Khan Academy's Shortcut to Growth: The Trick Behind the Scenes - Build What's Next
Case Study

Khan Academy’s Shortcut to Growth: The Trick Behind the Scenes

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Not-for-profit educational organisation Khan Academy was able to growth hack their way to over 3.8 million unique visits a month, thanks to Google App Engine. Find out how.

Based in Mountain View, California, Khan Academy is a not-for-profit that produces and posts a vast collection of free educational online videos about math and science topics ranging from algebra and trigonometry to biology and economics.

Millions of students, educators, and self-learners around the world watch the videos, both on the Khan Academy’s YouTube channel and on its hugely popular website (www.khanacademy.org), where students answer some 1.5 million practice questions per school day. The Khan Academy development team continually tweaks the site based on how visitors choose to learn.

Challenge

Khan Academy’s beginnings date back to 2004, when Sal Khan’s cousin asked him to remotely tutor her daughter in math. Khan was happy to help and more than qualified, given his three MIT degrees and his Harvard MBA.

As more relatives and friends asked Khan for tutoring assistance, he began videotaping short lessons and posting them to YouTube. His knack for distilling complex concepts into easy-to-follow tutorials helped the videos go viral.

Sal knew he needed to offload the technical and maintenance concerns so he could work on what was important. To grow, it was important for him to be able to stop worrying about things like deployment issues and running his own server.

Ben Kamens, lead developer for Khan Academy

Khan maintained a website for his growing video library for several years, but the platform experienced limitations as traffic increased.

At the same time, media attention was growing, and technology industry leaders, including Microsoft founder Bill Gates and Silicon Valley venture capitalist John Doerr, began lending their support and evangelizing Khan’s mission and work. It was at this point that Khan quit his job as a hedge fund analyst to devote his full-time attention to the site’s growing potential.

“With Google App Engine, we don’t need a system administrator or anyone dedicated to deploying our app, so 99 percent of our time is spent working on our application,” says Ben Kamens, lead developer, Khan Academy.

“Sal knew he needed to offload the technical and maintenance concerns so he could work on what was important, which was to make more videos for the Khan Academy library,” explains Ben Kamens, lead developer for Khan Academy. “To grow, it was important for him to be able to stop worrying about things like deployment issues and running his own server.”

Solution

Khan Academy chose App Engine as its hosting and application development platform because App Engine could easily house its growing collection of 2,000-plus videos, resolving the organization’s overall server and maintenance issues with a single solution.

Using App Engine freed the team to focus on the user experience and the array of content that makes the academy such a powerhouse.

“A lot of what the Khan Academy is about is collecting data on student behavior so we can teach them better,” Kamens says. “Did they use a hint? Have they watched the video before? That data is being stored on Google App Engine so we can figure out what the most effective videos are, or where students struggle the most.”

Khan Academy provides individual profiles to students so they can analyze their learning progress, which means the organization needs systems running in the background to collect and track of all this data. Because App Engine takes care of server support, Khan Academy’s five developers can spend almost all of their time improving site functionality.

“If we didn’t have Google App Engine, we’d be spending a lot more time figuring out server setup and working on routers,” Kamens says. “Our ability to focus on the actual product is the benefit of Google App Engine.”

With the App Engine dashboard, which provides information like response time, uptime, and error rates, the development team also has an easy way to watch over site performance. “It lets us see what the average response time is, so we can keep it really low,” Kamens explains.

Results

During the US school year, Khan Academy receives more than 3.8 million unique visits a month — all served through App Engine. To support this much traffic, a typical company would need an internal system administration staff.

“With Google App Engine, we don’t need a system administrator or anyone dedicated to deploying our app, so 99 percent of our time is spent working on our application,” explains Kamens. “Our application lives on Google App Engine, and we bank all of our scalability and traffic concerns on Google App Engine. Even huge traffic spikes from Sal’s media appearances don’t worry us since we know that Google App Engine will handle the spike.”

Kamens also likes the fact that he and his team can turn to the Google App Engine support team for assistance when they need it. He also finds helpful tips on the Google App Engine blog.

