8 ms·

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

40 points by shishy 4y ago

rwmj 4y ago
Two companies I'd absolutely not want within miles of my health records.
- giantg2 4y ago
  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?
  - rwmj 4y ago
    Hosting sensitive stuff in the cloud is absolutely centralising it and giving access to anyone that can issue a national security letter or join Google in particular roles, or just hacks it because someone left the keys in a git repository.
    - giantg2 4y ago
      Eh, not exactly a definition I would use. It depends on the location. It's completely different to have Epic manage all the data under their account vs having the org's IT set up their own account/servers/etc. There's really nothing stopping a national security letter from grabbing your health data under the current architecture.
      - _jal 4y ago
        There's a huge difference between the effort required to get one person's records from wherever they are now and the effort required to trawl through a centralized database. Put all the data in one place and make it easy to access and LEOs are going to treat it the same way they do their other data sources - abuse it up to the point they can get away with. It happens every single time.
        giantg2 4y ago
        But it's not all in one place, even in the cloud. You have numerous machines, data centers, client encryption, etc. "abuse it up to the point they can get away with." And I guarantee anything that would happen in the cloud is already happening.
        _jal 4y ago
        > And I guarantee anything that would happen in the cloud is already happening. Then you should be much more careful about what you choose to guarantee, because you'd be wrong, and that heavily devalues your "guarantees". Many of the abuses described in the article below are simply not possible when data is distributed amongst many actors. And many of the targeted abuses would never have happened without easy access to these databases. https://apnews.com/article/699236946e3140659fff8a2362e16f43 https://apnews.com/article/699236946e3140659fff8a2362e16f43 It simply comes down this this: make data more available, and it will be used more. In theory, it is possible to build audited systems that, combined with oversight, could solve a lot of this. But in practice, audit trails are frequently never built, oversight ranges from powerless to nonexistent, and the extreme deference cops get in this country means this stuff is rarely investigated and results in wrist slaps when it is.
        giantg2 4y ago
        "Then you should be much more careful about what you choose to guarantee, because you'd be wrong," Please, do show me how I'm wrong. HIPAA allows the disclosure of some health information without a warrant. There are plenty of abuses that happen today. Would centralizing increase those? Sure. But they are already happening. And again, I don't see whether these are truly centralized like a DB, or if they're independently on the cloud (or perhaps you didn't answer that because you're trolling).
        _jal 4y ago
        > perhaps you didn't answer that because you're trolling You don't get to accuse me of trolling when you're being intentionally unresponsive and obtuse. Just another username I'm not going to waste time on in the future.
- corndoge 4y ago
  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.
- renewiltord 4y ago
  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.
  - throwawaybutwhy 4y ago
    'blessed hell' - Are you talking about Chronicles or Clarity or both? Ain't familiar with either, am I at risk of contracting MUMPS?
- kakoni 4y ago
  So who technically owns "your" records? Hospital vendor?
giantg2 4y ago
We'll see how this goes. Maybe a win for some things, like possibly better security standards enforcement to protect against ransomware.
- nradov 4y ago
  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.
ocdtrekkie 4y ago
Hopefully the law will intervene here. We should have a right to not have our medical data ingested by Google, and Google's already gotten in trouble for this in the UK. We really need the government to outright forbid Google from healthcare at this point.
- Spivak 4y ago
  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.
  - Teever 4y ago
    You say that like it means something. If something merely being against the law was enough to stop people from doing something we wouldn't need cops and lawyers would we? It's not enough for something to be against the law, that law has to be enforced/enforceable. What's stopping Google from lobbying to change the law?
    - Spivak 4y ago
      Well if you think Google has that kind of power then a law that prevents Google from hosting healthcare data at all isn't gonna work either.
  - 2OEH8eoCRo0 4y ago
    > They could do some machine learning I never consented to that.
