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.

Data security is an ongoing concern for anyone managing a data warehouse. Organizations need to control access to data, down to the granular level, for secure access to data both internally and externally. With the complexity of data platforms increasing day by day, it’s become even more critical to identify and monitor access to sensitive data. In many cases, sensitive data is co-mingled with non-sensitive data, and access restrictions to sensitive data need to be enabled based on factors like data location or presence of financial information. There may also be nuances where data is sensitive for some groups of users, while for others, it is not. 

Today, we’re pleased to announce the general availability of BigQuery row-level security, which gives customers a way to control access to subsets of data in the same table for different groups of users. Row-level security (RLS) extends the principle of least privilege access and enables fine-grained access control policies in BigQuery tables. BigQuery currently supports access controls at the project-, dataset-, table- and column-level. Adding RLS to the portfolio of access controls now enables customers to filter and define access to specific rows in a table based on qualifying user conditions—providing much needed peace of mind for data professionals. 

“Our digital transformation and migration of data to the cloud magnifies the business value we can extract from our information assets. However, granular data access control is essential to comply with international regulatory and contractual requirements. BigQuery row-level security helps us comply with data residency and export restrictions,” says Jarrett Garcia, Iron Mountain’s Enterprise Data Platform Senior Director. “It enables us to manage fine-grained access controls without replicating data. What used to take months for approval and access provisioning can now be done more efficiently and effectively. We are looking forward to implementing additional data security capabilities on the BigQuery roadmap to address other critical business use cases.”

How BigQuery row-level security works

Row-level security in BigQuery enables different user personas access to subsets of data in the same table. Customers who are currently using authorized views to enable these use cases can leverage RLS for ease of management. To express the concept of RLS, we have introduced a new entity in BigQuery called row access policy. Row access policies map a group of user principals to the rows that they can see, defined by a SQL filter predicate. 

Secure logic rules created by data owners and administrators determines which user can see which rows through the creation of a row-level access policy. The row-level access policies created on a target table by administrators or data owners are applied when a query is run on the table. One table can have multiple policies applied to it.

Below is an example, where row-level access policies have been created to filter data based on users’ “region”.

In the illustrated scenario above, row-level access policies have been created to verify a querying user’s region and to give them access only to the subset of data relevant to that region. Access policies are granted to a grantee list which support all types of IAM principles such as individual users, groups, domains or service accounts. In this example, when a user queries the table, row-level access policies are evaluated to assess which, if any, policies are applicable to that user. The group ‘sales-apac’ is granted access to view a subset of rows where region = ‘APAC’ whereas the group ‘sales-us’ is granted access to view a subset of rows where the region = ’US’. Likewise, users in both groups will see rows in both regions, and users in neither group will not see any rows.

Row-level access policies can also be created using the SESSION_USER() function to restrict access only to rows that belong to the user running the query. If none of the row access policies are applicable to the querying user, the user will have no access to the data in the table.

When a user queries a table with a row-level access policy, BigQuery displays a banner notice indicating that their results may be filtered by a row-level access policy. This notice displays even if the user is a member of the `grantee_list`.

When to put BigQuery row-level security to work

Row-level access policies are useful when you have a need to limit access to data based on filter conditions. The row-access policies’ filter predicate supports arbitrary SQL, and is conceptually similar to the WHERE clause of a SQL query. Filter predicates support the SESSION_USER() function to restrict access only to rows that belong to the user running the query. If none of the row access policies are applicable to the querying user, the user will have no access to the data in the table. Currently, the column used for filtering must be in the table, but we anticipate adding support for subqueries in the filter expression, opening up access to use cases where data is filtered based on lookup tables and calculated values. Row-level access policies can be created, updated and dropped using DDL statements. You will be able to see the list of row-level access policies applied to a table using the BigQuery schema pane in the Cloud Console,  which simplifies the management of policies per table, or by using the bq command-line tool.

Row-level security is compatible with other BigQuery security features, and can be used along with column-level security for further granularity.  Since row-level access policies are applied on the source tables, any actions performed on the table will inherit the table’s associated access policies, to ensure access to secure data is protected. Row-level access policies are applicable to every method used to access BigQuery data (API, Views, etc). 

