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: 
 

******************

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
 

******************

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

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

Every so often we do a program in my House Calls for Healthcare Professionals series of audio and video-casts that really seems to hit the mark in demonstrating the value of Microsoft technologies in the healthcare industry. I want to draw your attention to one such program.

Arkansas Children’s Hospital is cutting edge when it comes to developing solutions on Microsoft technology. First, take a look at my Blog entry on this topic to get some background and then download or listen to our audio-cast with ACH to learn more about CarePoint and other solutions. This program is especially compelling because one of my guests is a patient at the hospital; a 16 year-old boy who has cystic fibrosis and has spent more time in the hospital than most of us can ever imagine. Find out how Microsoft technologies including Xbox 360, Media Center, Visual Studio, IE, and many others have come together to make hospital stays a whole lot more enjoyable for patients, their friends, and family at Arkansas Children’s Hospital.

Here is where you can stream the audio-cast or download it to your MP3 device

Arkansas Children's Hospital: IT Innovations Enhancing the Care of Hospitalized Children
This program is also available in MP3 for download.

Program Guests:

David Higginson is chief information technology officer at Arkansas Children's Hospital (ACH). He earned a degree in accounting/finance from Liverpool University and qualified as a Chartered Management Accountant. He began developing computer systems at the age of 10 and later combined his computer and financial expertise when he began developing systems for the Massachusetts Institute of Technology and the British Post Office. Since moving to ACH in 1996, Mr. Higginson has developed numerous award-winning computer systems with the help of his team of 14 developers, who have created more than 400 systems in less than five years.

Penny Ward is a registered nurse who joined Arkansas Children's Hospital in 1993. Since 2002 she has been a Nursing Director for the Adolescent and General Medicine units and for the Dialysis and IV teams at the hospital.

Christopher Holstead is 16 years old and has cystic fibrosis. He has been admitted to Arkansas Children's Hospital many times and has seen how the hospital has improved the patient care experience.

Additional resources

Healthblog - additional information and screenshots of ACH CarePoint patient entertainment/education solution

Arkansas Children's Hospital

Windows XP Media Center

Xbox

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

A friend sent me a link to an article written for SearchCIO.com by senior editor, Kate Evans-Corriea. Ms. Evans-Corriea's article entitled "Age Does Matter" reflects on what she says was a common theme at Gartner's recent Symposium ITxpo. That theme is perhaps best captured in a quote from Gartner analyst, Tom Bittman, who says, "It's not the technology; It's not the process that's holding us back. It's the culture".

As I read the article, I couldn't help but think about a conversation I had just had with a colleague who currently serves as a hospital CIO. He expressed to me his total frustration with hospital culture and healthcare providers. In fact, he is so frustrated that after ten years on the job he is looking for another position; this time likely in another industry.

His hospital had recently purchased a very advanced surgical management system that included anesthesia scheduling and work-flow automation. The anesthesiologists at first welcomed these new tools, although one of the docs had initially pushed back because he had designed his own solution that he thought was a lot better than the vendor solution selected by the hospital.

Even so, after a few weeks using the new system, several of the older and most influential members of the anesthesia group simply proclaimed that they didn’t like what the hospital had purchased and would be going back to using their old paper processes. And, as my colleague noted, "that was that".

A similar scenario had recently played out in the radiology department. The mammography unit was asked to start using the hospital's digital PACS system. They prepared the docs for the fact that their productivity could initially fall by as much as 30 percent until they got used to the new tools and work-flow. The docs agreed to give it a try, but as soon as their productivity actually did take a nose-dive, they rebelled and refused to use the new system.

I know what you may be thinking. Screw the doctors! Tell them they have no choice but to use the new systems. As a doctor and a former hospital VP/CIO and CMIO, I know it's not that easy. Those doctors are the life blood of the hospital. It took years to recruit the physicians who run the mammography unit. And the anesthesiologists? They along with their powerful surgeon allies are responsible for most of the hospital’s profit margin.

The CIO also told me about his hospital's struggle to implement an electronic charting system in nursing. He said the VP of Nursing gives the initiative good lip service, but her first in command is a 50 year old nurse who has never worked anywhere else, and there’s a lot of passive-aggressive behavior going on in the rank and file. Since the nurses are all employees, you might think administrators could just lay down the law and mandate the use of the nursing documentation system. But you would be naïve to think that. The average age of nurses working at the hospital, especially as managers and unit leads, is 50-plus. There’s a huge nursing shortage with lots of vacancies in posted positions. They have a powerful union. It’s hard to tell them what to do.

