Do you want to fire up a bunch of techies? Talk about multicloud! There is no shortage of opinions. I figured we should tackle this hot topic head-on, so I recently talked to four smart folks—Corey Quinn of Duckbill Group, Armon Dadgar of Hashicorp, Tammy Bryant Butow of Gremlin, and James Watters of VMware—about what multicloud is all about, key considerations, and why you should (or shouldn’t!) do it.

Five important insights came out of these discussions. If you’re on a multicloud journey or considering one, keep reading.

Do: Choose to do multicloud for the right reasons

Don’t do multicloud because Gartner says so, implores Corey Quinn. Before embarking on a multicloud, define a “why” focused on business value journey, says Armon Dadger. For example, you might want to use services from each public cloud because of their differentiated services, according to Tammy Bryant Butow. Armon also calls out regulatory reasons, existing business relationships, and accommodating mergers and acquisitions. On the topic of M&A, Corey points out that if you acquire a company that uses another cloud, it’s usually expensive and difficult to consolidate. It can be smarter to stay put.

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Don’t: Over-engineer for workload or data portability

Thinking that you’ll build a system that moves seamlessly among the various cloud providers? Hold up, says our group of experts. Armon points out that aspects of your toolchain or architecture may be multicloud—think of some of your workflows or global network routing—but that shifting workloads or data is far from simple. Corey says that trying to engineer for “write once, run anywhere” can slow you down, and ignores the inherent uniqueness that’s part of each platform. Specifically, Corey calls out the per-cloud stickiness of identity management, security features, and even network functionality. And data gravity is still a thing, says James, that causes some to dismiss multicloud outright.

If you’re using multiple public clouds, you take advantage of the distinct value each offers, Armon says. Use native cloud services where possible so that you see the benefits from useful innovations, built-in resilience, and baked-in best practices. The value from that cloud-infused workload may outweigh the benefits of seamless portability.

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Do: Recognize different stakeholder interests and needs

James smartly points out that many multicloud debates happen because people are arguing from different perspectives. Context matters. If you’re an infrastructure engineer who invests heavily in a given cloud’s identity and access management model, multicloud looks tricky. Or if you’re a data engineer with petabytes of data homed in a particular cloud, multicloud may look unrealistic. James highlights that many developers default to multicloud because their local tools—where all the work happens—are multicloud. A developer’s IDE and preferred code framework(s) aren’t tied to any given cloud. Be aware that groups within your organization will come at multicloud from distinct directions. And this may impact your approach!

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Don’t: Go it alone

Corey talks about the importance of asking others what worked, and what didn’t. Tammy offers her best practices around sharing results from experiments. It’s about sharing knowledge and tapping into it for community benefit. Others have probably tried what you’re trying, and can help you avoid common pitfalls. If you’ve just made an architectural choice that didn’t work out, share it, and help others avoid the pain. 

Read research from analysts, go to conferences or watch videos to observe case studies, and join online communities that offer a safe place to share mistakes and learn from others.

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Do: Experiment first using techniques like multi-region deployments

If you think you can operate systems across clouds, how about you first try doing it across regions in a specific cloud, suggests Corey. Getting a system to properly work across cloud regions isn’t trivial, he says, and that experience can help you uncover where you have architectural or operational constraints that will be even worse across cloud providers.

This is great guidance if your multicloud aspirations involve using multiple clouds to power one application—versus the more standard definition of multicloud where you use different clouds for different applications—but can also surface issues in your support process or toolchain that fail when faced with distributed systems. Start with muti-region deployments and chaos engineering experiments before aggressively jumping into multicloud architectures.

The Google Cloud take

Do the things above. It’s great advice. I’ll add three more things that we’ve learned from our customers.

