Friday, December 16, 2016

brown suede ankle boots


[introductory music playing] eric schmidt: thank you very,very much for that kind introduction. so why would google be here? right? a very interesting conference,not a conference we would normally attend. and one day we started thinking,how much do people use google for health?

and then i realized, what'sthe most important search i could do? so i typed, how longwill i live? it seems like a reasonablequestion. and up comes an agecalculator. and i programmed it,and it said 67. wrong answer. [laughter] eric schmidt: so i reprogrammedit again and i

got 86, right answer,and i'm done. so you see google is veryimportant to my health because i have to meet the newprogramming goal. nearly one out of every twoamericans have one or more chronic health conditions. i was struck by this. you all are doctors, medicalprofessionals, you all know this. i didn't realize it.

hypertension, arthritis,respiratory diseases, cholesterol chronic mentalconditions, heart disease, eye disorders, asthma, and diabetes,and these are people who live with these things dayin and day out, and they use the internet a lot now. there is emerging evidence-- here's some of the numbers--eight million americans research a health-relatedtopic on the internet. more than 2/3 start theirresearch with a search engine.

it turns out that 2/3 ofinternet search engines, users trust the internet, whereas asmaller percentage trust their own doctors. all right, this islike a problem. it's something we canwork on together. usually it is especially strongfor younger users. doctors are learning how to workwith patients that are better educated abouttheir health. so, for example, 2/3 now of allus physicians are using

the internet. and they use it for prescriptiondrug interaction, this sort of thing. we have a lot of studiesthat show this. so what has emerged is acontroversy over this question of this new form ofinternet use. is it good or is it bad? so time magazine,dr. scott haig-- you know you love thesecontroversies--

dr. scott haig says, and theseare his words, "a seasoned doc gets good at sizing what kind ofpatient he's got and how to adjust his communication styleaccordingly." and he's talking about his particular patient."i knew susan was a googler, queen, perhaps, ofall googlers. but i couldn't dance with thisone." because he had so much trouble with her aggressiveknowledge and the way she approached it. this elicited a doctor fightwith dr. [? perak ?]

and this is from hima month later. quoting from the earlierarticle, "'i was a unnerved about how she brandished herinformation, too personal and too rude on our firstmeeting,' he wrote. he proceeded to call her the'queen, perhaps, of all googlers, a class of patientshe referred to as brain suckers.'" this isa compliment. he goes on. "so the problem withdr. haig's article, other than petulance, is that he'signoring every single internet

trend in health care overthe past decade. the medical establishment, infact, has taken way too much time to understand that theinternet is a disruptive innovation that has overturnedthe status quo. it has leveled the playingfield between expert and novice, in this case,doctor and patient. and while some doctors likedr. haig may find that challenge threatening to theirstatus as an expert, the web is now providing the kind ofinformation doctors need to be

aware of if we want to continueto be good at our job and the kind of trends thatwill help the patients be healthier and smarter." so i think this sort of funfight between two senior doctors lays out theproblem that google wants to help solve. it is a fundamental problem. it is certainly one of thefundamental medical problems, and it is certainly one of thefundamental information

problems. i was alarmed to find out howmuch information was being used at google about personalinformation. we had no medical training. i have a ph.d. so i'mcalled doctor. and i always say, well,i'm not a real doctor. so my first few weeks at googlei show up, and we get this letter from a fellowthis says, thank you for saving my life.

and i go, that's prettyinteresting, a startup so it turns out he was havingwhat you all would know is heart attack symptoms. and so hetypes them into google, and the first result says, you arehaving a heart attack. dial 911. by the way, that's thecorrect answer. we're very proud of this. so what happens is he does911, and they show up. what is the drug that theygive you to make sure you

don't die in the middleof a heart attack? whatever that drug isthey gave it to him. and they said, hadyou not called us immediately you'd be dead. so we told that story to ourengineers to explain why it was so important to have answerswithin 1/10 of a second because even secondsmatter in health. and we've since receivedmany such you saved my life kind of letters.

and it's one thingto run a company. it's another thing to savesomebody's life. it's pretty phenomenal. so we got interested in thisquestion about medical health and health in general notknowing much about it. and we started looking at theinteresting problems in the world where our technologycould help. we've formed a group, and we're working on global public health.

