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How the tech giant is attacking the healthcare space
Google In
Healthcare
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#googlehealth
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Nikhil Krishnan
A B O U T T H E A N A L Y S T
Nikhil Krishnan is a senior analyst at CB Insights, where he produces data-
driven analysis and research reports on trends in digital health, ag tech, and
construction. He sends the weekly Digital Health Insights newsletter to
30K+ members. His research has been featured in The Economist, New
York Times, Wall Street Journal, and more.
Prior to joining CB Insights, Nikhil worked at Uber, the Small Business
Administration, and Relationship Science.
Most popular analyses by Nikhil:
Oscar Health Insurance Strategy Teardown
Apple In Healthcare
@nikillinit | nkrishnan@cbinsights.com
Senior Analyst
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Contents
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Organization structure
Google's innovation strategy and advantages in health
Google's using AI to combat disease
Google Cloud and the healthcare data layer
Google's future plans in healthcare
13
G O O G L E I N H E A L T H C A R E
Organization structure
14
In 2015, Google
restructures as
Alphabet.
Several
subsidiaries are
dedicated to
healthcare.
15
The healthcare focused divisions
Verily is focused on using data
to improve healthcare via
analytics tools, interventions,
research, and more.
DeepMind is dedicated to
artificial intelligence research.
One of its main initiatives is
finding ways AI can be applied
to healthcare.
Arthur Levinson, CEO
Andrew Conrad, CEO
Calico is focused on learning
about the process of aging and
age-related diseases. The hope
is to find ways to combat this.
Demis Hassabis, CEO
16
G O O G L E I N H E A L T H C A R E
Google's innovation,
strategy, and advantages
17
Google and Verily shift strategies
"Only through the truth are we
going to defeat Mother Nature."
December 7th, 2015
"Mother Nature defeated us wildly."
April 19th, 2017
Andrew Conrad, CEO Verily
18
Google is expanding its search for where it can
be most useful in healthcare

Increased investment and
exposure to startups
Looking outside of the US for
technologies and partners
Establishing partnerships
with more existing
healthcare players
19
"To aid our pursuit of some of healthcare's
biggest challenges, Verily recognizes that
we need to collaborate with both large,
market-leading companies and pioneering
start-ups who are working tirelessly to push
the boundaries, operating on the edge of
technology. With this in mind, we have created
Verily Partner Space, a hub for promising young
companies and entrepreneurs who join us on
our campus in South San Francisco."
V E R I L Y L O O K S F O R I N N O V A T I O N V I A E A R L Y S T A G E S T A R T U P S
Verily Partner Space
S E L E C T L A B C O M P A N I E S
20
GV also increases healthcare startup exposure
Number of Google Ventures digital health and healthcare deals, 2013 - 2017
9
8
15
16
27
2013
2014
2015
2016
2017
CB Insights
21
Google is looking outside of the US
Verily raises $800M from Temasek
Holdings to commercialize and partner
internationally
Verily invests in European VC + Google
invests in Chinese AI drug discovery company
Alphabet's Verily Invests In
$300 Million EU Biotech Fund
June 15th, 2017
22
DeepMind partners with NHS eye hospital
to conduct AI research
July 5th, 2016
The partnership strategy
23
Google's 3 main advantages
E N T E R I N G H E A L T H C A R E
AI expertise
Cash pile
Consumer reach
24
Google's 3 main advantages
E N T E R I N G H E A L T H C A R E
AI expertise
Cash pile
Consumer reach
25
Healthcare is becoming a data problem
153 exabytes of
healthcare data produced
2013
2,314 exabytes
of healthcare data projected
2020
International Data Corporation
26
The data is coming from different places
EMR penetration rate
wearables sold in 2017
human genomes sequenced
IDC, Forbes, CDC
113M
500K+
86%+
27
As data begins to define healthcare,
Google's expertise in AI is its main
advantage.
28
Google is emphasizing it's an AI/ML first company
Mentions of "Machine Learning" in earnings transcripts, 2013 - 2017
CB Insights Earnings Call Database
Google is
focusing on
ML/AI
Google is emphasizing its
machine learning and
artificial intelligence
capabilities.
