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.

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.

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.

At 340 square miles, the City of Memphis is among the largest in the United States in terms of land area. Memphis has over 6,800 lane-miles of city streets, enough to drive back and forth to Los Angeles four times. Keeping these streets well maintained and safe for citizens and visitors is a major priority for the city.

Lots of traffic, lots of roads, and a four-season climate prone to wintertime freeze-thaw-refreeze cycles means the opportunity for potholes. Although the city aims to fill potholes within five business days of notification, it can take longer, especially during winter and early spring. Last year, the city’s Public Works crews repaired some 63,000 potholes, only 20% of which were reported by residents. Approximately 32,000-man-hours each year are spent repairing potholes, with seasonal fluctuations requiring ten to twelve Street Maintenance crews working steadily during the winter months. Still, many went unreported, leading the city to flag pothole request resolution under “needs improvement” on its open data portal website.

Like many large cities, Memphis also struggles with vacant and blighted properties. Nearly 15,000 properties in Memphis are likely vacant, and city officials contend that many are owned by out-of-town investors who live elsewhere and do not take necessary restoration or maintenance steps. These properties can decrease the value of surrounding real estate and discourage new businesses and other residents from moving to an area. Citizen frustration and concerns over the number of blighted properties has made blight eradication a major focus of the City of Memphis.

Historically, residents reported potholes and blighted properties by calling 311, or more recently by using the Memphis 311 app. However, these reports only covered about 20 percent of the problems — often the worst cases. And by the time residents took the initiative to submit a 311 report, they usually weren’t feeling good about the situation.

Recognizing that potholes and vacant properties are often the most visible indicators of whether a city government is doing its job efficiently, Memphis Mayor Jim Strickland and CIO Mike Rodriguez began looking for ways they could apply technology to fix the problems. Mike approached Google for ideas, and Google recommended conducting a machine learning proof-of-concept (POC) with SpringML, a Google Cloud Partner.

“Memphis is focused on easy living, and we want to do everything we can to keep our citizens happy,” says Mike Rodriguez. “Working with Google and SpringML to reduce potholes and urban blight using machine learning and artificial intelligence was an easy decision.”

Bringing machine learning to city operations and budgets

The city’s goal is to detect potholes and abandoned properties by analyzing video footage of roads and residential properties. It wanted to classify potholes by width and depth, and share the information with workers who can repair them. For abandoned properties, it wanted to enable more strategic deployment of resources for homeowners citywide and take action to hold neglectful property owners accountable.

The POC began by training TensorFlow models for ML object detection using preconfigured AI Platform Deep Learning VM Images on Compute Engine. SpringML helped set up cameras and developed a user interface to collect pothole data and automate the 311 ticketing process.

Together, the teams analyzed 30 days of video from a moving city bus and high-resolution video from 360-degree cameras mounted to a code enforcement vehicle, overlaid with data from 311 reports. As the models were refined, accuracy quickly climbed from 50 percent to over 90 percent as models were taught to differentiate a pothole from a manhole cover or other object.

The city also imported routes, potholes, and paving data along with geolocation data from ArcGIS and Google Maps into BigQuery to better understand street conditions and the proximity of potholes to one another. BigQuery also analyzes city property records, tax records, 311 reports, and third-party survey data on-demand to predict where homes are starting to become run down and where neighborhood decay is most likely to occur. The SpringML team created a pilot analysis to begin vacant property protections and developed a user interface tool to interact with the model’s results.

“Google Cloud Platform made it possible for us to experiment with machine learning and artificial intelligence to help solve our city’s problems while working within the budget constraints of a municipal IT organization,” says Mike. “Google turned a ‘nice to have’ into a ‘let’s do this!'”

Identifying 75 percent more potholes

Memphis expects to substantially reduce the number of potholes on its streets, creating a better driving experience for residents and visitors alike. Because drivers won’t be as likely to swerve to miss a pothole, streets will be safer and friendlier to bicycles and scooters. Fewer potholes will also save the city between $10,000 and $20,000 annually in city claims that it pays out in cases where vehicle damage results from a pothole that was not addressed in a timely manner.

“Historically, Public Works has relied primarily upon Street Maintenance crews to proactively locate and fill potholes. As Memphis has over 6,800 lane-miles of public streets, it is a daunting task to reliably survey the entire system in an efficient and systematic way,” says Robert Knecht, Public Works Director for the City of Memphis. “The outcome of the data collected will be invaluable to Public Works so that it can ensure it is managing the city’s street system in a more proactive manner.”

Memphis will be able to better prioritize road maintenance based on condition and impact, increasing the efficiency of its Public Works road crews. Analyzing video of streets also gave the city visibility into issues it wasn’t previously aware of, such as curbs, gutters, and manhole covers that had been mistakenly paved over and need to be excavated. The ML process is easily transferrable to other concerns as well, helping the city identify illegal signs or spools of cable hanging on light posts that could be potentially unsafe.

Helping communities recover and thrive

Memphis is also having success in analyzing predictive trends to combat high rates of abandoned and blighted properties, surpassing 97.5 percent accuracy. “In the past, Public Works experimented with comprehensive, city-wide blight identification by using approximately 200 volunteers to survey and photograph over 237,000 city parcels. This effort was costly, took a long time to complete, and resulted in inconsistent data collection,” says Robert. “Blighted property conditions can change quickly in a city the size of Memphis. Now, with this new technology, Memphis will be able to make a significant difference in the efforts to proactively and comprehensively identify and manage blighted and substandard properties.”

Code Enforcement with better data-driven detection mechanisms enables the city to also identify cases where homeowners are not physically or financially able to keep up with the challenges of homeownership and make them aware of resources that are available to assist them. Memphis Code Enforcement can do a better job of finding people living in derelict properties that pose hazards to inhabitants’ health and safety, and help them fix those problems or find a new place to live.

“Using SpringML and Google Cloud Platform to detect indicators of vacant or blighted properties will help Memphis create safer neighborhoods that will be more attractive to businesses and home buyers,” says Mike. “Property values and employment will go up, crime will go down, and social services can be more focused and effective.”

Revolutionizing service delivery for citizens

Memphis is proving the viability of a cost-effective, cloud-based machine learning model that other cities can follow. The city is already looking into new applications of AI and ML that will further improve city services and help it build a better future for its 652,000 residents.

As part of his commitment to a transparent government, Memphis Mayor Jim Strickland created an open data policy that commits to releasing raw data and sharing it with citizens in a variety of downloadable formats. Going forward, this transparency will help citizens understand how their needs are being served and uncover new, innovative use cases for AI and ML.

“Our goal is to become a smart city, and technologies such as Google Cloud Platform and SpringML put us ahead of the game,” says Mayor Strickland. “Google understands data, and there isn’t a better company to help us analyze our data resources for actionable insights.”