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Epic Tells Customers It Will Stop Google Cloud Integrations

264 points by nsriv 7y ago

toomuchtodo 7y ago
Doesn’t bode well for Google’s cloud ambitions, but squares with what the marketplace looks like (clients absolutely hungry for those with Azure experience and AWS to a lesser extent). Azure is unpleasant to work with, but the deals are apparently being made (mostly outside of tech centric firms). Kudos to MS’ sales teams.
- bfung 7y ago
  ^^^ spot on. My thought while reading the article was how poor Google’s sales and customer support culture is across the entire company that has led to non-tech firms picking solutions with Azure and AWS who invest heavily on the support side.
  - tmpz22 7y ago
    Wasn't the irk of Google's Ascension deal the Google Sales team forcing a data sharing agreement in exchange for a sweeter cloud resource prices?
  - l33tman 7y ago
    I was operating a fairly large AWS operation, and had the idea to at least check with G Cloud if they were interested (usually you get a boatload of free credits to startups). After 3 emails spread over several months I eventually got a note saying I should expect to talk with my Google Cloud salesguy, but it can only happen over a Hangout. And not any hangout - they sent a cheap ass Android "netbook" that I had to physically go to the post office to get, that the Hangout call was supposed to happen through. I did get it from the post office, noted that it took minutes to start up, then gave it away and never heard from GC again.
    - guitarsteve 7y ago
      That’s so strange. Does anyone know why they’d want to chat using special hardware?
      - killjoywashere 7y ago
        Because he's l33tman, man. l33t.
        l33tman 7y ago
        Haha exactly! No, I'm sure they could have accepted any Hangouts call or being coerced into accepting a phonecall as well. But truthfully what they wrote in the sendout was like I described - they outlined the procedure to go get the netbook and use it and at no point did they suggest a physical phone number to call or similar. I went along with it as far as I did just because I was kind of baffled by the suggested procedure :) I assume it was part of some marketing scheme to try to market Hangouts and/or Chromebooks (or whatever it was) at the same time as GCP, but it just confused the sale and added unnecessary pain-points. The AWS guys just send an email and let me call them by a normal phone.
    - aianus 7y ago
      I was part of the GCP startup program starting Sep 2018 and just had a normal hangouts call with the GCP sales guy. Your experience sounds nuts.
  - munk-a 7y ago
    I think AWS is also going to start seriously suffering from their terrible billing experience pretty soon. I think I can see the beginnings of the damage showing up in how many HOWTOs and retrospectives are out there about unexpected AWS charges, but I don't think it's caused a noticeable impact for them yet.
    - axaxs 7y ago
      Not just their billing, but their terrible interface. I shouldn't have to ctrl f everytime I want to check ec2 instances. Whoever decided to show 200+ "services" on a single screen is a crazy person.
      - bfung 7y ago
        At the company level of conversation, the UI of AWS services isn't that big of a deal. The people with budget authority usually don't even see the AWS UI and have most likely never logged in.
        axaxs 7y ago
        OK, granted. But I'm the dude using it. And when asked, I'll champion anything else. Sometimes making engineers happy makes a sale.
blakesterz 7y ago
I didn't really understand what this meant until the very end of the actual MSNBC article. At least I think I get it now. “We’ve historically seen hospital systems make these decisions independently of their medical record provider,” said Aneesh Chopra, the president of health-technology company CareJourney and the former chief technology officer of the United States. “It will be interesting to see if Epic’s thumb on the scale moves cloud market share.” So apparently if I'm a hospital I can run the Epic systems anywhere, or at least store my records anywhere, well, at least at AWS or Azure, and apparently not Google now.
- bcrosby95 7y ago
  Sure, but: > That report notes that "insufficient interest" from Epic customers in Google is behind the decision to focus efforts instead with those cloud competitors. It seems like if you run Epic Systems at Google, you were in a minority that is apparently not worth supporting. This seems less like Epic putting their thumb on the scale, and more like their customers putting their thumb on the scale.
  - reaperducer 7y ago
    I have only limited experience in the healthcare space when it comes to cloud selection, but I can tell you that every single healthcare company I work with uses Azure. They don't do it because it may or may not be right for their needs. They pick Azure because somewhere along the line the mid- and upper-level managers, including director-level IT people, have been made to believe that anything other than Windows is insecure and not suitable for HIPAA. If I even mention the word "Linux" or "AWS" to them they immediately curl up in a little ball mentally and treat me like I'm some kind of evil script kiddie, or magical wizard. It's truly baffling the responses I get from people who are supposed to be in charge of these things. I don't know these people outside of boardroom presentations, so I don't know how they got this way. My best guess is that it's either Microsoft salesmen, industry conferences, or simply what they're comfortable with and anything else is not worth risking their jobs.
    - 7y ago
berbec 7y ago
Has it become "nobody got fired for using AWS"?
- toomuchtodo 7y ago
  Azure if you don’t want to give your dollars to a competitor (anything Amazon competes in). That’s Microsoft’s big cloud selling point: "we sell you tech services, we’ll never be competing in your vertical."
- organsnyder 7y ago
  In healthcare, absolutely. And it was only a few years ago that it was "on-prem" instead of "AWS".
  - ska 7y ago
    on-prem still is, in a lot of the space. But it's changing.
kyrra 7y ago
Googler, opinions are my own. WSJ has had some good converge about parallel medical record stories that are going on right now too, as has CNBC: https://www.cnbc.com/2020/01/17/epic-systems-warns-customers-it-will-stop-supporting-google-cloud.html https://www.cnbc.com/2020/01/17/epic-systems-warns-customers... https://www.wsj.com/articles/paging-dr-google-how-the-tech-giant-is-laying-claim-to-health-data-11578719700 https://www.wsj.com/articles/paging-dr-google-how-the-tech-g... WSJ podcast about it: https://www.wsj.com/podcasts/the-journal/why-google-is-pushing-into-health-data/19d0dbe3-fe29-4c6d-a547-926df9a3ec89 https://www.wsj.com/podcasts/the-journal/why-google-is-pushi... To quote the end of the WSJ article: > Existing players in the health-care data market also fear that the tech giant will gain too much power in their industry. Some hospital and technology executives say they declined deals with Google lest it become a future competitor. > “We could never pin down Google on what their true business model was,” says a Cerner executive involved in the discussions.
- platform 7y ago
  Oracle has done the same in the last 25 years. Company I worked for used Oracle database for an enterprise system. Oracle over the years, acquired some of our competitors. Then every time customers would need to renew database licenses with Oracle, Oracle's sales reps would try to sell them the competing enterprise systems that they had acquired.