1. Don’t fear multicloud. You’re already doing it. You don’t single-source everything. As Corey mentioned, you probably already have one cloud for productivity tools, another for source code, another for cloud infrastructure. You’ll use software and application services from a mix of providers for a single app. You have that experience in your team and have been doing that for decades. What people do rightly worry about is using more than one infrastructure service beneath an application, as that can introduce latency, security, and logistical hurdles. Make sure you know which model your team is considering.
2. Embrace the right foundational components, including Kubernetes. Will everything run on Kubernetes? Of course not. Don’t try to do that. But it also represents the closest thing we have to a multicloud API. Companies are using Kubernetes to stripe a consistent experience across clouds. And this isn’t just to orchestrate containers, but also to manage infrastructure and cloud-native services. Also, consider where you need other fundamental consistency across clouds, including areas like provisioning and identity federation.
3. Use Google Cloud as your anchor. Here’s a fundamental question you have to decide for yourself: Are you going to bring your on-premises technology and practices to the cloud, or bring cloud technology and practices on-prem? We sincerely believe in the latter. Anchor to where you’re trying to get to. We offer Anthos as a way to build and run distributed Kubernetes fleets in Google Cloud and across clouds. By using a cloud-based backplane instead of an on-prem one, you’re offloading toil, leveraging managed services for scale and security, and introducing modern practices to the rest of your team.

We learned a lot about multicloud through these discussions, and it seems like others did too. That’s why we’re going to do a second round of interviews with a new crop of experts so that we can keep digging deeper into this topic. Stay tuned!

For more than 10 years, NMK Textile Mills has manufactured bed linens for major retailers in the United States and Canada. As e-commerce exploded, the company’s co-founder saw an opportunity to grow the business. So, in addition to manufacturing bed linens wholesale for retail customers, NMK Textile Mills reworked its complete supply chain to manufacture products for California Design Den, which became an e-commerce retailer selling its own fashion-forward products directly to consumers online.

With California Design Den’s push into e-commerce, it became apparent the SMB company (with about 250 global employees) faced the same tough supply chain questions as large retail customers, including maintaining enough inventory to meet customer demand in a timely, efficient way.

California Design Den depended upon a myriad of systems to track its complex forecasting and reordering processes. Team members typically planned inventory manually using desktop spreadsheet software, which could lead to excess inventory. Accurately forecasting demand and supply was essential to the company’s financial success—but it was also a challenge.

A couple years ago, California Design Den partnered with Pluto7, a technology solutions provider that offers a software as a service (SaaS) called Planning In A Box. Leveraging Google Cloud Platform machine learning and artificial intelligence, Planning In A Box intelligently helps predict demand and balances it with supply.

But that was just the beginning. “Along the way, we realized that to compete with larger retailers, make quicker decisions, and move faster, we needed to go further,” says Deepak Mehrotra, Co-founder and Chief Adventurer at California Design Den.

With guidance from Pluto7, California Design Den began migrating its database to Google Cloud Platform. Using Google BigQuery, Google Compute Engine, Google Cloud SQL, and Google Cloud Storage, and experimenting with Google Cloud Vision and Google Cloud AutoML, the company is reducing inventory carryovers by more than 50%, improving the accuracy of demand planning quarter over quarter, and gaining granular insights into how individual SKUs are performing.

“We would need an army of data scientists to make faster decisions on pricing and inventory levels. With Google Cloud Platform machine learning and artificial intelligence, we don’t need that. We can make much faster pricing decisions to optimize profitability and move inventory.”

—Deepak Mehrotra, Co-founder and Chief Adventurer, California Design Den

No need for army of data scientists

“Using Google Cloud Platform machine learning and AI was essential for California Design Den if it was to compete successfully with larger retailers,” Deepak says.

For example, tastes and fashions in bed linens can change quickly and consumer prices fluctuate. With more than 2,500 SKUs, it wasn’t possible for California Design Den’s team to continuously monitor product demand and experiment with competitive pricing in real time.

“We would need an army of data scientists to make faster decisions on pricing and inventory levels,” says Deepak. “With Google Cloud Platform machine learning and artificial intelligence, we don’t need that. We can make much faster pricing decisions to optimize profitability and move inventory.”

