Google is dismantling its health division
businessinsider.com
businessinsider.com
At ClearHealth we lost many, many potential projects, partners and dollars over the years to "we are going to see what google is doing", "we are in talks with google", etc.
The damage is very large but difficult to calculate.
Have said this before, but healthcare is the Afghanistan of tech where giant empires go in thinking they can solve it and leave beaten years later wondering what happened. We're still about 5 years before a viable tech gets traction that could be useful in that space, and interestingly imo, one of the YC 2021 batch is the most well positioned to do it because they are doing authorization as a service (warrant.dev), which could meet the basic delegation need which is the pattern the whole health world is predicated on. We do collaboration pretty well with tech and we're just starting to make headway on identity and access control, but we haven't figured out workflow delegation and designation in any meaningful and open federated way, which is the necessary condition of the basic physician/nurse, physician/specialist, physician/hygenist, physician/orderly etc. workflow pattern.
What people don't get about healthcare is that it is not a vertical or a sector, it is a parallel planned economy of autonomous entities, not unlike higher education but more distributed. I have done a lot of consulting work in a very large single payer system over the years, and the reocurring pattern is that even government thinks it's an enterprise, or a collection of enterprises. It's really an archipeligo of federated diverse organizations that orbit doctors and other health care providers. When you think, "oh, I've got a document management system or search for health!" you don't unless it is document management or search for a hyper-federation (like a hypergraph). You don't build products for this, you build tools, and the "healthiness" of a given tech is about how it supports this complex and dynamic relationship pattern.
If I were google developing technologies for health, I'd be solving the basic hyperfederation problems. I hate to say it, but from a technology perspesctive, it's very likely a blockchain problem, where the health ontology (HL7,FHIR, etc) gets distributed via the consensus, and individual records would be graphs over its elements. Unfortunately, HL7 suffers from the same architecture complexity problem, where complex standards and rules yield stupid behavior in the field. This is to say the problem is health information techs all fail for the same reason, which is the basic problem of imposing central or top down design models on a stubbornly bottom up economy full of non-technologists.
It does a great job pointing out the various players and the conflicting interests between them. Highly recommend for anyone looking to learn more.
Great metaphor. It's kinda like Education: if you come in thinking you're going to make money, all the existing players say "Hello, sailor!"
I joined Google in 2005. Even then, executives who were out of favor were sent to the "health care division" which was commonly understood as the one-way door out of Google.
Your statement can stop there.
There isn't some huge amount of money sloshing around in education when contrasted to healthcare.
In education, you're fighting over pennies. If you want money in education, you have to target the "tutoring" level which is boutique and caters to those with extra money.
du@50km.com
That's not what `tr` does. It replaces each letter S-P-A-M with the letter in the same position in the string D-U. Because "du" is shorter than "spam," `tr` just reuses U for letters 3 and 4. So the mapping is S->D, P->U, A->U, M->U, making "spam@50km.com" into "duuu@50ku.cou," and the -s flag then compresses multiple repeated U's into one.
Lesson: don't be too clever.
A few other lessons from this: 1) test your scripts, 2) be clever enough, 3) email obfuscation stopped working in 2000 for preventing spam, 4) handle spam at your receipt
Can confirm, worked at an EHR vendor, and we didn't see enhancements to our aging interfaces until Meaningful Use measures came into play.
HL7 standards don't really dictate any particular architecture, they just define public APIs and interoperability formats. The data models are inherently complex because the problem domain is complex; attempts at simplification tend to cut off important use cases.
Maybe.. but have you seen the Apple Watch lately? Basic fall detection, ecg, o-sat, noise level monitoring, etc. Id say that’s pretty great progress.
This sounds like standard delegation and the facade pattern from capability security. Software lost a lot of time because we didn't go with security models built for delegation from the get go. People ended up rediscovering then when the web exploded and wanted to share things securely.
Your federated network is an interesting problem. Capabilities are suited to the core delegation and authorization aspects, but there's obviously a whole lot to be layered on top that is no doubt challenging.
Very rightly said.
However, that's also because of the traditional resistance of the healthcare to adopt (and adapt technology) to improve processes/ workflows. As well as onerous regulations.
But the unfortunate reality is you can't just go "hack stuff", disrupt some paradigms, craft a few apps, throw in some AI, sprinkle some crypto around, code it all up in the cool language and technology stack of the month, and come up with something useful. It's long hard thankless grinding work that's frequently blocked by regulations, risk adverse institutions, interoperability with legacy systems, and people and business processes more so than simple matters of technology.
You also have to accept you frequently won't be the smartest person in the room when you're dealing with healthcare professionals, which is real kryptonite to a lot of move-fast-and-break-stuff types.
Minor story as perspective. Initiative was hatched to extend Google Maps Street View inside of buildings. High level meetings were held. No technical roadblocks.