- trhway 7y ago
  >> “We could never pin down Google on what their true business model was,” says a Cerner executive involved in the discussions. I think they really do understand what the Google true business model is, and this is exactly why they say that and avoid giving Google the access to the data.
- atoav 7y ago
  The cool thing about medical data is, that you only have to lose them once in order to be out there
organsnyder 7y ago
Epic being concerned about a giant gaining too much power? That's cute.
- karpodiem 7y ago
  Which of the two has a trillion dollar market cap with monopoly like market share in multiple business to consumer product sectors? There’s nothing novel about what Epic or any other B2B enterprise software company does (for the most part), other than total addressable market (and profits) being far smaller than the B2C FAANG giants - the market caps reflect this as well.
  - manigandham 7y ago
    Microsoft, Amazon, and Google are all trillion dollar companies operating in multiple sectors. Why is Google special in this regard?
    - karpodiem 7y ago
      Right. And while Epic does the heavy lifting of crafting software to support healthcare provider workflows, integrating dissimilar systems (PACS, etc.), and storing all that data, the companies you mentioned feel they can create value by attempting to automate diagnosis and potentially offer some integration point for genetic counseling.
      - killjoywashere 7y ago
        As a physician forced to use Epic, I'm not sure "crafted" is the word I'd use to describe their software. It's more like they addressed the spec from the C suite in a way that was equivalent to punching health care providers in the face. They take Dad's money, and use it to pay thugs to beat up his kids.
        asah 7y ago
        Serious q: are the other systems any better? Have you tried them? Have you compared notes with physicians using them? (I'm new to the field and genuinely curious... I haven't heard anybody saying anything nice about any of them...)
leshokunin 7y ago
Might want to specify which Epic. I was left wondering in what way Fortnite was connected to Google Cloud integrations.
- flounder3 7y ago
  Did you read the article? It begins with "Electronic health record giant Epic Systems..."
  - whiddershins 7y ago
    From the guidelines: ‘ Please don't comment on whether someone read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that." ‘
- mjevans 7y ago
  I agree that it's good to at least specify the industry domain this affects as from the headline someone might assume the Epic they know, or be confused about which Epic is involved if they know of both.
semerda 7y ago
At Sutter, every machine is Windows and runs Epic integrated. Epic is much more than EHR. It’s a hospital layer sitting ontop of Windows. Naturally, it integrates with Active Directory and I can see why Google would have little dominance. Saying that, I wonder if Epic has a plan to go after smaller players who might be using Google Apps and fears google’s dominance.
Narkov 7y ago
> “We could never pin down Google on what their true business model was,” says a Cerner executive involved in the discussions. Imagine being that insecure in what you do. What were they looking for? A non-compete from Google? Innovate or die.
- ska 7y ago
  I don't think that is fair. Understanding your partners business model is a key part of dd for collaboration. If the partner is being cagey about it, there is probably a reason, and it probably isn't a good sign.
- JumpCrisscross 7y ago
  > What were they looking for? A non-compete from Google? Good faith. Google has for years selected for raw bureaucratic ambition and a cloistered view of technical talent. That set of cultural defects is coming home to roost.
- manigandham 7y ago
  > "Innovate or die" You can say the same to Google Cloud.
- briffle 7y ago
  Especially when Amazon is making moves into insurance and pharmacy spaces
  - deanCommie 7y ago
    The difference is Amazon won't use confidential AWS data to drive their other verticals. Google's very business model is selling their users to their customers.
    - theevilsharpie 7y ago
      Can you provide a source, either in the form of a ToS/privacy policy or an evidence-backed article, showing that Google uses customer data stored in GCP for advertising purposes?
lawrenceyan 7y ago
No more Fortnite? /s
1290cc 7y ago
Google is doing the right thing. EPIC is a perfect example of the walled garden ecosystem that extracts every last drop from its clients and keeps anyone trying to innovate out. Healthcare tech could use the competition to drive down costs related to medical record management and exchange.
- solo1preneur 7y ago
  > EPIC is a perfect example of the walled garden ecosystem that extracts every last drop from its clients and keeps anyone trying to innovate out. Google doesn't do this?
  - 1290cc 7y ago
    They aren't innocent either but I welcome the competition in a market segment that is dominated by so few players who strangle any innovation.
- neuro_image3 7y ago
  Absolutely. | Also EPIC is spectacularly unfit for purpose. Total garbage software that essentially functions as a billing tool.
  - ShirtlessRod 7y ago
    How is it "garbage software"?
    - JshWright 7y ago
      It's a billing system with clinical related functionality tacked on. It's pretty frustrating to use from the perspective of a "boots on the ground" user.
      - ShirtlessRod 7y ago
        That's a pretty pessimistic and quite frankly not accurate assessment of the software. They have a ton of clinical functionality, and that's what the majority of the dev/design spends their time on at their users group meeting, among other places. You might not like it, but many do.
jeanvalmarc 7y ago
GCP seems culturally a terrible fit for anything compliance-related. Azure and AWS both offer high-compliance regions (Azure Government / AWS GovCloud) that are absolutely necessary for many industries (medical, defense, etc). Slightly salty about this as I am currently migrating a legacy Firebase app because Google doesn't care...
- morpheuskafka 7y ago
  GovCloud is for government agencies though, mostly to facilitate rules such as no access by foreign nationals. Just because you are in a regulated field doesn't mean you qualify to use it.
- xyst 7y ago
  Government Cloud seems to revolve around “access controls” to the cloud instances. I skimmed over one of specifications (“FedRAMP”) and most of the requirements seem like the standard requirements for any type of multi-tenant system (eg, user login expiry). Doesn’t seem like it offers anything different from the “non-government” packages.
twodave 7y ago
I really don’t think this has anything to do with competition (if anything Google is competing with Amazon and Microsoft here, not Epic). The article muddies the waters somewhat, but all the quotes are telling a story that says (not untruthfully) they’re dropping it due to its outsized maintenance burden in relation to the proportion of their clients who use it.
- neandrake 7y ago
  There might be some fear of competition. Google is offering healthcare solutions some of which seem to be angled at "owning" the healthcare data. I'm only vaguely familiar with Epic's offerings but a lot of these solutions that Google offers seem to encroach in that territory: https://cloud.google.com/solutions/healthcare-life-sciences/ https://cloud.google.com/solutions/healthcare-life-sciences/ https://cloud.google.com/solutions/modernize-legacy-apps/ https://cloud.google.com/solutions/modernize-legacy-apps/ https://cloud.google.com/healthcare/ https://cloud.google.com/healthcare/