Try it out

We’re always working to enhance BigQuery’s (and Google Cloud’s) data governance capabilities, to provide more controls around managing your data. With row-level security, we are adding deeper protections for your data. You can learn more about BigQuery row-level security in our documentation and best practices.

In recent years, the grocery industry has had to shift to facilitate a wider variety of checkout journeys for customers. This has meant ensuring a richer transaction mix, including mobile shopping, online shopping, in-store checkout, cashierless checkout or any combination thereof like buy online, pickup in store (BOPIS).  

What’s more, in the past year and a half alone grocers have had to enable consumers new ways to shop for essentials. This has included needing to rapidly integrate or build on-demand delivery apps, offer curbside pickup with near-instant fulfillment as well as support touchless and cashless checkout experiences. Searches on Google Maps for retailers in the US with curbside pickup options have increased by 9000% since March 2020, and we believe these trends from 2020 will continue to define the future of grocery shopping.

The future of grocery will require agility and openness

Firstly, the need to rapidly adapt to changing consumer habits will be the new normal. Grocers will increasingly look to digitally transform legacy retail systems and modernize point of sale (POS) platforms to deliver and scale omnichannel experiences as quickly as possible. This necessitates a more agile and open architectural approach to technology – one built on microservices and leverages APIs so that new applications and experiences can be built, integrated and delivered faster.

Automation and data-driven retailing will be table stakes

In order for retailers to blend what they’re offering in the store with digital experiences more efficiently, they will also need to automate more. For example, with automation and business intelligence, grocers can take labor that might have been tied up with tender operations and checkout and redistribute those resources to restocking shelves, curbside pick-up or improving customer experiences. 

Automation and access to real-time in-store inventory & supply chain data can also help grocers avoid the supply chain challenges seen in the early days of COVID-19. Grocers will need to find ways to leverage automation to ingest, organize, and analyze data from physical store networks, digital channels, distribution centers to better forecast demand and manage future fluctuations.

How NCR and Google Cloud are helping grocers adapt to disruption with operational agility

Helping grocers improve operational agility to address changing consumer shopping habits and to thrive during times of disruption is something that NCR and Google Cloud have teamed up to do. NCR has over 135 years of experience in retail, having invented the cash register and are continuing to help grocers innovate. NCR Emerald builds upon the company’s leadership in POS software and has turned it into a unified platform that helps grocers operate the entire store from front to back. The solution supports cashier-led checkout, self-checkout, integrated payments, merchandising, and enables regional managers and corporate employees access to the analytics and tools needed to optimize loyalty programs and promotions.

NCR has invested in a comprehensive, agile, and API-led retail architecture that lets grocers continually innovate and design new experiences as customers and the industry evolve. By running Emerald on Google Cloud, NCR can offer the solution on a subscription basis, helping grocers lower upfront capital expenditures and ensuring scalability. What’s more, NCR can tap into Google Cloud’s strength in data, analytics, and openness to deliver three key imperatives. Let’s take a look at each of these below.

Run the way grocers need to while leveraging Google Cloud as a single source of logic

Traditionally the POS system lived in the store. If disaster strikes, people still need access to food and essentials so the grocery store still needs to operate. It hardly gets more mission-critical than that. NCR Emerald is built on microservices, leveraging Kubernetes for front-of-house compute, and VMs (See graphic 1 below). This makes it easy to support lightweight clients accessible by store employees via any range of mobile devices, computer terminals, self-service kiosks, peripheral devices like receipt printers as well as legacy applications.

What’s unique is that because Emerald runs on Google Cloud, it supports all those in-store and digital touchpoints mentioned above, but also allows grocers to run lean. Emerald leverages Google Cloud as a single source of truth and operates a lot of what it does out of logic. Every sales transaction coming from every channel, including e-commerce, can be logged via NCR’s Hosted Service and centralized in BigQuery and Bigtable as a transaction data master. This enables the grocer to manage any transactional use case very consistently, whether it e supporting customers who want to purchase in one store and return in another, offering digital receipts or the ability to exchange online purchases in store. Emerald on Google Cloud can help retailers extend capabilities through the power of the cloud but not need to live exclusively in the cloud. In other words, the solution allows grocers the ability to run the way they need to.

