Lung cancer is the leading cause of cancer death in the United States and like any cancer, early detection is crucial to survival. Screening at-risk populations is an important part of reducing mortality, and if concerning nodules are found on imaging, further testing may be required. Today, we’ll share how Northwell Health uses Google Cloud products such as Cloud Healthcare APIs and BigQuery to increase caregiver productivity and deliver better care for patients with findings that indicate potential development of lung cancer.

Northwell is New York’s largest healthcare provider

Northwell Health is New York’s largest healthcare provider with 23 hospitals and nearly 800 outpatient facilities. Northwell’s nearly 4,000 doctors care for millions of patients each year, and at this scale, there is an immense amount of healthcare data to manage. To better manage and leverage this data, Northwell Health partnered with Google Cloud starting in 2018.

Enabling caregivers to spend more time with patients

Nic Lorenzen, the lead developer of Northwell Emerging Technology and Innovation team, has a mission to put together data for caregivers in a way that makes sense. It is no secret that inefficient electronic health records systems have a negative impact on a physician’s ability to deliver quality care. Traditional EHRs have information distributed across many tabs, which forces caregivers to spend considerable time at the computer trying to find information. Moreover, speed of care matters. If care is delayed, patients may have to spend more time in the hospital and may suffer worse health outcomes.

To solve this problem, Nic’s team focused on giving caregivers the most relevant pieces of data at the right time by developing an intelligent clinician rounding app. The data needed to derive these insights can depend on the caregiver’s role–a nurse cares about different things than a cardiologist. This system aggregates multiple data sources, and provides patient-specific insights to caregivers.

This system would not have been possible before with traditional EHRs and data warehouses that have proprietary data models and rarely sync data in real time. Now with data easily accessible through Google Cloud’s Healthcare solutions, Nic’s team can deliver the right clinical information to the right people instantly. These days, Nic says, “instead of spending 75% of our time dealing with architecting the underlying platforms, we spend 75% of our time focused on  higher value use cases for clinicians and patients. Google Cloud’s Healthcare solutions have greatly improved our developer productivity and time to value.”

Caregivers have found this new system to be a game changer.Before the implementation of this system, caregivers would spend, on average, seven to nine minutes finding the data needed to make medical decisions for one patient. Now, that aggregated information is delivered to a caregiver’s mobile device in less than a second.

Ensuring patients get the right care with the power of AI

There are a number of reasons why patients might not get the care that they need. For example, patients today can go to multiple hospitals and clinics settings, and coordinating care across multiple facilities is complex. Regional hospitals and clinics have their own siloed view of their data, so pertinent information gathered by one clinic might not be seen by another. These gaps in clinical data lead to gaps in patient care.

When a patient gets radiologic imaging, they may have findings unrelated to the reason they initially got the imaging. For example, a chest CT for a car accident might reveal an incidental lung nodule that could be cancerous. Unfortunately, research shows that a large portion of patients do not get follow up for these incidental findings because it isn’t the primary reason why the patient is seeing a doctor. Moreover, social determinants of health are a factor that affects which patients receive follow-up care. Identifying these patients and providing the necessary follow up care prevents adverse events related to delayed detection of cancer.

With Cloud Healthcare solutions, Northwell built an AI model to identify these patients so that oncologists can appropriately follow up with patients who have findings suspicious for lung cancer. The AI model detects incidental pulmonary nodules in radiology reports so that doctors can then contact the patients that need follow-up care. Nic says his team was able to build this system in a week: “Google Cloud did a lot of heavy-lifting for us and allowed us to get to the AI applications much faster. It allowed us to build a platform that just works.” 

Healthcare systems can now rapidly generate healthcare insights with one end-to-end solution, Google Cloud Healthcare Data Engine. It builds on and extends the core capabilities of the Google Cloud Healthcare API to make healthcare data more immediately useful by enabling an interoperable, longitudinal record of patient data. Northwell Health uses Google Cloud as the core of their platform, enabling their developers to create solutions to the most pressing healthcare problems.