The Khan Academy staff has come to completely rely on App Engine. “We are constantly using more of Google App Engine’s capabilities and have been happy with the performance,” Kamens says. “It’s nice to have an easy deployment process since we deploy the site on average at least once a day, [and] sometimes up to nine or 10 times [a day].”

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Leverage Apigee X to Access API Backends with Multiple VPCs

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Initially users/customers did not have to worry about securing backend API across many VPCs. Here is a blogpost diving into the Apigee X, overcoming VPC peering challenges and selecting an architectural plan to leverage APIs in multi-tenant environ.

API gateways are a critical component of a modern architecture. Apigee X is Google Cloud’s API management platform. It also allows users of the legacy Apigee Edge product to leverage Virtual Private Cloud (VPC) products and features, like Cloud Armor and Load Balancers. With these new security and availability advantages come a new set of challenges. The biggest challenge is accessing API backends in multiple VPCs. This introduces  VPC peering transitivity restrictions. Only two VPCs can be peered in sequence, but the Apigee X Runtime already consumes one peering connection. This blog post discusses overcoming transitivity limits, with an eye on future managed services that solve the problem.

VPC Peering Transitivity Limits

The main challenge with Apigee X is that customers have backend servers in multiple distinct VPCs. This means that Apigee X Runtime traffic must traverse multiple VPC peering  connections. However, peering transitivity limits VPC networking to only one sequential VPC hop.

In the past (Apigee Edge / SaaS) customers did not need to worry about securing their backend APIs across multiple VPCs. Apigee X networking is a new feature, compared to the original Apigee SaaS product.

VPC Connectivity Options

VPC peering is the easiest option. The restriction is that connectivity wise, only one peering hop is allowed, which is already consumed by a connection to the Apigee X Runtime. The Apigee X Runtime resides in a Google managed VPC.

Internal Global Load Balancers (ILBs) with Managed Instance Group (MIG) backends is the second option. This peering solution is complex though.

The open internet is the most parsimonious solution. Apigee X facilitates this, but it would violate the security mandates of many Google Cloud customers.

The final option is Cloud VPN. Cloud VPN supports transitivity across multiple VPC network hops. As well the implementation steps are relatively simple. Traffic does not traverse the open internet for VPCs within Google Cloud.

Apigee X Networking Explained

ApigeeX is a Private Service Access (PSA) based service that is deployed and managed in a tenant project. A tenant project is a project that is tied to the Apigee X Runtime, in a one-to-one relationship. The Apigee X deployment natively manages a load balancer in the customer’s VPC for ingress traffic. By default, egress to non-private routes from Apigee X is through Cloud NAT in the tenant project. The default Apigee X deployment is more suitable for non hub-and-spoke network design.

Single VPC Hub Design

Figure 3 demonstrates the API request flow. External API requests come from the internet and first encounter the XLB. The XLB has the Apigee X Runtime as a backend, using Network Endpoint Group to contain the Apigee X Environment Group domain name. From here the Apigee X Runtime sends the API request over the VPC peering connection to apigee-x-project.

Google Cloud VPN connections allow Virtual Private Clouds (VPCs) to reference each other’s internal resources, with the help of Google Cloud Routers. Cloud Routers advertise each VPCs’ IP address ranges. This enables traffic over the Cloud VPN tunnels to reference resources via their private IP addresses. Additionally, Google Cloud DNS peering facilitates a consumer VPC to reference hostnames in a producer VPC.

From the apigee-x-vpc (consumer), the API request references a backend-project-a-vpc (producer) resource hostname, via DNS peering. This would be the backend identified in an Apigee X API proxy. The request itself does not traverse the DNS peering connection. Instead, the API request goes through a Cloud VPN tunnel. In this way, Cloud VPN is used as a substitute for VPC peering.

Shared VPC Hub Design

A more advanced example is a shared VPC hub project, illustrated in Figure 4. The general idea is the same; use Cloud VPN connections instead of peering connections, advertise routes using Cloud Router and use DNS peering to reference any compute resources by their hostnames.

What is interesting is the idea that the apigee-x-project can use a subnet in a shared VPC, independently of the hub-project, which is in the same shared VPC. Shared VPC subnets do not violate the VPC peering transitivity limit (only two peered VPCs in sequence). This architecture pattern can be scaled to connect multiple shared VPCs via VPN tunnels. This is analogous to cascading hub-and-spoke architecture pattern: the inner hub-and-spoke is the shared VPC (with the apigee-x-project) and the outer hub-and-spoke is the VPN connected backend-projects.

