Google Products Helps HMH's Healthcare Staff Work from Anywhere Efficiently and Securely! - Build What's Next
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Google Products Helps HMH’s Healthcare Staff Work from Anywhere Efficiently and Securely!

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When many challenges knocked the door as an aftermath of the 2020 COVID-19 pandemic, the 17-hospital healthcare system decided to extend its partnership with Google to elevate patient data security and safe, equitable access. Read how!

Hackensack Meridian Health (HMH) executive Mark Eimer explains how an ambitiously-timed rollout of a comprehensive suite of Google products helped the entire organization—from doctors to IT staff—achieve better security, cultivate a more equitable work environment, and ultimately, improve patient outcomes.

How does a recently merged, 17-hospital healthcare system fast-track a platform migration and hardware rollout securely and in a way that improves work for everyone, regardless of location or role? These are the questions that kept me up at night in early 2020, when the pandemic demanded a “big bang”—something our legacy laptops and operating systems couldn’t handle.

We began our work with Google in 2020 with the adoption of Chrome as our default browser. As we migrated platforms, keeping patient data safe was of the utmost importance to us, along with providing every staff member with the tools they needed to work virtually. Our staff often experienced issues accessing our web-based applications using Internet Explorer or Edge Browser, a problem that went away when we switched to Chrome. Chrome’s versatile compatibility also made it easier for my team to migrate all of our web-based operations, and Chrome’s security and manageability were key components to making this switch a huge win for the organization.

The success of this migration led us to extend our Google partnership to patient care applications—where Google’s expertise in AI and ML helps scale the use of diagnostics tools and improve other aspects of the patient journey.

image4.jpg
Patient care is at the center of HMH’s mission

Achieving security at every step 

Like so many other healthcare organizations, we’ve been concerned about ransomware attacks. This is part of why we moved to Google Workspace and distributed over 3,000 Chrome OS devices in kiosk mode in March of 2020, when many of us went remote due to the pandemic. We were very concerned about team members accessing corporate applications through home devices that were running EOL operating systems (WIN7), as well as a general lack of antivirus and encryption measures.

We were protected by the fact that Google’s software and hardware both had built-in security features that we needed to stave off sophisticated attackers. For example, Chrome OS automatically updates to the latest security update and encrypts data living outside the cloud on the hardware. These features protected us from security-related disruptions, letting us securely move a huge library of file shares and emails across thousands of accounts to Google Chrome OS in just four months.

A year later, in March 2021, we migrated the enterprise over to Google Workspace and saw an immediate reduction in spam by 30% from the inherent built-in AI/ML. This meant staff were less likely to receive (and click through) phishing attempts. My team could connect, create, and collaborate easily and securely—even as more of us were working from home and needed to access sensitive data remotely. 

Leveling the playing field

As an organization, we were surprised by how many team members didn’t have personal computers at home. We quickly decided that if we needed team members to work from home, the health network would have to supply hardware. Chromebooks’ lower price tag compared to PCs—on top of their built-in security controls—allowed us to purchase, deploy, and support that initial distribution of 3,000 Chromebooks to team members in less than three weeks, providing devices to every eligible remote employee instead of just a select few. This was vital to reaching our equitable technology goal as part of our diversity and inclusion initiative: everybody has the same tools to do good work.

When all employees have what they need to do their jobs well, we get better patient outcomes. Before we began this cloud adoption journey, patient and staff experiences were different within the hospitals and outside of them. 

Now it’s the same wherever our staff is, and we’ve seen efficiency and accessibility benefits extend to the patient side. For example, we built a web-based contact center that supports 80 locations that use Workspace and Chrome OS devices. Since customer service, admin, and providers are all on the same system, it has become a one-stop shop for patients.

Furthermore, through the Grow with Google program, we were able to provide another benefit to employees that drove our equity goals. Google trained 50 non-IT staff members—from environmental services, food and nutrition, and other non-tech areas who were interested in making a career change to IT—on the Google products we were using. They may not have thought about switching to a career in IT before the Grow with Google program came to our organization, but through this partnership, they now have that opportunity.

A strategic, long-term partner

With any large-scale rollout, the work doesn’t end once laptops are in employee hands. Google has shown their commitment to long-term collaboration as they continuously optimize their products for the unique needs of healthcare providers and go the extra mile in tailoring tools to our staff’s workflows. 

For example, on the Chrome OS side, the Google team has helped our registration desks and document centers with device integration for hardware like credit card readers and e-signature pads. They’ve also helped us meet security and privacy requirements mandated by state and federal governments around HIPAA, Medicaid, and Medicare reimbursements. Over this next year, we’ll look at a feature roadmap with Google Cloud to deliver further enhancements, iterating on the product itself to meet our needs for the present and the future.