  - modmans2nd 7y ago
    Epic doesn’t “own” any of the EHR data in their customer’s databases. Not sure when “competition “ you refer to can be considered to come from.
    - neandrake 7y ago
      Sorry - by "own" I meant that it's in their system, a "walled garden". Any other vendor system looking to integrate has to sign business deals with Epic in addition to whatever institution is using it. I did not mean that Epic gets access to see and use that data as what seems to be a separate concern people have of Google.
  - avocado4 7y ago
    Google is now building an EHR as direct competition to Epic. It's definitely related to this move. Fwiw I welcome Google's entrance to this market because Epic's EHR and business practices are equally aweful.
thatGuy0000 7y ago
Fuck Epic and fuck being stuck in healthcare development hell
killjoywashere 7y ago
This is a head-in-the-sand move by US companies (not just Cerner and Epic, but the hospital system CIOs). If they really think Google is going after healthcare data, they should keep in mind Google is already working with NHS and has a little thing called the Billion Users project focused on India. The British and Indian populations have the same health problems Americans do. Proportions might change, but the content is qualitatively the same. Also, I wonder if AWS is pushing their heads into the sand. Particularly now that Cerner committed to AWS but DoD gave Jedi to Azure (Defense Health and VA are migrating their medical records to Cerner). AWS may be pressuring a customer (Epic) to squeeze their customers. Which absolutely sounds like something I'd expect from Amazon.
- powowow 7y ago
  Your AWS conspiracy theory is bizarre.
  - dang 7y ago
    Would you please stop breaking the site guidelines? You've been doing it a lot, unfortunately, and we're hoping for more thoughtful conversation here. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- ta999999171 7y ago
  Since I can't respond to the "bizarre" comment - what problems do you have with the speculation?
- Angostura 7y ago
  > they should keep in mind Google is already working with NHS You should keep in mind that this is pretty controversial in the UK.
deleted 7y ago
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synaesthesisx 7y ago
I don't blame them - from my understanding there are certain Google Cloud services that have glaring security holes/are legitimately HIPAA violations.
- ghayes 7y ago
  Can you cite news articles or other sources to this effect? Otherwise, this comment is strictly hearsay.
- dontblink 7y ago
  It's amazing to me how social media is used to spread FUD against some companies. Please provide sources.
  - synaesthesisx 7y ago
    It's amazing to me how social media is used by employees to shill certain corporations. https://www.managedcaremag.com/dailynews/20191113/hhs-investigating-google-ascensions-project-nightingale-hipaa-violations https://www.managedcaremag.com/dailynews/20191113/hhs-invest... https://healthitsecurity.com/news/google-uchicago-medicine-sued-for-sharing-identifiable-patient-data https://healthitsecurity.com/news/google-uchicago-medicine-s... I've heard there are a couple Google Ventures - backed healthcare startups that have questionable HIPAA-compliance as well, directly from clients that have worked with them. They're not necessarily holes in GCP itself but rather in integrations with certain services.
    - briffle 7y ago
      Neither of those are Google cloud related
zerotolerance 7y ago
Before I read the article I was guessing that it had to do with the leaked memo regarding Google cloud growth targets and the popular conclusion that they'll be shutting it down or pivoting that LoB in 2023. https://news.ycombinator.com/item?id=21815260 https://news.ycombinator.com/item?id=21815260
shmerl 7y ago
Does anyone know, if Epic implemented parallelized Vulkan renderer in their engine, or they dropped the whole parallelization effort and enabling Vulkan for high end features? If anyone is using it for development, please comment. Epic "archived" their TODO item on Trello: https://trello.com/c/lzLwtb5P/124-vulkan-for-pc-and-linux https://trello.com/c/lzLwtb5P/124-vulkan-for-pc-and-linux
- grzm 7y ago
  Epic is not Epic - https://en.wikipedia.org/wiki/Epic_Systems https://en.wikipedia.org/wiki/Epic_Systems - https://en.wikipedia.org/wiki/Epic_Games_Store https://en.wikipedia.org/wiki/Epic_Games_Store
  - shmerl 7y ago
    Oh, thanks for clarifying, I confused them with different Epic indeed.
    - danielbln 7y ago
      You're not alone, I went down a few comment threads in here being more and more surprised that Epic games has such a strong foothold in the health market already. Whoops, guess it pays off to actually read the article.
semerda 7y ago
Epic is a cash cow private company. Sutter Health in the Bay Area paid $1B for its EHR. Epic stays quiet to protect its walled gardens; deeply integrated into hospital infrastructure. No doubt Google is a threat to them. Here’s an old article I found that references this juicy revenue opportunity (the rest have been cleared by Epic, so the story goes): https://www.healthcareitnews.com/news/setback-sutter-after-1b-ehr-system%20crashes https://www.healthcareitnews.com/news/setback-sutter-after-1...
- stygiansonic 7y ago
  I talked to a doctor at Stanford and he mentioned to me one reason why the main Stanford Health and Stanford Children's Health have separate patient portals (not unified) that you have to create separate logins for is because of the huge amount Epic wanted to charge to merge them. (They both run separate Epic instances as far as I can tell)
  - echelon 7y ago
    How are leeches like this tolerated? The sooner they are driven out of business, the better.
    - warent 7y ago
      They're not entirely tolerated fortunately. The US government has been taking action to tear down EHR walled gardens via the Cures Act[1] which is manifesting in public access APIs called FHIR. [1] https://en.wikipedia.org/wiki/21st_Century_Cures_Act https://en.wikipedia.org/wiki/21st_Century_Cures_Act
      - parasubvert 7y ago
        FHIR is nice but doesn’t completely reduce the complexity of integrating the underlying data itself considering the mess that is HL7 and mess that occurred with v3. The situation is sort of like moving from SOAP+XML Schemas to REST/JSON. Easier to develop, but the underlying data structures are still extremely complicated and tricky to get right. This is especially true when dealing with ancient systems written in niche languages/database hybrids (MUMPS comes to mind): https://en.m.wikipedia.org/wiki/MUMPS https://en.m.wikipedia.org/wiki/MUMPS
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gsich 7y ago
Smart choice, considering the shutdown of GCE in 2023.
- metahost 7y ago
  Are you being sarcastic?
  - gsich 7y ago
    No. https://www.cnbc.com/2019/12/17/google-reportedly-wants-to-be-top-two-player-in-cloud-by-2023.html https://www.cnbc.com/2019/12/17/google-reportedly-wants-to-b... The dementi was overspecific. "We did not discuss this in 2018". Which could mean they discussed it in 2019 or 2017.
maxtollenaar 7y ago
Used to intern at Epic in 2015. I asked my manager why they weren't on cloud. He said our customer data is too critical to be stored in cloud. Interesting how things have change in a very short time
eschaton 7y ago
So no running MUMPS code on Google Cloud then?
- killjoywashere 7y ago
  Actually, VMWare supports OpenVMS and VMWare runs in GCP, so MUMPS should be good to go.
- kotaKat 7y ago
  Pull a CPSI/Evident and run HTML5, Linux, and Cobol on one gloriously confusing platform.
tallgiraffe 7y ago
