As a physician, I know how important it is to have access to my patient's health information.   As a patient, I know how frustrating it is to have my health information scattered across multiple doctors, ambulatory clinics and hospitals.  As a care manager for my elderly parents, I've experienced firsthand how difficult it is to keep track of their doctor appointments, medications, and medical problems.

Today, in Washington, D.C., Microsoft is announcing a new tool that will begin to bring order to this chaos.  It's called HealthVault; an environment of new online services to help people SEARCH, STORE and CONNECT their health information, putting them in control of  their, and their family’s health and wellness.

HealthVault, designed with security and privacy in mind, is built on the principle that people should have a copy of their own health information, have control over it, and be able to share their information with whomever they choose.  I think many people are going to proclaim, "It's about time!".

Using HealthVault, people will be able to store and control an array of health information, including prescription medication lists, health histories, hospital discharge summaries, lab results, fitness data and search results.

In addition to being a place to securely store and share personal health information, people can also use HealthVault to access and put to practical use a variety of new health services and home health medical devices.

Microsoft HealthVault Connection Center will make it possible for people to upload health-related data, such as that taken from blood-pressure cuffs, heart rate monitors, blood glucose monitors and peak flow meters. The technology is straightforward and makes it easy to confidently share health information with family, caregivers or physicians. With the support of partners that will develop these services and devices, Microsoft has committed to a platform that is free to consumers, inclusive of industry standards and trusted through robust privacy and security safeguards.

Speaking of privacy and security, I know that nothing is more important when it comes to your personal health information.  The HealthVault platform is underpinned by the following clear, strong health privacy commitments:

• The Microsoft HealthVault record you create is controlled by you.
• You decide what goes into your HealthVault record.
• You decide who can see and use your information on a case by  case basis.
• Microsoft does not use your health information for commercial purposes unless you are asked and you clearly tell Microsoft they may.

Rest assured, we know that transforming healthcare is an incredibly complex challenge – one which no single organization can solve alone. It will require the participation of leaders in every sector of the healthcare ecosystem if success is to be achieved.  However, with Microsoft's broad customer reach, extensive software platform and broad partner community, we believe that we have the depth and breadth required to help transform the way people and providers connect with health information and  services. 

You can learn more about today's launch of HealthVault by clicking on this video clip with Microsoft Health Solutions Group Corporate VP, Peter Neupert and Dr. Deborah Peel, founder of the Patient Privacy Rights Foundation.

I'm pleased to announce that more than 40 other innovative organizations – from leading medical providers, health management device manufacturers, and national health agencies are embarking with us on this challenge to bring the health industry into the Internet age.  We invite the rest of the health industry to join us. 

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

 

Last April I posted a piece on this Blog entitled "If Disney Did Healthcare".  I commented that there was a lot the healthcare industry could learn from Disney about customer service, customer experience, and customer satisfaction.  It was one of those posts that generated a number of comments.  The following month, I posted a piece called "If Wal-Mart Did Healthcare" where I discussed some of the factors contributing to the rapid growth of the retail health clinic industry and its focus on customer relationship management, convenience, value, and price transparency. 

Yesterday, I received an e-mail from Jake Poore, President of a consulting firm called Integrated Loyalty Systems.   As soon as I read it, I just knew I had to share it with Channel 10 readers.  So, here it is: 
 

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Bill:

I enjoyed reading your April Blog regarding Disney and Healthcare, mainly because that is exactly what I chose to do in my life...translate Disney service and leadership principles into healthcare delivery of care. I went from the happiest place on earth to...well, healthcare (smile).

My career at Disney spanned nearly two decades and I created and managed the healthcare consulting team at the Disney Institute for 6 years, but it was obvious we were only allowed to be a benchmarking company and unable to help clients take it through fruition. Not anymore. For the past 6 years my team of ex-Disney and Southwest Airline execs have done just that. I invite you to visit my web site www.WeCreateLoyalty.com or call me so I can share many of the tools of how we are changing the face of healthcare one hospital at a time!