Fixing VPC Peering with Private Service Connect

Private Service Connect (PSC) allows private consumption of services across VPC networks. This feature is coming to Apigee X in the first half of 2022. Private Services Access (PSA) is what enables you to reach services’ internal IP addresses. Apigee X is a PSA service, hence its ability to connect to backends by their internal IP addresses. PSC is the missing piece that will natively support Apigee X backends in other VPCs.

What Next?

Try it out for yourself! We built and shared a working Terraform example in our Github repository. Apigee X opens up users to the products and features of Google Cloud VPCs. VPC transitivity limits do require some work to overcome. Private Service Connect (PSC) will solve Apigee X VPC peering challenges later in 2022. A great next step would be to implement a “wheel” architecture pattern. This is an evolution of the hub-and-spoke design, where spoke VPCs peer to each other. Cloud VPN makes this possible and PSC makes a wheel more feasible to implement. The advantage of a wheel is that spokes no longer rely on a hub VPC; for example productizing APIs in a multi-tenant environment. More details are available in the following ebook: The API Product Mindset

Resources

You can find the Terraform code in the Github repository.

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Apigee: Unlock Innovation by Managing APIs for SAP Workloads

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Businesses looking to move their SAP environments to Google Cloud often operate out of legacy systems and APIs that prevent data monetization. Google's Apigee API Management Platform's multi-security and privacy features, AI-based automation and global cloud network benefits SAP customers tackle challenges using APIs to unlock true data value and innovation.

Businesses migrating their SAP environments to Google Cloud do so for a number of reasons. Most cite the agility, scalability and security advantages of migrating SAP workloads to Google Cloud; many also focus on improved uptime and performance. 

At some point, most businesses also want to explore the idea that there’s a fortune locked up in their business data—and that the cloud holds the key. But leveraging the cloud to transform data into dollars is a process that involves special challenges—and specialized tools to address these challenges. For businesses running SAP environments in the cloud, most of which maintain a significant stake in legacy systems and data stores, the challenges tend to get even bigger.

The promises and pitfalls of APIs

This is where Google Cloud’s advanced data analytics, machine learning and AI capabilities, especially our API (application programming interface) management tools, come into play. Our Apigee API Management Platform is emerging as a star player for many of our SAP customers because it can open the door to innovation and opportunity for SAP systems and data stores.

API management speaks directly to what it really means to get value from business data. By connecting the right data sets with people willing and able to monetize that data, your business can benefit both indirectly (for example, by generating insights that lead to increased sales or better customer experiences) and directly (such as by selling access to your data to another business).

APIs have emerged as a pillar of modern digital business practices because they facilitate precisely these types of transactions. Today, every mobile device, website and application uses APIs to access connected services and data sources. APIs provide connection points between apps, platforms and entire application ecosystems. And by using de-facto standards such as REST (representational state transfer), businesses can utilize APIs to build and deploy innovative applications quickly.

3 reasons legacy systems and modern APIs don’t mix

Google Cloud customers running SAP environments may be ready to find the value in their data, but their SAP systems and data, as well as legacy APIs that don’t adhere to REST or other modern approaches,  may not quite be up to the task. This is because:

  • Balancing accessibility, usability and security is a tough task—and the stakes are high. Opening up access to business-critical systems to third-party as well as internal developers could raise significant risks. Even for SAP teams with a high focus on security, the process of providing dependable, programmatic access to legacy SAP systems often involves significant time and effort. And while limiting access and API functionality are both valid ways to mitigate security risk, employing these tactics can slow the pace of innovation and very quickly undermine the reasons for starting this process in the first place.
  • Managing APIs across legacy SAP applications and other data stores can be complex, costly and technically challenging. There’s a fundamental mismatch between the “how and why” of modern APIs and the types of programmatic access for which legacy systems were designed. Modern apps, for example, typically deliver API requests in far greater numbers; that’s true for client-side single-page applications as well as for more traditional server-side apps running on modern, elastically scaled app servers. There are also disparities in the size and structure of data payloads between what modern apps were designed to use and what legacy systems were designed to serve.

