Google, Epic ink deal to migrate hospital EHRs to the cloud to ramp up use of AI

The thing is an inflexible abomination and a total nightmare for users. There is ongoing outrage in Finland over the deployment of the system in healthcare and social work: https://en.wikipedia.org/wiki/Epic_Systems#Finnish_experienc...

It is an expensive regression that crashed productivity for everyone.

It's all like that. Medical software is a ghetto.

I think it's partly because those who have a passion for the industry aren't good developers and good developers don't have a passion for the industry.

Not to mention a lot of decisions are driven by medical doctors and if you think software developers believe that being good at one thing makes them good at all things, you are going to love medical doctors.

> As far as I know, it's still some janky visualbasic UI with a M/UMPS backend (well w/ a modernization wrapper).

You are correct. They haven't changed in last 20 years. Even in their coding tests, they write pseudo code or ask you to write some code (with basic code grammar & layout provided), which is thinly veiled MUMPS.

And there's a proctor who watches you & your screen over remote connection - lest you googled anything related to the problems. It was very creepy

They are finally reaching the point of rolling out their new clients that get off Visual Basic, so that’s something.

M, however, ends up being a combined database/business logic platform (and it’s fairly speedy at that, if that’s what you want). Extracting data into a nice tidy relational database does take time and development effort, though, but they have a reasonably robust process for this already.

This article seems to be a relatively mundane announcement to me. You could already do this same stuff with Epic on Azure, but I guess more options are nice.

While it's been at least a decade since I've looked at M/UMPS ... I do remember the database having some really interesting stuff going on that suits the storage of healthcare data well. The language itself though ... a complete abomination.

Just an aside, the MyChart web app is very well designed and easy to use compared to other medical sites.

What do you mean by "pulling data out"? The underlying database doesn't really matter for that. Epic supports an extensive set of APIs, including many that implement open industry standards.

https://open.epic.com/

Since they have lots of pull in the industry it makes lots of sense for google to partner with them. Possibly they can modernize them but I don’t think that is very likely this looks like more of making a larger moat for both companies.

Well they are moving from visual basic UI towards web->

"Epic is moving the current primary end user application, Hyperspace, to a web-based framework. Hyperdrive, our new client application,"

Right now rich people in developed countries can afford the best doctors. Most people in the world get shitty healthcare. An AI assisted medical staff can significantly raise the bar.

In many low income settings, even access to a medical professional means a long wait time. I see AI serving a valid purpose of guiding busy humans who have little free time. An AI can take current symptoms, past medical history, clustering the data based on travel history, real-time outbreaks, etc, etc and come up with candidate diagnoses.

> AI is a shiny object that does not solve any of the most urgent problems in healthcare, and almost certainly distracts from them [...] It is not going to benefit patients, certainly not vs other ways the money could be spent (more staff, more beds)

I am baffled. AI clearly accomplished amazing things very recently, at the very least in language and image generation, self driving and problem solving as it pertains to games and upset a lot of expectations in the process. AI also, clearly, is used as a buzzword to confuse a lot of people (often times including the ones who are using it).

What grand insight could anyone have into what is going to on right now everywhere (and, clearly, there is a lot of stuff going on, right now, everywhere) to justify such a sweeping statement?

My take on this, although it is not entirely clear from the article, is that Epic wants to move most of their computing to the cloud and Google felt left out and now they have a hospital chain who wants to partner which gives Epic a reason to add Google cloud compatibility (i.e., a customer will pay for the translation). There are a variety of things that might happen to the data once it is in the cloud. AI's can be trained on all the patient data and look for correlations (such as "all doctor X's patients do poorly" or "Unit 12 is responsible for most sepsis problems".) AI's are NOT going to be making a diagnosis any time soon, the doctors won't stand for it, and there is no AI capable of it yet. Even AI's that inspect radiology can only report to a real radiologist who then has to make their own decision (and is legally responsible for that decision.)