By integrating all its data onto Google Cloud Platform, California Design Den’s team gains deeper insights into product sales over time, which in turn helps the company improve demand planning by better determining which styles to manufacture and sell in the future.

“When experienced employees leave, their knowledge leaves with them. By having all data in one place, and with machine learning and AI, California Design Den can go back in its history, look at products made or sold years ago, and analyze product performance.”

—Deepak Mehrotra, Co-founder and Chief Adventurer, California Design Den

Merging visuals with data

Before Google Cloud Platform, team members had to dig through spreadsheets and run scenarios to get a sense of how particular products had sold. The next step was to perform keyword searches across the company’s photo library in the cloud to find each product’s image. From there, a team member would insert the product images into a presentation, along with relevant data points, to provide a report for stakeholders on how particular styles performed.

Today, California Design Den, with the help of Pluto7, is integrating its entire product image library with its database on Google Cloud Platform. Experimenting with Google Cloud Vision and Google Cloud AutoML, California Design Den is moving towards a day when team members can run sales scenarios and get deep background data on individual product performance while viewing images of the relevant products.

Merging product visuals with data will help designers and team members better understand sales patterns over time and in context. In the past, making correlations between things like which sheet colors sold well in California, compared to how the same sheet colors performed on the East Coast, was something that California Design Den employees primarily did in their heads.

“When experienced employees leave, their knowledge goes with them,” says Manjunath Devadas, Founder and CEO at Pluto7. “By having all data in one place, and with machine learning and AI, California Design Den can go back in its history, look at products made or sold years ago, and analyze product performance.”

“We are literally growing the complexity of our business on all levels, including designing, manufacturing, selling, reordering, inventory holding—everything.”

—Deepak Mehrotra, Co-founder and Chief Adventurer, California Design Den

Reimagining supply-demand balancing

Pluto7’s mission statement is to democratize supply demand balancing with machine learning and AI. California Design Den is a case in point, as the combination of Planning In A Box and Google Cloud Platform gives the company greater control over its destiny.

“Big retailers used to tell us what to manufacture and how much they would pay for it,” says Deepak. “That was our primary business, and if we didn’t accept the terms, a competitor would.” Today, in addition to continuing to make products for retailers, California Design Den can design, make, and sell a variety of designs for itself, including custom and limited-edition products, thanks to Google Cloud Platform and Pluto7 software offerings. The payoff is not only in having a more diversified business. California Design Den also receives more favorable profit margins by selling its own products.

“We are literally growing the complexity of our business on all levels, including designing, manufacturing, selling, reordering, inventory holding—everything,” Deepak says. “We can make smaller batches. We can connect directly with consumers. We can identify the missing pieces—what should we produce next, when, and how much? We otherwise couldn’t afford the level of talent it would take to do this.”

Cutting through the noise

Google and Pluto7 software helped California Design Den reduce inventory carryovers by more than 50%. Inventory tracking and distribution, along with insights and visibility into product sales, are faster, more efficient, and accurate. Google Cloud Platform flexible pricing, speed, reliability, security, and scalability enable California Design Den to stay relevant and be more competitive.

In addition to benefiting from Google Cloud Platform, California Design Den relies on G Suite—also part of Google Cloud—to enhance collaboration among its global teams. Previously, the company’s email server would sometimes crash, due to the heavy load of sharing product photos and other data. “Gmail and Google Drive handle the everyday demands on the business effortlessly and reliably,” Deepak says.

“Google machine learning and AI enable us to cut through all the noise from raw data, so we can see what’s important. We can focus on analytics to guide us to success today and in the future.”

—Deepak Mehrotra, Co-founder and Chief Adventurer, California Design Den

The company is exploring additional ways to leverage Google Cloud Platform in the near future. For example, one possibility is to import customer reviews from sites where products are sold into Google BigQuery, and to use that data to perform sentiment analysis via Google Cloud Natural Language. It could provide another valuable data source to help California Design Den’s team decide where to focus future designs.

“Google machine learning and AI enable us to cut through all the noise from raw data, so we can see what’s important,” Deepak says. “We can focus on analytics to guide us to success today and in the future.”