so, for example, we've pickedprevention and cure of blindness where we're donatingmoney to an incredibly important cause. eradication of polio,another huge, huge and important cause. eradicating the guinea wormwhich is called the world's most painful disease. we're working with organizationswho are, in my view, just heroic, just everyone of them a hero trying to

solve something whichwill compound for the next 5,000 years. we've also started looking atprograms related to global public health. and information technology,which is what we do well, can really help here. we like the notion ofpredict and prevent. so, for example, if our computersystems can be programmed in such a way thatthey can detect early

outbreaks we can get ahead ofthese waves of information. so early detection,preparedness, and response systems for emerging threats,especially in the third world where a little bit ofuncorrelated data could give us just enough information thatvoom, all of a sudden there's an outbreak of thisparticular strange disease in like laos. and we can get there before itcrosses over into the much larger, and, in many cases, moredangerous areas because

of the crowding. so in a country like laos whereit could take almost nine weeks for a reported caseto get into the information system, maybe we can get thatinformation into the reporting systems earlier and thendetect them using new mathematical techniques,pretty interesting. we can also, using theinformation that we have, get a lot more information to peoplewho don't have it. it turns out that there aremany, many examples where

textbooks are reallynot available. virtually all of the moneyis going into textbooks. well, if these systems areonline, you don't need the textbook, or you can havethem be current. and, in many cases, we can alsouse google to make sure people know that these services,especially the free services in ghana, for example,that these health services are, in fact,available to them. people in countries which arenot as developed as ours spend

an awful lot of time not knowingabout systems and services that are available justdown the street because the connections arenot so great. so if you take the model thathealth is important, that information is important, andthat we have both the resources and the will to workon it, what is the underlying architectural trend thatwe're working in? and let's just talk about it inthe context of the growth of the internet.

everybody here knows theinternet is a big deal. it is by far the fastest growingmedium in history now, more than $1.3 billion users onthe order of $200 million a year new users, the ray ofunderlying technology innovation is notslowing down. a technology-based case wouldoffer you that moore's law, which is the rule thatsemiconductors double in the capacity or speed every 18months, is going to continue for another at least 10 yearsor so until we hit various

photolithographic limits. there is another bizarre lawcalled kryder's law that says that memory doublesevery 12 months. so if you have cpus going atevery 18, which is, by the way, a factor of a 100 in 10years, and you have memory doubling every 12 months, whichis about a factor 1,000 over 10 years because of thecompounding, you can see the enormous things thatcan happen. an example would be that inthe year 2019, if current

trends continue, a device thesize of an ipod will have 85 years of video in it, whichmeans that you carry a device which you cannot watch untilafter you're dead. it's like the ultimatedissatisfaction device. there's always something i'm notgoing to be able to watch on this device. the one i really got megoing, by the way-- we were reviewingthis yesterday-- there are 10 hours of videobeing uploaded into youtube

every minute. god knows what the qualityof that video is, but it's coming. so you take a look at this rate,and this is going to become much more massive thananything that we have seen. blogging is another one. they're on the order of 70million blogs and 120,000 blogs being created every day. more than half of those arecreated by people who are less

than 18 years old. as we know, if you haveteenagers, they have a lot to say, and they're sayingit online. and if you're a parent youmight want to read it. so users are going to use thistechnology, and they're going to use it to say alot about health. they're going to have variousforms of not only communities but ways in which theyhelp each other. and they provide adviceto each other.

did this work? did this not work,and so forth. and the notion of dailysupport groups, the traditional people around theroom, is now going to become very much online. there's something calleddailystrength which has more than 500 supportgroups online. it works really, really well. there's something called psychcentral which has more than

600,000 users who visit theirwebsites, libraries, and communities. we do things like we have birdflu, we have both reported cases on a google map as well asthe communities to study it so that the scientists and thepeople who think they might be victims of the same diseasecan all see the same information, et cetera. we're beginning to see peopletell their stories on youtube. humanity is fascinating becauseof our need for

self-expression. a young woman named kat createda series of 34 videos about her battle with anorexiaand got more than a million people viewing it as shesuffered through this terrible disease with obviously a lot ofsupport and help to help to try to address her problems. it's interesting, by the way,that the professionals of the room will say, oh my god, we'vegot all of these crazy people out there who havediseases now commenting it and

sharing information. and a lot of people have studiedthis, and it turns out that the vast majority of userreported health information is, in fact, accurate, includingthe diagnosis which is a surprise to me. and the most recent study saidthat only about 6% of it is inaccurate. by the way, 6% still means youshould go to the doctor. you shouldn't just read onlineand just do that.

you should talk toa professional. but the fact of the matter isthat 94% is accurate, and is pretty impressive. and it shows you that peopledo want to share accurate information for each other. now, architecturally, to me thissets up the premise for what google is doing. the change in power here istransformative, and it has occurred in other industries.

