The Mayo Clinic innovation summit known as Transform has always looked hopefully towards the convergences, synergies and creative disruption awaiting medicine in the promising digital future.

This may have been the year those words finally seemed real.

Google, in case you hadn't heard, has arrived in Rochester, and every breakout session in the two-day happening at Mayo Civic Center, now in its 11th year, seemed to anticipate that partnership with all of its hopes and challenges for patients, medicine and health. But Transform 2019 was also a program intent on tripping up its 400 internal and external attendees up with the knotty, nagging people-problems facing medicine, challenges that smart design and Big Data cloud computing will be sorely tested to unravel.

Channeling a night-clubby ethos, the gathering does its best to rip up the playbook for medical meetings. The ballroom for keynote speakers has turned down the lights, bathed the stage in blue and splashed the wall with geometric patterns. Crews have installed the front three rows with sleek couches and coffee tables, and the back of the room is lined with high-top workstations complete with charging ports. If Mayo CEO Gianrico Faruggia were to begin prowling the stage in a black turtleneck and jeans, speaking through AirPods about the latest killer application, he wouldn't have been out of place.

But it's not so much about the employees who get off at the top of the elevator. The Mayo Clinic on display at Transform is peopled by mid-level innovators charged with rolling up their sleeves and thinking outside the box. Consultants in off-the-rack menswear shared tables with tech heads in shirtsleeves and skinny jeans. At the break, catering had swapped out the standard squadron of cheese danish for asparagus spears in aioli cups.

Will it be enough to channel a Silicon Valley ethos, given the so-so track record of treating chronic disease through adherence to medication protocols? Because officially, Google isn't here to help patients stay on their A1C pills.

"We see Mayo Clinic as the leader in the world for treating rare and complex diseases," said Google's Director of Global Healthcare Solutions Aashima Gupta during a Thursday afternoon conversation on the big stage with event moderator Tom Weber and Mayo Clinic Chief Information Officer Christopher Ross. The hope for AI, Gupta said, lay in better utilizing technologies like imaging, genomics and the voluminous data collected on patients such that "by combing all these data points we can hopefully get better outcomes."

Google has a two-sided business model, the audience soon learned, one in which the familiar side of the business collects data on search engine users to sell ads while the company's lesser-noted enterprise side now contracting with Mayo engages in something of the opposite: selling and guarding cloud computing and artificial intelligence. As depicted at Transform, the technology giant will serve Mayo upon its request only to sift through the clinic's voluminous de-identified patient data in search of under-examined patterns that might change the way we look at disease.

It will pose an interesting set of dilemmas if those searches upset some longstanding treatment assumptions. Were they, say, to determine that foregoing carbohydrates and eating saturated fat in its place does more to turn back type 2 diabetes and by extension heart disease, as recent trials have shown, than lipid or glucose control. But cloud computing can only answer to the data points investigators choose to collect.

In the meantime, the medical community here finds itself charged with running dueling missions, one looking for breakthrough treatments to rare and complex conditions, the other learning how to manage patients' chronic health conditions more effectively with physicians pressed for time. Brainstorming sessions on AI wrestled with the nature of treating patients while Siri or Alexa take notes, something that is clearly coming, and the Duke University behavioral economist Dan Ariely spoke at length about how telling people to do the right thing is wildly ineffective compared to building in conditions to achieve a desired outcome.

He even brought up glucose control pills.

That soon no one will be able to visit Mayo without their A1C and everything (besides their name) migrating in encrypted form to a Google-protected network was a given. "Will the patient have a choice of not having their data go into the cloud?" asked Weber pointedly late in the hour.

"No," said Ross.

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