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Alphabet is spending billions to become a force in health care

economist.com

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Re: Alphabet is spending billions to become a force in health care

#181

Post by racking7 »

claytongulick wrote: post #68
paulmd wrote: post #57

As someone who worked in this area: > Google is also giving health records another whirl. The new initiative, called Care Studio, is aimed at doctors rather than patients. Google’s earlier efforts in this area were derailed in part by hospitals’ sluggishness in digitising their patient records. Not just digitizing but also in sharing them. Hospital systems are very very reluctant to send out a copy of their records,…

FHIR makes a lot of this better, but EHR vendors hate it for that reason. Also, it's complex to implement. Fortunately, we have HAPI [1] and it's very good, but has deployment complexity only a java developer could love. There's been a couple false starts on a nodejs based FHIR server, but nothing open source and production ready that I've found. [1] https://hapifhir.io/

FHIR provides a structure for communicating these data, but does not solve the hard problem in the parent comment about the massive heterogeneity of health care data across institutions (and even within institutions). The same messiness of the original raw data in the proprietary EHR data format can be replicated in FHIR. But at least the mess is available then in an open data format and a bit more regimented on canonical elements (i.e. things like effectiveDate/DateTime).

Have you used HAPI FHIR in production at any scale? Our experience is that it completely falls over under any reasonable strain. Try working with a few thousands patents and ~100M Observations and you will see HAPI work very poorly. It's great that HAPI is very feature rich on the API side--they've implemented most of the spec. But JPA and how they're using it is not a healthcare-scale technology. Google's (Spanner based) and Microsoft's (CosmosDB & SQL Sever based) FHIR API are better at scale but have far fewer features. I'm actually ok with that because the FHIR spec's query functionality is actually much more limited. Google's BigQuery integration really helps here. I'm interested to see where AWS is going with Health Lake. In talking with them I believe they have the best paradigm for their technical implementation.

It is a shame that the open source FHIR servers haven't been great. I think they will probably improve once a scalable paradigm for working with FHIR emerges.

Re: Alphabet is spending billions to become a force in health care

#182

Post by mateo1 »

randcraw wrote: post #129
cardosof wrote: post #72

Just imagine a world where they revolutionized healthcare as they did with advertising!

Google will succeed at healthcare only after medical decisions can be reduced to A/B tests. That is to say, never. After wasting many millions on failures like Calico, Google hasn't learned that healthcare is a service that's continuous, custom, and complex. And since the "customer's" health and life are at stake, maintaining health is a damned sight more important and difficult to do sufficiently well than Google's…

>Google will succeed at healthcare only after medical decisions can be reduced to A/B tests. That is to say, never.

Never, or literally tomorrow if they take over. "Personalised medicine" decisions made with "AI" will provide a perfectly unaccountable black box to blame when (if ever) the general public realises that vulnerable and poor people have been getting the B end of the A/B testing.

I agree with the rest of the post but god have mercy on us if these companies take over healthcare. I never thought I'd be living in such a totalitarian state in my life.

Re: Alphabet is spending billions to become a force in health care

#183

Post by yborg »

airza wrote: post #144
Finnucane wrote: post #124

So, another service that Google can build two different versions of, then discontinue without warning after a couple of years?

"We're sunsetting Google Pacemaker on December 31, 2029..."

"Repent, Harlequin!" Said the Ticktockman.

Re: Alphabet is spending billions to become a force in health care

#184

Post by mateo1 »

paulmd wrote: post #57

As someone who worked in this area: > Google is also giving health records another whirl. The new initiative, called Care Studio, is aimed at doctors rather than patients. Google’s earlier efforts in this area were derailed in part by hospitals’ sluggishness in digitising their patient records. Not just digitizing but also in sharing them. Hospital systems are very very reluctant to send out a copy of their records,…

There is another aspect to this. Treating all hospital records as an infallible and comprehensive record of truth, carving them in stone and having them follow you for the rest of your life is plain dangerous. They are to be interpreted in a complex context, and their relevancy fades over time as well.

Re: Alphabet is spending billions to become a force in health care

#185

Post by rayiner »

lotsofpulp wrote: post #66
rayiner wrote: post #40

Earlier quoted context omitted.

> IMO, the Pacific coast states need to reject national health care, create a health-care pact between states that slowly grows larger by adding new states. If another state doesn't want to join, then, so be it. It blows my mind that they don’t do this. During most of the 20th century, Democrat-run states wanted to tax Republican California to pay for social programs. So doing things at the national level was critica…

Vermont did try it. https://en.wikipedia.org/wiki/Vermont_health_care_reform It does not work for the reasons tptacek wrote. With freedom of movement, eventually net benefit recipients will move in, and net payers into the system will move out.