CEO Sundar Pichai
mentioned in a recent
earnings call that Google
is preparing itself as we
move from a "mobile first"
world to an "AI first" one.
0
10
20
30
40
50
60
2013
2014
2015
2016
2017
Amazon
Apple
Facebook
Google
Microsoft
29
In big tech,
Google is the
most active
investor and
acquirer of AI
companies.
CB Insights
30
"So tomorrow, if AI can shape healthcare, it has to work through
the regulations of healthcare In fact, I see that as one of the
biggest areas is where the benefits will play out for the next 10 -
20 years."
Sundar Pichai, CEO
NDTV
O P T I M I S M F O R A I I N H E A L T H C A R E
31
Google's 3 main advantages
E N T E R I N G H E A L T H C A R E
AI expertise
Cash pile
Consumer reach
32
Google has distribution and consumer
relationships
Google products with more than 1 billion users
33
NPS Benchmarks
People like
Google
Compared to some of the
existing players in the
health industry like health
insurance, Google has a
much higher Net
Promoter Score (NPS).
50
12
Google
Health Insurance (average)
Google's NPS is much higher than that
of health incumbents
34
Google's 3 main advantages
E N T E R I N G H E A L T H C A R E
AI expertise
Cash pile
Consumer reach
35
Alphabet Earnings Calls
Google has cash
Google has a steady and
growing cash pile and
revenue stream outside of
healthcare.
This means it has the
resources to invest in
cash-heavy projects,
weather regulatory
uncertainty, and deal with
the longer timelines
associated with
healthcare.
$58.7B
$64.4B
$73.1B
$86.3B
$101.9B
2013
2014
2015
2016
2017
Google's cash pile over time
Alphabet's end-of-year cash on the balance sheet, 2013 - 2017
36
G O O G L E I N H E A L T H C A R E
Google using AI
to combat
disease
37
The 3 parts of tackling disease
A R E A S O F I N T E R E S T
Data generation for possible
disease indicators
Early detection of disease
Management or intervention
of disease
1
2
3
38
Google is tackling specific diseases
E Y E D I S E A S E
Data Generation
Optos
Disease
Detection
Disease/Lifestyle
Management
DISEASE PROGRESSIOND I A B E T E S
H E A R T
D I S E A S E
P A R K I N S O N ' S
M U L T I P L E
S C L E R O S I S
Diabetic
Retinopathy
Research
Ocular Mount
Dexcom
Glucose Monitor
Cardiogram
Study
Onduo +
Smart Syringe
Monitoring Patent +
Study Watch
Retina Heart
Health Analysis
Study Watch
Personalized
Parkinson's
Liftware
One Brave
Idea
Study Watch
MS
Observational
Study
Galvani
Bioelectronics
39
Google is tackling specific diseases
E Y E D I S E A S E
Data Generation
Optos
Disease
Detection
Disease/Lifestyle
Management
DISEASE PROGRESSIOND I A B E T E S
H E A R T
D I S E A S E
P A R K I N S O N ' S
M U L T I P L E
S C L E R O S I S
Diabetic
Retinopathy
Research
Ocular Mount
Dexcom
Glucose Monitor
Cardiogram
Study
Onduo +
Smart Syringe
Monitoring Patent +
Study Watch
Retina Heart
Health Analysis
Study Watch
Personalized
Parkinson's
Liftware
One Brave
Idea
Study Watch
MS
Observational
Study
Galvani
Bioelectronics
40
Optos provides Google with retinal image data
41
Google is building on its eye disease research
"The results show that our algorithm's
performance is on-par with that of
ophthalmologists."
Performance of the algorithm (black curve) and
eight ophthalmologists (colored dots) for the
presence of referable diabetic retinopathy
based on 9,000+ images.