I share this because it is so typical of the culture in healthcare, and not only here in America. It speaks volumes on the issue that Gartner is drawing to our attention; it isn’t so much about the technology as it is about the culture, and the need for more carefully orchestrated change management.

Of course some of these hassles will resolve as the “dinosaurs” retire. But based on what Gartner is saying the age and culture issue won't go away. Instead of “why must I use this computer instead of my paper” the argument will become “why must I use this (fill in the blank) instead of my computer"?

Bill Crounse, MD     Worldwide Health Director      Microsoft

Arkansas Children’s Hospital

That is exactly what has happened at Arkansas Children’s Hospital. ACH is based in Little Rock. It is the only full-service children's hospital in the state. The staff at ACH decided it was time to replace the hospital's aging in-room television system with something a little more contemporary. At first, they looked at systems that might typically be found in good hotels. However, they soon discovered that these systems were too expensive, too inflexible, and too limiting for what they really wanted to accomplish. They wanted a system that would provide their young patients with a full spectrum of on-demand movies, television, Internet, video gaming, and patient education. They also wanted a highly flexible platform on which they could provide other services now and well into the future. Finally, they wanted complete control over the system and its attributes that could be fine-tuned to meet the age-appropriate needs of patients, their friends and family. When they didn't find what they needed on the open market at a price they could afford, they decided to build it themselves.

The solution they came up with uses Microsoft Media Center, Xbox 360, and SQL Server. It extends the hospital's IT infrastructure out to the patient's bedside. Patients access the system through a custom designed interface on a 15-inch flat screen monitor next to the bed. This set-up lends itself to easy cleaning between patients. The monitor also becomes a kind of "command-central" for doctors and nurses who want to access a patient's electronic record or review x-rays and other data with the patient in his or her room. Movies, games, educational videos, Internet access, e-mail, messaging, etc. are viewed on a 32-inch LCD screen mounted on the wall across from the bed.

Home screen to the bedside entertainment and education system at Arkansas Children's Hospital based on Microsoft Media Center

Yesterday, I recorded one of my House Calls audio-casts with the staff at ACH. That program will be posted on my House Call's site on Microsoft.com within the next few days. In the meantime, I just couldn't wait to tell you about this. Although the solution has just finished a limited pilot, the decision has already been made to roll it out hospital-wide. One of the highlights of my audio-cast was interviewing a 16 year-old young man who is a frequent patient at ACH. To hear his excitement about using the new bedside entertainment and education system at ACH was reward in itself. He said the system is totally awesome in helping him stay in touch with school, friends and family during extended hospital stays. His doctor has used the bedside monitor to review test results with him. And the TV, movies and Xbox games are way cool!

Custom user interface that controls entertainment and education options as displayed on a 15-inch flatscreen monitor at the patient's bedside

Congratulations to ACH Chief Technology Officer, David Higginson, and his staff. This is just one of more than 400 clinical and business solutions this team has built at Arkansas Children's Hospital in the last five years alone. I met David a while back when he visited us here at Microsoft in Redmond. It was evident then that he and his team were up to some amazing work. My thanks also are extended to Penny Ward, RN, for sharing her enthusiasm about the bedside solution at ACH. And, my very special thanks go to Christopher Holstead, the 16 year-old patient at ACH, for sharing his thoughts about the new bedside entertainment and education system.

Be watching here on HealthBlog for more information when my House Calls’ audio-cast with Arkansas Children’s Hospital goes live on the Net.

Bill Crounse, MD   Worldwide Health Director   Microsoft

Everywhere I go, I get questions about Microsoft's acquisition of a technology and company known as Azyxxi from MedStar Health in Washington, D.C.. Last summer, shortly after the acquisition took place, I invited company founders and Microsoft executives to join me in an audio-cast discussion about the technology and why it attracted Microsoft's attention. Since then, there's been a great deal of speculation about who the first customer or customers might be.

Azyxxi is a unified health enterprise platform that helps improve cross-organizational access and insight to clinical, administrative, and financial data. It was recently announced that New York Presbyterian Hospital, the nation's largest not-for-profit, non-sectarian hospital, selected Microsoft Azyxxi. A short time later it was revealed that Johns Hopkins Hospital and Medical Center will also be an early customer and development partner for Azyxxi.

In this edition of my House Calls for Healthcare Professionals audio-cast series, we get an update on what has happened since last summer, and explore why a prestigious hospital system like New York Presbyterian decided to implement it.

To listen to the program, click on the links below:

Microsoft Azyxxi update: Development partner and first customer
This program is also available in MP3 for download.