Epic is ruthless and takes competition out by any means necessary. They are a dinosaur that avoided competition for decades, and Google is a massive thread. This is good news because they are scared, and Google has an infinite runaway to take them out. Epic should have worked tirelessly to innovate and improve US healthcare, but instead chose to stay still and to profit. They won’t be for long.
- ksmsnxn 7y ago
  Is Google going to try to compete in the EHR space? I don’t think of them as an enterprise software company - at least not in the same way as an Oracle or MSFT. My impression of their strategy/focus is that they are trying to sell cloud compute and ML services?
  - tallgiraffe 7y ago
    I feel like Google is an everything company. Traditionally EHR has been done via enterprise and connections, but it doesn’t mean google can’t change it. In fact, they could open a network of Google hospitals, and run their own software on them, or buy a big chain. Much like Amazon got WholeFoods, Google can get into the game if they choose to, and at the end of the day, if they want to grow, they will have to find more avenues to expand to.
    - aguyfromnb 7y ago
      >In fact, they could open a network of Google hospitals, and run their own software on them, or buy a big chain. Much like Amazon got WholeFoods, I'm a fan of Google, but what's with people thinking Silicon Valley companies can easily "get into" everything? What business is Google in that leads you to believe they could run hospitals? They couldn't even design a decent social network, which is their wheelhouse. At least Amazon was selling groceries before they bought Whole Foods.
      - tomrod 7y ago
        Generally barriers to entry preserving market power are what Warren Buffett looks at when BH buys companies. SV recognizes that tech typically lowers common barriers to entry like management silo expertise.
leoh 7y ago
Google is absolutely doing the right thing. Anything that can be done to enhance the efficacy of EMR software will help lead to better patient outcomes. As far as I can tell, Google is approaching the problem foremost from the perspective of "how can we make people healthier by making software more effective." Epic and Cerner are simply not doing that. Somewhere in the comments here someone mentioned that most EMR software is a billing system with record keeping attached. Although implementations vary between hospitals, the software is always purchased by administrators, typically with little input from doctors. In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This means that if a patient comes through the medical system frequently, doctors have to read pages and pages of unstructured text to get a sense of what's going on for the patient. The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes for patients. Google has made a lot of mistakes. If they build something doctors truly want to use and that helps properly organize information, however, and if Google doesn't misuse the data/people aren't unreasonably paranoid about data misuse, it will be a godsend for the industry and it will save lives. We haven't even begun to talk about the potential for machine learning and statistics to understand what treatments are most effective if data are structured properly. This is unquestionably an interesting and unique case where collecting massive amounts of data and handing in to a trusted, competent, creative, research-oriented authority could have incredible benefit for mankind. I don't trust Cerner or Epic with this mission for a second.
- cle 7y ago
  I try hard not to give my data to Google, for a lot of reasons. As a patient, having my healthcare provider hand my data over for them to monetize in God-knows-what ways is...undesirable.
  - deleted 7y ago
    [deleted]
  - sz4kerto 7y ago
    This is where things get mixed up. EPIC is suggesting that using Google Cloud is somehow equivalent with handing data over to Google so that Google works with that data. These are absolutely, extremely different. Assuming that Google will somehow break into your VMs or GKE clusters to get data out and monetize it is crazy, of course, but EPIC tries to suggest that.
tasssko 7y ago
To be fair if anyone is going to take on Epic its big tech. What is really needed is legislation to protect your data. This area seems ready for disruption.
codred 7y ago
Major part of Google Health team came from Deep Mind. We have a lot of doctors and people used to work for NHS. Our goal to help doctors, nurses in their work, save patients lives and revolutionise the industry. We are complient with privicy regulations and see huge potential in what we do. Majority of negative comments are driven by fear of Google selling data for targeted adds but in all our agreements with trust we clearly state our goals and practices. I'd rather people concentrate on positive side and huge potentials in front of us instead of FUD.
inscrutable 7y ago
There seems to be major disengenuousness on behalf of EPIC and Cerner, and some ignorance on behalf of WSJ. GCP != Google Health, at least for the purposes of patient privacy. If you hold the encryption keys, google can't do anything, or am I wrong in that assumption? It is fine, and expected, to rule out GCP for storing your own records for competitive reasons (e.g. choosing them would make future Google Health integrations easier). It is also expected, if not quite fine, to try to actively prevent your customers from using GCP. Cerner seemed happy to play a few rounds of golf with Eric Schmidt regarding using GCP, presumably to try to glean insight into Google Health, while EPIC flat out refused a meeting. Cerner then helpfully provided a misleading quote to the WSJ to help spread FUD.
metafizikal 7y ago
everyone has conspiracy theories about what is "really going on here", this is to stamp out a competitive threat in google, or whatever, but I do think this story probably is just that hospitals (and "traditional enterprises" broadly) are not using GCP for their cloud infrastructure and are instead going with AWS or Azure.
- microcolonel 7y ago
  I still don't see why they have to be tied to a single provider. Seems like a major weakness of large customers in this space, that they're unwilling to demand standards or protect themselves from exploitation in this way. Obviously there will be new APIs for services which are not yet a commodity, but there are some highly standardized offerings from every major "cloud" vendor which should be configurable in roughly the same way; many of them even have similar limitations, like AWS and Azure (last I tried) not having the option to expose their VPSes directly over IPv6.
logfromblammo 7y ago
> "This is not us mining somebody’s records to sell ads, to learn from it, to do machine learning, to develop products. We developed this on de-identified data." "De-identified data" is "somebody's records". Also, for all the PR put behind the patient, Epic (and likely Cerner too) focus all their bizdev efforts on what the hospital and HMO administrators want, because they're the ones that sign the checks. Back when I worked there, they threw huge stacks of employees at customizing every installation, and significant developer effort at making broad customization possible. If patient care were the primary issue, every Epic implementation would be identical at the keyboard shortcut level. Hospital admins would have had to backdoor their customizations in by forcing their physicians and nurses to demand them as features. But instead, I saw page after page of customizations, inserting arbitrary administrator-created workflows on the staff via the software.