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Combining technology and expertise

Delivering the future of healthcare

The benefits we’ve seen around security and usability—and the ability to provide all staff with equal access to Google’s technology—are why we’re expanding our partnership with Google to both the administrative and clinical sides of HMH. In addition to further Google rollouts with corporate, next year we’re distributing Chromebooks to all 350 of our ambulatory clinics.

We’re also working with the Google professional services team to create a custom AI model that analyzes 3D mammogram images. This AI model will enable two providers to read mammograms—which adheres to international best practices but is currently rare in the US—without requiring additional time. Conducting double readings of mammograms will yield better health outcomes for our patients, such as a lower patient recall rate and an increased accuracy in detecting breast cancer.

We’re currently building the model using a variety of Google Cloud products, including Cloud Healthcare API. Once complete, this model is expected to be trained, deployed, and maintained in Google’s Vertex AI, allowing our providers to be more productive as they make clinical decisions with AI support. As the model is proven over time, we plan to make the predictive services accessible to other healthcare organizations.

With Google, we’re able to achieve a unified architecture for storing data as well as training and deploying AI models, which enable our staff to work more efficiently and securely from anywhere. While I may not be able to predict the future as accurately as AI can, I foresee our continued partnership with Google as a key part of HMH’s improved provider and patient outcomes.

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Start Your Serverless Expeditions Now!

Google Cloud’s fully managed serverless platform like Cloud Run helps build and run highly scalable containerized applications. In traditional scenarios, over or under-provisioning enterprise applications can result in outages and cost hurdles. Severless Experts at the Google Cloud succinctly breakdown what serverless means for an organization and how Engineering Managers and CTO can rest assured with the predictability, developer productivity, automated release process and infrastructure abstraction.

Watch the video to unravel the serverless journey with Cloud Run!

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Google is the Top Provider for Continuous Integration Tools, According to Forrester

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Google’s continuous integration (CI) and continuous delivery (CD) platform, Cloud Build, emerges as a Leader for Continuous Integration.

“Google Cloud Build comes out swinging, going toe to toe with other cloud giants. Google Cloud Build is relatively new when compared to the other public cloud CI offerings, they had a lot to prove, and they did so.”

— Forrester Wave: Continuous Integration Tools

Forrester Wave on Continuous Integration identifies most significant continuous integration (CI) tool providers and shows how each vendor measures up on 27 criteria. Download the full report to see what makes Cloud Build a Leader in Continuous Integration.

Forrester Cloud CI tools Diagram Image

In the report, you will learn:

  • Where the market stands and where it’s going
  • Why Google has the strongest score for security and compliance within CI/CD
  • How Cloud Build ranks amongst the other vendors on performance and scalability
  • How Cloud Build’s enterprise strategy and vision are superior to other vendors
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The Latest in Spring Cloud GCP: Upgrading the Sample Bank of Anthos App

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Upgrade your Bank of Anthos app with Spring Cloud GCP 4.0 to take advantage of new features and boost performance. In this blog, we'll guide you through the upgrade process and show you how to streamline development with Spring Cloud GCP 4.0.

We’re excited to announce that Spring Cloud GCP version 4.0 is now generally available! In this post, we’ll be describing what the new major version has to offer, and demonstrating the process of using the migration guide on one of our reference architectures, Bank of Anthos.

What’s new?

With this release, Spring Cloud GCP officially supports Spring Boot 3.x. However, this migration involves a number of breaking changes as outlined in the migration guide. The full list of changes made is available on Github, but the one of the most significant differences is that Java 17 is now a minimum requirement.

Another notable feature of this release is the addition of starter artifacts – Spring Boot starters for Google Cloud – that provide dependencies and auto-configurations for 80+ Google Client libraries. Just as the name suggests, these starters can serve as helpful starting points when working with a new client library. For now, they’re in preview. 

These starters are not included in the BOM by default and need to be added as a dependency to your project before they can be used. For example, if you wanted to get started with Cloud Text-to-Speech, you would include the following:

<dependency>
    <groupId>com.google.cloud</groupId>
    <artifactId>google-cloud-texttospeech-spring-starter</artifactId>
    <version>4.0.0-preview</version>
  </dependency>

The upgrade process

We prepared a migration guide to help answer any questions involved with moving from 3.x to 4.x.  Let’s follow those instructions to migrate Bank of Anthos.