Enable data-driven and real-time decision making for grocers

Store managers, regional managers, category managers, and others all require different cuts of the data to do their jobs effectively. However, data silos persist and how data is formatted and arranged can still remain pretty static. Therefore allowing users with different roles the ability to view and analyze that data quickly and in different ways continues to be a challenge. 

As mentioned above, Emerald leverages Google Cloud data management solutions as the central repository for transactional, behavioral, and merchandising data. Every transaction from every store and every channel can be stored via NCR Hosted Service on BigQuery and Bigtable. NCR Analytics then harnesses the advanced analytical and data visualization capabilities of Looker to help grocers get a consolidated view of their business across all channels and then allow employees to slice and dice the data they way they need to. NCR Analytics also leverages the power of Google Cloud AI and machine learning to add another level of intelligence to the retailer’s data. For example, store managers can visualize how well they’re using their real estate and see how productive lanes 1-3 are compared with 7-10 or compare self-service versus manned lanes. By mapping to the retailer’s own catalog, they can also break down category-level performance and trends.

NCR Analytics takes advantage of Google Cloud’s data pipeline to reduce processing time, with scaling and resource management provided out of the box. By letting the cloud store and process the data, NCR is providing the ability for retailers to analyze their data in near real-time across all platforms – a real game changer in the grocery business.

Open APIs let grocers continually enrich the retail experience

Finally, Emerald is built on an API-first architecture managed through Apigee. It uses the power of Apigee as an open API platform to expose how Emerald can work with other NCR applications like loyalty and promotions, and third party applications like mobile ordering and order delivery to enrich the grocery experience for employees and customers. Every API that Emerald uses is available on Apigee, allowing them to share code samples and giving developers the ability to run scripts. This approach can allow retailers the ability to innovate in a fraction of the time and cost, speeding up 3rd party integrations up front and as businesses grow. 

Take, for example, Northgate Market, a chain of 40 stores in California, that were able to transform its digital operations and enable experiences that set it apart from competitors – quickly and simply with Emerald. It took less than 6 months to go from contract to live deployment in the first store. Since then, Northgate Market has been able to extend their intelligence by leveraging the power of Looker and NCR Analytics.

Learn more about how NCR has been able to leverage an open, cloud-enabled architecture to help customers innovate across the retail, hospitality, and banking industries on the webinar “Role of APIs in Digital Transformation”. You can also learn more about how Northgate uses e-commerce to transform customer experience and gain consumer insights.

Editor’s note: We’re hearing here how martech provider Wunderkind easily met the scaling demands of their growing customer base on multiple use cases with Cloud Bigtable and other Google Cloud data solutions.

Wunderkind is a performance marketing channel and we mostly have two kinds of customers: online retailers, and publishers like Gizmodo Media Group, Reader’s Digest, The New York Post and more. We help  retailers boost their e-commerce revenue through real-time messaging solutions designed for email, SMS, onsite, and advertising. Brands want to provide a one-to-one experience to more of their customers, and we use our extensive history with best practices in email marketing and technology to help brands reach more customers through targeted messaging and personalized shopping experiences. With  publishers, it’s a different value proposition, we use the same platform to provide a non disruptive and personalized ad experience for their website. For example, if you are on their site and then you left, we might show an ad tailored to you when you come back later – depending on the campaign. 

After running into limitations with our legacy database system, we turned to Cloud Bigtable and Google Cloud, which helped us be more flexible and easily scale for high traffic demand – which can be a stable 40,000 requests per second, and meet the needs of our growing number of data use cases. 

Three different databases power our core product

In our core offering, companies send us user events from their websites. We store these events and later decide (using our secret sauce) if and how to reach out to those users on behalf of our customers. Because many of our customers are retailers, Black Friday and Cyber Monday are big traffic days for us as. On such days, we can get 31 billion events, sometimes as many as  200K events per second. We show 1.6 billion impressions that have seen close to 1 billion pageviews. And at the end of all this, we securely send about 100 million emails. We noticed the same thing for election time; traffic reached the same high volume. We need scalable solutions to support this level of traffic as well as the elasticity to let us pay only for what we use, and that’s where Google Cloud comes in.

