Entries tagged with emr - Channel 10

Microsoft Healthcare Common User Interface: Now available free worldwide

bcrounse — Tue, 11 Sep 2007 19:48:00 GMT

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.

American Healthcare and Falling Bridges: Too much in common

bcrounse — Wed, 08 Aug 2007 23:16:00 GMT

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

A Common User Interface to Clinical Systems

bcrounse — Sat, 14 Jul 2007 00:47:00 GMT

On October 21st, 2005, I wrote an entry on this Blog about the need for a more common and intuitive user interface to clinical information systems. Here's part of that entry:

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Jim Lynch, R.N. is quoted by Health Data Management's on-line news service on remarks he recently made during a presentation at the 77th Convention and Exhibit of the American Health Information Management Association. In his address, "Electronic Medical Records: Expect the Unexpected", Mr. Lynch recounts the plaudits and pitfalls encountered at Oklahoma City-based Integris Health during the implementation of their EMR. He says, “A major part of the problem was that the electronic record was not easy to use--the interface is not as simple as Microsoft Word, and many physicians had absolutely no computer skills.”

Indeed! Why is it that EMR interfaces have to be so challenging for clinicians? The typical community physician in many American cities admits patients to more than one hospital. In my own community, it's not unusual for docs to call on three or four different hospitals. One hospital might use Meditech; another IDX; another Cerner; and yet another something else. Even if any one of these systems had the "perfect" user interface, how can a clinician become proficient on all of them? How much training would that take!

Bill Crounse, MD

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I am now extremely pleased to tell you about something that I believe may be the tipping point in moving us toward a common user interface to clinical systems, perhaps worldwide. For the past couple of years, Microsoft has been working with administrators, clinicians and other experts in the United Kingdom to design a common user interface for clinical and administrative systems at the National Health Service. With the consent of the NHS and its Connecting for Health initiative, the design guidelines and tools are now being made available to developers around the world with the launch of the CUI Website.

As noted on the website, design guidance has been produced through a rigorous user-centred design process that incorporates primary and secondary research, usability testing, consultation with software providers and integrated hazard assessments. Patient Safety Assessments (PSAs) are continually performed to ensure the Design Guidance meets safety concerns.

The guidance is targeted at both existing clinical applications and those that are being designed and architected right now. The second part of this release is the implementation of much of that guidance in the form of control libraries for both WinForms 2.0 and ASP.NET. The website contains explanation and samples for each of the Web controls with the Codeplex project hosting a download of both the Winforms and the ASP.NET Control library.

Example of Common User Interface Design

If you are a developer of applications used in healthcare, an IT professional, or just someone who is passionate about clinical information systems, I urge you to become familiar with this excellent work, and help us make it even better by joining the dialogue here on CodePlex (http://www.codeplex.com/mscui). Take a look at the CUI Website and be sure to watch the introductory video.

My thanks to our Microsoft UK team and our colleagues at the National Health Service for providing leadership in addressing a much needed solution that will improve patient safety while providing a much easier to use, more consistent interface to clinical systems.

Bill Crounse, MD Worldwide Health Director Microsoft Corporation

Commodity software; the next wave in contemporary hospital information systems

bcrounse — Thu, 21 Jun 2007 03:30:00 GMT

Hospital de São Sebastião

Earlier this year, I shared the amazing story of Torrevieja Salud Hospital in the Valencia Region of Spain. Hospital IT staff at Torrevieja Salud had built a very robust, end-to-end hospital information system using commodity, off-the-shelf developer tools, software, and technologies from Microsoft. They did it for just a fraction of what is typically spent in American hospitals on solutions from the big HIS vendors.

The first week of June, I visited another hospital that has taken a similar approach. The hospital, Hospital de São Sebastião, is located about 30 kilometers outside of Porto, Portugal and services a total population of about 383,000 people. I visited Porto to speak at our EMEA Health Leader's Forum. The first day of the two-day event, we were treated to a tour of Hospital de São Sebastião provided by the hospital's CEO, Dr. Hugo Meireles; CIO, Rui Gomes; Internist, Dr. Luis Pedro, and ER physician, Dr. Jorge Teixeira.