264 points by nsriv 7y ago

Doesn’t bode well for Google’s cloud ambitions, but squares with what the marketplace looks like (clients absolutely hungry for those with Azure experience and AWS to a lesser extent). Azure is unpleasant to work with, but the deals are apparently being made (mostly outside of tech centric firms). Kudos to MS’ sales teams.

bfung 7y ago
^^^ spot on. My thought while reading the article was how poor Google’s sales and customer support culture is across the entire company that has led to non-tech firms picking solutions with Azure and AWS who invest heavily on the support side.
- tmpz22 7y ago
  Wasn't the irk of Google's Ascension deal the Google Sales team forcing a data sharing agreement in exchange for a sweeter cloud resource prices?
- l33tman 7y ago
  I was operating a fairly large AWS operation, and had the idea to at least check with G Cloud if they were interested (usually you get a boatload of free credits to startups). After 3 emails spread over several months I eventually got a note saying I should expect to talk with my Google Cloud salesguy, but it can only happen over a Hangout. And not any hangout - they sent a cheap ass Android "netbook" that I had to physically go to the post office to get, that the Hangout call was supposed to happen through. I did get it from the post office, noted that it took minutes to start up, then gave it away and never heard from GC again.
  - guitarsteve 7y ago
    That’s so strange. Does anyone know why they’d want to chat using special hardware?
    - killjoywashere 7y ago
      Because he's l33tman, man. l33t.
      - l33tman 7y ago
        Haha exactly! No, I'm sure they could have accepted any Hangouts call or being coerced into accepting a phonecall as well. But truthfully what they wrote in the sendout was like I described - they outlined the procedure to go get the netbook and use it and at no point did they suggest a physical phone number to call or similar. I went along with it as far as I did just because I was kind of baffled by the suggested procedure :) I assume it was part of some marketing scheme to try to market Hangouts and/or Chromebooks (or whatever it was) at the same time as GCP, but it just confused the sale and added unnecessary pain-points. The AWS guys just send an email and let me call them by a normal phone.
  - aianus 7y ago
    I was part of the GCP startup program starting Sep 2018 and just had a normal hangouts call with the GCP sales guy. Your experience sounds nuts.
- munk-a 7y ago
  I think AWS is also going to start seriously suffering from their terrible billing experience pretty soon. I think I can see the beginnings of the damage showing up in how many HOWTOs and retrospectives are out there about unexpected AWS charges, but I don't think it's caused a noticeable impact for them yet.
  - axaxs 7y ago
    Not just their billing, but their terrible interface. I shouldn't have to ctrl f everytime I want to check ec2 instances. Whoever decided to show 200+ "services" on a single screen is a crazy person.
    - bfung 7y ago
      At the company level of conversation, the UI of AWS services isn't that big of a deal. The people with budget authority usually don't even see the AWS UI and have most likely never logged in.
      - axaxs 7y ago
        OK, granted. But I'm the dude using it. And when asked, I'll champion anything else. Sometimes making engineers happy makes a sale.

blakesterz 7y ago

I didn't really understand what this meant until the very end of the actual MSNBC article. At least I think I get it now. “We’ve historically seen hospital systems make these decisions independently of their medical record provider,” said Aneesh Chopra, the president of health-technology company CareJourney and the former chief technology officer of the United States. “It will be interesting to see if Epic’s thumb on the scale moves cloud market share.” So apparently if I'm a hospital I can run the Epic systems anywhere, or at least store my records anywhere, well, at least at AWS or Azure, and apparently not Google now.

bcrosby95 7y ago
Sure, but: > That report notes that "insufficient interest" from Epic customers in Google is behind the decision to focus efforts instead with those cloud competitors. It seems like if you run Epic Systems at Google, you were in a minority that is apparently not worth supporting. This seems less like Epic putting their thumb on the scale, and more like their customers putting their thumb on the scale.
- reaperducer 7y ago
  I have only limited experience in the healthcare space when it comes to cloud selection, but I can tell you that every single healthcare company I work with uses Azure. They don't do it because it may or may not be right for their needs. They pick Azure because somewhere along the line the mid- and upper-level managers, including director-level IT people, have been made to believe that anything other than Windows is insecure and not suitable for HIPAA. If I even mention the word "Linux" or "AWS" to them they immediately curl up in a little ball mentally and treat me like I'm some kind of evil script kiddie, or magical wizard. It's truly baffling the responses I get from people who are supposed to be in charge of these things. I don't know these people outside of boardroom presentations, so I don't know how they got this way. My best guess is that it's either Microsoft salesmen, industry conferences, or simply what they're comfortable with and anything else is not worth risking their jobs.
  - 7y ago

berbec 7y ago

Has it become "nobody got fired for using AWS"?

toomuchtodo 7y ago
Azure if you don’t want to give your dollars to a competitor (anything Amazon competes in). That’s Microsoft’s big cloud selling point: "we sell you tech services, we’ll never be competing in your vertical."
organsnyder 7y ago
In healthcare, absolutely. And it was only a few years ago that it was "on-prem" instead of "AWS".
- ska 7y ago
  on-prem still is, in a lot of the space. But it's changing.

kyrra 7y ago

Googler, opinions are my own. WSJ has had some good converge about parallel medical record stories that are going on right now too, as has CNBC: https://www.cnbc.com/2020/01/17/epic-systems-warns-customers-it-will-stop-supporting-google-cloud.html https://www.cnbc.com/2020/01/17/epic-systems-warns-customers... https://www.wsj.com/articles/paging-dr-google-how-the-tech-giant-is-laying-claim-to-health-data-11578719700 https://www.wsj.com/articles/paging-dr-google-how-the-tech-g... WSJ podcast about it: https://www.wsj.com/podcasts/the-journal/why-google-is-pushing-into-health-data/19d0dbe3-fe29-4c6d-a547-926df9a3ec89 https://www.wsj.com/podcasts/the-journal/why-google-is-pushi... To quote the end of the WSJ article: > Existing players in the health-care data market also fear that the tech giant will gain too much power in their industry. Some hospital and technology executives say they declined deals with Google lest it become a future competitor. > “We could never pin down Google on what their true business model was,” says a Cerner executive involved in the discussions.