and everyone else isstruggling with it. and we want to work withyou to make this one be successful. in the entertainment andmedia industry-- i have lots of statistics-- 42% of users 18 to 29 usethe internet as their primary news source. i find this very disturbing. 30% of users 18 to 29 use avideo sharing site such as

youtube daily. so if you're not in that agegroup, you're not seeing this cultural shift which, if youremember when you were that age, seemed obvious toyou at the time. to them this is obvious. it's obvious thisis how the world is going to be organized. and one of the consequencesof this is the traditional industries are declining.

the one that i worry themost about a cd music. sales of cds have declined 19%because people either purchase or illegally steal theinformation online. these are very, very real issuesfor those industries. now when you use google,you can do a number of interesting things. so one of the things that youstart, is you start learning about the history of medicine. so i said, well, what are someinteresting things to learn?

we're scanning all thesebooks, right? well there are a lot ofbooks written about health 150 years ago. so here's an example, the fulltext of the medical times and gazette, which is a britishmedical journal written, this one, in december, 1858. so it's 150 years ago. the surgical procedure fortreating conjunctivitis, which is pink eye, he gives thepatient a mixture of laxatives

and tells him to apply adozen leached to the eye if the pain returns. i presume that the leachesjust change the pain to a different paradigm. the full text for a treatiseof military surgery and hygiene in 1865 with more than40,000 surgical operations performed during the us civilwar, presumably all with a large amount of alcohol andvodka, including medical treatment for gunshot wounds,amputations, gangrene,

tetanus, and general hygienein military hospitals. so i have all this information,right? i've got this transformativephenomenon. i have all of these searchesand so forth. i need some solution to this. what i really want,by the way, is something very personal. i want access to my cholesteroltest. i want the x-ray on my sprained ankle.

why can't we solvethat problem? now we've decided tobring sort of a different model to it. we're going to partner withleaders in health care to cross-connect, to makethis problem and literally get it fixed. and we want to apply theprinciples of the internet, but we want to apply them inconjunction with the leaders in the medical communityto get the right

outcome for the end user. so the first principle that weestablished was, it's the consumer's data. it's not anybody else's data. it's the consumer's data. so from our perspective we takea consumer focused view. so in this model users canaccess their data and control who gets to see it. and the data follows theconsumer wherever they go.

so if they move from oneprovider or one doctor it's still with them. they take it with them to thenext doctor, institution, insurance company,what have you. and this is an importantdistinction in many of our systems. think aboutclosed versus open. cell phones are typicallyclosed. if you buy a cell phone allyour contacts are there. it's very, very difficultjust to switch phones.

whereas if you think aboutbanking atms when you go from one bank to another, it doesn'tsort of matter except for transaction charges. you can pretty much get anybanking atm to give you the money, the same thing. so you want a system where itsort of doesn't matter. the system takes care of all ofthese complicated things. it's really end user focused. there are more than 200 personalhealth record systems

in the us, and most ofthem are closed. that is they're tethered to aparticular health system. and this is a system thatwe see this commonly in industries that havenot yet been fully internetized, if you will. and it makes sense because it'snot possible to have a single standard. and so smart people tend tobuild a system that solves the problem that they see in frontof them, and then someone else

duplicates some of that work. so here's an opportunity toget these systems tied together and get the best ofbreed out of everyone. so in our case, if you take theposition that 30% switch health insurance companies eachyear, which is data which is a huge surprise to me,maybe not to you all. the benefit of consumerinteroperability is extremely significant. there's one study that saidthat literally open health

care standards, which have been,i think, discussed at the [? hymns ?] for a long time,could deliver savings of $78 billion-- and that'sbillion with a b-- annually just in terms of theability for these systems to interoperate, let alone thehealth care benefits which are very important. so it seems to us that consumercontrol over the user information will only work ifthere's a strong privacy and security policy.

so in our case, our model isthat the owner of the data has control over who can see it,and trust for google is the most important currencyon the internet. it's easy to understand. if you have a user-centricmodel, and you violate that trust, the users willgo somewhere else. so you have to start off withthe premise that the information in your healthrecord, or whatever you want to call it is yours, and itdoesn't get shared or given to

anyone else withoutyour permission. if you do so then it happens,and otherwise is won't. now we're in the midst of thisenormous shift to what we call cloud computing. and cloud computing, the modelhere, is that rather than having all that informationstuck on my personal computer, it's stuck on a setof servers. we call them cloud computing orclouds because we used to draw crowds to describe it.