Special thanks to Kalyan Pamarthy, Product Management Lead on Cloud Healthcare and Natural Language APIs for contributing to this blog post.

Advances in artificial intelligence (AI) and machine learning (ML) have led to increased adoption in the financial services sector. A prominent use for this technology is to assist in key compliance and risk functions, including the detection of fraud, money laundering, and other financial crimes and illicit finance, as well as trade manipulation — collectively referred to as “Risk AI/ML.” As the use of these models grows, so do questions about managing risks associated with the models. 

In particular, regulators, financial institutions, and technology service providers have been looking into whether existing Model Risk Management (MRM) guidance — which has traditionally been the regulatory regime applicable to managing model risk in the financial services industry — continues to be relevant for AI/ML models. And, if so, how should the guidance be interpreted and applied to this new technology?

As the financial sector increasingly adopts artificial intelligence and machine learning techniques, it is critical for regulators, financial companies and technology providers to work together to assure that there are clear rules of the road,” says Jo Ann Barefoot, AIR CEO and co-founder. “Updated guidelines on the responsible use of these models can help prevent novel technologies from causing harm, and can also open up better ways to combat risk in areas like money laundering, illicit finance, and fraud.

Our new white paper, written in partnership with the Alliance for Innovative Regulation (AIR), seeks to address that question, with the aim of fostering thought and dialogue among agencies, the financial services industry, risk model vendors, and entities interested in the performance, outputs, and compliance of models used to identify, mitigate, and combat risks in financial services. This white paper does not address issues that may arise with other applications of AI/ML in the financial services industry, such as consumer credit underwriting or models using generative AI or Large Language Models, which are better addressed iteratively. 

The paper argues that MRM guidance, given its broad, principles-based approach, continues to provide an appropriate framework for assessing financial institutions’ management of model risk, even for Risk AI/ML models. Working within an existing framework takes advantage of the knowledge and operational capabilities of institutions that already understand this framework, instead of having to create an entirely new approach, which generally takes longer to implement and make effective. Nonetheless, the paper recognizes that AI/ML models have unique traits and characteristics compared to conventional models, including their potential dynamism and pattern recognition capabilities. These distinctions must be in focus when considering how MRM guidance should be applied to Risk AI/ML models. 

Taking into account those unique aspects of AI/ML models, the paper offers specific observations and recommendations regarding the application of MRM guidance to Risk AI/ML models, including:

• Risk assessment: In assessing risk, it is important to recognize that AI/ML models are not inherently more risky than conventional models. A risk-tiering assessment must consider the targeted business application or process for which a model is used, as well as the model’s complexity and materiality. To assist in these assessments, regulators could clarify that the use of AI/ML alone does not place a model into a high-risk tier and publish further guidance to help set expectations regarding the materiality/risk ratings of AI/ML models as applied to common use cases.
• Safety and soundness: Due to the dynamic nature of Risk AI/ML models, reliance on extensive and ongoing testing focused on outcomes throughout the development and implementation stages of such models should be primary in satisfying regulatory expectations of soundness. To that end, the development of technical metrics and related testing benchmarks should be encouraged. Model “explainability,” while useful for purposes of understanding the specific outputs of AI/ML models, may be less effective or insufficient for establishing whether the model as a whole is sound and fit for purpose.
• Model documentation: The touchstone for the sufficiency of documentation should be what is needed for the bank to use and validate the model, and understand its design, theory, and logic. Disclosure of proprietary details, such as model code, is unnecessary and unhelpful in verifying the sufficiency of a model and would deter model builders from sharing best-in-class technology with financial institutions.
• Industry standards and best practices: Regulators should support the development of global standards and their use across the financial services and regulatory landscape by explicitly recognizing such standards as presumptive evidence of compliance with the MRM guidance and sound AI/ML risk mitigation practices. In addition, regulators should foster industry collaboration and training based on such standards.