platform 7y ago
Oracle has done the same in the last 25 years. Company I worked for used Oracle database for an enterprise system. Oracle over the years, acquired some of our competitors. Then every time customers would need to renew database licenses with Oracle, Oracle's sales reps would try to sell them the competing enterprise systems that they had acquired.
trhway 7y ago
>> “We could never pin down Google on what their true business model was,” says a Cerner executive involved in the discussions. I think they really do understand what the Google true business model is, and this is exactly why they say that and avoid giving Google the access to the data.
atoav 7y ago
The cool thing about medical data is, that you only have to lose them once in order to be out there

organsnyder 7y ago

Epic being concerned about a giant gaining too much power? That's cute.

karpodiem 7y ago
Which of the two has a trillion dollar market cap with monopoly like market share in multiple business to consumer product sectors? There’s nothing novel about what Epic or any other B2B enterprise software company does (for the most part), other than total addressable market (and profits) being far smaller than the B2C FAANG giants - the market caps reflect this as well.
- manigandham 7y ago
  Microsoft, Amazon, and Google are all trillion dollar companies operating in multiple sectors. Why is Google special in this regard?
  - karpodiem 7y ago
    Right. And while Epic does the heavy lifting of crafting software to support healthcare provider workflows, integrating dissimilar systems (PACS, etc.), and storing all that data, the companies you mentioned feel they can create value by attempting to automate diagnosis and potentially offer some integration point for genetic counseling.
    - killjoywashere 7y ago
      As a physician forced to use Epic, I'm not sure "crafted" is the word I'd use to describe their software. It's more like they addressed the spec from the C suite in a way that was equivalent to punching health care providers in the face. They take Dad's money, and use it to pay thugs to beat up his kids.
      - asah 7y ago
        Serious q: are the other systems any better? Have you tried them? Have you compared notes with physicians using them? (I'm new to the field and genuinely curious... I haven't heard anybody saying anything nice about any of them...)

leshokunin 7y ago

Might want to specify which Epic. I was left wondering in what way Fortnite was connected to Google Cloud integrations.

flounder3 7y ago
Did you read the article? It begins with "Electronic health record giant Epic Systems..."
- whiddershins 7y ago
  From the guidelines: ‘ Please don't comment on whether someone read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that." ‘
mjevans 7y ago
I agree that it's good to at least specify the industry domain this affects as from the headline someone might assume the Epic they know, or be confused about which Epic is involved if they know of both.

semerda 7y ago

At Sutter, every machine is Windows and runs Epic integrated. Epic is much more than EHR. It’s a hospital layer sitting ontop of Windows. Naturally, it integrates with Active Directory and I can see why Google would have little dominance. Saying that, I wonder if Epic has a plan to go after smaller players who might be using Google Apps and fears google’s dominance.

Narkov 7y ago

> “We could never pin down Google on what their true business model was,” says a Cerner executive involved in the discussions. Imagine being that insecure in what you do. What were they looking for? A non-compete from Google? Innovate or die.

ska 7y ago
I don't think that is fair. Understanding your partners business model is a key part of dd for collaboration. If the partner is being cagey about it, there is probably a reason, and it probably isn't a good sign.
JumpCrisscross 7y ago
> What were they looking for? A non-compete from Google? Good faith. Google has for years selected for raw bureaucratic ambition and a cloistered view of technical talent. That set of cultural defects is coming home to roost.
manigandham 7y ago
> "Innovate or die" You can say the same to Google Cloud.
briffle 7y ago
Especially when Amazon is making moves into insurance and pharmacy spaces
- deanCommie 7y ago
  The difference is Amazon won't use confidential AWS data to drive their other verticals. Google's very business model is selling their users to their customers.
  - theevilsharpie 7y ago
    Can you provide a source, either in the form of a ToS/privacy policy or an evidence-backed article, showing that Google uses customer data stored in GCP for advertising purposes?

lawrenceyan 7y ago

No more Fortnite? /s

1290cc 7y ago

Google is doing the right thing. EPIC is a perfect example of the walled garden ecosystem that extracts every last drop from its clients and keeps anyone trying to innovate out. Healthcare tech could use the competition to drive down costs related to medical record management and exchange.

solo1preneur 7y ago
> EPIC is a perfect example of the walled garden ecosystem that extracts every last drop from its clients and keeps anyone trying to innovate out. Google doesn't do this?
- 1290cc 7y ago
  They aren't innocent either but I welcome the competition in a market segment that is dominated by so few players who strangle any innovation.
neuro_image3 7y ago
Absolutely. | Also EPIC is spectacularly unfit for purpose. Total garbage software that essentially functions as a billing tool.
- ShirtlessRod 7y ago
  How is it "garbage software"?
  - JshWright 7y ago
    It's a billing system with clinical related functionality tacked on. It's pretty frustrating to use from the perspective of a "boots on the ground" user.
    - ShirtlessRod 7y ago
      That's a pretty pessimistic and quite frankly not accurate assessment of the software. They have a ton of clinical functionality, and that's what the majority of the dev/design spends their time on at their users group meeting, among other places. You might not like it, but many do.

jeanvalmarc 7y ago

GCP seems culturally a terrible fit for anything compliance-related. Azure and AWS both offer high-compliance regions (Azure Government / AWS GovCloud) that are absolutely necessary for many industries (medical, defense, etc). Slightly salty about this as I am currently migrating a legacy Firebase app because Google doesn't care...

morpheuskafka 7y ago
GovCloud is for government agencies though, mostly to facilitate rules such as no access by foreign nationals. Just because you are in a regulated field doesn't mean you qualify to use it.
xyst 7y ago
Government Cloud seems to revolve around “access controls” to the cloud instances. I skimmed over one of specifications (“FedRAMP”) and most of the requirements seem like the standard requirements for any type of multi-tenant system (eg, user login expiry). Doesn’t seem like it offers anything different from the “non-government” packages.

twodave 7y ago

I really don’t think this has anything to do with competition (if anything Google is competing with Amazon and Microsoft here, not Epic). The article muddies the waters somewhat, but all the quotes are telling a story that says (not untruthfully) they’re dropping it due to its outsized maintenance burden in relation to the proportion of their clients who use it.

neandrake 7y ago
There might be some fear of competition. Google is offering healthcare solutions some of which seem to be angled at "owning" the healthcare data. I'm only vaguely familiar with Epic's offerings but a lot of these solutions that Google offers seem to encroach in that territory: https://cloud.google.com/solutions/healthcare-life-sciences/ https://cloud.google.com/solutions/healthcare-life-sciences/ https://cloud.google.com/solutions/modernize-legacy-apps/ https://cloud.google.com/solutions/modernize-legacy-apps/ https://cloud.google.com/healthcare/ https://cloud.google.com/healthcare/
- modmans2nd 7y ago
  Epic doesn’t “own” any of the EHR data in their customer’s databases. Not sure when “competition “ you refer to can be considered to come from.
  - neandrake 7y ago
    Sorry - by "own" I meant that it's in their system, a "walled garden". Any other vendor system looking to integrate has to sign business deals with Epic in addition to whatever institution is using it. I did not mean that Epic gets access to see and use that data as what seems to be a separate concern people have of Google.
- avocado4 7y ago
  Google is now building an EHR as direct competition to Epic. It's definitely related to this move. Fwiw I welcome Google's entrance to this market because Epic's EHR and business practices are equally aweful.

