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.

Point-In-Time Recovery (PITR) is a critical capability for enterprise applications.  It allows database administrators to recover from accidental data deletion by restoring their production databases to a time before the incident.  

Cloud SQL for PostgreSQL launched support for PITR in July 2020, allowing you to recover from disasters like data corruption or accidental deletion by restoring your Cloud SQL instance to a previous time. We’re excited to announce an additional enhancement to PITR for Cloud SQL for PostgreSQL that makes enabling PITR an even easier decision: for instances with Point-in-Time Recovery newly-enabled, the write-ahead logs being stored for PITR operations (which are the transaction logs that are used to go back in time) will no longer consume disk storage space.  Instead, when you enable PITR for new instances, Cloud SQL will store transaction logs collected during the retention window in Google Cloud Storage, and retrieve them when you perform a restore.  Because transaction logs can grow rapidly when your database experiences a burst of activity, this move will help reduce the impact these bursts have on your provisioned disk storage.  These logs will be stored for up to seven days in the same Google Cloud region as your instance at no additional cost to you.  

PITR is enabled by default when you create a new Cloud SQL for PostgreSQL instance from the Google Cloud console, and transaction logs will no longer be stored on the instance for instances that have PITR newly enabled.  If you have already enabled PITR on your PostgreSQL instances, this enhancement will be rolled out to your instances at a later point.  If you want to take advantage of this change sooner, you can first disable and then re-enable PITR on your instance (which will reset your ability to perform a point-in-time restore to the time at which PITR was re-enabled).  On instances with this feature enabled, you’ll notice that consumed storage on your instance will reduce relative to the volume of write-ahead logs (WAL) generated by your instance.  The actual amount of storage your logs consume will vary by instance and by database activity – during busy times for your database, log size may shrink or grow.  However, these logs will now only be stored on your instance long enough to successfully replicate to any replicas of the instance and to ensure that they are safely written to Cloud Storage; afterwards, they will be removed from your instance.

We’re excited to continue to enhance Cloud SQL for PostgreSQL to ensure that disaster recovery is easy to enable, cost effective, and seamless to use.  Learn more about this change in our documentation.

Founded in 2006, PaGaLGuY started as a forum that enabled students, typically aged between 20 and 30 to discuss and seek advice on academic issues. By 2011, PaGaLGuY had increased its traffic to about 250,000 page views per month. The business is now one of India’s largest education networks and provides an app that users can download to their Android and iOS devices.

Over the past six years, PaGaLGuY has extended its service to include video advice from experts on education topics and grown the number of views of its pages to 1.5 million per day. As Head of Technology for the business, Sandeep Kalidindi has played a key role in ensuring PaGaLGuY is as engaging as possible to users. “Because the product is advertising based, the greater the user engagement, the greater the advertising revenue,” Kalidindi explains.

Google Cloud Platform Results

• Supported growth to 1.5 million page views per day and demand spikes that see requests increase from about 90 per second to about 1,200 per second
• Reduced API latency from about 1 second to about 40 milliseconds
• Reduced system administration time from three to four days per week to 30 minutes every two weeks

In 2015, PaGaLGuY’s senior management team decided to deliver an even more relevant experience for users of the education network. “The core thing we had to do was personalise the experience for each and every student that visited PaGaLGuY,” Kalidindi says. “So we had to capture each student’s data to customise what they see when they open the site.”

The business also found traffic to the network was straining its infrastructure. During demand peaks, created by exams involving as many as 5 million students, PaGaLGuY would be inaccessible for periods of 30 minutes to one hour. Furthermore, average API latency had climbed to an unacceptable 1 second, compromising performance.

PaGaLGuY needed to access extensive compute resources to undertake its planned change. Had the business relied on a physical technology architecture to undertake the transformation, it would have had to purchase capacity equivalent to 16 new servers. “There was no way with a small team we could grow to that extent in a short time,” Kalidindi says. “This was the right moment for us to explore cloud services.”

The business established two primary requirements the selected cloud service needed to meet. First, PaGaLGuY had to be able to scale the platform with costs rising only in proportion to the increase in resources consumed. Accordingly, the business would have to minimise the number of employees required to manage the cloud environment. Second, the platform had to give PaGaLGuY easy access to student data and the ability to undertake prompt, granular analysis.

PaGaLGuY reviewed available public cloud services and determined that Google Cloud Platform (GCP) was the best fit for its business. “Google Cloud Platform was considerably more mature than the alternatives, with a high degree of automation and a suite of managed services,” Kalidindi says. PaGaLGuY management then discussed with Google how to optimise cost, performance and availability of its personalised education network on GCP.

With assistance from Google and business transformation specialists Searce, PaGaLGuY was able to deliver the platform into production on GCP in 10 months. “Searce was very proactive in ensuring the environment met our needs and allowing us to gain priority access to Google services in development,” Kalidindi says. “Their team was integral to the success of the migration.”

PaGaLGuY has been running in production in GCP for two years. The education network’s GCP architecture comprises a scalable back-end built on Google App Engine; a managed environment for its containerised applications in Google Kubernetes Engine; messaging-oriented middleware through Google Cloud Pub/Sub; a relational database in Google Cloud SQL; a managed data analytics warehouse running in Google BigQuery; stream and batch data processing through Google Cloud Dataflow; and object storage in Google Cloud Storage.

PaGaLGuY has leveraged GCP services to break down its platform application from a monolithic build to a series of microservices running in Google App Engine that enable independent deployment cycles, minimise test and quality assurance overheads and provide clearer monitoring and logging.

Running on GCP has enabled PaGaLGuY to add new personalisation features and grow fourfold without having to add any new engineers or administrators to accommodate the increased traffic. The business has also used the platform to seamlessly collect and aggregate students’ data for analysis, reporting and delivering a more targeted user experience. Furthermore, PaGaLGuY has been able to provide its management team with direct access to Google BigQuery to scrutinise data rather than require them to wait at least a day to view reports created by the product or technology teams.

Support demand peaks of 1,200 requests per second

“Thanks to Google Cloud Platform, we can easily support demand peaks that see requests per second rise from an average 90 per second to about 1,200 per second for as long as 45 minutes,” Kalidindi says. Due to GCP’s scalability, PaGaLGuY can ensure its education network remains available and performance remains consistent during those periods.

Latency cut to 40 milliseconds

The business has also reduced average API latency from 1 second to about 40 milliseconds. Furthermore, using GCP has enabled PaGaLGuY to automate most of its processes and reduce system administration requirements from three to four days a week across its team members to about half an hour per week.

The performance of GCP has transformed PaGaLGuY’s culture and processes. “Once our team was exposed to Google Cloud Platform and understood the superiority of the platform, our mindset changed from ‘let us do everything on our own’ to ‘let us do what we do best’ and delegate the remainder,” Kalidindi says. The quality of the service provided by GCP means PaGaLGuY effectively considers the cloud provider as part of its team. “We are always eager to see what new services are being launched and are extremely excited about what Google Cloud Platform can provide as part of its roadmap.” he concludes.