Kindest regards,
 

Jake
 

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So there you have it.  Hospitals can now learn from Disney (and Southwest) on how to transform their industry to better serve patients.  And yes, I know that healthcare with all its complexities, regulations, bizarre market dynamics, etc. is a very different business than theme parks or airlines.  But then again, some of the most dynamic and successful healthcare organizations, including many that I have personally had an opportunity to advise, have revolutionized  the way they do business by studying the best practices of other industries; Denver Health and Virginia Mason Medical Center being just two examples that come to mind.

And by the way, since contemporary information technology is such a vital component of the organizational transformation that is needed in the healthcare industry, I invite you to that conversation as well.  We have an entire team of folks who would be delighted to tell you more.

Bill Crounse, MD   Worldwide Health Director    Microsoft Corporation

Anyone who works in healthcare knows that many of today’s clinical software applications leave a lot to be desired when it comes to “user experience”.  Unlike ubiquitous, commodity software used in other businesses, healthcare applications are highly proprietary and often based on legacy technologies.  Clinicians find that much of what’s available today is often too hard to use.  Becoming proficient on these clinical applications requires lots of training and that can mean taking already scarce healthcare workers off-line for days or weeks at a time.  Worse yet, even if clinicians become proficient on one vendor’s solution, they are likely to encounter something entirely different in every hospital where they work, requiring even more training.  But what if there was a common, more standardized user interface for clinical applications?  What if the user experience was pretty much the same no matter where a clinician worked?  Would doctors, nurses and other clinical workers be better served?

Last July on this Blog I told you about an ambitious project to develop a standardized user interface to administrative and clinical systems.  The project was launched more than a year ago by Microsoft and the United Kingdom’s National Health Service.  It is part of a country-wide upgrade of the data spine, clinical and administrative applications used by the NHS.

Based on that work, Microsoft has launched  The Microsoft Health Common User Interface (CUI) web site.  It provides Design Guidance and controls that allow a new generation of safer, more usable and compelling health applications to be quickly and easily created. In this special video edition of my House Calls for Healthcare Professionals series, we take a look at the the work that's been going on at the NHS and how that work, through the MSCUI, now offers promise to improve worker satisfaction and patient safety around the world.  Enjoy the show!

Bill Crounse, MD    Worldwide Health Director      Microsoft Corporation

Downloads:  iPod,  MP3,  PSP,  WMA,  WMV,  WMV (High),  Zune

Program Guests

Dr. Mike Bainbridge is a former general medical practitioner who now leads the Clinical Architecture team at NHS Connecting for
Health, a group that delivers innovations in hardware design, clinical interface design and interfaces to the electronic medical record for both healthcare professionals and citizens.

Stephen Corbett is Head of UI Design for NHS Connecting for Health where he evangelizes the user-centred design approach to building software.  Since graduating in Ergonomics in 1988, he has been working in the field of software usability in various industries.

Andrew Kirby is a Director at Microsoft UK where he is responsible for the delivery of solutions and services to the National Health Service which includes the delivery of the Common User Interface Programme.

A little more than a year ago, I introduced Channel 10 readers to Azyxxi, Microsoft's unified health enterprise platform solution.  I also recorded an audio-cast with executives from our Health Solutions Group.  A few months ago, I updated you with another audio-cast featuring one of Azyxxi's early adopter customers, New York Presbyterian Hospital.  Today, Microsoft is announcing the addition of yet another well known hospital system to the growing list of Azyxxi customers; Novant Health.

Novant will implement Azyxxi throughout the enterprise, initially focusing on intensive care units and emergency departments and then expanding throughout its eight acute care hospitals and an 800-physician medical group.  With Novant and NY Presbyterian, early Azyxxi adopters now include 21 different hospitals at academic medical centers such as Johns Hopkins Health System; large health systems such as MedStar Health; and the Wisconsin Health Information Exchange, which will eventually tie together 25 different hospitals in Southeastern Wisconsin.