We’ll start by cloning and building the application before the upgrade, according to the quickstart and development guide:

PROJECT_ID=<YOUR-PROJECT-ID>
gcloud services enable container --project ${PROJECT_ID}

git clone https://github.com/GoogleCloudPlatform/bank-of-anthos.git
cd bank-of-anthos/

gcloud services enable container.googleapis.com monitoring.googleapis.com \
  --project ${PROJECT_ID}

REGION=us-central1
gcloud container clusters create-auto bank-of-anthos \
  --project=${PROJECT_ID} --region=${REGION}

gcloud container clusters get-credentials bank-of-anthos \
  --project=${PROJECT_ID} --region=${REGION}

skaffold run --default-repo=gcr.io/${PROJECT_ID}/bank-of-anthos

At the end of this, you should see a “deployment stabilized” message:

Deployments stabilized in 9.657 seconds

With the environment set up for development, we’re ready to move on to the actual migration. The migration is already complete at time of writing, but here’s the full list of changes made:

With those changes in place, the app is upgraded and ready to re-deploy!

Live example

For a finished example of this migration, check out the Bank of Anthos repository on Github. It’s an excellent sample application that showcases a polyglot Java & Python app, served on Kubernetes and Google Cloud. All CI/CD and configurations are open source, so it may be instructive as you approach this migration.

Thanks for reading, and feel free to provide comments or feedback on Twitter, or in the issues section of the repository.

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Anthos for Manufacturing: Tackle DevOps Complexities and Drive Digital Transformation

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KRM Series Part 5: Learn to Manage and Configure Hosted Resources with Kubernetes

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Learn from the Part 5 of the Google Cloud's Build a Platform with KRM series' to understand three major reasons to use KRM for cloud-hosted resources. You can even learn from the demos on how to use Config Connector to manage GCP resources.

This is the fifth and final post in a multi-part series about the Kubernetes Resource Model. Check out parts 12, 3, and 4 to learn more.  

In part 2 of this series, we learned how the Kubernetes Resource Model works, and how the Kubernetes control plane takes action to ensure that your desired resource state matches the running state. 

Up until now, that “running resource state” has existed inside the world of Kubernetes- Pods, for example, run on Nodes inside a cluster. The exception to this is any core Kubernetes resource that depends on your cloud provider. For instance, GKE Services of type Load Balancer depend on Google Cloud network load balancers, and GKE has a Google Cloud-specific controller that will spin up those resources on your behalf. 

But if you’re operating a Kubernetes platform, it’s likely that you have resources that live entirely outside of Kubernetes. You might have CI/CD triggers, IAM policies, firewall rules, databases. The first post of this series introduced the platform diagram below, and asserted that “Kubernetes can be the powerful declarative control plane that manages large swaths” of that platform. Let’s close that loop by exploring how to use the Kubernetes Resource Model to configure and provision resources hosted in Google Cloud.

KRM Hosted
Click to enlarge

Why use KRM for hosted resources?

Before diving into the “what” and “how” of using KRM for cloud-hosted resources, let’s first ask “why.” There is already an active ecosystem of infrastructure-as-code tools, including Terraform, that can manage cloud-hosted resources. Why use KRM to manage resources outside of the cluster boundary? 

Three big reasons. The first is consistency. The last post explored ways to ensure consistency across multiple Kubernetes clusters- but what about consistency between Kubernetes resources and cloud resources? If you have org-wide policies you’d like to enforce on Kubernetes resources, chances are that you also have policies around hosted resources. So one reason to manage cloud resources with KRM is to standardize your infrastructure toolchain, unifying your Kubernetes and cloud resource configuration into one language (YAML), one Git config repo, one policy enforcement mechanism. 

The second reason is continuous reconciliation. One major advantage of Kubernetes is its control-loop architecture. So if you use KRM to deploy a hosted firewall rule, Kubernetes will work constantly to make sure that resource is always deployed to your cloud provider- even if it gets manually deleted. 

A third reason to consider using KRM for hosted resources is the ability to integrate tools like kustomize into your hosted resource specs, allowing you to customize resource specifications without templating languages. 

These benefits have resulted in a new ecosystem of KRM tools designed to manage cloud-hosted resources, including the Crossplane project, as well as first-party tools from AWSAzure, and Google Cloud

Let’s explore how to use Google Cloud Config Connector to manage GCP-hosted resources with KRM. 

Introducing Config Connector

Config Connector is a tool designed specifically for managing Google Cloud resources with the Kubernetes Resource Model. It works by installing a set of GCP-specific resource controllers onto your GKE cluster, along with a set of Kubernetes Custom Resources for Google Cloud products, from Cloud DNS to Pub/Sub.

How does it work? Let’s say that a security administrator at Cymbal Bank wants to start working more closely with the platform team to define and test Policy Controller constraints. But they don’t have access to a Linux machine, which is the operating system used by the platform team. The platform team can address this by manually setting up a Google Compute Engine (GCE) Linux instance for the security admin. But with Config Connector, the platform team can instead create a declarative KRM resource for a GCE instance, commit it to the config repo, and Config Connector will spin up the instance on their behalf.

