"We are teaching cloud to speak the healthcare industry language"

Amit Zavery, VP & Head of Platform and Aashima Gupta, Head of Healthcare Strategy & Solutions, Google Cloud in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We are teaching cloud to speak the healthcare industry language”

PP: Welcome back to my podcast. Today’s special guest are Amit Zavery and Aashima Gupta from Google. We are going to be talking about the exciting announcement that they made recently about their Cloud Healthcare API and a lot of other things. So, Amit and Aashima it is great to have you on the show. Tell us about how Google Cloud is helping healthcare organizations with digital transformation and operating efficiencies.

AZ: Broadly at Google Cloud, we work very closely with many industries, and healthcare is one of the top ones where we have been providing them a lot of technology to run their different systems today, which they operate. That could include being able to run their applications on top of our infrastructure, be able to connect those applications together using a lot of the technology we provide for backend connectivity, to be able to build to modernize those applications and really get the benefits of the latest technologies like Kubernetes and Istio, to be able to get benefits around expanding that portfolio in an easy manner as well and be able to manage it very quickly and easily as well, and then be able to expose that information and systems to all the different users they might have in their industry. That is where we provide a lot of connectivity, also a lot of algorithms and AI capabilities for them to improve the efficiency of the systems they run today. In healthcare, we have been doing a lot more of that nowadays where a lot of modernization happening, as well as they wanting to be able to expose their systems and make it more efficient using APIs as well. We do a lot of work to improve the lifecycle of managing the APIs and exposing that as well.

AG: Google cloud is now becoming much more industry-focused and healthcare is one of the industries in the overall Google cloud portfolio. From the industry standpoint, our mission for healthcare is very similar and a reflection on Google’s overall mission, which is to connect that information and make it accessible and useful. We have adopted that for healthcare, but for our customers and the enterprises, and help them connect that information and make it accessible and useful. So, when I say connect, that is where the API is coming. When we say useful, that’s where AI/machine learning comes in because the data needs to be connected and make more useful. And of course, doing it in a secure and HIPAA compliant way from the industry standpoint. So that is how our products and solutions are purpose-built for the industry in all three different areas. The product – Cloud Healthcare API, it is the cornerstone for us in terms of data, platform, and connectivity that Amit just talked about.

PP: Great background and the healthcare cloud API has been in the works for a while and you recently made the announcement and launched it. So, what Cloud Healthcare API is, what need are you are trying to address in the market and who is your target audience?

AG: So, from the healthcare perspective, providers in the industry are looking for a meaningful way to look into the data. That is a very simple problem, but very profound one because data is buried in different silos. So, when you are looking to the EHR data or you looking to it, talk about images, MRI, CT scans, their DICOM, then PACS systems and you’re looking to genomic information. That is a completely different data siloed to different formats. Our hope for the Cloud Healthcare API is ingestion of different industry-standard data sources providing a managed service so that data can get hosted onto the cloud as a managed service. We are teaching cloud to speak the healthcare industry language. So, we speak HL7 and FHIR, clinical core components which represent 80% of use cases from the healthcare standpoint. Similarly, so to put it in perspective, let’s say if you want to run a query today to say female age 45 to 55 who have BRCA1 and BRCA2 gene and who haven’t gotten their mammogram and their healthcare insurance allows that if you want to now connect that you need to connect to your EHR system, your claim systems, your imaging all that different point data silos. Cloud Healthcare API allows the ease of ingestion, we are taking the complexity of ingesting different formats, giving a unified access in the cloud. And once the data is in the cloud, it just means to an end, the end to create meaningful applications, apply AI/ machine learning, and create an ecosystem around that.

AZ: Once you have the data in the system, how do we now make it useable? And how do you make sure that the right kind of privileges, right kind of security, right kind of policies are applied to that data as well as who gets access to what and when did they get access, the governance around that, all the stuff is really the heavy lifting we provide. So as part of the technology we have around the API management capabilities in Google Cloud with the product with Apigee and a few of the things we build around it. We can now allow operators to put a lot of policies into those access to the data as required. And we are able to track it all the way, end to end, so that you have ability to introspect and find out what happened and when and eventually make it available to people who need to have it in an easy way. Once you have that privileges, you should be able to access things through an API and be able to now use that information to create much more meaningful applications with it. So, if you want to build a mobile application, you want to build another kind of data sharing application or few other things. Those are all doable once we kind of provide these policies on top of it and it does not go rogue then, because we are able to now manage it. And then you have systems in place with the IT groups and the business practitioners, analysts who can now run this thing and operate it in a much smarter way. So that is what the technologies we build around. What Aashima was talking about is to really provide the whole lifecycle, governance, policy management, security, tracking, and delivery and ease of use over time so there is much more value and real-time capabilities you can build on it.