Google
42
DeepMind is partnering with Moorfields Eye
Hospital to scale eye scan analyses
43
Google has been building implantable eye
devices to help with weakening eyesight
CB Insights Patent Database
44
Eye interventions have been a consistent focus
area for Verily
Word frequency in Verily's published patents, 2013 - 2017
CB Insights Patent Database
2013
2014
2015
2016
2017
polymer layer
wearable device
handheld tool
implanted device
optical beam
analyte sensor
magnetic particle
flexible substrate
eye mountable device
lens enclosure
eye mountable device
electrical contact
eye mountable device
pathology image
plunger head
second polymer
biological tissue
light source
handheld tool
wearable device
first polymer
response signal
electrical contact
magnified pathology
mountable device
bio compatible layer
analyte response
sensing device
data packet
polymer layer
compatible layer
power supply
contact lens
enclosure material
response signal
wearable device
bio compatible layer
accommodation actuator
second layer
measurement period
response signal
compatible layer
assistive device
magnetic nanoparticles
ophthalmic device
hydrophilic copolymer
target tissue
magnetic field
first layer
target person
45
Verily is partnering with Novartis/Alcon, but
project status is unclear
Autofocus contact lens being developed by
Verily and Alcon suffers delay
November 18th, 2016
46
Google is tackling specific diseases
E Y E D I S E A S E
Data Generation
Optos
Disease
Detection
Disease/Lifestyle
Management
DISEASE PROGRESSIOND I A B E T E S
H E A R T
D I S E A S E
P A R K I N S O N ' S
M U L T I P L E
S C L E R O S I S
Diabetic
Retinopathy
Research
Ocular Mount
Dexcom
Glucose Monitor
Cardiogram
Study
Onduo +
Smart Syringe
Monitoring Patent +
Study Watch
Retina Heart
Health Analysis
Study Watch
Personalized
Parkinson's
Liftware
One Brave
Idea
Study Watch
MS
Observational
Study
Galvani
Bioelectronics
47
Glucose monitoring is one of Google's earliest
medical device projects + it's doubling down
CB Insights Trends Tool
CLICK HERE TO RUN THIS SEARCH IN PLATFORM
48
The fasting tear glucose level did not appear to be a
satisfactory index for classifying a person as a diabetic or
normal. It was found that after the peroral glucose load
test a tear glucose level at 11 mg/100 ml (0.61 mmol/l)
resulted in only 4.6% of the diabetics being missed, while
5.8% of the normal persons were misclassified as
diabetics.
British Journal Of Opthamology
C A N T E A R S B E U S E D ? T B D
49
Verily is looking at other ways to capture
glucose data
Slide from Dexcom investor presentation
50
Verily partnership is increasingly mentioned
Mentions of "Verily" in Dexcom earnings calls, 2013 - 2017
CB Insights Earnings Transcripts Tool
CLICK HERE TO RUN THIS SEARCH IN PLATFORM
51
Improved glucose monitoring enables Verily's
diabetes management program Onduo
52
" just last week, Onduo, a joint venture between Verily
and Sanofi, began a limited commercial launch of its
diabetes management platform."
O N D U O B E G I N S R O L L O U T
Sundar Pichai, CEO
CB Insights Earnings Call Data
February 2, 2018
53
Google looking to new tools?
Patent: Smart Syringe
Possible expansion into Type 1 diabetes?
Patent
"Over time, the company plans to expand
its focus to include the Type 1 diabetes
community, and eventually to people at
risk of developing diabetes with the goal
of helping them better prevent the onset
of the disease." Onduo website
Select
Companies:
54
A new N=14,011 study shows heart rate sensors you're wearing already like the Apple
Watch, Android Wear, Garmin, or Fitbits can detect early signs of diabetes.
Researchers at Cardiogram and UCSF validated the accuracy of DeepHeart, a deep
neural network, in distinguishing between people with and without diabetes,
achieving 85% accuracy on a large data set which included 200 million heart rate and
step count measurements.