So how does this work? Our externally facing APIs, which are running on Google Kubernetes Engine, receive those user events—up to hundreds of thousand per second. All the components in our architecture need to be able to handle this demand. So from our APIs, those events go to Pub/Sub, Dataflow and from there they are written to Bigtable and BigQuery, Google Cloud’s serverless, and highly scalable data warehouse. This business user activity data underpins almost all our products. Events can be things like product views or additions to shopping carts. When we store this data in Bigtable, we use a combination of email address and the customer ID as the Bigtable key and we record the event details in that record. 

What do we do with this information next? It’s important to mention that we also mark the last time we received an event about a user in Memorystore for Redis, Google Cloud’s fully managed Redis service. This is important because we have another service that is periodically checking Memorystore for users that have not been active for a campaign-specific period of time (it can be 30 minutes, for example), then deciding whether to reach out to them.

How we decide when we reach out is an intelligent part of our product offering, based on the channel, message, product, etc. When we do reach out, we use Memorystore for Redis as a rate limiter or token bucket. In order not to overwhelm the email or texting providers we send API requests to, we throttle those requests using Memorystore. (We prefer to preemptively throttle the outgoing API requests as opposed to handling errors later.)

When we do reach out, often we will need details for a specific product—let’s say if the website belongs to a retailer. We usually get that information from the retailer through various channels and we store product information in Cloud SQL for MySQL. We pull that information when we need to send an email with product information, and we use Memorystore for Redis to cache that information, since many of the products are repeatedly called. Our Cloud SQL instance has 16 vCPUs, 60GBs of memory and 0.5TB of disk space and when we perform those product information updates, we have about a thousand write transactions per second. We are also in the process of migrating some tables from a self managed MySQL instance, and we keep those tables synchronized with Cloud SQL using Datastream. 

Our user history database was originally stored in AWS DynamoDB, but we were running into problems with how they structured the data, and we’d often get hot shards but with no way to determine how or why. That led to our decision to migrate to Bigtable. We set up the migration first by writing the data to two locations from Pub/Sub, performed some backfill of data until that was up and running, and then started working on the reading. We performed this over a few short months, then switched everything to Bigtable. 

So, as mentioned, we are using Bigtable for multiple databases. The instance that stores our user events has about 30 TB with about 50 nodes.

Profile management

A second use case for Bigtable is for user profile management, where we track, for example, user attributes based on subscription activity, whether they’ve opted in or out of various lists, and where we apply list-specific rules that determine which targeted emails we send out to users. 

Our very own URL shortener

Our third use case for Bigtable is our URL shortener. When our customers build out campaigns and choose a URL, we append tracking information to the query string of the URLs and they become long. Many times, we are sending them via SMS texts, so the URLs need to be short. We originally used an external solution, but made the determination that they couldn’t support our future demands. Our calls tend to be very bursty in nature, and we needed to plan for a future state of supporting higher throughput. We use a separate table in Bigtable for this shortened URL. We generate the short slug that is 62 bit-encoded and use it as the rowkey. We use the long slug as a Protobuf-encoded data structure in one of the row cells and we also have a cell for counting how many times it was used. We use Bigtable’s atomic increment to increase that counter to track how many times the short slug was used. 

When the user receives a text message on their phone, they click the short URL, which goes through to us, and we expand it to the long slug (from Bigtable) and redirect them to the appropriate site location. Obviously, for the URL shortener use case, we need to make the conversion very quickly. Bigtable’s low latency helps us meet that demand and we can scale it up to meet higher throughput demands.

Meeting the future with Google Cloud

Our business has grown considerably, and as we keep signing up new clients, we need to scale up accordingly, and Bigtable has met our scaling demands easily. With Bigtable and other Google Cloud products powering our data architecture, we’ve met the demand of incredibly high traffic days in the last year, including Black Friday and Cyber Monday. Traffic for these events went much higher than expected, and Bigtable was there, helping us easily scale on demand. 

We are working on leveraging a more cloud native approach and using Google Cloud managed services like GKE, Dataflow, pub/sub, Cloud SQL , Memorystore, BigQuery and more. Google has those 1st party products and we don’t see the value in rolling out or self managing such solutions ourselves..

Thanks to Google Cloud, we now have reliable and flexible data solutions that will help us meet the needs of our growing customer base, and delight their users with fast, responsive, personalized shopping messaging and experiences. 

Learn more about Wunderkind and Cloud Bigtable. Or check out our recent blog exploring the differences between Bigtable and BigQuery.