and then you can pick up anycomputer and just access that. and the easiest way to seethat model is imagine-- everyone here basicallycarries a laptop, one kind or another-- imagine what happens whenyou drop your laptop. it's like a really bad day. sometimes it's a badweek or a year. so what you want to have theability to do is pick up any laptop, and with appropriatepermission, login and

password, get everythingthere. so this new emergent model ofserver-based information, and technically what happensis the computer connects to the internet. the program that you need comesdown really quickly, in less than 1/10 of a second, andthere it is as if it had always been there. but the data is managed, i liketo say, by professionals. because we know how to backyour information up.

we make sure you never lose,and so forth and so on. this is a core part of google'soverall strategy, but it's particularlyapplicable here. because why don't i havemy x-rays in my cloud? after all, they'repictures of me. why doesn't the doctor justpump it in there. and then when i have my nextsituation it'll just be there. and it doesn't matter whatviewing device or so forth? maybe i'm at a differentcountry.

maybe i've upgraded. maybe i've switched froma pc to a mac or something like that. eric schmidt: sorry, sorry,sorry, sorry, sorry sorry. i'm on the board of apple. everyone here has those littleyellow immunization cards. i'm terrified i'm goingto lose this card. and i don't know whatit says, by the way. it's just scribble.

but it's really important to goin and out of the country, and that's my job. so why can't i just have thatin my cloud, and when i get their pop up my thing andjust sort of show it. a more serious example-- i guess these areall serious-- is in hurricane katrina. a tremendous amount of healthinformation was lost during that terrible disaster, whichagain, had it been in a cloud

server it would havebeen kept. so you get the idea. now so you it there and you go,this will never happen. we have skeptics inthe audience. people say, well, he's a niceguy, and he's from google. and they're ahead of things. and 5% of the people willadopt this stuff. that's always truein year one. but in year 10, it's usually70% or 80% have adopted it.

and let me remind you that 10years ago, when we started but looking at electronic commerce,the studies were 80% to 90% of the people will neveruse electronic commerce because they do not trust thattheir credit card will be safe on the internet. and i'm not suggesting yourcredit card is safe on the internet now, by the way. but 80% of people now trustthe internet with their credit cards.

so as people become comfortablewith these models tens and tens of millionsof people switch over. and as they do we develop thesystems that make sense. so when you think about thismodel, it's particularly applicable for something like,let me pick x-rays. there are two billionx-rays annually, and each x-ray is 10 megabytes. that's 200 petabytes. petabytes is a verylarge number.

in my world it isn't. so you could just put them allonline and then we wouldn't have to argue about this. and then wherever you went you'dbe able to have all that information, and you wouldhave it historically. 62 million cat scans annually. these are even biggerfiles than x-rays. why are they are not availableto me wherever i go? why are they in that onebuilding that i can't remember

where i went when ihad my cat scan? and they probably lost it anywaybecause that's not their primary focus. again, this is a problem thatcan be easily solved. so the important thing is thatany scenario where information is sort of isolated is ascenario where health is not well delivered. what we want to do is we wantto make sure that all that information, however wacky,and however relevant, and

however irrelevant, is availableto the professional when they're in a situation likein the emergency room. so, if god forbid, i was inan emergency room here in florida, i'd want whoever issitting there trying to figure how to keep me going to haveaccess to the last n years of my radiological experiences, andi'd like them to have it instantaneously. and we can do that now. so in order to do all of this,we organized ourselves around

a health advisory council. i wanted to take a minute, andwhat i'm going to do is i'm going to show you a videoof what they had to say. and then i want to doa demo of the system that we're now trialing. i think it'll give you agood sense of where we think this is going. this is version one. and before i say anything else,i want to mention that

google is not a company thatdesigns a product then ships it, and then justsort of waits. we iterate, and iterate,and iterate, and iterate, and iterate. and we iterate ona weekly basis. our products are in beta test,if you know what that means, or sort of general testing fora couple of years as we try them here and try them there. and we were fortunate to have aninitial beta test partner,

cleveland clinic, to do this. but first, in looking at thehealth advisory council, we were sort of overwhelmed by39 new pathogens have been identified. how do we deal with this? modern travel is dealing withthese sort of disease and spreading them very quickly. prescription drugs, they're morethan 13,000 prescription drugs on the market today, butonly a few hundred are

actively prescribed. how do we get the other ones,the information of the other ones available? there are 110 medicalspecialties in the ama guide. half of the doctors in the uswork in practices with fewer than five physicians. so we have this explosion ofinformation, but we have the structure and we have thelimitations that exist in the medical community today.