T H E G A P : D I A B E T E S D E T E C T I O N
Cardiogram
Study: Ordinary wearables can flag signs of diabetes,
according to new Cardiogram study
55
Google is tackling specific diseases
E Y E D I S E A S E
Data Generation
Optos
Disease
Detection
Disease/Lifestyle
Management
DISEASE PROGRESSIOND I A B E T E S
H E A R T
D I S E A S E
P A R K I N S O N ' S
M U L T I P L E
S C L E R O S I S
Diabetic
Retinopathy
Research
Ocular Mount
Dexcom
Glucose Monitor
Cardiogram
Study
Onduo +
Smart Syringe
Monitoring Patent +
Study Watch
Retina Heart
Health Analysis
Study Watch
Personalized
Parkinson's
Liftware
One Brave
Idea
Study Watch
MS
Observational
Study
Galvani
Bioelectronics
56
Verily's Study Watch is an enabling tool for
many different kinds of research
Able to capture data
from ECGs, heart rate,
electrodermal activity,
movement, and more
Large internal storage
and processor baked in
Can do over-the-air
software updates
57
Google also patents passive heart monitor and
stroke detection via everyday objects
CB Insights Patent Database
58
Verily publishes paper looking at cardiovascular
risks via retinas using machine learning
Nature
59
Verily's "One Brave Idea" issues a $75M grant to
better understand heart disease management
60
Google is tackling specific diseases
E Y E D I S E A S E
Data Generation
Optos
Disease
Detection
Disease/Lifestyle
Management
DISEASE PROGRESSIOND I A B E T E S
H E A R T
D I S E A S E
P A R K I N S O N ' S
M U L T I P L E
S C L E R O S I S
Diabetic
Retinopathy
Research
Ocular Mount
Dexcom
Glucose Monitor
Cardiogram
Study
Onduo +
Smart Syringe
Monitoring Patent +
Study Watch
Retina Heart
Health Analysis
Study Watch
Personalized
Parkinson's
Liftware
One Brave
Idea
Study Watch
MS
Observational
Study
Galvani
Bioelectronics
61
Personalized Parkinson's aims to track
everything about people with the disease
Technology Review
Data captured from the Study Watch as well as
blood tests and brain scans
Partnering with researchers and universities in
the Netherlands, follows 650 volunteers
Verily is contributing $13M to the study
62
[Bastiaan Bloem, a neurologist who directs the Parkinson Center at Radboud University
Medical Center] says all the data will be freely available, but "Verily will have a crack at
the data to build algorithms."
Bloem expects the data will permit classification of Parkinson's patients into sub-types
who might benefit from different treatments. "We hope to get fine-grained phenotype
people like you, a 50-year-old man with red hair, will have this or that outcome, but only
if you exercise," he says.
T H E G O A L : B U I L D A L G O R I T H M S O N T O P O F T H E D A T A
Technology Review
63
As Google learns more about the
disease, it's currently moving
towards helping management of
those afflicted.
64
65
Google is tackling specific diseases
E Y E D I S E A S E
Data Generation
Optos
Disease
Detection
Disease/Lifestyle
Management
DISEASE PROGRESSIOND I A B E T E S
H E A R T
D I S E A S E
P A R K I N S O N ' S
M U L T I P L E
S C L E R O S I S
Diabetic
Retinopathy
Research
Ocular Mount
Dexcom
Glucose Monitor
Cardiogram
Study
Onduo +
Smart Syringe
Monitoring Patent +
Study Watch
Retina Heart
Health Analysis
Study Watch
Personalized
Parkinson's
Liftware
One Brave
Idea
Study Watch
MS
Observational
Study
Galvani
Bioelectronics
66
MS Observational Study builds on existing
Brigham and Women's Hospital research
Brigham and Women's Hospital
The collaboration builds on existing research
Comprehensive Longitudinal Investigation of
MS (CLIMB), which tracks 2,000+ patients
Study Watch captures data on gait, mobility,
dexterity, and more.
Verily will help with machine learning expertise
to bring datasets together and generate
insights.
67
Bioelectronics as
a possible
intervention?
Verily is working with GSK
to develop miniature
electronics to control how
electrical signals flow
throughout the body.
This could be used to
assist MS patients with
their gait, or even be used
in halting the disease as
we learn how it
progresses.