Governance controls: Regulators should use guidance to advance the use of governance controls, including incremental rollouts and circuit breakers, as essential tools in mitigating risks associated with Risk AI/ML models.

In an era where AI technology has the potential to revolutionize financial services, we acknowledge the foresight of our regulators in setting a solid foundation and blueprint for navigating the labyrinth of potential risks through the MRM guidance,” says Philip Moyer, Global VP, AI and Business Solutions at Google Cloud. “We believe there is room for greater coherence and precision, enhanced risk-mitigation approaches, and refined best practices surrounding AI and ML risk models. Whether it’s in capacity building or information sharing, our call to action is for greater collaboration between regulators and financial institutions. We’re confident that our collective efforts today will help shape a more robust and resilient future for financial services.

We invite a discussion of additional considerations, including the importance of examiner and industry training and collaboration, as well as openness by regulators to continue to refine the MRM guidance as AI/ML technologies develop and standards emerge. 

Implementing our recommendations would advance several goals. It would help regulators, financial institutions, and technology providers work together to better serve their shared purpose of protecting the safety and soundness of the financial system. At the same time, implementing the recommendations and continuing work in this space would promote the adoption of cutting-edge technologies in the industry, including those that combat such scourges as money laundering, illicit finance, and fraud.

You can read the full white paper here.

Businesses around the globe are realizing the benefits of replacing legacy data silos with cloud-based enterprise data warehouses, including easier collaboration across business units and access to insights within their data that were previously unseen. However, bringing data from numerous disparate data sources into a single data warehouse requires you to develop pipelines that ingest data from these various sources into your enterprise data warehouse. Historically, this has meant that data engineering teams across the organization procure and implement various tools to do so. But this adds significant complexity to managing and maintaining all these pipelines and makes it much harder to effectively scale these efforts across the organization. Developing enterprise-grade, cloud-native pipelines to bring data into your data warehouse can alleviate many of these challenges. But, if done incorrectly, these pipelines can present new challenges that your teams will have to spend their time and energy addressing. 

Developing cloud-based data ingestion pipelines that replicate data from various sources into your cloud data warehouse can be a massive undertaking that requires significant investment of staffing resources. Such a large project can seem overwhelming and it can be difficult to identify where to begin planning such a project. We have defined the following principles for data pipeline planning to begin the process. These principles are intended to help you answer key business questions about your effort and begin to build data pipelines that address your business and technical needs. Each section below details a principle of data pipelines and certain factors your teams should consider as they begin developing their pipelines.

Principle 1: Clarify your objectives

The first principle to consider for pipeline development is clarify your objectives. This can be broadly defined as taking a holistic approach to pipeline development that encompasses requirements from several perspectives: technical teams, regulatory or policy requirements, desired outcomes, business goals, key timelines, available teams and their skill sets, and downstream data users. Clarifying your objectives clearly identifies and defines requirements from each key stakeholder at the beginning of the process and continually checks development against these requirements to ensure the pipelines built will meet these requirements.This is done by first clearly defining the desired end state for each project in a way that addresses a demonstrated business need of downstream data users. Remember that data pipelines are almost always the means to accomplish your end state, rather than the end state itself. An example of an effectively defined end-state is “enabling teams to gain a better understanding of our customers by providing access to our CRM data within our cloud data warehouse” rather than “move data from our CRM to our cloud data warehouse”. This may seem like a merely semantic difference, but framing the problem in terms of business needs helps your teams make technical decisions that will best meet these needs. 

After clearly defining the business problem you are trying to solve, you should facilitate requirement gathering from each stakeholder and use these requirements to guide the technical development and implementation of your ingestion pipelines. We recommend gathering stakeholders from each team, including downstream data users, prior to development to gather requirements for the technical implementation of the data pipeline. These will include critical timelines, uptime requirements, data update frequency, data transformation, DevOps needs, and security, policy, or regulatory requirements by which a data pipeline must meet.