how do we bridge that gap? so we formed this healthadvisory council. and i think maybe what we shoulddo is just run the video, and you'll seefor yourself what they have to say. [video playback] dean ornish, md: i'm trainingis in internal medicine. i'm a clinical professor ofmedicine at ucsf, and i'm also the founder and president ofthe nonprofit preventive

medicine research institute. molly coye, md: i'm a physician,and i was a public health officer in two states. paul tang, md: i'm the vicepresident and chief medical information officer at the paloalto medical foundation. robert m. wachter, md: it's adisparate group of doctors offices, and hospitals, andpharmacies that really aren't tied together. sharon terry: people often saythe health care system, but

there isn't one. molly coye, md: it's about timethat consumers had all of the information they need inorder to really manage their own health. paul tang, md: one of thebiggest challenges is really to promote and supportdeveloping partnerships between patients, their familycaregivers, and their professional healthcare providers. sharon terry: for example, toget my own medical records,

it's almost impossible. to coordinate the various piecesof my medical care is impossible. robert m. wachter, md: what weknow from good research is that 50,000 to 100,000 americansdie every year from medical mistakes. dean ornish, md: so much ofhealth care so fragmented. it's in silos. not only the inefficiency if youhave to fill out the same

form every time you go toanother doctor, but there's so little communication betweenthe doctors. robert m. wachter, md: we havethis extraordinary workforce of doctors, and pharmacists,and nurses. but we abuse them because wehandle information so poorly, and we make their workso difficult. sharon terry: so the ideal rolewould be that we all have the information that we need atour fingertips, that it's really accessible, that it'swell protected in the sense

that it's private. paul tang, md: there's atremendous amount of information available online. what we need is a wayto organize it. robert m. wachter, md: and sosome sort of entity in the use of information technology isnecessary to try to create a level of coordination. dean ornish, md: so workingtogether with the health advisory team at google, we'retrying to change that.

sharon terry: if we accept thatcurrently there isn't a system for health care, and thatwe really need to look at how to interconnect the variouspieces, what we see is the ability of google toaggregate information to give us a great user interfaceto use it. paul tang, md: i think googleis in a terrific position to be able to organize healthinformation so that it's useful to an individual. robert m. wachter, md: hopefullyat the end of the

day the docs and the patientswill actually be looking at the same information so thatwe're not acting across purposes, but we're acting asmembers of the same team. molly coye, md: that'sa powerful weapon to improve health. [end video playback] eric schmidt: so we organizedthis group. we organized a set of partnersboth as advisers, but also some companies thatwe're trying.

and i want to get their logosup so you can see them. but the basic idea here was togo to everyone we could find who had a lot of patient dataand then work with them to develop standards that weresecure, by the way, that would take information that thesefolks have in their proprietary databases and suckit into the google health infrastructure that i havebeen describing. and i suspect when you look atthe list you'll see almost all of us interact with manyof the firms that

are here on the chart. so the basic idea here is thatwe developed a set of protocols-- which is sort of whatgoogle does-- which are easy for these guysto connect their proprietary data systems to, and with userpermission, take that information and put itinto a user place. and that user place, call it apersonal health record, call it what you want, canthen be worked on.

the problem that we have is thatwithout this information we would be making the end userduplicate a lot of work. so we need these folksas partners. and it's in theirinterest because they want better health. they want people to have moreinformation and more choices. it makes good sense. and so, for example, some ofthem will help with lists of doctors because their businessis insurance.

so they know what doctorsthey have, which doctors offer this insurance. others have drug information,drug interaction information. other ones have just healthinformation in general. and obviously we want todo this as broadly as we possibly can. so i think i've talkedenough here. and i think it's moreinteresting

to hear a demo anyway. i'd like to introducedr. roni zeiger. roni is a google employee whois also an emergency room doctor and the unusual aspectthat he's both a doctor as well as a masters in informationtechnology. roni, where are you? dr. roni zeiger: i'm here. eric schmidt: ah, here's roni. there you are, roni.

and roni is one of the chiefarchitects of this vision. he has been working onthis for a long time. his first task was to try tounderstand how accurate or inaccurate google waswithout any help. and he started off lookingat taxonomies. and today when you use google,and you type in one of these long words that are medicalwords, the results have been shaped by the judgment and thealgorithms that roni and his team invented.

so once he put that in placehe decided to work on this broader initiative. roni. dr. roni zeiger: thankyou, eric. ok, the friendly loginpage we see here actually is not live yet. but i assure you that everythingelse you see is real live product. so here we.

