“Dr Google” used to have a reputation for overdiagnosis, predicting death or disaster. Patients were relying on the search engine when they felt ill: one in 20 queries related to health. Often, people typed in symptoms, only to scare themselves with what they then read.
Prem Ramaswami, a product manager at Google, realised that doctors distrusted the search engine’s results, and the company needed to learn far more about healthcare to make its information more relevant and appropriate. “Arguably, the people who knew the most were not promoting people to come to Google,” he says.
Ramaswami turned to Harvard Medical School to design a custom executive education programme, to run in 2015-16, to help the company understand healthcare. What Google’s employees — from vice-presidents to engineers — learnt laid the foundation for its push into the healthcare market. “Taking this course, I felt like our work on health search would not be complete until doctors were prescribing Google to their patients,” Ramaswami says (though not literally, he adds).
Now, when you google “headache”, the search engine strikes a more reassuring tone. Veronica Pinchin, another product manager who took the course, says Google worked closely with doctors at the medical school to make sure the search engine was designed to be “really beneficial”.
“Headaches can, for example, be migraines, thunderclap headaches, brain tumours or aneurysms, but 99 per cent are just because you are tired and stressed,” she says. “So now when you google ‘headache’, it says a headache can be normal and not caused by any underlying disease.”
Dr David Roberts, dean for external education at Harvard Medical School, and associate dean Dr Stanley Shaw were charged with ensuring the programme met Google’s needs. They had 40 students — from Google’s core business and other group companies, including research arm Verily Life Sciences — who each completed four sessions totalling 15 days spread over a few months.
Given technology’s potential to transform healthcare, the academics thought at first Google might want to learn from specialists in big data and genomics. But Dr Roberts says the company told him that “we can google the answers to most of this stuff — we want to understand a lot of things that aren’t googleable”. The focus instead was on how doctors interact with patients and how the healthcare system works.
Google was one of many technology companies that had been trying to change healthcare; it had abandoned its medical records service in 2011. Dr Roberts realised the tech industry had a “graveyard of healthcare products and services, which were cool ideas, none of which were used”. He knew the company needed to understand how the complex healthcare system in the US works and what the obstacles were for patients and doctors.
Together, the company and the academics devised a curriculum that involved listening to patients’ experiences of struggling to obtain information about treatments or clinical trials. They also observed how doctors were overwhelmed by the task of entering patient data into clunky electronic records systems, and they had ethical discussions about what the US — and Google — could or should be doing to help patients in developing countries.
The course has become a model for executive education at Harvard Medical School, with other companies such as US conglomerate General Electric, cloud computing platform Athenahealth, also of the US, and Japanese pharmaceutical company Takeda creating their own programmes there. Dr Shaw says the industry is “under siege”, with pressures on pharmaceutical companies, hospital systems and doctors. But, he adds, there is also “real opportunity” to serve patients in a different way.
The Google staff on the programme were particularly enthusiastic about field trips, including visits to doctors’ offices and emergency rooms, and an excursion with physicians providing support for homeless patients on the streets. As for technology, the software the healthcare providers were using was “pretty far behind the times”, says Pinchin. “So much of the technology used by doctors was quite basic. There’s a lot of manual typing, there’s a lot of system crashes or waiting for ages to get a record pulled up.”
Besides practical problems, the fieldwork helped the students understand the cultural conflicts between tech — where disruption is cast as an exciting opportunity — and healthcare. Ramaswami said that to medics disruption meant “the things that cause death . . . like cancer”.
Google’s staff came away with the course with a clearer idea of what a company whose mission is to organise the world’s information could contribute to healthcare. Katherine Chou, Google’s head of product for AI in health, says her division is looking at how to “democratise some of the clinical expertise”. “Artificial intelligence is very good at dealing with messy, huge volumes of data,” she says.
The company’s plans range from looking at how doctors could use speech recognition to reduce their paperwork burden, to a project in India using AI to examine retinal images to try to detect diabetes-related eye disease. Chou says they are also working closely with patient advocacy groups to think about what information they need, and exploring how Google could help people managing lifestyle diseases and chronic conditions.
Google has hired more doctors since the programme started, including Dr David Feinberg, former chief executive of Geisinger (a Pennsylvania-based healthcare provider), who now heads Google Health, and Dr Toby Cosgrove, former chief executive of the Cleveland Clinic medical centre, as an adviser to Google Cloud’s healthcare business.
Before the course, Ramaswami says he used to begin his talks about health tech with, “The problem with the medical industry is . . . ”. Now, he says he has more empathy with doctors and the medical system. “I can’t say how transformative it was.”
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