Another use of the cloud data is to aggregate data across many institutions, mostly to allow medical studies. The NHS in Britain has all their patients in one database which allowed them to do incredible studies related to the Sars-Cov-2 pandemic. Currently the US has no such capability, all that data is in silo's in each health institution, each with their own data formats and their own workflow. Get all the data into clouds, all in the same format, and it can be used for medical research across a much larger population. There are privacy concerns, but there are very desirable benefits to everyone. It would be preferable if government got involved rather than having industry do this for profit. The forced change to electronic health records would have been the perfect time to do this, but the lobbyists won instead so the US health datasphere is still highly fragmented. Migration to the cloud might be another opportunity to fix the problem.

I can tell you that the current focuses of AI implementations are around real, impactful issues: sepsis risk, readmission risk, deterioration index, etc.

The problems with AI in healthcare are:

1) People don’t want it to be a black box - that means quantifying the factors that go into a recommendation

2) Operationalizing AI recommendations is hard. AI tends to give gradiated information on binary decisions (e.g. there’s a 68% chance this patient is septic. Should someone go check on them? What if they were 49%?). The challenge becomes deciding how that information should be shown to people and what the acceptable false positive and false negative rate are.

3) The same problems of AI everywhere. Things like garbage in garbage out, unrealistic user expectations, feeling like it basically tells you what you already know, the challenge of getting insight from a pile of data.

On the other hand, basic statistical techniques with access to a large amount of patient outcomes may find drug side effects faster. It's kind of crazy that this stuff is not better tracked already. Of course AI is the shiny new thing in the press release.

It could be greatly beneficial to the patient. Time will tell, but I also expect the financial optimization issues will take precedence over the rest.

Additionally, this is the typical example of the medical industry tackling problems from the wrong angle. We should be (MUCH) improving data retrieval and measurement reliability in medicine before we can hope to make anything approaching "stable diffusion for medicine"...

It's okay, it'll "optimize for outcomes"

Meaning... those with critical conditions will be left in a room (acceptable losses), those with mild conditions will receive a high amount of treatment (ensuring no one moves from mild to critical, overall reducing fatalities).

And hospital IT workers have the horrorest of horror stories so hopefully this frees them up to not go bald by 35.

Long term I expect that advanced persistent security threats will force almost all small and medium enterprises to migrate to cloud platforms whether they want to or not. It takes quite a high level of scale and technical competence to maintain a secure infrastructure against ransomware.

Epic primarily uses the InterSystems Caché database, which is essentially a modernized edition of MUMPS. It is about as "legacy" as any piece of software can be with parts of the code dating back to 1966, but still works well and for certain applications it's still superior to more modern databases.

BigQuery is not an appropriate database for an EHR.

Epic used to be notorious for lack of interoperability. They now have an extensive set of open APIs and are active participants in industry standards development organizations.

https://open.epic.com/

Just in case there's some confusion here - Epic is Epic the healthcare company, not Epic Games. And Epic the healthcare company most likely already has all of your healthcare records.

You don't want Epic to be within miles of your health records? Well, friend, I've got bad news for you. They are the largest Electronic Medical Record (EMR) company in America. 4 out of 5 patients are in their system. Don't worry too much, though, the records are stored in the blessed hell that is their custom DBMS.

I generally agree. It sounds like Epic and Google won't have direct access, but are just allowing Epic using orgs the ability to host on the cloud instead of in their own data center. Or are they centralizing it?

So who technically owns "your" records? Hospital vendor?

In the EU, Google as well as any other American owned firm are already forbidden from handling personally sensitive information. IANAL but I can not see this as legal in EU in any way. Even before the Gogle involvement, the mere fact that Epic handles such sensitive data across many European countries is bizarre.

It will be interesting how this pans out and when/if EU whatchdogs will discover it / intervene.

Google is not magically unbound by HIPAA so Google can't actually do much of anything with the data outside of host it. They could do some machine learning but you can't mix data so it would have to be client specific which I see no issue with.