this is the home page,the google health homepage, of diana. she's a fictional user who isalso part of the cleveland clinic pilot. now diana just cameback from visiting relatives out of town. unfortunately she came downwith a bad sinusitis. she saw a local doctor, and heprescribed for her amoxicillin to treat her sinusitis.

now if we drill into the detailsof her conditions list we see that some of the data wasentered by diana herself, and some of the datashe imported from the cleveland clinic. now because she explicitlygave the cleveland clinic permission to also pull datafrom her google health account, if we hop over to hercleveland clinic mychart account from epic systems, wesee that it also now contains her new prescription andher new diagnosis.

now some of you probably noticedthat diana's allergic to penicillin. the drug interactions featureof google health checks for interactions between drugs,allergies, and conditions. eric schmidt: i'mstill confused. how did this happen? shouldn't the doctor havefigured that out? dr. roni zeiger: so i'll admit,eric, that when i see patients i do sometimes forgetto ask about allergies.

in this case, diana herself mayhave forgotten about her penicillin allergy. fortunately her cleveland clinicdoctors do know about her penicillin allergy. and we just saw that they'realso now aware that she was prescribed amoxicillin. diana herself now has a safetycheck available to her that reminds her to talk to herdoctor about this. now another very cool featureabout google health is

something that we call googlehealth reference pages. so the user studies that we'vedone so far have taught us that consumers really want somebasic context, especially about conditions that they maynot know much about or that they may be wondering if theyhave. we include here also some informative, if sometimes abit spooky, illustrations as well as relevant and dynamicallygenerated news, web search results, researcharticles from google scholar, and pointers to discussiongroups.

now the last thing i want toshare with you is what i find most exciting about what we'redoing in google health. diana can choose to connect hergoogle health account to any of a growing number of thirdparty services that have integrated with googlehealth using our soon-to-be-published apis. and what we're seeing here is alive application that, with the user's explicit permission,has pulled their data from their medication listsin google health and can

display it in a variety ofinteresting ways that google health does not. eric schmidt: so whowrote this app? did we write this app? dr. roni zeiger: no,this is written a company called solventus. eric schmidt: didwe know this? dr. roni zeiger: we gave themaccess to our apis. eric schmidt: ok,did we pay them?

dr. roni zeiger: wedid not pay them. eric schmidt: good. should they pay us? dr. roni zeiger: i don't thinkthey should pay us either. eric schmidt: sorry,just checking. so it's like they can do whatthey want and just connect into our system. dr. roni zeiger:that's correct. and diana can choose to workwith them if she wants to.

so i might want to print thisout, this weekly view, and put it by my medicine cabinet. another developer created amedication reminder gadget that i can put on mypersonalized igoogle homepage. and i cannot wait to see theamazing and innovative tools other developers can create forthe google health users. eric schmidt: for benefit of theaudience, do you have some tools or ideas? i think drug interactionsis an obvious one.

but, as a doctor, there must belike 500 other categories, if you had all thatinformation, that you could go over. what are some others that youthink would be most powerful? dr. roni zeiger: well i thinkthat from my own experience, and more importantly fromhearing from our users and the experts that we're workingwith, i think some of the things that would be really neatis if i could enter the immunizations of my children andto get a useful dashboard

of everything that they've haddone, what they need to do next, and when. if i could get customized feedsof news and research articles that are targetedto my conditions and my medications. eric schmidt: wouldn't it benice, for example, if there was a corpus, and then theysaid, the disease you have has been cured. call here.

dr. roni zeiger: i would wantto know immediately. eric schmidt: right,speed matters. ok. well, thank you verymuch, roni. dr. roni zeiger: my pleasure. [applause] eric schmidt: i wanted you tosee it because we did this partnership with clevelandclinic. cleveland clinic is areally neat group.

they're very, very large. they're very large in general. they have a lot ofdifferent sites. they have more than 100,000people inside their medical health system. and so they were willing to workwith us to help define this standard whichis, of course, non-exclusive to anyone. but hopefully this willshow you the benefit.

and we'll see how wellthis goes over the next month or two. and as we broaden this, wehope to broaden this to essentially everyone that'spossible in the united states. the technology that's used isextremely simple from our perspective. it's an internal interface whichallows you to move data, and we use it for a lot ofour other applications. it's a security model andso forth, so it's all

standardized. so we've managed to layer thison top of just google. and that's why this will move soquickly and be so exciting. cleveland clinic todayhas more than 1,370 people in this trial. and over the next few weekswe'll find out do we really make a differencein their health? what is missing? what are the next key apps?