Panel guests

Yesterday, Microsoft officially launched the first commercial product from a group and technology known as Microsoft surface computing. The product is called Milan; a coffee-table sized PC that takes touch screen technology to entirely new levels and gives users a highly interactive experience with all things digital. For now, you'll be seeing the technology in business environments such as hotels, casinos, and retail establishments. You can read more about that here:

I first told you about surface computing last July when I met with colleagues at Microsoft Research to produce a video segment for my House Calls for Healthcare Professionals series. In that video, Dr. Eric Horvitz and surface computing guru, Andy Wilson, and I talked about the technology and possible implications for the healthcare industry. At the time Andy's work was going under the code name Play Anywhere. My head was literally spinning with ideas on how this new user interface could be used in radiology, physical therapy, anatomical pathology, and other disciplines. It also occurred to me that this new way to interact with a computer, manipulate screen images, and navigate through data could be immensely important to clinical work-flows demanding a more hands-free, no-touch solution such as might be desirable during surgery or certain medical procedures.

If you are a developer of solutions for the healthcare industry, or just an enthusiast of forward-looking technologies, you may want to give my video another look. You may also want to view another video that was shot during an “In the Labs” keynote panel at the Gartner ITXpo at the Moscone Center in San Francisco. In the video, broadcast by CNET, Dr. Eric Horvitz also ponders possible medical uses for surface computing. Finally, if you take a look at another video I recently did with UCSF physician and CMIO, Dr. Michael Blum, and Motion Computing VP, Joel French, you'll catch us talking about the touch screen features found on Motion Computing's newest Tablet PCs running Windows Vista. Put two and two together, and I think you'll begin to see where all this is going.

I would like to extend my congratulations to Andy Wilson and his fellow researchers at Microsoft Research, as well as to my colleagues in our surface computing group. Way to go! I can't wait to see how some of our partners in the healthcare ISV community will take advantage of surface computing in tomorrow's clinical applications.

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

It's ironic that this interview was released while I'm attending the first-ever Asia-Pacific HIMSS conference in Singapore. Last evening, I met with several clinicians who were telling me how tele-medicine and e-mail are being embraced by clinicians and patients all across this country, especially for primary care. As you may know, Singapore has a very progressive public-private healthcare system that serves the population extremely well at a cost to the GNP that is only one third of what we spend in the US.

As I travel the world, not only am I seeing more progressive use of information technology in healthcare compared to the US, I'm just plain seeing lots of technology everywhere that we don't have. Even the taxi cabs here are marvels of IT on wheels. Want to charge your cab ride using a credit card? No problem. Want a GPS-enabled turn by turn tour of the town? Got it. Want the cab's computer to calculate your fare and then explain it to you in your native language? Done! Oh, I did I tell you about the cell phones people use here that are years more advanced than anything you'll see in the US, or that my hotel room has a 42-inch fully digital, high definition LCD TV with more than 100 channels? I think you get the idea.

Better wake up America before it's too late! An electronic health record for most American's within ten years (now just seven years since that proclamation was made)? They already have that in Singapore. And tomorrow? Well, let's just say officials here and elsewhere around the world see a very big market for delivering healthcare to Americans who are either willing to travel for it, or better yet, want to receive a least a portion of their care on-line.

Bill Crounse, MD  Worldwide Health Director  Microsoft Corporation

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

I’m writing this from Orlando, Florida, where I just delivered the opening keynote for the American Association of Urgent Care Medicine annual conference and exhibition at the Walt Disney World Resort. As you might imagine, I come here frequently for such engagements as well as for Microsoft corporate conferences. It is one of the few places that can really handle large groups. On previous visits I’ve had the pleasure of taking the “back stage” tour of Walt Disney World. I’ve also spent a little time at the Disney Institute. Business people from all over the world come to Disney to learn the magic of running the Magic Kingdoms. In addition, whenever I visit Orlando I try to spend a little of my downtime visiting the Disney parks. On this trip, I took another look at Epcot and Disney’s MGM Studios. All this got me to thinking about what it would be like if Disney did healthcare. Here are a few of my observations:

If Disney did healthcare there would still be long lines and lots of waiting, but they would handle the lines so well that nobody would really mind. Furthermore, if you were really in a hurry you could always grab a Fast-Pass. Despite the long lines, the total experience would be so compelling that any wait would soon fade from memory.

If Disney did healthcare our hospitals and clinics would be impeccably clean, safe and extremely efficient despite the press of humanity seeking services there every day.

The doctors and nurses, and everyone else from janitor to clerk, would greet patients with a smile. Grumpiness wouldn’t be tolerated. All workers would understand that they were cast members playing the most important roles in their patients’ lives. They would always strive to put the customer first.