- yetanother12345 4y ago
  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.
ryanburk 4y ago
note that they already supported this migration capability to AWS and Azure. example: https://cloudblogs.microsoft.com/industry-blog/microsoft-in-business/business-transformation/2022/03/25/epic-on-azure-gaining-rapid-momentum/ https://cloudblogs.microsoft.com/industry-blog/microsoft-in-...
deleted 4y ago
[deleted]
caycep 4y ago
The problem with Epic is that they seem to refuse to deal with their technical debt. As far as I know, it's still some janky visualbasic UI with a M/UMPS backend (well w/ a modernization wrapper). And why change because hospital CIOs are willing to approve contracts worth hundreds of millions (and their competitors are even worse) Maybe it all works...however slowly... but pulling data out of what is effectively a bunch of antiquated and super siloed-bins seems overly labor intensive and cost ineffective. The other announcement was that they were doing to do a partnership with Apple, but sounded like the task of actually making a modern native client on MacOS was beyond their technical skill...(their iOS app efforts are...not pretty...)
- zitterbewegung 4y ago
  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.
- bena 4y ago
  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.
  - philwelch 4y ago
    It's also heavily regulated, which it probably should be, but that has certain tradeoffs and consequences.
    - deleted 4y ago
      [deleted]
    - caycep 4y ago
      regulated...by the HHS panel that conveniently includes Judy Faulkner, CEO of Epic...
theGnuMe 4y ago
I don't think hospitals really want to run their own datacenters so this makes a lot of sense especially for the new AI medical applications.
- Spivak 4y ago
  And hospital IT workers have the horrorest of horror stories so hopefully this frees them up to not go bald by 35.
Eleison23 4y ago
The odds are never in our favor!
version_five 4y ago
I'm actually less concerned with the privacy implications (which are concerning) than with the idea of more "AI" in healthcare. AI is a shiny object that does not solve any of the most urgent problems in healthcare, and almost certainly distracts from them, while all the "quick wins" are going to be the usual automation of what should be personal interactions, making it worse for everyone that is not the "average" customer. AI investment in healthcare is for the benefit of the AI providers only. It is not going to benefit patients, certainly not vs other ways the money could be spent (more staff, more beds)
- rscho 4y ago
  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"...
- citilife 4y ago
  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).
- cheriot 4y ago
  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.
  - nradov 4y ago
    Perhaps, but previous attempts by researchers to generate clinical insights by merging clinical records from multiple provider organizations and then doing retrospective outcomes analysis have produced disappointing results. Data quality is generally bad, leading to a fundamental garbage in / garbage out problem. There is little consistency between documentation practices across providers, and many findings aren't recorded at all. So in order to get a useful data set, researchers have to do a huge amount of manual data cleansing. Current AI/ML algorithms are incapable of automating much of this work.
mtzaldo 4y ago
Chromebooks at the hospitals?
pfisherman 4y ago
The use of “AI” here is style without substance. The thing that jumps out at me is “Epic workloads” on Google cloud, which sounds a lot like generating reports on cloud rather than on prem(?).
ThinkBeat 4y ago
The press release is of course nearly devoid of interesting facts The "We will use AI" and that will be great. Is highly annoying. M/UMPS and Visual Basic 6 running on Google Cloud. That might be the first time for that stack. Maybe. They used to run off of a proprietary or at least legacy database as well. I wonder if they still are. It will be interesting to integrate that to conform with BigQuery. Or perhaps they will export all the data to a sane store first. Epic is notorious for not integrating with any other system. Or at least they were a decade ago.
- nradov 4y ago
  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/ https://open.epic.com/
  - kakoni 4y ago
    I believe technically there is Chronicles, Epics own "database framework/abstraction" that runs on top of Caché. Then about Caches superiority, this is the only public benchmark that I could find (from Intersystems) https://community.intersystems.com/sites/default/files/documentation/Cache_benchmark-1c69bf617b51d5a2dee145442deaa371.pdf https://community.intersystems.com/sites/default/files/docum... Where 8-core server (back in 2009 that is) could do about 2 million database reads per second.