Healthcare breakthroughs change the world and bring hope to humanity through scientific rigor, human insight, and compassion. We believe AI can contribute to this, with thoughtful collaboration between researchers, healthcare organizations and the broader ecosystem. 

Today, we’re sharing exciting progress on these initiatives, with the announcement of limited access to Google’s medical large language model, or LLM, called Med-PaLM 2. It will be available in coming weeks to a select group of Google Cloud customers for limited testing, to explore use cases and share feedback as we investigate safe, responsible, and meaningful ways to use this technology. 

Med-PaLM 2 harnesses the power of Google’s LLMs, aligned to the medical domain to more accurately and safely answer medical questions. As a result, Med-PaLM 2 was the first LLM to perform at an “expert” test-taker level performance on the MedQA dataset of US Medical Licensing Examination (USMLE)-style questions, reaching 85%+ accuracy, and it was the first AI system to reach a passing score on the MedMCQA dataset comprising Indian AIIMS and NEET medical examination questions, scoring 72.3%.

Industry-tailored LLMs like Med-PaLM 2 are part of a burgeoning family of generative AI technologies that have the potential to significantly enhance healthcare experiences. We’re looking forward to working with our customers to understand how Med-PaLM 2 might be used to facilitate rich, informative discussions, answer complex medical questions, and find insights in complicated and unstructured medical texts. They might also explore its utility to help draft short- and long-form responses and summarize documentation and insights from internal data sets and bodies of scientific knowledge.

Innovating responsibly with AI

Since last year, we’ve been researching and evaluating Med-PaLM and Med-PaLM 2, assessing it against multiple criteria — including scientific consensus, medical reasoning, knowledge recall, bias, and likelihood of possible harm — which were evaluated by clinicians and non-clinicians from a range of backgrounds and countries. 

Med-PaLM 2’s impressive performance on medical exam-style questions is a promising development, but we need to learn how this can be harnessed to benefit healthcare workers, researchers, administrators, and patients. In building Med-PaLM 2, we’ve been focused on safety, equity, and evaluations of unfair bias. Our limited access for select Google Cloud customers will be an important step in furthering these efforts, bringing in additional expertise across the healthcare and life sciences ecosystem. 

What’s more, when Google Cloud brings new AI advances to our products, our commitment is two-fold: to not only deliver transformative capabilities, but also ensure our technologies include proper protections for our organizations, their users, and society. To this end, our AI Principles, established in 2017, form a living constitution that guides our approach to building advanced technologies, conducting research, and drafting our product development policies. 

From AI to generative AI 

Google’s deep history in AI informs our work in generative AI technologies, which can find complex relationships in large sets of training data, then generalize from what they learn to create new data. Breakthroughs such as the Transformer have enabled LLMs and other large models to scale to billions of parameters, letting generative AI move beyond the limited pattern-spotting of earlier AIs and into the creation of novel expressions of content, from speech to scientific modeling. 

Google Cloud is committed to bringing to market products that are informed by our research efforts across Alphabet. In 2022, we introduced a deep integration between Google Cloud and Alphabet’s AI research organizations, which allows Vertex AI to run DeepMind’s groundbreaking protein structure prediction system, AlphaFold.

Much more is on the way. In one sense, generative AI is revolutionary. In another, it’s the familiar technology story of more and better computing creating new industries, from desktop publishing to the internet, social networks, mobile apps, and now, generative AI.

Building on AI leadership

Additionally, today we’re announcing a new AI-enabled Claims Acceleration Suite, designed to streamline processes for health insurance prior authorization and claims processing. The Claims Acceleration Suite helps both providers of insurance plans and healthcare to create operational efficiencies and reduce administrative burdens and costs by converting unstructured data into structured data that help experts make faster decisions and improve access to timely patient care. 