These examples boil down to the same issue: If your business is running legacy SAP systems or is in the process of migrating away from them, you’ll have serious work to do to make your data accessible for modern use cases and integrations. And asking third-party developers to adjust their methods and skill sets to consume your legacy systems is going to be a very tough sell.

  • Monetizing API access presents another set of technical and practical challenges. For many companies, the name of the data game is monetization: actually charging developers for the privilege of accessing your high-value data sources. Getting this right isn’t just a matter of putting a virtual turnstile in front of your existing APIs. Any monetization strategy lives or dies based on its pricing—and this means understanding exactly who’s using your data, when they access it and how they’re using it. Even if you are not charging your developers for API calls, there are also some valuable insights to be gained from more advanced types of analysis, right up to having a unified view of every data flow and data interaction related to your organization’s API traffic. Overall, API monetization demands that APIs be built in a modern style, designed and maintained for developer consumption rather than just, per legacy methods, for exposing a system.

It probably comes as no surprise that an SAP environment, whether or not it’s considered legacy, was designed to focus on SAP system data and not designed to open the data inside an SAP system to other applications. And since these tools don’t build themselves, the question becomes, who will build them?

Apigee: Bridging the gaps with API management

An API management solution such as Apigee can help IT organizations tackle these issues more efficiently. In practice, companies are turning to Apigee for help with three primary SAP application modernization patterns, all of which speak to the challenges of using APIs to create value:

1. Modernizing legacy services. One of Apigee’s most important capabilities involves placing an API “wrapper” around legacy SAP interfaces. Developers then get to work with feature-rich, responsive, thoroughly modern APIs, and the Apigee platform handles the process of translating and optimizing incoming API calls before passing the requests through to the underlying SAP environment.

This approach to API management also gives IT organizations some useful capabilities. Apigee simplifies the process of designing, implementing and testing APIs that can add more functionality on top of legacy SAP interfaces; and it helps manage where, how and when developers work with APIs. This is also the basis for Apigee’s API monitoring and metrics—essential capabilities that would involve significant effort for most IT teams to build themselves.

2. Abstracting APIs from source systems. By providing an abstraction layer between SAP legacy systems and developers, the Apigee platform also ensures a consistent, reliable and predictable developer experience. Through this decoupling of APIs from the underlying source systems, Apigee can adjust to changes in the disposition and availability of systems while carrying on business as usual with developers using its APIs. In this way, SAP enterprises can package and market their API offerings—for example, publishing APIs through a developer portal—and lets them monitor API consumption by target systems.

Decoupling the source system from the developer entry points also shields connected applications from significant backend changes like a migration from ECC to S/4HANA. As you make backend changes to your services, apps continue to call the same API without any interruption. The migration may also provide opportunities for consolidating multiple SAP and non-SAP implementations into S/4HANA or cleaning up core SAP systems by moving out some of the functionality to cloud-native systems. Because Apigee abstracts consuming applications from changes to underlying systems and creates uniformity across these diverse systems, it can de-risk the migration from ECC to S/4HANA or similar consolidation projects.

3. Creating cloud-native, scalable services. Apigee also excels at bridging the often wide gap between SAP applications and modern, distributed application architectures in which microservices play an essential role. In addition to repackaging SAP data as a microservice and providing capabilities to monetize this data, Apigee takes on some essential performance, availability and security functions: handling access control, authentication, security monitoring and threat assessment plus throttling traffic when necessary to keep backend systems running normally while providing applications with an endpoint that can scale to suit any of your workloads.

Needless to say, Apigee’s security capabilities are absolutely essential no matter how you’re using API management tools. But because Apigee also offers performance, analytics and reliability features, it can position companies to jump into a fully mature API monetization strategy. At the same time, it can give IT teams confidence that opening their SAP systems to innovation does not expose mission critical systems to potential harm. 

Conrad Electronic and Apigee: using APIs to drive innovation

We’re seeing quite a few businesses using Apigee to create value from legacy SAP environments in ways that didn’t seem possible before. For an example of how Apigee and the rest of Google Cloud work together to open new avenues for innovation for SAP users, consider Conrad Electronic.