and one of our messages toyou are, if you have an opportunity to buildan application on top of this platform-- because remember, this is notjust a personal health system. it's really a platform forinteracting on a user's data with their permission. if you've got an idea that canreally change the world in medicine, we want you to buildit on top of this platform. so with that, thank you very,very much for your time.

male speaker: to moderate ourquestions and answers, let's bring out our president andceo, mr. steve lieber. [music playing] steve lieber: good morning. good morning. well, eric, i think you showedus and told us what we've been waiting to hear this week. you created a lot of buzz withthe announcement last week, and we certainly wanted to seeand hear what you had to show

and tell us today. we're going to turnthe lights up. and we've got some alittle bit of time left for some questions. and while we've got peoplecoming up to the mic, let me ask the first one. you talked about consumeradoption of internet technologies, the uptake, andall that, low percentage first year, picks up after that.

have you got any predictions interms of what that cycle is going to be? eric schmidt: with respect tothese tools, i think it will completely be determined by twothings, the ease of use of the interface and the servicesthat we can provide. ease of use turns out to beone of the most important things in one of theseinternet services. it's true not just for health. if people get confused, if youstart asking them the wrong

questions, they quicklybecome sort of tired and they move on. so we worked hard with this userinterface to be able to capture health information,with people's permission, very, very quickly. the moment you do that you haveto immediately show them something that's useful like anoh wow moment, like, oh my god, i i'm healthier, or i gotthis piece of information, or i'm sick, or something.

and then once they have thatexperience they'll come back and come back. so my guess would be that thiswill grow very quickly to at least early adopters duringthe first year. it's hard to know afterthe earlier adopter phase how quickly. but our goal is everyone or atleast everyone who wants this kind of information. steve lieber: great.

ok, let's start overhere, joyce. audience: it was a great talkand very interesting to see. i'm an analyst in this space. and one of my colleagueswas hired to look at the payment space. we were expecting to find thatgoogle payments was really well received and incrediblysuccessful. and our sense was that in thepayment space it hasn't been that successful and that therehasn't been a sufficient

commitment to that space afterthe product launch. how do we know how committedgoogle is to this space? and how do we get a senseto judge where we'll be in a year? eric schmidt: well i disagreewith your question about google payments. google payments is a productthat was designed to make it quicker for advertisersto get their money. and on that metric it worksextremely well.

and we certainly put a lotof money and focus on it. we have a lot of partners. this is an end user product. payments was not. payments was really aninfrastructure part. so the question here aboutgoogle, a consumer product will be whether consumerslike it. and successful consumerproducts take off extremely quickly.

so you'll know very quickly. but if we make a mistake or ifwe don't get the ui right then it'll take longer. but i can assure you we've beenworking on this for a couple of years. so many of our queries arehealth-related that we must be successful here either with thisapproach or modification of this approach as we learnwhat works and what does not. steve lieber: great, thanks.

yes, my name's corey ziegler. i'm in a small rural hospitalin northern new york. and as i listen to this, firstof all, i applaud you for pushing standards. because those are the issuesthat are really kind of at the core of what we're trying tolink all these separate systems together. but in speaking with ourphysicians, when we present them with the data from anotherphysician or outside

of something they're familiarwith, they have some reluctance to trust that data. and there's some complianceand some risk management issues for the facilitiesin trusting that data. so if they use it for clinicaldecision making i'm concerned about the liability. do you have any commentson that? have you guys discussed that? eric schmidt: we have, andwe have found that more

information usually solvesthis problem. of course there are people whosay, well, that's not my information so i'm goingto ignore it. such groups have existed forthousands of years in our history, and they've oftendone really bad things. it's really much better to beaware of the information that other people have evenif you don't use it as your final diagnosis. so even in a situation whereyou are unwilling or, by

regulation, you're unable touse the information that google health has in it,it has to be helpful. it must fundamentally at leastinform your decision as a high quality caregiver. we're not trying to changethe way doctors work. we think that the doctorprofession is obviously a very, very important andvery well thought of. and doctors need to figure outhow to use this information to achieve their objective whichis greater patient health.

we're providing information. they'll sort it out. steve lieber: ok, overhere on this side. audience: one of the thingsyou spoke about was the building of trust for people touse these kind of systems. and i think a lot of people willprobably feel ok having their information in google'scloud knowing that you're probably real good atkeeping things safe. but a lot of people i've spokento are also wondering

what's in it for google tohave this information. talking to one of your engineersat the booth, the phrase he used is monetizationpath. and is there a monetization pathfor this information that you're going to be holdingfor people? eric schmidt: not inthe short-term. we're making a commitment thatthe data itself will never be shared with anyone withoutthe end user permission. one of the things that we'velearned is that if we have a

powerful, so-called verticalsite that does something really, really neat, that personis more likely to use google in its traditionalways and therefore click on our ads. we have a great success storythere with google news. you can make a lot of money withads and other services on google news, but we've decidednot to because we know that people who use google newsare more likely to do more google searches.