On the clinical side, last year we announced Medical Imaging Suite, an AI-assisted diagnosis technology being used by Hologic to improve cervical cancer diagnoses and Hackensack Meridian Health to predict metastasis in patients with prostate cancer. Elsewhere, Mayo Clinic and Google have collaborated on an AI algorithm to improve the care of head and neck cancers, and Google Health recently partnered with iCAD to improve breast cancer screening with AI.

From these examples and more, it’s clear that the healthcare industry has moved from testing AI to deploying it to improve workflows, solve business problems, and speed healing. With this in mind, we expect rapid interest in and uptake of generative AI technologies. Healthcare organizations are eager to learn about generative AI and how they can use it to make a real difference.

Looking ahead

The power of AI has reinforced Google Cloud’s commitment to privacy, security, and transparency. Our platforms are designed to be flexible, including data and model lineage capabilities, integrated security and identity management services, support for third-party models, choice and transparency on models and costs, integrated billing and entitlement support, and support across many languages. 

While we’ll have some innovations like Med-PaLM 2 that are tuned for healthcare, we also have products that are relevant across industries. Last month, we announced several generative AI capabilities coming to Google Cloud, including Generative AI support in Vertex AI and Generative AI App Builder, which are already being tested by a number of customers. Developers and businesses already use Vertex AI to build and deploy machine learning models and AI applications at scale, and we recently added Generative AI support in Vertex AI. This gives customers foundation models they can fine-tune with their own data, and the ability to deploy applications with this powerful new technology. We also launched Generative AI App Builder to help organizations build their own AI-powered chat interfaces and digital assistants in minutes or hours by connecting conversational AI flows with out-of-the-box search experiences and foundation models.

As AI proves its value, it’s likely there will be increased focus on high-quality data collection and curation in healthcare and life sciences. Improving the flow and unification of data across health care systems, referred to as data interoperability, is one of the most important building blocks to leveraging AI, and it helps organizations run more effectively, improve patient care, and helps people live healthier lives. We expect to continue our investments in technology, infrastructure, and data governance.

We’re committed to realizing the potential of this technology in healthcare. By working with a handful of trusted healthcare organizations early on, we’ll learn more about what can be achieved, and how this technology can safely advance. For all of us, the prospects are inspiring, humbling, and exciting. 

If you’re interested in exploring generative AI on Cloud, you can sign-up for our Trusted Tester program or reach out to your Google Cloud sales representative.

Powered by Vertex AI (Google Cloud’s platform for accelerating development and deployment of machine learning models into production), SAVI (Semi Automated Vision Inspection)1 is transforming surgical instrument identification and cataloging, leading to fewer canceled surgeries and easing pressure on surgery waitlists.

Max Kelsen, an analytics and software agency that specializes in machine learning, has worked closely with Google Cloud and Johnson & Johnson MedTech to create a system that can manage tens of thousands of individual devices, their characteristics, and how they apply to each set or tray used by a surgeon. SAVI does this while delivering a one in 10,000 real-world error rate, much faster and more accurately than manual processes currently in use across the industry. Implementing SAVI can also unlock end-to-end visibility and traceability across the surgical set supply chain and provide advanced analytics and insights.

Eliminating time-consuming manual processes

Surgeons need a large number of specialist instruments and devices to complete complex, delicate procedures. Because each tray of these instruments can typically cost more than $350,000, and having every type of set on shelf at every surgical facility is not feasible, manufacturers generally loan them to hospitals for procedures, such as inserting one of the manufacturers’ implants into a patient’s knee. Once a procedure is complete, the hospital returns the instrument tray to the manufacturer for storage and re-distribution to other hospitals as needed.

Each time a hospital returns a tray, the manufacturer needs to check that each instrument is there, correctly placed, cleaned, and fit for the purpose of the next procedure. As each set may hold more than 400 instruments, completing this process manually is complex and time-consuming. While each tray is checked before and after surgery at the hospital, and again when it arrives and leaves the manufacturer’s facility, Max Kelsen finds that 5% of surgeries can still be affected by missing, broken or bent instruments. This has a severe downstream impact on private hospitals in particular, directly affecting patient safety and outcomes; in Australia, for example, around 60% of surgeries are performed in private hospitals.