Conrad Electronic combines many years of history as a successful German retailer with a progressive approach to innovation. The company has digitally transformed itself by leveraging an existing, legacy SAP environment alongside Google BigQuery, which provides a single repository for data that once resided in dozens of disparate systems. Conrad Electronic is using Apigee to amplify the impact and value of its transformation on two levels.

First, it’s using Apigee to manage data exchanges with shipping companies and with the procurement systems of its B2B customers, giving these companies an improved retail experience and reducing the friction and potential for error that come with traditional transaction environments.

At the same time, Conrad Electronic uses Apigee to give its own developers a modern set of tools for innovation and experimentation. A small development team ran with the idea, building an easy-to-use tool that gives in-store staff and visitors access to key product, service and warranty information, using their own tablets and other devices.

“APIs give people the freedom and independence to implement their ideas quickly and effectively,” said Aleš Drábek, Conrad Electronics’ Chief Digital and Disruption Officer. “As an effective API management solution, Apigee enables us to harness the power of APIs to transform how we interact with customers and how we transfer data with our B2B customers.”

Explore the possibilities with API management

To learn more about how Apigee can solve the challenges that come with opening up your SAP systems to new business models and methods for innovation, see here. Also for more information on Google Cloud solutions for SAP customers, see here.

Whitepaper

A Guide to Accelerating Developer Productivity and Agility

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Business needs for digital solutions have intensified the urgency for rapid application development and deployment. At the same time, widespread adoption of cloud computing has revolutionized the IT environment used by both enterprises and consumers.

In addition, the acceleration of digital transformation has increased the availability of developer tools and deployment environments. Besides, the vibrancy of the DevOps movement and the multiplicity of development tools and infrastructures mean that developers enjoy greater decision-making authority in the development of digital solutions.

As a result, developers not only confront the challenge of shipping software faster but also encounter competing challenges to ensure software quality and the appropriate mitigation of risks associated with rapid development and deployment.

Hence, to move quickly and with confidence, developers must use tools that automate the full software development life cycle and work across platforms and operating systems.

Developers need to adopt FaaS, a cloud platform that allows developers to develop, deploy, and manage event-driven applications without the responsibility of managing the infrastructure on which the applications run.

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Managed containers: An enterprise standard at Colgate-Palmolive

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Discover how Colgate-Palmolive enhances application deployment, innovates faster, and simplifies enterprise management using Google Cloud's managed container offerings and Kubernetes. Learn more...

Kubernetes is an increasingly key part of the application deployment strategies at large organizations, and one of the most recommended options for the teams we work with. An idea brought to life at Google, organizations throughout the world use containers and Kubernetes on-premises, in Google Cloud, or in a multi-cloud scenario, and it has emerged as a leading application deployment platform. And because it’s open source, anyone can pop the hood, so to speak, to see how each component of it works, creating a trusted, verifiable framework that users can rely on.

Customers begin their Kubernetes and containerization journeys using various offerings in our product portfolio. Some, like Colgate, started their modernization journey with Kubernetes. Colgate is an $18B global consumer products company with ~34,000 diverse and dedicated people serving over 200 countries and territories. Through science-led innovation, they drive growth and reimagine a healthier future for all people, their pets, and our planet. 

During ideation, they talked through various considerations: What technology strengths does their organization have? What skills do their teams need? What will this initiative look like a decade from now? They implemented the following Kubernetes-focused architecture:

At Colgate-Palmolive, we rely on Kubernetes and have embraced Google Kubernetes Engine as our preferred way to manage it. Our DevOps, Architecture, and newly-established Open Source groups use this industry standard, open source platform, and find that GKE reduces the effort necessary to run our workloads.
-David Wiser, Manager, GIT, Architecture and DevOps, Colgate-Palmolive

Supporting a variety of use cases and teams

Google Cloud also helped Colgate break new ground over the years, especially in the areas of cloud-native networking, security, monitoring, pub/sub, managed containerization, and multi-tenant environments.