thatGuy0000 7y ago

Fuck Epic and fuck being stuck in healthcare development hell

killjoywashere 7y ago

This is a head-in-the-sand move by US companies (not just Cerner and Epic, but the hospital system CIOs). If they really think Google is going after healthcare data, they should keep in mind Google is already working with NHS and has a little thing called the Billion Users project focused on India. The British and Indian populations have the same health problems Americans do. Proportions might change, but the content is qualitatively the same. Also, I wonder if AWS is pushing their heads into the sand. Particularly now that Cerner committed to AWS but DoD gave Jedi to Azure (Defense Health and VA are migrating their medical records to Cerner). AWS may be pressuring a customer (Epic) to squeeze their customers. Which absolutely sounds like something I'd expect from Amazon.

powowow 7y ago
Your AWS conspiracy theory is bizarre.
- dang 7y ago
  Would you please stop breaking the site guidelines? You've been doing it a lot, unfortunately, and we're hoping for more thoughtful conversation here. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
ta999999171 7y ago
Since I can't respond to the "bizarre" comment - what problems do you have with the speculation?
Angostura 7y ago
> they should keep in mind Google is already working with NHS You should keep in mind that this is pretty controversial in the UK.

deleted 7y ago

[deleted]

synaesthesisx 7y ago

I don't blame them - from my understanding there are certain Google Cloud services that have glaring security holes/are legitimately HIPAA violations.

ghayes 7y ago
Can you cite news articles or other sources to this effect? Otherwise, this comment is strictly hearsay.
dontblink 7y ago
It's amazing to me how social media is used to spread FUD against some companies. Please provide sources.
- synaesthesisx 7y ago
  It's amazing to me how social media is used by employees to shill certain corporations. https://www.managedcaremag.com/dailynews/20191113/hhs-investigating-google-ascensions-project-nightingale-hipaa-violations https://www.managedcaremag.com/dailynews/20191113/hhs-invest... https://healthitsecurity.com/news/google-uchicago-medicine-sued-for-sharing-identifiable-patient-data https://healthitsecurity.com/news/google-uchicago-medicine-s... I've heard there are a couple Google Ventures - backed healthcare startups that have questionable HIPAA-compliance as well, directly from clients that have worked with them. They're not necessarily holes in GCP itself but rather in integrations with certain services.
  - briffle 7y ago
    Neither of those are Google cloud related

zerotolerance 7y ago

Before I read the article I was guessing that it had to do with the leaked memo regarding Google cloud growth targets and the popular conclusion that they'll be shutting it down or pivoting that LoB in 2023. https://news.ycombinator.com/item?id=21815260 https://news.ycombinator.com/item?id=21815260

shmerl 7y ago

Does anyone know, if Epic implemented parallelized Vulkan renderer in their engine, or they dropped the whole parallelization effort and enabling Vulkan for high end features? If anyone is using it for development, please comment. Epic "archived" their TODO item on Trello: https://trello.com/c/lzLwtb5P/124-vulkan-for-pc-and-linux https://trello.com/c/lzLwtb5P/124-vulkan-for-pc-and-linux

grzm 7y ago
Epic is not Epic - https://en.wikipedia.org/wiki/Epic_Systems https://en.wikipedia.org/wiki/Epic_Systems - https://en.wikipedia.org/wiki/Epic_Games_Store https://en.wikipedia.org/wiki/Epic_Games_Store
- shmerl 7y ago
  Oh, thanks for clarifying, I confused them with different Epic indeed.
  - danielbln 7y ago
    You're not alone, I went down a few comment threads in here being more and more surprised that Epic games has such a strong foothold in the health market already. Whoops, guess it pays off to actually read the article.

semerda 7y ago

Epic is a cash cow private company. Sutter Health in the Bay Area paid $1B for its EHR. Epic stays quiet to protect its walled gardens; deeply integrated into hospital infrastructure. No doubt Google is a threat to them. Here’s an old article I found that references this juicy revenue opportunity (the rest have been cleared by Epic, so the story goes): https://www.healthcareitnews.com/news/setback-sutter-after-1b-ehr-system%20crashes https://www.healthcareitnews.com/news/setback-sutter-after-1...

stygiansonic 7y ago
I talked to a doctor at Stanford and he mentioned to me one reason why the main Stanford Health and Stanford Children's Health have separate patient portals (not unified) that you have to create separate logins for is because of the huge amount Epic wanted to charge to merge them. (They both run separate Epic instances as far as I can tell)
- echelon 7y ago
  How are leeches like this tolerated? The sooner they are driven out of business, the better.
  - warent 7y ago
    They're not entirely tolerated fortunately. The US government has been taking action to tear down EHR walled gardens via the Cures Act[1] which is manifesting in public access APIs called FHIR. [1] https://en.wikipedia.org/wiki/21st_Century_Cures_Act https://en.wikipedia.org/wiki/21st_Century_Cures_Act
    - parasubvert 7y ago
      FHIR is nice but doesn’t completely reduce the complexity of integrating the underlying data itself considering the mess that is HL7 and mess that occurred with v3. The situation is sort of like moving from SOAP+XML Schemas to REST/JSON. Easier to develop, but the underlying data structures are still extremely complicated and tricky to get right. This is especially true when dealing with ancient systems written in niche languages/database hybrids (MUMPS comes to mind): https://en.m.wikipedia.org/wiki/MUMPS https://en.m.wikipedia.org/wiki/MUMPS

deleted 7y ago

[deleted]

gsich 7y ago

Smart choice, considering the shutdown of GCE in 2023.

metahost 7y ago
Are you being sarcastic?
- gsich 7y ago
  No. https://www.cnbc.com/2019/12/17/google-reportedly-wants-to-be-top-two-player-in-cloud-by-2023.html https://www.cnbc.com/2019/12/17/google-reportedly-wants-to-b... The dementi was overspecific. "We did not discuss this in 2018". Which could mean they discussed it in 2019 or 2017.