PP: What I understand, this is a generally available API, but I think was a term that you used, which means it is free. And I think you do not have to necessarily use a Google cloud platform for managing your data and you can use the API on whatever environment you have got your data in. Can you clarify that for the benefit of our listeners?

AG: So, the data is coming to Google Cloud. When you leverage industry-standard, API is like USCDI data set of FHIR APIs that Amit is talking about. There is an interoperability both at the semantic level so and the data interoperability. Meaning if you speak the common language no matter where your data resides, those APIs will still work. So, it is not a Google proprietary dataset, we’re talking FHIR, we’re talking HL7, we’re talking DICOM. And these common APIs are common language regardless of where your data is stored. So the trick is, understanding and ingesting the data, creating a unified or unified layer and then exposing through the FHIR APIs and those APIs are the same, whether you’re connecting with on-premise, whether you are connecting with a cloud hasn’t let you speak the same language from the north bound API. We have this terminology we call north bound versus south bound. What we are saying here is the open standards allow for that data portability and it’s very important because we don’t want now to be logged into one infrastructure. It is a managed service, we’re giving the tools out. What we’re doing on top of that is better connectivity when you use Google cloud, we have inbuilt and BigQuery machine learning that we are applying, it comes gateway to that machine learning, building models and creating insights on top of that.

AZ: The key thing is that applications you build could be running anywhere. I think with these APIs and with API management capabilities we built, you can build an application, leverage the things we have through this API. But the application is independent of where you want to run that application.

PP: And that is where your Apigee API Gateway and API management platform also comes into the picture. So, you are abstracting the API and the data layer underneath from the actual application there. Are you planning to implement, or have you already implemented the full set of the CMS FHIR data standards? What is the roadmap for that?

AG: So, if you look into the USCDI, which is the core dataset we have implemented that. We have a full listing. If you look go into the documentation, what are the FHIR resources we are supporting. This FHIR has a very robust community of developers, innovators working on it. Our hope is, as and when the new FHIR resources are introduced, we can support them in our product, but a lot of representation of clinical data as FHIR is a continuous journey right now.

PP: You made a reference to the final interoperability ruling as well and it’s been pushed out for six months and so. Does that in any way impact your product or market roadmap? Is there any implication at all for the healthcare API?

AG: I believe the changes we are seeing with COVID-19 and pandemic. It is underscoring the need for interoperability. So, think of that if your labs were available as a FHIR resource, then I could connect with LabCorp or any other information. Of course, with the patient consent and the right security and privacy. But today I believe we are all seeing the response as a nation from the COVID-19 and connecting information from the patient perspective would have been a lot better if interoperability rules were in place of anything. We will see rapid exploration for these going forward.

PP: That’s what I’m seeing as well, there are several clients that we work with are already down the path of getting ready for the compliance dates. You mentioned one of your clients in the Google blog, which is Mayo Clinic and John Halamka, who is quoted in the blog, has also been on my podcast. Can you share a little bit about what is going on there specifically as it relates to the API itself and have you deployed it there, what are some of the use cases? Are you in a position to share some insights from that experience for the benefit of others who are looking to adopt the API?

AG: With Mayo Clinic, we formed our partnership last September and one of the premises of the partnership is cloud to be the cornerstone for the digital transformation for Mayo Clinic. We are very honored and really inspiring to work with Mayo Clinic. They are the leading physician expertise. Now, when you combine that with Google’s AI and machine learning capabilities, our data analytics capabilities, our API management capabilities. So, they are really looking into unifying the data and just ingesting from different data sources and creating that digital platform and cloud healthcare API is the engine and where all the different data sources and the data will be collected. When we say cloud is a cornerstone of the foundation, it is a means to an end to create more meaningful applications. And one thing I would like to underscore here, as the data is coming into the cloud and we are looking into building an app ecosystem or creating meaningful applications the healthcare industry needs more examples of implementations like theirs, the work that we talked about was the crux of it. If we can do it in a governed way, secure way, this is not going to take off. So, it is very important to get that implementation rigor in the engine. That is what Apigee provides that secure gateway to connect to that information, the right analytics, the right reporting. Which API is a public, which are private, and which are for your partner and in building that robust operating model for API as a lifecycle is critical.

PP: So, Amit we have work together on client engagements where Apigee has been the API management platform of choice, and many of the things that Aashima is referring to are being adopted. All the throttling and the air traffic control and all that stuff. What is your sense of the general adoption level of an API and microservices architecture as a strategy in healthcare enterprises? How do you rate or compare healthcare with other sectors that you are working with?