Hospital de São Sebastião is a 317 bed, acute care and trauma facility built in 1999. From the very beginning, hospital planners wanted an organization that would be a significant cut above other public health hospitals in Portugal. Rather than buy a hospital information system, CIO Mr. Rui Gomes and his small but dedicated staff of 11 full-time employees set out on a quest to build the IT foundation, business, and clinical applications that would best serve the hospital and the people who worked there. It has been an iterative project that appears to be serving hospital workers and the patients they care for extremely well.

Internal Medicine specialist Dr. Luis Pedro shows me how he accesses patient information and documents his work while caring for patients at Hospital de São Sebastião located just outside of Porto, Portugal.

Over the years I have toured some of America's so-called "most wired" facilities. In fact, the Seattle area hospital where I served as Vice President, CIO and CMIO for many years was often cited in that most-wired category of leading American institutions. But quite honestly, I must say that I have rarely toured a hospital where I have seen physicians so seamlessly using information technology as I observed during our tour of Hospital de São Sebastião. This is all the more remarkable when one considers that they built most of the solutions they are using all by themselves. And, they did it using commodity software that costs just pennies on the dollar compared to equivalent solutions used in US hospitals.

Doctors roamed the halls with Fujitsu Tablet PCs while wirelessly connected to the hospital's network. They had complete access to all patient data including imaging, lab results, etc., and they performed all of their charting from admission to discharge electronically.

Screen shot of HIS solution in use at Hospital de São Sebastião

Nurses and other caregivers also used the hospital information system. In the emergency room, an electronic triage system not only helped to prioritize treatment, but timed and tracked exactly how that treatment was delivered; sending gentle reminders to staff whenever patients were left waiting longer than necessary

Screen shot of ER triage application at Hospital de São Sebastião

To be fair, the system didn't have all the bells and whistles that might be found on big vendor solutions used in American hospitals. CPOE was still a work in progress although doctors were using an electronic prescribing solution. But that is precisely my point. The system was designed to do exactly what the staff really needed most. It has an interface and tools that make it intuitive, fast, and highly functional. What it lacked I would place in the category of "nice to have" rather than "have to have". And perhaps that is why the home-built HIS solution in use at Hospital de São Sebastião is so popular with physicians and other caregivers at the hospital.

In case you are wondering, some of the Microsoft products and solutions IT professionals used to build the HIS at Hospital de São Sebastião include; Active Directory, SQL Server 2005, SharePoint Services, SQL Reporting Services, Balanced Score Card Manager, ISA Server, BizTalk, Exchange, .Net Framework, and Visual Studio 2005.

My congratulations to Rui Gomes, his IT staff and caregivers at Hospital de São Sebastião!

Bill Crounse, MD Worldwide Health Director Microsoft Corporation

If Wal-Mart Did Healthcare.......

bcrounse — Wed, 02 May 2007 16:57:00 GMT

Last month, after delivering a keynote address in Orlando and spending a little time visiting Disney attractions, I wrote a piece that pondered what it might be like if Disney did healthcare. Last week I was in Washington, D.C., for the World Health Care Congress. The closing keynote was provided by Lee Scott, President and CEO of Wal-Mart Stores. In his keynote, Mr. Scott shared information about Wal-Mart's plans to open healthcare clinics in their stores. They already have more than 40 clinics operating in Wal-Mart stores. The clinics are primarily staffed by nurse practitioners who provide basic primary care services. Mr. Scott said Wal-Mart wants to partner with providers around the country to open perhaps 600 more clinics in the next couple of years. He sees a potential for more than 2000 clinics to one day be operating in Wal-Mart facilities.

In addition, Wal-Mart, Intel and other major employers have announced their intent to provide a transportable personal health record for employees. In fact, the retail health movement which includes organizations such as MinuteClinic and RedClinic, is very focused on using technology to improve care quality and safety as well as to enhance the "patient experience". Price transparency, a factor that is all but absent in services offered in traditional care facilities, has become a hallmark for the retail movement. Likewise, retail clinics go overboard when it comes to savvy marketing, customer relationship management, and patient convenience. And although organized medicine has taken some pot-shots at the clinics, patients seem to love them.