Config Connector
Click to enlarge

What does this declarative resource look like? A Config Connector resource is just a regular Kubernetes-style YAML file- in this case, a custom resource called Compute Instance. In the resource spec, the platform team can define specific fields, like what GCE machine type to use. 

  apiVersion: compute.cnrm.cloud.google.com/v1beta1
kind: ComputeInstance
metadata:
  annotations:
    cnrm.cloud.google.com/allow-stopping-for-update: "true"
  name: secadmin-debian
  labels:
    created-from: "image"
    network-type: "subnetwork"
spec:
  machineType: n1-standard-1
  zone: us-west1-a
  bootDisk:
    initializeParams:
      size: 24
      type: pd-ssd
      sourceImageRef:
        external: debian-cloud/debian-9
...

Once the platform team commits this resource to the Config Sync repo, Config Sync will deploy the resource to the cymbal-admin GKE cluster, and Config Connector, running on that same cluster, will spin up the GCE resource represented in the file.

Cluster
Click to enlarge

This KRM workflow for cloud resources opens the door for powerful automation, like custom UIs to automate resource requests within the Cymbal Bank org. 

Integrating Config Connector with Policy Controller 

By using Config Connector to manage Google Cloud-hosted resources as KRM, you can adopt Policy Controller to enforce guardrails across your cloud and Kubernetes resources.  

Let’s say that the data analytics team at Cymbal Bank is beginning to adopt BigQuery. While the security team is approving production usage of that product, the platform team wants to make sure no real customer data is imported. Together, Config Connector and Policy Controller can set up guardrails for BigQuery usage within Cymbal Bank. 

with policy controller
Click to enlarge

Config Connector supports BigQuery resources, including JobsDatasets, and Tables. The platform team can work with the analytics team to define a test dataset, containing mocked data, as KRM, pushing those resources to the Config Sync repo as they did with the GCE instance resource. 

  apiVersion: bigquery.cnrm.cloud.google.com/v1beta1
kind: BigQueryJob
metadata:
  name: cymbal-mock-load-job
  annotations:
    configsync.gke.io/cluster-name-selector: cymbal-admin
spec:
  location: "US"
  jobTimeoutMs: "600000"
  load:
    sourceUris:
      - "gs://cymbal-bank-datasets/cymbal-mock-transactions.csv"

From there, the platform team can create a custom Constraint Template for Policy Controller, limiting the allowed Cymbal datasets to only the pre-vetted mock dataset: 

  rego: |
        package bigquerydatasetallowname
        violation[{"msg": msg}] {
          input.review.object.kind == "BigQueryDataset"
          input.review.object.metadata.name != input.parameters.allowedName
          msg := sprintf("The BigQuery dataset name %v is not allowed", [input.review.object.metadata.name])
        }apiVersion: constraints.gatekeeper.sh/v1beta1

These guardrails, combined with IAM, can allow your organization to adopt new cloud products safely- not only defining who can set up certain resources, but within those resources, what field values are allowed. 

Manage existing GCP resources with Config Connector 

Another useful feature of Config Connector is that it supports importing existing Google Cloud resources into KRM format, allowing you to bring live-running resources into the management domain of Config Connector. 

You can use the config-connector command line tool to do this, exporting specific resource URIs into static files: 

  config-connector export "//sqladmin.googleapis.com/sql/v1beta4/projects/cymbal-bank/instances/cymbal-dev" \
    --output cloudsql/

Output:

  apiVersion: sql.cnrm.cloud.google.com/v1beta1
kind: SQLInstance
metadata:
  annotations:
    cnrm.cloud.google.com/project-id: cymbal-bank
  name: cymbal-dev
spec:
  databaseVersion: POSTGRES_12
  region: us-east1
  resourceID: cymbal-dev
...

From here, we can push these KRM resources to the config repo, and allow Config Sync and Config Controller to start lifecycling the resources on our behalf. The screenshot below shows that the cymbal-dev Cloud SQL database now has the “managed-by-cnrm” label, indicating that it’s now being managed from Config Connector (CNRM = “cloud-native resource management”).

cnrm
Click to enlarge

This resource export tool is especially useful for teams looking to try out KRM for hosted resources, without having to invest in writing a new set of YAML files for their existing resources. And if you’re ready to adopt Config Connector for lots of existing resources, the tool has a bulk export option as well. 

Overall, while managing hosted resources with KRM is still a newer paradigm, it can provide lots of benefits for resource consistency and policy enforcement. Want to try out Config Connector yourself? Check out the part 5 demo.


This post concludes the Build a Platform with KRM series. Hopefully these posts and demos provided some inspiration on how to build a platform around Kubernetes, with the right abstractions and base-layer tools in mind. 

Thanks for reading, and stay tuned for new KRM products and features from Google. 

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