Principle 2: Build your team

The second principle to consider for pipeline development is build your team. This means ensuring you have the right people with the right skills available in the right places to develop, deploy, and maintain your data pipelines. After you have gathered your pipeline requirements, you can begin to develop a summary architecture that will be used to build and deploy your data pipelines. This will help you identify the human talent you will need to successfully build, deploy, and manage these data pipelines and identify any potential shortfalls that would require additional support from either third-party partners or new team members.

Not only do you need to ensure you have the right people and skill sets available in aggregate, but these individuals need to be effectively structured to empower them to maximize their abilities. This means developing team structures that are optimized for each team’s responsibilities and their ability to support adjacent teams as needed.

This also means developing processes that prevent blockers to technical development whenever possible, such as ensuring that teams have all of the appropriate permissions they need to move data from the original source to your cloud data warehouse without violating the concept of least privilege. Developers need access to the original data source (depending on your requirements and architecture) in addition to the destination data warehouse. Examples of this are ensuring that developers have access to develop and/or connect to a Salesforce Connected App or read access to specific Search Ads 360 data fields.

Principle 3: Minimize time to value

The third principle to consider for pipeline development is minimize time to value. This means considering the long-term maintenance burden of a data pipeline prior to developing and deploying it in addition to being able to deploy a minimum viable pipeline as quickly as possible. Generally speaking, we recommend the following approach to building data pipelines to minimize their maintenance burden: Write as little code as possible. Functionally, this can be implemented by:

1. Leveraging interface-based data ingestion products whenever possible. These products minimize the amount of code that requires ongoing maintenance and empower users who aren’t software developers to build data pipelines. They can also reduce development time for data pipelines, allowing them to be deployed and updated more quickly. 

• Products like Google Data Transfer Service and Fivetran allow for managed data ingestion pipelines by any user to centralize data from SaaS applications, databases, file systems, and other tooling. With little to no code required, these managed services enable you to connect your data warehouse to your sources quickly and easily.
• For workloads managed by ETL developers and data engineers, tools like Google Cloud’s Data Fusion provide an easy-to-use visual interface for designing, managing and monitoring advanced pipelines with complex transformations.

2. Whenever interface-based products or data connectors are insufficient, use pre-existing code templates. Examples of this include templates available for Dataflow that allow users to define variables and run pipelines for common data ingestion use cases, and the Public Datasets pipeline architecture that our Datasets team uses for onboarding.

3. If neither of these options are sufficient, utilize managed services to deploy code for your pipelines. Managed services, such as Dataflow or Dataproc, eliminate the operational overhead of managing pipeline configuration by automatically scaling pipeline instances within predefined parameters.

Principle 4: Increase data trust and transparency

The fourth principle to consider for pipeline development is increase data trust and transparency. For the purposes of this document, we define this as the process of overseeing and managing data pipelines across all tools. Numerous data ingestion pipelines that each leverage different tools or are not developed under a coordinated management plan can result in “tech sprawl”, which significantly increases the management overhead of data ingestion pipelines as the quantity of data pipelines increases. This becomes especially cumbersome if you are subject to service-level agreements, or legal, regulatory, or policy requirements for overseeing data pipelines. Preventing tech sprawl is, by far, the best strategy for dealing with it by developing streamlined pipeline management processes that automate reporting. Although this can theoretically be achieved by building all of your data pipelines using a single cloud-based product, we do not recommend doing so because it prevents you from taking advantage of features and cost optimizations that come with choosing the best product for your use case. 

A monitoring service such as Google Cloud Monitoring Service or Splunk that automates metrics, events, and metadata collection from various products, including those hosted in on-premise and hybrid computing environments, can help you centralize reporting and monitoring of your data pipelines. A metadata management tool such as Google Cloud’s Data Catalog or Informatica’s Enterprise Data Catalog can help you better communicate the nuances of your data so users better understand which data resources are best fit for a given use case. This significantly reduces your pipeline’s governance burden by eliminating manual reporting processes that often result in inaccuracies or lagging updates.