As we discussed in my most recent audio-cast, New York Presbyterian Hospital and its associated network is using Azyxxi to unify its existing and legacy information systems to create broad accessibility of its vast quantities of information. New York Presbyterian's senior vice president and CIO, Aurelia Boyer says, “As we’ve automated more and more of the processes within the hospital and created more electronic data sources, our ability to mine and utilize that data is becoming more of a priority. Making the data from different systems available in a way that makes good management, clinical and quality sense takes a lot of effort, and is a major goal for an institution like ours. Giving people in the hospital ready access to different kinds of data is priceless to us.”

Whereas New York Presbyterian is looking at Azyxxi as an administrative tool to guide organizational decisions, Novant Health is working to implement Azyxxi in support of its clinical operations.  “I’ve seen estimates that say a physician spends most of his or her time collecting information about the patient before they deliver the care,” says  Rich McKnight, Novant’s CIO. “Our goal is to dramatically reduce the amount of time in information gathering, and increase the amount of time in taking care of the patient.”
 
It has been my personal pleasure to attend many Azyxxi customer briefings with executives from our Health Solutions Group.  I can tell you that the solution is generating lots of excitement in the industry.  I also remember very well sitting with a senior finance executive at MedStar Health in Washington, D.C., as he was extolling the virtues of Azyxxi for revenue cycle enhancement and recovery.  The system gave Washington Hospital visibility to millions of dollars in high-value procedures and tests that were being improperly coded and therefore not collected by the hospital; millions of dollars that can now be spent delivering care to patients.
 
As Azyxxi liberates healthcare data from the constraints of silos and systems that don't "talk" to one another, I can only imagine the implications for providing cost and quality transparency in the industry, and our potential to improve the efficacy and efficiency of the care being provided by clinicians.

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

Does information technology really improve care quality and safety?  Can well designed and implemented clinical software applications really improve physician satisfaction?  Can healthcare information technology really have a positive return on investment?  For Vanderbilt University Medical Center's perioperative anesthesia department the answers are yes, yes, and yes! 

While not every IT solution in healthcare clearly demonstrates results as stunning as those I'm about to share,  here's what I gleaned from a keynote presentation made by Dr. Paul St. Jacques earlier this week at the MSHUG Tech Forum 2007 in Redmond. Dr. St. Jacques shared the stage with me on day one of the conference.  I delivered the opening keynote, and he provided the close.

Dr. St. Jacques is Associate Professor and Director of Anesthesiology Informatics in the anesthesiology department at Vanderbilt.  Vanderbilt's perioperative information management system, VPIMS, serves as "master control" for the medical center's 60 operating rooms in 6 suites, handling thousands of surgical cases each year.  You may be surprised to learn that less than 5 percent of all surgeries in America are fully managed and documented electronically.  That's right.  In the year 2007, 95 percent of the "life and death" work-flow processes in surgery are still done on paper.

So what's to be gained by going electronic?  How about a 100 percent improvement in on-time cases starts, or a 90 percent compliance with perioperative antibiotic protocols resulting in an 1 percent decrease in surgical wound infections.  How about a 67 percent reduction in chart errors.  How about the average time to produce a billable chart moving from 12 days to 1, with a $1 Million plus improvement in formerly lost revenues.  Or how about a 10 percent yearly increase in case volume without adding capacity, keeping in mind that every additional case per day generates more than $1 Million in revenue per year.

 VPIMS handles everything from surgery scheduling, to perioperative documentation, to billing.  In addition, a module called Vigilance provides real-time monitoring of every operating room in the facility with multi-view streaming video, patient vital signs, alerts and reminders.  It might look like something out of Star Wars, but what it does for patient safety and staff satisfaction is priceless.  And did I mention there's a whole lot of Microsoft technology under the covers?

Greater detail on VPIMS is beyond the scope of my Blog.  Let me just say if you ever want proof that information technology in medicine saves lives and saves money, look no farther than the very fine work going on at Vanderbilt.  And yes, VPIMS has been so successful at Vanderbilt that the medical center is exploring options to commercialize and sell it.  And with 95 percent of the market still doing perioperative management on paper, they should have no problem finding customers.
 