AZ: I think we have a lot of customers who use API management and Apigee product in the healthcare sector. It has gone up a lot over the last couple of years than it used to be before. If you look at the adoption of API management, I will say the highest industry penetration no doubt is telecommunication, financial services, retail media. And healthcare is becoming one of those top five now. There a lot of interest, especially now where you want to have efficiency, you want to have things which are connected well and a business process, which is little more digitized. So digital transformation is starting to become a big requirement by a lot of healthcare customers. It is also opening the ability to collaborate and share things between different pieces of the ecosystem and is becoming top of mind for many healthcare customers I speak to nowadays. And the number of projects we are seeing now with the Apigee in healthcare is gone up considerably. This was slow-moving earlier on, but now I think has gotten faster. I would say retail, financial services are a little faster at digitizing a lot of the processes and integrating the systems because they have multi-channel kind of access required for banks. For example, you want physical access as well as digital access, like retailers that physical stores have e-commerce and the multi-channel kind of mobile-based applications. I am having a similar mindset now in healthcare. So, it is been late to the journey but exhilarated very much over the last couple of years.

PP: Is there a typical profile of healthcare enterprises that you find are faster adopters of API and microservices?

AZ: In healthcare specifically, I have seen with the providers who have provided healthcare services. They want to connect those things together, so you have one single way of accessing patient records and sharing that with the different providers. And on the backend to the insurance companies to digitizing those processes where it was very difficult for them to have a single view of a patient or single view of a claim or single view of the physicians, those kinds of things. So those are the typical early and the fastest growing area in the healthcare side for us. Digitizing any complex process, basically.

PP: When you talk about digital transformation, people are mostly thinking about digital front doors, the experience that UX/UI, telehealth now, of course, is front and center where everybody don’t usually think about API and microservices strategy as a digital transformation enabler. And once you start seeing the productivity benefits for development and speed of innovation and so on and so forth, that is when these things start becoming a little clearer. So, it is kind of behind the scenes in some way.

AZ: You are hundred percent right; I think that this is not about improving your user experience only. And you will do want to have that always because your customers want to have a good experience dealing with you. But now I think the efficiency, the cost savings, the business continuity, all the kind of stuff is becoming top of mind. And those all come from the backend. Is it really connecting systems and making them easy to interoperate? And there is a lot of as you know, more about health care than ever will. But there are a lot of systems out there some are legacy, some are homegrown, some are packaged, some are modern. All the things still need to interoperate. And there is the need for making that happen in a seamless manner using technologies like Apigee, Google Cloud also provides a lot of other things in that space to modernize and integrate. And I think that really makes a big difference for digital transformation.

AG: That is why clients are adopting this platform thinking for their lot of assets. When you look at a typical hospital system. They have wealth of information. If you think of it, patients, medications, what treatments work for all. Ever since 2009 where 94 percent of hospitals have an EHR. Now that information is there and if you want to build an application and connected experience. So, it is not just UX layer, it is connecting the right data and making sure it’s coming up when you either seeing the patient. Am I able to pull the data at the right time and create the right intervention or i I am a payer? By the way with the new rules from CMS ONC we should see a lot of acceleration from the payer side as well.

AZ: This has been you talking to the banking system and connecting the ecosystem, especially because you have now a lot of third-party people involved in the whole end-to-end flow. And I think that is really where having a well thought out technology set which has that in mind from the beginning. It is an important part, and that’s really where the line of the differentiation comes in when we talk about Apigee. We talk about Google cloud. We talk about some of the connectivity in the technologies. Is it really that built in mindset? I think that really makes a big difference.

AG: And that’s hard work, doing it yourself takes years and years to build a product like Apigee and then creating all the vessels, the analytics, the governance, lifecycle.

PP: Apigee is remarkable story, and now, more than ever, you should be seeing an accelerated interest for the platform. Are you seeing providers or healthcare in general investing in unifying the data infrastructure? Are you also seeing a shift towards the cloud? I hear a lot of things about the cloud economics and that it is more expensive than you think it is. But in the net analysis it ends up costing us more. So, we must do the tradeoff. What do you see as it relates to the cloud story and particularly the whole data infrastructure that supports this digital transformation?