40 points by shishy 4y ago

rwmj 4y ago

Two companies I'd absolutely not want within miles of my health records.

giantg2 4y ago
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?
- rwmj 4y ago
  Hosting sensitive stuff in the cloud is absolutely centralising it and giving access to anyone that can issue a national security letter or join Google in particular roles, or just hacks it because someone left the keys in a git repository.
  - giantg2 4y ago
    Eh, not exactly a definition I would use. It depends on the location. It's completely different to have Epic manage all the data under their account vs having the org's IT set up their own account/servers/etc. There's really nothing stopping a national security letter from grabbing your health data under the current architecture.
    - _jal 4y ago
      There's a huge difference between the effort required to get one person's records from wherever they are now and the effort required to trawl through a centralized database. Put all the data in one place and make it easy to access and LEOs are going to treat it the same way they do their other data sources - abuse it up to the point they can get away with. It happens every single time.
      - giantg2 4y ago
        But it's not all in one place, even in the cloud. You have numerous machines, data centers, client encryption, etc. "abuse it up to the point they can get away with." And I guarantee anything that would happen in the cloud is already happening.
        _jal 4y ago
        > And I guarantee anything that would happen in the cloud is already happening. Then you should be much more careful about what you choose to guarantee, because you'd be wrong, and that heavily devalues your "guarantees". Many of the abuses described in the article below are simply not possible when data is distributed amongst many actors. And many of the targeted abuses would never have happened without easy access to these databases. https://apnews.com/article/699236946e3140659fff8a2362e16f43 https://apnews.com/article/699236946e3140659fff8a2362e16f43 It simply comes down this this: make data more available, and it will be used more. In theory, it is possible to build audited systems that, combined with oversight, could solve a lot of this. But in practice, audit trails are frequently never built, oversight ranges from powerless to nonexistent, and the extreme deference cops get in this country means this stuff is rarely investigated and results in wrist slaps when it is.
        giantg2 4y ago
        "Then you should be much more careful about what you choose to guarantee, because you'd be wrong," Please, do show me how I'm wrong. HIPAA allows the disclosure of some health information without a warrant. There are plenty of abuses that happen today. Would centralizing increase those? Sure. But they are already happening. And again, I don't see whether these are truly centralized like a DB, or if they're independently on the cloud (or perhaps you didn't answer that because you're trolling).
        _jal 4y ago
        > perhaps you didn't answer that because you're trolling You don't get to accuse me of trolling when you're being intentionally unresponsive and obtuse. Just another username I'm not going to waste time on in the future.
corndoge 4y ago
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.
renewiltord 4y ago
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.
- throwawaybutwhy 4y ago
  'blessed hell' - Are you talking about Chronicles or Clarity or both? Ain't familiar with either, am I at risk of contracting MUMPS?
kakoni 4y ago
So who technically owns "your" records? Hospital vendor?

giantg2 4y ago

We'll see how this goes. Maybe a win for some things, like possibly better security standards enforcement to protect against ransomware.

nradov 4y ago
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.

ocdtrekkie 4y ago

Hopefully the law will intervene here. We should have a right to not have our medical data ingested by Google, and Google's already gotten in trouble for this in the UK. We really need the government to outright forbid Google from healthcare at this point.

Spivak 4y ago
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.
- Teever 4y ago
  You say that like it means something. If something merely being against the law was enough to stop people from doing something we wouldn't need cops and lawyers would we? It's not enough for something to be against the law, that law has to be enforced/enforceable. What's stopping Google from lobbying to change the law?
  - Spivak 4y ago
    Well if you think Google has that kind of power then a law that prevents Google from hosting healthcare data at all isn't gonna work either.
- 2OEH8eoCRo0 4y ago
  > They could do some machine learning I never consented to that.
yetanother12345 4y ago
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.