Bill Crounse, MD  Worldwide Health Director   Microsoft Corporation 

PS  If you would like information about some of the other presentations at this year's MSHUG Tech Forum, my good friend and colleauge who serves as Microsoft's senior technical strategist for our worldwide health group, Roberto Ruggeri, provides play by play coverage on his Healthcare IT Blog.

I'd like to draw your attention to a new video that we've just released as part of my House Calls for Healthcare Professionals series.  The program takes a look at diagnostic software developed by Robertson Technologies.

I met Dr. Joel Robertson about five years ago.  I and others from Microsoft (most notably Dr. David Heckerman at Microsoft Research) have been advising Dr. Robertson during the development of his company's software.  The result of this work, NxOpinion, is one of the most significant, accurate, responsive and intuitive diagnostic programs I’ve seen.

I believe there are many applications for its use in emerging markets where physicians in rural villages or lesser-trained individuals working in public health need diagnostic support.  I believe there is also a role for diagnostic software in developed nations to improve patient safety and the quality of care in settings such as nurse call centers, community clinics, retail clinics, and urgent care settings.  There is also the potential for this technology to be used by consumers in evaluating personal health issues at home.

Enjoy the show! 

Bill Crounse, MD    Worldwide Health Director   Microsoft Corporation

See Video 

The Internet is abuzz today following a New York Times article by Steve Lohr about Microsoft's and Google's designs to change the game in healthcare.  Readers who follow this Blog will understand very well where I come down on all of this.  As a country, maintaining the status quo in our broken healthcare system (which really isn't a system at all) just isn't a viable option.  We spend about twice as much money per capita on health than any other nation on earth, yet the US ranks far behind other countries in many of the ways we measure the overall health status of a population.

Do I think that some kind of universal, government-run healthcare fix is the answer to all of our problems? Absolutely not!  One of the things I have learned as I have traveled around the world these past few years is that providing timely, cost-effective, equitable healthcare for an entire population of people is challenging no matter what payment system is in place.  Healthcare is expensive and it doesn't matter whether the payor is government (we pay), employers (we pay) or private citizens (again, we pay); many of the miracles of modern healthcare have become so expensive and so out of the reach for people of ordinary means, there's just not enough money in any system to apply them universally and equally to every citizen.  Therefore, healthcare always has been and always will be rationed in some way.

So, if how we pay for healthcare has flaws no matter what system is in place, we must find better ways and better systems to deliver more affordable and accessible care.  I've taken a few hits for my positive stance on retail clinics, home health, patient self-service, physician-patient e-mail, personal tele-health services, and other modalities to provide health information and medical services in ways besides those that our current "system" provides.  Many of my physician colleagues are on a war path against retail clinics.  They are calling every state legislator and pulling out every tool in their regulatory armamentarium in an attempt squash the movement, but they will ultimately fail.  Prohibition doesn't work.  Retail clinics will thrive or falter based on the quality of services they provide and the value that their customers perceive.  The whole reason this movement has gained a foothold is because medical professionals haven't been listening to their patients.  Patients want healthcare to behave like other industries.  It really doesn't matter who's paying the bill.  We are all paying the bill, and we expect more than we have been getting considering how BIG that bill has become. 

Doing something about this will take more than coming up with new ways to pay for healthcare as it is presently delivered.  We need new care delivery models, staffing models, business models, and a bevy of contemporary information and communication technologies to truly revolutionize American medicine.  Neither Google, nor Microsoft nor any of the other companies mentioned in Lohr's article can be your doctor, nor should they be.  But these companies can and should help us with the technologies that will be needed to change the game.  If not Microsoft or Google, then who?

Bill Crounse, MD     Worldwide Health Director     Microsoft

I've mentioned before on this Blog that I'm a fan of Most-Wired Online and its guest editorials.  Every so often, a Most-Wired edition comes across my desk that especially draws me in.  This week's editorials by Senator Sheldon Whitehouse of Rhode Island on Building a National Health IT Infrastructure and by Lois Taveras and Dadong Wan of Accenture on The Case for Pervasive Healthcare really hit a chord with me.

I suppose we all tend to gravitate to folks who think like us, but I couldn't help but ponder how relevant these editorials are to some of the really big issues we face in American healthcare.