Principle 5: Manage costs

The fifth principle to consider for pipeline development is manage costs. This encompasses both the cost of cloud resources and the staffing costs necessary to design, develop, deploy, and maintain your cloud resources. We believe that your goal should not necessarily be to minimize cost, but rather maximizing the value of your investment. This means maximizing the impact of every dollar spent by minimizing waste in cloud resource utilization and human time. There are several factors to consider when it comes to managing costs:

• Use the right tool for the job – Different data ingestion pipelines will have different requirements for latency, uptime, transformations, etc. Similarly, different data pipeline tools have different strengths and weaknesses. Choosing the right tool for each data pipeline can help your pipelines operate significantly more efficiently. This can reduce your overall cost, free up staffing time to focus on the most impactful projects, and make your pipelines much more efficient.
• Standardize resource labeling –  Implement and utilize a consistent labeling schema across all tools and platforms to have the most comprehensive view of your organization’s spending. One example is requiring all resources to be labeled by the cost center or team at time of creation. Consistent labeling allows you to monitor your spend across different teams and calculate the overall value of your cloud spending.
• Implement cost controls – If available, leverage cost controls to prevent errors that result in unexpectedly large bills. 
• Capture cloud spend – Capture your spend on all cloud resource utilization for internal analysis using a cloud data warehouse and a data visualization tool. Without it, you won’t understand the context of changes in cloud spend and how they correlate with changes in business.
• Make cost management everyone’s job – Managing costs should be part of the responsibilities of everyone who can create or utilize cloud resources. To do this well, we recommend making cloud spend reporting more transparent internally and/or implementing chargebacks to internal cost centers based on utilization.

Long-term, the increased granularity in cost reporting available within Google Cloud can help you better measure your key performance indicators. You can shift from cost-based reporting (i.e. – “We spent $X on BigQuery storage last month”) to value-based reporting (i.e. – “It costs $X to serve customers who bring in $Y revenue”). 

To learn more about managing costs, check out Google Cloud’s “Understanding the principles of cost optimization” white paper.

Principle 6: Leverage continually improving services

The sixth principle is leverage continually improving services. Cloud services are consistently improving their performance and stability, even if some of these improvements are not obvious to users. These improvements can help your pipelines run faster, cheaper, and more consistently over time. You can take advantage of the benefits of these improvements by:

• Automating both your pipelines and pipeline management: Not only should data pipelines be automated, but almost all aspects of managing your pipelines can also be automated. This includes pipeline/data lineage tracking, monitoring, cost management, scheduling, access management and more. This helps reduce long-term operational costs of each data pipeline that can significantly alter your value proposition and prevent any manual configurations from negating the benefits of later product improvements.
• Minimizing pipeline complexity whenever possible: While ingestion pipelines are relatively easy to develop using UI-based or managed services, they also require continued maintenance as long as they are in use. The most easily maintained data ingestion pipelines are typically the ones that minimize complexity and leverage automatic optimization capabilities. Any transformation in a data ingestion pipeline is a manual optimization of the pipeline that may struggle to adapt or scale as the underlying services improve. You can minimize the need for such transformations by building ELT (extract, load, transform) pipelines rather than ETL (extract, transform, load) pipelines. This pushes transformations down to the data warehouse that is use a specifically optimized query engine to transform your data rather than manually configured pipelines.

Next steps

If you’re looking for more information about developing your cloud-based data platform, check out our Build a modern, unified analytics data platform whitepaper. You can also visit our data integration site to learn more and find ways to get started with your data integration journey.

Once you’re ready to begin building your data ingestion pipelines, learn more about how Cloud Data Fusion and Fivetran can help you make sure your pipelines address these principles.