68
Using a mouse model of [multiple sclerosis], experimental autoimmune
encephalomyelitis, we show that autoreactive T cells access the central nervous
system via the fifth lumbar spinal cord Impairing soleus muscle contraction by tail
suspension is sufficient to reduce localized chemokine expression and block entry of
pathogenic T cells at the fifth lumbar cord, suggesting that regional neuroimmune
interactions may offer therapeutic targets for a variety of neurological diseases.
L O O K I N G F O R A N M S C U R E
Cell
Preliminary studies suggest stimulation of certain areas
can stop MS progression in rats
69
ReWalk Robotics builds soft
exoskeletons to help people recover
from strokes and neurological disorders
Select Investors
ProSeed Venture Capital, SCP Vitalife,
YASAKAWA Electric
C O U L D G O O G L E P A R T N E R W I T H O R A C Q U I R E E X O S K E L E T O N C O M P A N I E S T O A I D
M O B I L I T Y I M P A I R E D M S P A T I E N T S ?
Funding
$11.4M (Public)
S I M I L A R C O M P A N I E S
70
G O O G L E I N H E A L T H C A R E
Google Cloud and the
healthcare data layer
71
Interoperability and data access are huge
problems in healthcare
ClearDATA
14%
Of surveyed doctors said
they could access
EHR information
across care settings
79%
Of survey doctors said
comprehensive
access to full patient records
was extremely critical
72
Google wants to create the new data
infrastructure in healthcare for
people to build on.
73
Google has
learned from its
mistakes
In 2008 Google started a
personal health record
initiative called Google
Health, which shut down
in 2011.
Google is now plugging
into the healthcare
infrastructure by working
with providers,
researchers, and existing
health institutions.
74
How Google is integrating into the health data
infrastructure
Creating pipes within health
giants
Pushing Google-Cloud-
enabled services
Building its own datasets for
third parties to build on
1
2
3
75
How Google is integrating into the health data
infrastructure
Creating pipes within health
giants
Pushing Google Cloud
enabled services
Building its own datasets for
third parties to build on top of
1
2
3
76
Google is building data pipes with a new health
data standard called FHIR
Fast Healthcare Interoperability Resources
(FHIR) developed under the non-profit HL7
organization
Uses a similar data sending and retrieval
mechanism to web standards (e.g. discrete
taggable data elements instead of full
documents, JSON/XML formats, etc.)
Can be used to build application programming
interfaces (APIs) to port data from places
77
DeepMind is plugging into patient records using
FHIR to power a third-party app ecosystem
TechCrunch
78
DeepMind is
building its own
apps, too
DeepMind is building its
own apps. Streams, for
example, is a tool for
nurses and clinicians to
detect acute kidney injury
earlier.
79
Apigee lets
institution build
their own APIs
and apps
Google acquired Apigee
for $625M, which
included an API
management software
that uses FHIR to enable
interoperability.
Apigee is one of the
services offered through
the Google Cloud suite.
80
How Google is integrating into the health data
infrastructure
Creating pipes within health
giants
Pushing Google-Cloud-
enabled services
Building its own datasets for
third parties to build on top of
1
2
3
81
Google is pushing their cloud platform
Mentions of "cloud" in Alphabet's earnings calls, 2013 - 2017
CB Insights Earnings Transcripts Tool
82
Google offers G Suite for healthcare
practitioners built on top of its cloud offering
TechCrunch
83
Google Blog
Open-source
tools for research
Google is rolling out open-
source tools for
researchers, such as
DeepVariant for genomic
analysis.
DeepVariant also
demonstrates one other
advantage Google has in
the space: it can test its
products with Verily, its
in-house life sciences
team which helped in
releasing the software.
84
"One of the things that we've done is one of my scientists has
worked to create a yeast tracker that allows us to figure out how
old each yeast cell is it's computer vision."
Daphne Koller
Former Chief Computing Officer, Calico
CB Insights A-ha! Conference
M O R E T O O L S T O C O M E ?