Senator Whitehouse is advocating for a public-private partnership akin to the COMSAT legislation for satellite communications during the Kennedy administration.  The partnership would drive interoperability, privacy and security rules, and EMR data standards for healthcare IT.  As I've hop-scotched around the world and seen for myself, America is woefully behind in the adoption of IT in healthcare (and don't even get me started on even more basic infrastructure failings like roads, bridges, airports, etc.). 

Taveras and Dadong write eloquently about the opportunity to transform healthcare delivery and services with pervasive technology that would help us better care for the elderly, treat people with chronic diseases, and frankly serve just about everyone else far more safely and efficiently than we do today.  Their editorial is a two-parter and I suspect next week's edition will deal with the harsh reality that unless we change reimbursement mechanisms and perverse incentives in American healthcare, these very real solutions will never see the light of day.  

Regular readers of my Blog will immediately understand why I embrace what these guys are saying.  Whether it is my commentaries on the potential for Unified Communications in Healthcare, Remote Physiological Monitoring, the need for a Common User Interface, the value proposition for Commodity Software in Healthcare IT, Failing American Infrastructure, and more; there is a very common theme.  And that theme is interwoven in everything Whitehouse, Taveras and Wan are writing about.

Wake up, America! If you think our foreign competitors don't see HUGE opportunities to beat us in healthcare because of our failings in IT and our screwed up system, think again.  We are at a crossroads here.  American healthcare as an industry is at risk of collapsing just like that freeway bridge in Minneapolis.  

Bill Crounse, MD   Worldwide Health Director      Microsoft

If your company ever comes to Redmond for a health industry briefing at our Executive Briefing Center, or you happen to attend one of the many keynotes I give at industry conferences throughout the year, you'll more than likely see what is known as our Health Future Vision video. 

This is the third such health industry video we have produced here at Microsoft.  It has been my pleasure to work closely with Ian Sands and his Industry Innovations Group (IIG) to bring these videos to life.  What's particularly interesting is how accurate the videos have been in predicting future industry trends and how technology will influence the way we work.  Perhaps that's because IIG does so much internal and external research before producing one of these videos.  We also base them on technology that is either currently available but not widely implemented, or on technology that is being actively pursued in the labs at Microsoft Research.  In any event, everything you see in the video is based on technology that is available now, or is very likely to be available within a 7 to 12 year time frame.

Our newest Future Vision Video also captures the essence of healthcare industry trends that I've been following and writing about for the last few years.  This includes the rising tide of consumerism in healthcare, the retail movement, commoditization of services, information everywhere, and globalization.

In the video, we follow a young pre-diabetic patient as she ventures out on a run. During her run, various physiologic functions are being monitored and data is being sent in real time to her personal health record. 

A case manager, who has been given permission by the patient to see her data, becomes aware that she may qualify for a new clinical trial.  When the young woman returns home she enters into a virtual consultation with her case manager who directs her to check with her personal physician about possible enrollment in the study.  She immediately schedules a "virtual conference" with her personal physician.

The scene switches to the young woman's endocrinologist as he beings to make rounds in a hospital.  He uses a very light-weight Tablet computer to gather information on his patients, locate needed equipment, and conduct his patient visits. 

 

We see him performing a retinal exam on one of his diabetic inpatients and sharing results with the patient. 

He later enters a special room where he conducts a "virtual visit" with the young woman we saw at the beginning of the video.  The physician, his patient, and a clinical researcher collaborate on details of the proposed clinical trial.

The doctor instructs his patient to visit a nearby retail setting, where as the video comes to a close, we see her using her "digital wallet" and a kiosk to get necessary tests and medication for the clinical trial.

I think the video accurately reflects the kind of consumer-directed, quality and price transparent, knowledge-driven healthcare delivery system we'd all like to see.  And while this is just a video, it certainly captures the essence for how information technology will help transform medical practice to better connect people and data, facilitate improved collaboration, and better inform everyone involved.

Bill Crounse, MD   Worldwide Health Director    Microsoft Corporation