I don’t see evidence of that. Vermont grew slower than the country as a whole over the last decade, so it’s not like there was an influx of new residents.

It sounds like people in Vermont just wouldn’t put their money where their mouth is and pay the taxes required for universal healthcare. Our German au pair paid almost 40% on her entry level office job. If you want universal healthcare like the Europeans well that’s what it costs.

Re: Alphabet is spending billions to become a force in health care

#186

Post by actuator »

zasdffaa wrote: post #152
actuator wrote: post #146

Earlier quoted context omitted.

Completely disagree. There is huge scope in healthcare for automation, pre-emptive diagnosis and raising the bar for precision. It is mostly going to be done by a company with good AI chops, I would put my money on Google, from what I have heard about their efforts.

Which is entirely orthogonal from how they might (ab)use that data. They are a commercial company. It will be commercialised. No. Not ok by me.

Healthcare in US is run by commercial companies only. The diagnosis machines are made my commerical companies only.

I am not sure what you mean by commercialised.

Re: Alphabet is spending billions to become a force in health care

#187

Post by actuator »

avgDev wrote: post #159
actuator wrote: post #146

Earlier quoted context omitted.

Completely disagree. There is huge scope in healthcare for automation, pre-emptive diagnosis and raising the bar for precision. It is mostly going to be done by a company with good AI chops, I would put my money on Google, from what I have heard about their efforts.

I've been thinking how to enter the medical space with software. My cousin has EDS, diagnosing the illness is pretty trivial. It took her 15+ years and when she was diagnosed she was already in severe decline. She could have been diagnosed a decade ago but some doctors just have no interest in googling symptoms and listening to patients.

I am so sorry to hear about her but this is the exact reason why I am hopeful with companies like Google entering this space and making diagnosis better.

We have so many smart devices that can record so much data, and it doesn't even have to be auto recording. If you had a headache, if you can mark that and over time based on a pattern it can recommend you to see a specialist or get some tests done.

Re: Alphabet is spending billions to become a force in health care

#188

Post by zasdffaa »

actuator wrote: post #186
zasdffaa wrote: post #152

Earlier quoted context omitted.

Which is entirely orthogonal from how they might (ab)use that data. They are a commercial company. It will be commercialised. No. Not ok by me.

Healthcare in US is run by commercial companies only. The diagnosis machines are made my commerical companies only. I am not sure what you mean by commercialised.

Was speaking as a brit where this hasn't happened to the extent in the US.

What it means is I was one step behind :)

Re: Alphabet is spending billions to become a force in health care

#189

Post by actuator »

zasdffaa wrote: post #188
actuator wrote: post #186

Earlier quoted context omitted.

Healthcare in US is run by commercial companies only. The diagnosis machines are made my commerical companies only. I am not sure what you mean by commercialised.

Was speaking as a brit where this hasn't happened to the extent in the US. What it means is I was one step behind :)

NHS is struggling with wait times and staff shortages, no? I have heard a lot of them is in radiology departments. These diagnostic improvements will help there as well, and for a state funded healthcare like NHS, more automation is good.

As much as I don't like for profit companies monetising this, I am not sure if I know of a better path to innovation.

Re: Alphabet is spending billions to become a force in health care

#190

Post by Atreiden »

rayiner wrote: post #41
googlryas wrote: post #29

Earlier quoted context omitted.

Isn't it fairly obvious how the costs could be decreased? Dozens of other countries have figured it out, there isn't some secret.

And what’s the secret? Having the government do it can’t be the reason, because there’s plenty of government-run things, such as education and transit, where the US pays more to get less, just as in healthcare.

The secret is representative government. In the US there are only two parties, and they have entirely opposite goals. The democrats want more Government spending programs, Republicans want less. So when Democrats are in charge and the US tries to expand things like healthcare, education, and transit, the Republicans step in and do everything in their power to create the most ineffectual legislation that they can. Obamacare is the perfect example of this.

They then use those broken, ineffective programs as evidence of "the governments" incompetence (ignoring the fact they they _are_ the government), bolstering their arguments for rolling back government regulation and spending. This way, private interests are able to dominate the market and the money keeps flowing 'round. I'm convinced this is the mechanism behind both the increasing income/wealth inequality in the US, and the broken state of public infrastructure/services.

The solution is election reform. The data has shown that neither party represents the actual interests of the people, and they only get away with it because of the Game Theory around our election system. Get rid of the Electoral College and FPTP - 1 Person:1 Vote & Ranked-Choice voting would create a cataclysmic shift in US politics in short order.

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