Over time Colgate began to leverage Google’s managed container portfolio, which includes Cloud Run. Cloud Run lets you run containers on top of a serverless platform, unlocking workload possibilities for public websites, private services, APIs and batch jobs and eliminating a lot of the time spent on infrastructure management. Cloud Run also requires no prior knowledge of Kubernetes or containers.

When we first came to Google Cloud, our preferred languages were JavaScript, Python, and Java. This made it easy for small and/or event-based applications to hit the ground running with Cloud Functions. Expertise in Linux and the Open Container Initiative made onboarding to Cloud Run simple and smoothed the learning curve as we experimented with Kubernetes.
-Matthew Tattoli, Software Engineer, Colgate-Palmolive

Simplified enterprise-level management

Many teams have found that they prefer the serverless, hands-off approach that Cloud Run provides, and Colgate now evaluates Google Cloud’s serverless solutions alongside GKE for any applications destined for the cloud. At the same time, Cloud Run lets them continue to leverage their investment in workloads based on the Open Container Initiative. 

For example, Cloud Run is designed for Kubernetes compatibility with consistent management capabilities such as the ability to manage resources using kubectl via the config controller, and the ability to browse logs and metrics from both platforms in Cloud Logging and Monitoring. Cloud Run and GKE data planes are also interoperable, allowing Cloud Run and GKE services to be exposed behind a VPC behind private IPs using an internal load balancer. Cloud Run as an option has contributed to faster innovation, allowing Colgate to bring smiles to many more faces globally.

We have a growing number of applications running in the Cloud — migrations of legacy applications as well as new initiatives we’re starting to build. These applications exist on a wide spectrum of operating requirements, ages, and sizes, and we needed to find a foundation that could handle the heterogeneous demands our users had across our organization. We were pleased to find this in Google Cloud when many internal teams organically started exploring containers.
-Nicholas Farley, Software Engineer, Colgate-Palmolive

Google’s managed container offerings provide a composable and comprehensive set of solutions for customers’ applications. At Colgate, container-based managed services are used across the stack: on the front-end, where they use Identity-Aware Proxy to manage authentication and External Load Balancers to handle incoming traffic with high availability and low latency; at the application layer, where they can choose from Cloud Functions, Cloud Run, or GKE, depending on the level of control they need over the application; and at the internal load balancing level where NGINX® controllers serve internal applications. Together, these managed services ensure that Colgate has the flexibility to choose the right toolchain and maximize their goals for each use case. 

Colgate wanted to build internal applications on Cloud Run in a way that complied with their organization’s policies while maximizing developer productivity. They were able to use new features like the Cloud Run Identity Aware Proxy GA to build a secure, serverless deployment for their applications.

A great partnership with Google Cloud

Colgate and Google Cloud have enjoyed a deep partnership for many years, engaging across many technologies, teams, and design patterns.

Our deep partnership with the Google Cloud team has allowed us to get early access to capabilities that we’ve found valuable, give feedback on what can be improved, and enable our organization with best practices coming straight from the folks who built this technology.
-David Wiser, Manager, GIT, Architecture and DevOps, Colgate-Palmolive

They’ve engaged with Product and Engineering across compute, networking, Kubernetes, and serverless as they brought this new way of thinking to their users.

For Colgate and many of our customers looking to address the needs of the modern user, Google’s managed container offerings are a breath of fresh air. Its reliability, scalability, and control offer the  flexibility to build applications that meet the demands of both internal and external consumers. In addition, the variety of container offerings available on Google Cloud — GKE and Cloud Run — allow customers to make app deployment decisions based on the amount of Day 2 operations the users are willing to take on. Platform administrators appreciate the reduced management effort, users enjoy reduced downtime, and developers can simply deploy.


Google Cloud contributors: Rex Orioko, Rachel Tsao
Colgate-Palmolive contributors: Matthew Tattoli, Nicholas Farley, and David Wiser

Case Study

Google Cloud Helps Northwell Health to Boost Caregiver Productivity and Access to Right Care Using AI

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Northwell Health leverages Google Cloud products to build AI models that help identify patients with high probability of developing lung cancer, and guide the oncologists with those insights to deliver appropriate follow-up care. Read more!

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.

cancer.jpg
Source: https://commons.wikimedia.org/wiki/File:LungMets2008.jpg

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.

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