maxtollenaar 7y ago

Used to intern at Epic in 2015. I asked my manager why they weren't on cloud. He said our customer data is too critical to be stored in cloud. Interesting how things have change in a very short time

eschaton 7y ago

So no running MUMPS code on Google Cloud then?

killjoywashere 7y ago
Actually, VMWare supports OpenVMS and VMWare runs in GCP, so MUMPS should be good to go.
kotaKat 7y ago
Pull a CPSI/Evident and run HTML5, Linux, and Cobol on one gloriously confusing platform.

tallgiraffe 7y ago

Epic is ruthless and takes competition out by any means necessary. They are a dinosaur that avoided competition for decades, and Google is a massive thread. This is good news because they are scared, and Google has an infinite runaway to take them out. Epic should have worked tirelessly to innovate and improve US healthcare, but instead chose to stay still and to profit. They won’t be for long.

ksmsnxn 7y ago
Is Google going to try to compete in the EHR space? I don’t think of them as an enterprise software company - at least not in the same way as an Oracle or MSFT. My impression of their strategy/focus is that they are trying to sell cloud compute and ML services?
- tallgiraffe 7y ago
  I feel like Google is an everything company. Traditionally EHR has been done via enterprise and connections, but it doesn’t mean google can’t change it. In fact, they could open a network of Google hospitals, and run their own software on them, or buy a big chain. Much like Amazon got WholeFoods, Google can get into the game if they choose to, and at the end of the day, if they want to grow, they will have to find more avenues to expand to.
  - aguyfromnb 7y ago
    >In fact, they could open a network of Google hospitals, and run their own software on them, or buy a big chain. Much like Amazon got WholeFoods, I'm a fan of Google, but what's with people thinking Silicon Valley companies can easily "get into" everything? What business is Google in that leads you to believe they could run hospitals? They couldn't even design a decent social network, which is their wheelhouse. At least Amazon was selling groceries before they bought Whole Foods.
    - tomrod 7y ago
      Generally barriers to entry preserving market power are what Warren Buffett looks at when BH buys companies. SV recognizes that tech typically lowers common barriers to entry like management silo expertise.

leoh 7y ago

Google is absolutely doing the right thing. Anything that can be done to enhance the efficacy of EMR software will help lead to better patient outcomes. As far as I can tell, Google is approaching the problem foremost from the perspective of "how can we make people healthier by making software more effective." Epic and Cerner are simply not doing that. Somewhere in the comments here someone mentioned that most EMR software is a billing system with record keeping attached. Although implementations vary between hospitals, the software is always purchased by administrators, typically with little input from doctors. In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This means that if a patient comes through the medical system frequently, doctors have to read pages and pages of unstructured text to get a sense of what's going on for the patient. The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes for patients. Google has made a lot of mistakes. If they build something doctors truly want to use and that helps properly organize information, however, and if Google doesn't misuse the data/people aren't unreasonably paranoid about data misuse, it will be a godsend for the industry and it will save lives. We haven't even begun to talk about the potential for machine learning and statistics to understand what treatments are most effective if data are structured properly. This is unquestionably an interesting and unique case where collecting massive amounts of data and handing in to a trusted, competent, creative, research-oriented authority could have incredible benefit for mankind. I don't trust Cerner or Epic with this mission for a second.

cle 7y ago
I try hard not to give my data to Google, for a lot of reasons. As a patient, having my healthcare provider hand my data over for them to monetize in God-knows-what ways is...undesirable.
- deleted 7y ago
  [deleted]
- sz4kerto 7y ago
  This is where things get mixed up. EPIC is suggesting that using Google Cloud is somehow equivalent with handing data over to Google so that Google works with that data. These are absolutely, extremely different. Assuming that Google will somehow break into your VMs or GKE clusters to get data out and monetize it is crazy, of course, but EPIC tries to suggest that.

tasssko 7y ago

To be fair if anyone is going to take on Epic its big tech. What is really needed is legislation to protect your data. This area seems ready for disruption.

codred 7y ago

Major part of Google Health team came from Deep Mind. We have a lot of doctors and people used to work for NHS. Our goal to help doctors, nurses in their work, save patients lives and revolutionise the industry. We are complient with privicy regulations and see huge potential in what we do. Majority of negative comments are driven by fear of Google selling data for targeted adds but in all our agreements with trust we clearly state our goals and practices. I'd rather people concentrate on positive side and huge potentials in front of us instead of FUD.

inscrutable 7y ago

There seems to be major disengenuousness on behalf of EPIC and Cerner, and some ignorance on behalf of WSJ. GCP != Google Health, at least for the purposes of patient privacy. If you hold the encryption keys, google can't do anything, or am I wrong in that assumption? It is fine, and expected, to rule out GCP for storing your own records for competitive reasons (e.g. choosing them would make future Google Health integrations easier). It is also expected, if not quite fine, to try to actively prevent your customers from using GCP. Cerner seemed happy to play a few rounds of golf with Eric Schmidt regarding using GCP, presumably to try to glean insight into Google Health, while EPIC flat out refused a meeting. Cerner then helpfully provided a misleading quote to the WSJ to help spread FUD.

metafizikal 7y ago

everyone has conspiracy theories about what is "really going on here", this is to stamp out a competitive threat in google, or whatever, but I do think this story probably is just that hospitals (and "traditional enterprises" broadly) are not using GCP for their cloud infrastructure and are instead going with AWS or Azure.

microcolonel 7y ago
I still don't see why they have to be tied to a single provider. Seems like a major weakness of large customers in this space, that they're unwilling to demand standards or protect themselves from exploitation in this way. Obviously there will be new APIs for services which are not yet a commodity, but there are some highly standardized offerings from every major "cloud" vendor which should be configurable in roughly the same way; many of them even have similar limitations, like AWS and Azure (last I tried) not having the option to expose their VPSes directly over IPv6.

logfromblammo 7y ago

> "This is not us mining somebody’s records to sell ads, to learn from it, to do machine learning, to develop products. We developed this on de-identified data." "De-identified data" is "somebody's records". Also, for all the PR put behind the patient, Epic (and likely Cerner too) focus all their bizdev efforts on what the hospital and HMO administrators want, because they're the ones that sign the checks. Back when I worked there, they threw huge stacks of employees at customizing every installation, and significant developer effort at making broad customization possible. If patient care were the primary issue, every Epic implementation would be identical at the keyboard shortcut level. Hospital admins would have had to backdoor their customizations in by forcing their physicians and nurses to demand them as features. But instead, I saw page after page of customizations, inserting arbitrary administrator-created workflows on the staff via the software.