Deal eventually killed, because Google was unwilling to provide their raw data to the buildings' owner, for their own uses.
You're hamstringing a feature on your own app because you don't want to ship the data you collect to the person you're collecting it from? mind boggles
Could you please rephrase this? I don't understand that sentence.
For what it's worth, Google, or at least some subsegment, does seem to be trying to fix this issue. I had a somewhat offensive conversation with a recruiter recently where they told me they're looking for people (like me) with non-standard backgrounds who don't necessarily have the pedigree that the usual Google SWE hire has. I hope they also extend this thinking to moms with young children. I know a good many technical women who fell off the career ladder after having children and were never seem to be able to get a chance to get back on, ultimately taking jobs far beneath their abilities or just shifting industries altogether.
Excuse me? It's my device, don't rate limit me.
Also, what do you mean, "it's my device. Don't rate limit me"? Do you own Nest's network? If not, why are you mixing owning a network with owing a device?
I own the device, I should have a way to get real time data and issue however many requests I want to it.
It doesn't have to be through their network, they should provide a method of local access then.
Full disclosure: I joined Google in 2005 when this was still an active project, and in fact walked around GWC-3 and saw the Yellow Badge people (great symbolism there) taking their breaks. These were contractors who actually scanned the books for Burger King-level wages, and whose badges wouldn't even let them into the micro-kitchens.
Anyhow, I don't know if the University of Michigan (early volunteer) was supposed to get the scans. Supposedly, the whole world would. That didn't happen and you can read [1] for details.
As of 2015, at least, not even a Google employee could get at them. I was told I could go to someone's desk and read the book on their computer if I really wanted to see it (this was for patent research).
[1] https://www.theatlantic.com/technology/archive/2017/04/the-t...
For the general public HathiTrust is like Google Books with worse search and worse UI but more books readable in full. Sometimes I search Books and then go over to HathiTrust when I find that Books has unreasonably restricted viewing of some search hits.
And it's so many things -- it's regulation, it's slow-moving, it's hyper-local and non-uniform, it's privacy concerns, it's vested interests, it's interoperability, it's political.
Both health care and education have huge amounts of money poured into them -- the money spent on a child's education per-year is orders of magnitude greater than a Netflix or Spotify subscription. Same with your monthly health insurance costs. So despite all the challenges I listed above (and more), it still seems like if you can pull it off, it's a bet worth making. But that doesn't stop it from being really, really hard.
I suspect healthcare in the US (and probably elsewhere) has to deal with a lot of liability, and so processes that fly in other situations do not fare well in healthcare. Everything i has to be dotted and every t crossed to make sure you do not end up with any part of the culpability for an adverse healthcare outcome, as well as liabilities from laws such has HIPAA.
https://appleinsider.com/articles/21/08/19/apple-health-divi...
If Apple and Google are both ditching health projects simultaneously, I wonder if that suggests that they have advance warning of some change to the regulatory climate.
I'm not sure how one unties that particular knot.
[1] Corruption here being that the primary mission is the collection of monies and health outcomes are a tolerated side effect of that.
Sadly, my observation is that this is the rule (and not the exception) in many industries.
From _The Prince_ by Machiavelli
The long term trend is towards consolidation into combined payer + provider organizations like Kaiser Permanente. All the large medical insurers are hiring or acquiring more doctors to bring member care in house and better align the financial incentives.
But I think there is a growing opportunity for innovation in the new SMART on FHIR app stores run by several major EHR vendors. They're copying the Apple / Google app store model by allowing ISVs to use their platform in exchange for a cut of the revenue. In theory you can write an app once, then deploy to any standards compliant EHR (reality is a little more complex). So the platform handles all the compliance stuff and you can focus on innovation. I expect we'll see a wave of start-ups targeting that platform over the next few years.
I had a colleague go work for Google health in a fairly high role, but I didn’t know them well enough to ask why. Seeing what they did, it was a lot of positive sounding, but vapid, content put out and I could never tell what they did.
I kept thinking, “who would work for them when they’ll just get bored of this as PR?”
Not that others may necessarily be better, but they also don't have the same existing power.
[1] https://www.nbcnews.com/tech/security/google-sued-u-s-tracki... [2] https://www.nbcnews.com/tech/tech-news/google-sells-future-p... [3] https://www.bleepingcomputer.com/news/google/chrome-69-keeps... [4] https://www.wsj.com/articles/techs-dirty-secret-the-app-deve...
I don’t see federation of health records as all that interesting. Most people get comprehensive care from a major hospital.. I’ve taken records from one place to another and guess what, it’s basically a DVD of PDFs and images.
I don’t actually think it’s a real use case when you are in a network like that.
-Serge Brin, 2014