases of potential suicide every day.

However, these efforts have been controversial. While some have praised the efforts, calling them "ahead of the pack," others have criticized the opacity of Facebook's AI system. John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center, said, "It's hard to know what Facebook is actually picking up on, what they are actually acting on, and are they giving the appropriate response to the appropriate risk." Mason Marks, a research fellow at Yale Law School and NYU Law School, wondered if the model may cause people to "fear a visit from the police, so they may pull back and not engage in an open and honest dialogue."

7. Advancing global population health. Facebook also waded into global humanitarian projects by using AI to map population density worldwide. They say the initiative has already supported government and nonprofit organizations in their health efforts, including coordinating a measles vaccination campaign in Malawi. The high-resolution maps estimate the number of people living within each 30-mile tile on the grid, as well as insights on demographics, but use AI data, satellite images, and census data rather than Facebook data. Facebook claims the maps are three times more detailed than any other similar source.

Facebook must overcome troubled past to gain trust in health care

While these health care efforts suggest Facebook may have bigger plans for health care, the company first will have to build up more user trust in their data privacy and clearly define parameters for how the patient data they collect could be shared with advertisers.

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One major concern is that, while the company gets users' permission to collect a broad range of data, that doesn't necessarily mean that users expect or consent for it to be used in medical research or projects. As Aneesh Chopra, president of health software company CareJourney and the former White House chief technology officer said after news of Facebook's hospital patient data matching plan leaked, even if patient data was anonymized, "Consumers wouldn't have assumed their data would be used in this way."

In addition to the Cambridge Analytica scandal, Facebook has faced a number of other privacy scandals related to health. For instance, it's faced growing backlash over its handling of patient support groups. Last April, Facebook was grilled by lawmakers over its handling of the private medical data generated from these groups. In February, congressional leaders sent a letter to Zuckerberg summoning him to speak about reports that Facebook sold data about users' health-related group memberships to advertisers, leaving users open to bullying and vulnerable to predatory advertisements. A complaint by the FTC alleged similar charges, saying, "Sharing of privately posted personal health information violates the law, but this serious problem with Facebook's privacy implementation also presents an ongoing risk of death or serious injury to Facebook users."

In response, the company on April 30th created a new type of group—health support groups—which allow users to ask administrators to anonymously post health questions on their behalf. It also separates these groups dedicated to health with a separate designation on the site. However, critics argued that these changes felt more superficial than structural.

Other controversies have arisen based on third-party health and wellness apps selling personal information to Facebook. The Wall Street Journal conducted an investigation of 70 leading apps, and found that at 11 sent potentially controversial information to Facebook (including users' heart rates and ovulation tracking—even if they didn't have a Facebook account). Facebook responded that "sharing information across apps on your iPhone or Android device is how mobile advertising works and is industry standard practice," but the issue is far from settled. The company is now being investigated in a federal criminal investigation for letting tech companies see user's friends, contact, and other data.

Zuckerberg has admitted publically in congressional testimony that Facebook does collect some medical data from users. In a recent editorial, he called for greater privacy regulation and suggested that there "should be a way to hold companies such as Facebook accountable by imposing sanctions when we make mistakes."

But, despite these moves to rebuild their reputation for data privacy, the company has almost certainly damaged its reputation, likely greatly impinging their ability to gain the trust of health care consumers any time soon. According to a Fortune poll from November 2018, only 22% of Americans trust Facebook with their personal data, half as many who said the same for Amazon (49%), Google (41%), Microsoft (40%), and Apple (39%).

All of this means that, as Advisory Board's Peter Killbridge and Andrew Rebhan note, if providers choose to partner with a company like Facebook, they'll have to ensure that privacy is paramount, collection is secure, and that data is stored with the "same rigor as other, more standard protected health information."

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