If Disney did healthcare they would know everything about me from the moment I entered their clinic or hospital until the time I went home and everywhere in between. All of this would be facilitated by the best technology money could buy. And you better believe that would include customer relationship management tools. And even though computers would be running virtually everything, most of that technology would be invisible except where it was meant to be seen. Nothing could threaten the special relationship between provider and patient.

If Disney did healthcare they would still charge of ton of money, but their customers would seldom if ever complain because the total experience always exceeded expectations.

Bottom line; If Disney did healthcare there would be nothing (or perhaps everything) Mickey Mouse about it.

Bill Crounse, MD    Worldwide Health Director   Microsoft Corporation

In previous Blog entries and on my House Calls audio-cast series, I’ve highlighted healthcare customers who are doing some outstanding work using Microsoft and Microsoft partner solutions to build portals that make key performance indicators, quality standards, and price standards more transparent. These same solutions are being used to automate clinical and business work-flow processes, manage documents, and generally improve collaboration across the enterprise. Today, I want to focus on what I see as the next really big opportunity in healthcare; Unified Communication.

Healthcare is a communication intensive business. Good communication has a profound effect on the quality and safety of patient care. Communication also has a huge bearing on patient satisfaction. Yet historically, the options for how we communicate with each other in the healthcare industry have been somewhat limited. We are hampered by an industry that has far too long relied on old fashioned telephone, paging, fax, and mail (both postal and interoffice); not exactly the most contemporary communication infrastructure.

Today’s progressive businesses use a wide variety of tools and technologies to facilitate communication. Communication can be synchronous or asynchronous depending on the urgency or context of the message. Information can be relayed and exchanged by instant message, e-mail, telephone (including voice over IP), audio conferencing, or video conferencing. In addition, the concept of “presence” in communication technologies now allows us to know ahead of time if someone is available to receive a message or take a call. It also lets us set up rules on how, when, where, and on what devices we want to be contacted.

So let’s extend all that into the typical healthcare setting. No longer am I restricted to the telephone for communicating with colleagues or patients. Depending on the nature of the message, where I am and what I’m doing, I can decide to use either a synchronous or asynchronous mode of communication. No more waiting on hold or playing phone tag on the telephone. Furthermore, as communication technology converges to the computer and is increasingly facilitated by the Net, my choice of device is no longer restricted either. My office telephone, Smartphone, Pocket-PC, laptop, Tablet-PC or desktop PC will all be able to do the job for me whether it’s an instant message, e-mail, voice, or video communication that is required. This technology will also have a profound effect on the way we conduct meetings and do training in the future. The use of multi-media web conferencing and interactive e-learning technologies will absolutely explode in healthcare as we increasingly communicate electronically in the office and at home for grand rounds presentations, staff training, patient education, and more. Finally, advances in speech recognition and the incorporation of speech recognition technology into unified communications, will open up new vistas for securely accessing patient information and relaying clinical orders.

I’m not going to spill the beans on everything that is yet to come. But if you work in healthcare, or you are an industry vendor building communication and collaboration solutions for the healthcare industry, the future is blazingly bright.

Bill Crounse, MD         Worldwide Health Director        Microsoft

This morning, Rick Rashid, Senior VP for Microsoft Research kicked off our annual TechFest; an event here on the Redmond campus that celebrates the genius of Microsoft Research's worldwide labs by presenting more than 150 demos and 24 lectures. Think of it as a kind of exhibition of cutting-edge technologies from some of the best and brightest computer scientists and engineers from around the world all in one place. I always enjoy this event because it gives me a lot of insight to what's coming down the line and how it might be applied to my own industry, healthcare. One of the technologies Rick highlighted in his keynote this year was SenseCam, a little wearable device capable of digitizing audio, video and other data from every second of your life and storing it forever. When I first saw this technology more than a year ago, it got me to thinking about how it might impact future versions of the electronic or personal health record, or how this technology might be useful to patients with chronic disease. There are already promising results from small studies with people suffering from dementia and other cognitive disorders.

But there was something else Rick talked about this morning that has far more profound implications for our industry, and certainly for our country. He reported that only about 1 in 100 college freshman today are selecting computer science and engineering as a major, a trend that has been on a downward spiral for the last several years and has reached its lowest point ever. In my own travels I’ve been hearing colleagues, and deans of medical schools, bemoaning the quality and quantity of young people seeking careers in medicine today. Yet surprisingly both fields, IT and medicine, are forecasted to be leading industries for new job creation far into the future. Clearly, the number of jobs will far outstrip the supply of qualified candidates.