so we believe that if you, asa citizen, as a customer, if you will, of google health,we believe-- and there's lot of anecdotalevidence-- that you will be using googlefor many other things, ultimately click on ads, andit's a net positive. and we'll measure that. and i suspect it will be true. ok, back over hereon the right. audience: my name issreedhar potarazu.

i'm the ceo for a companycalled vitalspring. interestingly enough, abouteight years ago, i was a physician at johns hopkins. i practiced there forseveral years. and my mba thesis eight yearsago was about how we can build community-based networksbuilding communities around that. eight years ago people thoughtthe model would fail. over the last eight years wehave 40 of the fortune 500

companies now that we've beendoing business with where we're building, essentially,the next facebook model of health care. and essentially, as you saidearlier, there's an open model and a close model. employers are the ones stillpaying for health care today. and i can tell you speaking onbehalf of 40 of the nation's largest employers, they havea big problem in terms of empowering consumers to getinformation outside of a

closed model where advertisingis not allowed. and now we're building,essentially, the next social network amongst consumers'employees to get all of this information in thatclosed model because this is not banking. this isn't buyingconsumer goods. it's financed by people, andyet we're giving them the opportunity to find theinformation outside, and they're not paying for it.

how do we solve that? eric schmidt: [? dossier ?] is actually one ofthe partners. i don't know if you sawthem on the board. our general answer is thatopen standards will allow people to take these proprietaryinformation data, put it into the end user,and then that creates a balance of power. the end user then hasa choice of moving.

the doctor has a choice of usingthat information or not. in my experience, looking asa scientist, in most cases people are not very empoweredin the system. and this is a step to givethem more power. steve lieber: great questions,but we're running out of time. i've only got time forone more, sorry. audience: all right, thankyou very much. i'm paul [? schadler. ?] i am a practising physicianin denver, colorado.

and this is exciting,exciting stuff. i do have an occasional pang ofparanoia about big brother google knowing everything aboutme and everybody else. but as a physician i-- eric schmidt: but wait. it's just me. eric schmidt: sorry. audience: it's just a littleole boy from the country. nothing to worry about here.

eric schmidt: yeah, i grewup in rural virginia. audience: but as a physician, iand my colleagues, waste so much time collecting data that'sbeen collected in the past, and reviewing data that'sbeen reviewed in the past, and going over datathat's been gone over. and the oh wow moment that iperceive is when sarah comes in my office-- patients switch doctorsall the time now-- sarah comes in.

instead of handing me theform we say, do you have the google password. well, yes. can we access it? yes. we access it, boom. does everything look here good? her medical informationcomes in. her payment informationmay come in.

her insurance card number,it all downloads. sarah, the doctor will see youright now because he's not wasting his or her timereviewing the data. it's all in our system. he'll be with you injust a moment. that's an oh wow moment and thatwill improve health care. thank you. eric schmidt: thank you steve lieber: thank you.

thank you very much. was there a question in that? audience: there wasa question. i forgot the questioni was so excited. so then the question was-- and your optimism ledme ask this-- oh that will be simple. 50,000 gargantuabytes,no big deal. so while google is doing allthis easy stuff that you're

about to do, which a lot ofpeople have struggled with, are you going to go ahead andjust easily create a little interface so that these doctors,the 80% of the small practices can just use googleemr to put data into the system and have google emrcreate an scd-9 code and send a bill to the insurancecompany? eric schmidt: what i was goingto suggest is that's a classic example of a third party app. and we've got a number ofentrepreneurs here in the room

who could see. let's take your idea becauseit's a really good one. you've got a situation whereyou've got a patient and you've got their medical historyand you have their business relationships. and with their permission youcould imagine a whole bunch of applications which did exactlythe kind of thing you're talking about. we're unlikely to do it becausewe don't really

understand that partof the business. but our system is designedas a platform. and this is exactly whatwe're looking for. so i hope you found that companyand make yourself a lot of money. steve lieber: thank thankyou very much. eric, you have certainly openedour eyes this morning to a whole new world ofconsumer-facing health care. and we certainly appreciateyou joining us.

please join me again inthanking eric schmidt.

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