Where is all this going? I think the trend is generally healthy. People want affordable, convenient, high quality care. They are demanding more value for their healthcare dollar. They are looking for a healthcare industry that behaves more like other industries; one that is responsive to market forces and customer demands offering cycles of continuous quality improvement, improved productivity, and lower costs. As my colleague John Goodman of the National Center for Policy Analysis points out, healthcare would behave like other industries were it not for the perverse effects of traditional insurance programs on the supply side of the business. He writes;

Suppose we passed a law tomorrow prohibiting all insurance companies (including Medicare and Medicaid) from paying any medical bills less than $5,000. What would happen? The medical marketplace would transform almost overnight. Within a couple of months, there would be no such thing as a primary care physician (PCP) who did not post prices - at least for routine procedures. PCPs would offer telephone and email consultations. They would keep patient records electronically (just like lawyers and accountants). Overall, there would develop a teeming, bustling, entrepreneurial marketplace for primary care, diagnostic tests and most prescription drugs. Specialty markets would develop for the chronically ill, as doctors competed for their business instead of trying to avoid them. Patient education would become an emerging field, with providers offering to teach diabetics, asthmatics, etc. how to manage their own care. Internet drug sales would double, triple and quadruple, as brand drugs faced increasing competition from generic, therapeutic and over-the-counter substitutes. At the same time, overall health care spending would plummet.

What if Wal-Mart did healthcare? Yeah. What if?

Bill Crounse, MD Worldwide Health Director Microsoft Corporation

High on Microsoft solutions in healthcare

bcrounse — Mon, 12 Feb 2007 22:51:00 GMT

I'm back from New York City where I had an opportunity to meet with customers and provide a keynote at our Healthcare Executive Forum event at the Reuter's Building in Times Square. My visit to New York was all the more exciting (if that is the word to use) because the hotel where I stayed had a small fire in the middle of the night. The alarm forced an evacuation to the lobby from my room on the 50th floor. I thought of my firefighter father who always advised not to stay above the 10th floor because rescuers can't reach you by ladder. I didn't get much sleep, but I did get to observe how dozens of New York's finest responded to what could have been a very bad situation.

Speaking with me in New York were customer representatives from Memorial Sloan-Kettering Cancer Center and Atlantic Health. Pat Skarulis, Sloan-Kettering's VP and CIO, and Dr. Rich Mansour from Microsoft partner Eclipsys, provided a compelling presentation on MSKCC's IT environment. Virtually 100 percent of physician orders are done electronically. Sloan-Kettering is filmless and chartless. Their unified patient record reduces errors, reduces turnaround time, increases security and compliance, and eliminates lost "charts". They have also developed custom electronic order sets for all chemotherapy regimens, vastly improving workflow and increasing chemotherapy safety.

Jacque Brodt-Suggs, Director of Application Support at Atlantic Health, and a representative from Microsoft partner Quilogy, presented information on Atlantic's balanced scorecard application. After looking at scorecard applications on the market they decided that none of them really met Atlantic's criteria for customization and ease-of-use. Furthermore, when they learned from Microsoft that they already owned most of what they would need to leverage a portal solution offered by Quilogy, the decision was a no-brainer. According to Ms. Brodt-Suggs, the solution simplifies data collected and interfaced from 90 disparate systems, creates consistent definitions for performance measurement, and gives care teams first time access to metrics that help them understand how their work can support Atlantic's strategic goals. Oh, and did I mention this solution saved them a ton of money?

What both customers had in common was technology from Microsoft. That's the part of the story I really want to share. That's what gets me so excited. That's why I keep getting on airplanes to spread the word, and sometimes staying on top floors of hotels......... even when I know better.

If you would like more information, please visit our Microsoft Healthcare web site.

See you at HIMSS in New Orleans!

Bill Crounse, MD Healthcare Industry Director Microsoft

A Paperless Hospital Information System for less than $1 Million? What we can learn from Spain

bcrounse — Fri, 08 Dec 2006 22:28:00 GMT

Earlier this week I was in Barcelona, Spain, presenting at a Microsoft customer event called the Health Industry Leaders Innovation Forum. Healthcare executives from across the EMEA region came together to share information on how they are using information technology in healthcare and to exchange ideas on how to drive even greater innovation in the industry. We listened to presentations on progress being made in the provision of e-health services at the National Health Service in the UK including some exciting portal work in Wales. Members from our UK team discussed progress to date on the NHS Common-User-Interface initiative. A physician leader from Spain talked about healthcare industry trends and opportunities for venture-funded projects in his country, and IT executives from Egypt shared ideas on clinical transformation opportunities there. A complete review of the Forum proceedings is beyond the scope of my Blog, but I did want to share information on one of the presentations that particularly caught my attention. It caught my attention because it illustrates so well something I've been writing about on this Blog and elsewhere; how commodity software is being used to build very robust healthcare industry solutions quickly and inexpensively.