Johnson & Johnson MedTech has 60,000 surgical trays across the Asia-Pacific, and loans these trays out about 100,000 times per month. The manufacturer approached Max Kelsen to help design and develop a solution to make the supply chain more efficient, and to give more visibility into asset movement. As a Google Cloud Partner specializing in applying machine learning at scale in healthcare contexts, Max Kelsen had the expertise and track record to meet Johnson & Johnson MedTech’s need for a globally scalable solution that was engineered for quality and performance.

The first step was to establish a baseline for the project by determining how long the manufacturer’s team took to process each tray, and to set an efficiency number. We then spent six months determining and evaluating how to deliver a robust, accurate solution that outperformed current manual and labor-intensive methods in processing instruments and trays, globally. Our work included extensive technical feasibility research involving a representative sample for the variety and complexity of sets, trays, and devices needed for different types of surgery, including orthopedics, spinal trauma, and maxillofacial groups.

Working with Google Cloud to accelerate and de-risk the project

This is a familiar problem that is industry-wide. The issue has been widely explored and tried with a number of technologies over several years without producing the scalability and performance results required to make this an appropriate and feasible solution. Google Cloud partnered with Max Kelsen to accelerate and de-risk this large and strategic project for a mutual customer.

Technical feasibility took four months, prior to a year-long production pilot of SAVl in a distribution center in Queensland that services over 100 hospitals. After obtaining enough real-world data and experience to validate that the solution was as scalable and as accurate as needed, an Asia-Pacific rollout of the system commenced. SAVI is now live across Johnson & Johnson MedTech’s operations in Australia, New Zealand, and Japan, garnering recognition with a JAISA excellence award.

Google Cloud machine learning is integral to SAVI. Google Cloud’s technologies were a big differentiator for Max Kelsen’s engineering team in delivering the breakthroughs needed at scale, and in production, to meet Johnson & Johnson MedTech’s needs.

Reducing checking and documentation time

Running SAVI in Google Cloud has reduced the time Johnson & Johnson MedTech needs to check and document inspections of these surgical instrument sets by over 40%. The application also delivers consistent measurable quality that is often hard to measure at scale when using manual processes. During the pandemic, the application enabled Johnson & Johnson MedTech to operate with a lower headcount for the same volume output, enabling the organization to quickly service a backlog of waiting list surgeries.

In addition, the automation delivered with SAVI has reduced the time required to bring technicians up to speed on quality control processes, from eight to 12 months down to just three months, enhancing productivity and performance while delivering a more robust workforce.

So how does SAVI work in a real-world context? SAVI is deployed via a tablet and a web-based application incorporates an API to photograph the medical device trays, as shown below. Max Kelsen captures the photograph and sends it to a range of different services, via an API endpoint hosted on Google Cloud:

• Image information is stored in Cloud Storage
• Data relating to the trays is stored in Cloud SQL for PostgreSQL
• APIs and web UI components run in CloudRun
• Analytics data is stored within BigQuery

Once this tray and device onboarding stage is completed, the next step is to perform inferences from the images and data. By hosting online models with Kubeflow model serving on GKE, we enable a model to identify all the instruments in a tray at low latency.

Vertex AI Workbench notebooks are used for data exploration and modeling. Kubeflow training pipelines hosted on GKE are executed to produce machine learning models for specific surgical instrument sets. Several hundred machine learning models are then hosted with Kubeflow model serving on GKE, with state and analytics managed using Firebase. Using machine learning to infer from images whether any devices are incorrectly placed, dirty, or otherwise not fit for purpose, the data is then returned to the tablet for the user to respond accordingly.

Based on our success to date with SAVI, it is now available on Google Cloud Marketplace to help healthcare organizations achieve machine learning-powered efficiencies across a range of use cases, and ultimately improve patient safety and outcomes.

Not to be confused with the usage of Visual Inspection Model (Assembly) available in Vertex AI Vision