85
As more health institutions use Google Cloud
services, it becomes part of the infrastructure
Glintech
86
How Google is integrating into the health data
infrastructure
Creating pipes within health
giants
Pushing Google Cloud
enabled services
Building its own datasets for
third parties to build on
1
2
3
87
Google is building datasets for people to build
on as well
88
Project Baseline is tracking 10,000 voluntary
participants over 4 years
89
"By signing this consent, you are allowing the Baseline Team to keep all of the
information you provide in a database, called the Baseline Database
In the future, the Baseline Team may allow the data to be used by researchers outside of
the Baseline Team. If this happens, the Baseline Team will not include direct identifiers
(name, street address, phone number, and email address)."
Baseline's Informed Consent suggests the dataset will be used
for other researchers to access and build on
90
G O O G L E I N H E A L T H C A R E
Google's future plans
in healthcare
91
The next diseases to tackle?
C O P D
Data Generation
Study Watch
Disease
Detection
Disease/Lifestyle
Management
DISEASE PROGRSESIONC A N C E R
M E N T A L +
B E H A V I O R A L
H E A L T H
Senosis Health
Galvani
Biolelectronics (?)
Freenome +
MRI/CT images
Tumor detection
research
Radiotherapy
planning +
peer support
Search data
Quartet Health
A G I N G
Calico
(new drugs + lifestyle
changes)
Mobile based
intervention and
therapy
Calico
(aging process)
Calico
(data from mice)
92
Chronic Obstructive Pulmonary Disease
Senosis acquisition
Galvani Electroceuticals use case?
Source: GlaxoSmithKline
93
Cancer (various forms)
Freenome investment
Tumor identification research
Head and neck cancer radiotherapy
planning + peer to peer support
Gap: Data stream from
MRI and CT scans
Google, Clinicaltrials.gov
94
Mental and behavioral health
National Alliance on Mental Illness partnership
Quartet Health investment
Gap: Therapy or coaching for people
diagnosed with mental or behavioral illness
95
Aging
Studying other animal and biological systems to
understand aging process
New drugs and interventions
Google's Calico partners with new biotech
firm to develop anti-aging and cancer
drugs
March 24th, 2017
Calico, VentureBeat
96
Google moving into tools for doctors
In conjunction with Johnson & Johnson, Verily is working on
creating robots for surgeries. Some patents filed include ways
to use existing images and lighting to partially or fully
automatically conduct surgeries.
Google patented a combination of a pressure cuff, camera, and
machine vision to help doctors conduct an abdominojugular
reflux test, which requires a high level of precision and has a
large variance in how it's conducted by different doctors.
CB Insights Patent Database
97
Diagnostics for patients next?
Google's Pixel phone could be used for
new diagnostic and screening
capabilities, similar to the iPhone +
ResearchKit.
Google has a patent for a concussion
test via a type of headset. Google
could build new hardware with
diagnostic capabilities, including a
consumer version of the Study Watch.
CB Insights Patent Database
The Google Home could be used to
help screen for certain diseases via
Q&A, or help with adherence and
lifestyle management of disease.
98
Google + population health interventions
Debug aims to engineer and release
sterile mosquitoes into the population
in order to eliminate disease carrying
mosquitoes.
Future population health interventions
could see use of autonomous cars
from Waymo for in-car health
monitoring or find other uses for look
at other areas to use machine vision,
such as livestock disease outbreak.
Spinout Cityblock aims to support
Medicaid and Medicare patients by
understanding data about their
environments and social determinants
to provide personalized care.
99
Taking on the risk: Google Insurance
Verily
100
Will people trust Google?
Survey of registered voters: "How Much Do You Trust Google To Keep Your
Personal Data Private?"
Morning Consult + Politico National Tracking Poll
53%
Not At All/
Not Very Much
39%
A Great Deal/
A Fair Amount
8%
Don't Know/
No Opinion
101
Questions?
Twitter: @nikillinit
nkrishnan@cbinsights.com
102
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cbinsights.com
@cbinsights
Nikhil Krishnan
nkrishnan@cbinsights.com