AZ: I think in our view from the beginning and I think what we have been thinking about is that to make sure we have flexibility with one size fits all. There is a lot of different use cases we have seen with healthcare customers who have different needs, but also different profiles from the risk perspective or profiles from the infrastructure perspective. They might not all be willing to move all of it to cloud or they might want to keep everything in-house but modernize pieces of it. So, we want to give them flexibility and the way we architected lot of things in the Google cloud is to provide the ability to run things in hybrid. It is been our strategy from the beginning and make sure multi-cloud in a way. So, hybrid is a big thing for many of the healthcare customers specifically because we have a lot of their data in-house and the system’s already been operational and moving everything centrally might not make sense instantly. It makes sense to move to the cloud because you might want to get better insights or reduced tools which are not available on prem or whatever may be the case. We will have this flexible way of architecting and then you can do it specifically to a project, what and how you want to operate that. That is how we have been building a lot of these things. I think that it has really resonated very well with the healthcare customers because we are not saying that, you move everything to Google Cloud and that’s the only way to work with us kind of a mindset at all. We do operate a lot of things. We have technology like Anthos which runs multi-cloud. We just announced today the GA availability of Anthos running on AWS, for example. And soon Azure, it runs on-prem. Same thing with Apigee, runs on-prem, runs on hybrid, runs on Google Cloud. We just acquired a company called AppSheet where you can build an app without taking a single line of code, runs on top of any set of APIs eyes or on top of the G-suite, for example. A lot of those things we are doing aggressively to make it very easy for customers to adopt without having to do lot of work themselves.

AG: That is where the customer empathy is coming from. Again, from the industry not everything is cloud native or cloud ready. It is a multi-year journey that they take with us. It is a transformation truly. And from healthcare, there is that pattern that we do see that where there is a need to connect multiple different data modalities. As I gave you an example, when one piece of critical data element is in EHR, the other is in a different claim system, third is in an imaging system. Those innovative use cases require a layer where all of this comes together. So, then they are looking into creating this kind of secondary data layer of packet where data is ingested in the cloud and a unified layer is created on top of it.

PP: As it relates to cloud, is it fair to say healthcare is going to be a multi multi-cloud hybrid approach for the time being?

AZ: Yeah, I would think so. That is typically the kind of profiles you have seen with the healthcare customers. They will be looking at it that way. I think we have a lot of value we provide them. If they are running on Google Cloud directly, but of course, we still provide them a lot of the advantages and benefits of a technology if they want to run it in multi-cloud or hybrid. And we understand nobody is going to completely stop everything and move everything to one place. We must work in the way the customers want to work.

PP: We are now in the middle of the COVID-19 crisis. We are all sheltered at home. I know that Google and other technology firms have been doing things to help public health in terms of coming up with products. One thing that is been in the news is the contact tracing app that you’re working on together with Apple. Love to hear if you have anything to share with regards to that. And of course, anything else that you are doing to help clients right through the COVID-19 situation from a healthcare standpoint.

AG: From the COVID perspective and the blog that you just mentioned. We have lists of very targeted solution that we’re taking to market both helping researchers so they range from offering the very basic level, the cloud credit for leading researchers, then helping with a Kaggle competition, which is another unit in Google cloud, really bringing in the innovators and leading AI researchers to look into the data and help with the forecasting. The third thing that we have done is the solution for healthcare focused Chatbot, we have a solution which is cloud AI. It Is a conversational engine. So, the problem statement here is what we heard from our customers, especially healthcare lot of triage calls, they are looking into help and creating this digital triage so that patients will not have to come to the facility. We took the CDC questionnaire. So, any way we can alleviate the burden, the burden like reducing the in-person visit by a telemedicine or alleviate the burden on the call center by doing this conversational AI and the digital triage. Those are the offerings that we have today in the market and being actively working with a lot of our customers. These are unprecedented times and there is a lot of burden on a lot of folks. And then we also launched National Response Portal, which is our partnership with HCA and SADA. If you are looking to this cloud, there is looker, the dashboard, and creating this analytics and forecasting models on capacity and the critical care capacity in utilization reports from different facilities who can share the data. So those are few listed in the blog. We are taking Contact tracing very responsibly. There is a blog and more information on how API will be released. And we will be starting with the public health agencies first.

PP: We are coming up to the end of the time here. I really appreciate your sharing your thoughts on the API economy all the best for that product. Google is obviously very serious about healthcare and that is becoming increasingly clear to anyone to whom it is not clear. Where do you see yourself a couple of years from now if you want to share any thoughts on that? Look a little bit ahead after we come out of the COVID-19 crisis into a new normal, whatever the new normal maybe.

AZ: We will continue doing what we have been talking about for some time. The clarity which we have been providing to our customers has been straightforward in terms of how our innovation can help the health care industry. And that is really the long-term goal to the growth plan here.

AG: It will be accelerated, like what we thought we will have X months. It is like very compressed timeframe, but it is accelerating. There is a positive side like there is a digital acceleration at the unprecedented speed, especially healthcare industry will change in the most profound ways and it is about helping our customers through that journey.

PP: It is a wonderful time to be in healthcare and I feel personally very grateful. Because you can make a difference. Any final comments before we close out of the podcast?

AZ: Thank you for having us. I think there is a lot more opportunity for us to continue discussing this. And I think with the COVID situation healthcare industry is probably going to get transformed even faster. So, we are here to kind of collaborate and partner and work and see how we can help.

AG: Likewise, Paddy. Thank you for having us.

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.