The customer in this case is a new hospital in the Valencia region of Spain. Torrevieja Salud is a 250 bed, privately managed, public facility that recently began serving patients. It has 11 operating theaters, 22 surgical beds and a full service ER with a 50 bed observation unit. From the very beginning, project designers planned for a facility that would be completely paperless when it opened its doors. The commodity building blocks they used included SQL Server 2005, Exchange, Terminal Server, Windows Server, MS Dynamics NAV, BizTalk 2006-HL7 Adapter, SharePoint, and the .Net Framework. Over a 2-year period, a development team of just 22 people built a fully functional healthcare information solution they call Florence. It handles all clinical and administrative functions for the entire facility. It even provides a rich balanced scorecard view of key performance indicators. Partners included Microsoft, HP, Drager Medical, Palex, B Braun, and Servicom 2000. I asked how much money they thought they had spent developing their HIS? The answer was approximately €600,000 (around $800,000). Compare that to the tens, or hundreds of millions of dollars being spent for equivalent functionality in an American hospital of equal size and you're left scratching your head. In fact, even in those American hospitals spending that kind of money I've rarely seen a true "paperless" environment.

To be honest, I didn't have an opportunity to visit Torrevieja Salud and see it with my own eyes. But even if their HIS built on commodity software did half of what is being claimed or cost 10 times as much, it would still be a bargain. I'm sure the folks at Torrevieja would be delighted to show off their new facility to anyone who might be interested. American Hospitals take note. I think there is a lesson here!

Bill Crounse, MD Healthcare Industry Director Microsoft

Employer-driven Electronic Health Records: A needed catalyst for healthcare IT?

bcrounse — Thu, 30 Nov 2006 20:01:00 GMT

I've commented before on this Blog that much of the true innovation I see in the implementation of advanced information technology solutions in healthcare, particularly electronic health and medical records, is happening outside of the United States. There are two reasons why this is so. First, most healthcare in other countries is controlled and delivered through the public sector. Decisions about, and investment in, healthcare information technology are made by regional or national government agencies. Second, many nations are able to jump ahead of the U.S. because they are starting their healthcare industry transformations with a clean slate. By not being burdened with the complexity of integrating a patchwork quilt of outdated legacy systems and the disparate silos of information locked up in those systems or on paper, they are able to use the most contemporary, and often commoditized technology, on the market. The solutions they implement are not only more robust, but far easier for healthcare providers to use. They also tend to be much less costly.

I wouldn't proclaim that the solution to our healthcare IT woes in the U.S. is to abdicate to the government even though there is something to be said for centralized planning, command, and control as observed in other countries. Perhaps, however, there is another very powerful force for solving these problems that is a better fit with our American culture and way of life; Employers. If you read the Wall Street Journal yesterday, you no doubt saw the article proclaiming an initiative by several of America's largest corporations to "provide digital health records to their employees and to store them in a multimillion-dollar-data warehouse linking hospitals, doctors and pharmacies. Their goal: to cut costs by having consumers coordinate their own health care among doctors and hospitals." If we are ever going to reach President Bush's 2004 State of the Union promise of an electronic health record for most Americans within 10 years (now 8 years), this may be the way we get there.

This certainly isn't the first time that major employers have banded together and flexed their muscles to stimulate needed changes in the healthcare industry. The Leapfrog Group has been an effective change agent for hospital quality around a defined set of diseases and treatments. Hospitals had little choice but to tow- the-line when major employers and payors in their markets sounded off. I have no doubt that this newest initiative by employers to stimulate EHR/PHR adoption will help move things along in the United States. I would, however, urge these major employers to make every effort to work closely with organized medicine and care providers in planning and implementing these systems and services so they work equally well and provide an investment return for everyone in the healthcare ecosystem; patients, providers, family members, employees, and employers.

Next week I'll be attending the Health Industry Leaders Forum in Barcelona, Spain, where I'll have an opportunity to deliver an address and get an update on some of the most contemporary healthcare information technology projects in the region. I'll provide a summary in my next Blog post.

Bill Crounse, MD Healthcare Industry Director Microsoft Corporation