ryanburk 4y ago

note that they already supported this migration capability to AWS and Azure. example: https://cloudblogs.microsoft.com/industry-blog/microsoft-in-business/business-transformation/2022/03/25/epic-on-azure-gaining-rapid-momentum/ https://cloudblogs.microsoft.com/industry-blog/microsoft-in-...

deleted 4y ago

[deleted]

caycep 4y ago

The problem with Epic is that they seem to refuse to deal with their technical debt. As far as I know, it's still some janky visualbasic UI with a M/UMPS backend (well w/ a modernization wrapper). And why change because hospital CIOs are willing to approve contracts worth hundreds of millions (and their competitors are even worse) Maybe it all works...however slowly... but pulling data out of what is effectively a bunch of antiquated and super siloed-bins seems overly labor intensive and cost ineffective. The other announcement was that they were doing to do a partnership with Apple, but sounded like the task of actually making a modern native client on MacOS was beyond their technical skill...(their iOS app efforts are...not pretty...)

zitterbewegung 4y ago
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.
bena 4y ago
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.
- philwelch 4y ago
  It's also heavily regulated, which it probably should be, but that has certain tradeoffs and consequences.
  - deleted 4y ago
    [deleted]
  - caycep 4y ago
    regulated...by the HHS panel that conveniently includes Judy Faulkner, CEO of Epic...

theGnuMe 4y ago

I don't think hospitals really want to run their own datacenters so this makes a lot of sense especially for the new AI medical applications.

Spivak 4y ago
And hospital IT workers have the horrorest of horror stories so hopefully this frees them up to not go bald by 35.

Eleison23 4y ago

The odds are never in our favor!

version_five 4y ago

I'm actually less concerned with the privacy implications (which are concerning) than with the idea of more "AI" in healthcare. AI is a shiny object that does not solve any of the most urgent problems in healthcare, and almost certainly distracts from them, while all the "quick wins" are going to be the usual automation of what should be personal interactions, making it worse for everyone that is not the "average" customer. AI investment in healthcare is for the benefit of the AI providers only. It is not going to benefit patients, certainly not vs other ways the money could be spent (more staff, more beds)

rscho 4y ago
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"...
citilife 4y ago
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).
cheriot 4y ago
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.
- nradov 4y ago
  Perhaps, but previous attempts by researchers to generate clinical insights by merging clinical records from multiple provider organizations and then doing retrospective outcomes analysis have produced disappointing results. Data quality is generally bad, leading to a fundamental garbage in / garbage out problem. There is little consistency between documentation practices across providers, and many findings aren't recorded at all. So in order to get a useful data set, researchers have to do a huge amount of manual data cleansing. Current AI/ML algorithms are incapable of automating much of this work.

mtzaldo 4y ago

Chromebooks at the hospitals?

pfisherman 4y ago

The use of “AI” here is style without substance. The thing that jumps out at me is “Epic workloads” on Google cloud, which sounds a lot like generating reports on cloud rather than on prem(?).

ThinkBeat 4y ago

The press release is of course nearly devoid of interesting facts The "We will use AI" and that will be great. Is highly annoying. M/UMPS and Visual Basic 6 running on Google Cloud. That might be the first time for that stack. Maybe. They used to run off of a proprietary or at least legacy database as well. I wonder if they still are. It will be interesting to integrate that to conform with BigQuery. Or perhaps they will export all the data to a sane store first. Epic is notorious for not integrating with any other system. Or at least they were a decade ago.

nradov 4y ago
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/ https://open.epic.com/
- kakoni 4y ago
  I believe technically there is Chronicles, Epics own "database framework/abstraction" that runs on top of Caché. Then about Caches superiority, this is the only public benchmark that I could find (from Intersystems) https://community.intersystems.com/sites/default/files/documentation/Cache_benchmark-1c69bf617b51d5a2dee145442deaa371.pdf https://community.intersystems.com/sites/default/files/docum... Where 8-core server (back in 2009 that is) could do about 2 million database reads per second.