What's going on here? Somehow I think we are failing to instill a work ethic in our youth. Perhaps I can't blame them when all they see on television, magazines and the Net are glorifications of the rich and famous among us; movie icons, sports stars, rockers, rappers, instant celebrities and wanna-be's. Math and science are hard. It takes time to build a fortune the old fashioned way. Who wouldn't want to rake in millions for singing on the radio, blasting a home run, or acting on the silver screen? But you need only watch American Idol to confront the hard fact that the odds of that happening are solidly stacked against you. It's also interesting to note that even those American Idols generally got there by working very very hard, and often for many years in poverty and total obscurity, before hitting it big.

Yes, majoring in computer science is hard. Becoming a doctor is perhaps even harder. There are years of self sacrifice, delayed gratification, and countless hours studying and taking tests. But doing anything really worthwhile in life takes an equal amount of effort. That's why they call it "work". It's a message that seems to be getting lost on an entire generation of young people. And, it's a loss for which we will all pay dearly.

What do you think? Let us know.

Bill Crounse, MD          Worldwide Health Director            Microsoft

Last week while visiting New York City, I sat down for an interview with Peter Cervieri at ScribeMedia. Peter and I first met last December at the Consumer Health World conference in Washington, D.C. Peter had invited me to visit him at ScribeMedia's Manhattan headquarters the next time I was in the city, and so I did. I toured ScribeStudios and then Peter and I chatted for 30 minutes or so about some of our initiatives at Microsoft. We also videotaped the interview so Peter could share it with his "viewers". We talked about the National e-Prescribing Patient Safety Initiatiive (NEPSI) sponsored by a consortium of leading technology companies including Microsoft, payor organizations and academic medical centers across the nation. NEPSI makes an easy-to-use and secure web services e-prescribing solution from Microsoft partner Allscripts available free of charge to every physician in America. Adoption of e-prescribing by all physicians is essential to help reduce medication errors that according to a report from the Institute of Medicine injure more than 700,000 Americans each year.

We also talked about a range of other topics related to healthcare IT and Microsoft's role in the industry. I hope you enjoy the show.

Next Saturday, I'm off to HIMSS in New Orleans where I hope to see a lot of you. If you are in the neighborhood of the Microsoft booth on Monday or Tuesday, I hope you'll drop by and say hello. I hope you'll also be around for Steve Ballmer's keynote on Monday morning. I think you'll be inspired by his message and our vision for higher quality, safer, more effective and satisfying health and healthcare made possible by technology.

Bill Crounse, MD         Worldwide Health Director           Microsoft

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

Even if you work in a so-called “most wired” American healthcare facility, I guarantee if you look around you’ll still find lots of paper forms and processes. Paper is endemic in American hospitals and clinics, even in those with fairly robust enterprise information systems and electronic medical records. Paper is still used for staff scheduling, HR processes, reporting, transfers, discharges, and all kinds of other tasks.

There are a couple of ways around this. You can ask your HIS vendor to automate a work-flow that’s still trapped on paper. But often the aggravation, delays, and high costs don’t justify the return; and that's if you can even get them to do small projects like this. You can also buy specialized software to solve these problems, but you just end up with a bunch more departmental applications in an already crowded and complex array of applications that don’t talk to one another.

That’s why I have been so pleased to learn what some of our most innovative customers are achieving with software that so many of them already own. This is particularly true of the way some hospitals and clinics are using Microsoft Office and SharePoint Server (MOSS) and InfoPath Forms.

One such example comes from Children’s Memorial Hospital of Chicago. Last week at our Healthcare Executive Forum event in Minneapolis/St. Paul, Eric Gasber, RN, followed me on the podium with a presentation that truly wowed attendees. Eric describes Children’s use of SharePoint as a solution that “begins where the enterprise applications end”. In example after example he showed paper based workflow, reporting, and collaborative processes that had been automated with MOSS. Most of these solutions were developed by Eric with little help from IT. He’s created solutions for time off requests, patient financial services, crash cart logs, meeting agendas and materials, service requests, and pre-procedural forms and scheduling for interventional radiology, cardiac catheterization, and anesthesia. Some of these solutions took just hours to put into production. Some took days or weeks. Eric soon identified “power users” in the organization who could develop their own solutions and forms.  “If they have ever created a form in Word, they have most of the skills they need”, he says. 

In some cases the return on investment from these solutions is measured simply by delighted clinical or business staff. But in many cases, Eric can claim real dollars coming from his work. His solution for Cardiac MR scheduling resulted in an 80 percent increase in scanned cases per month. Total increased throughput in Cardiology and MRIs have resulted in an additional $6.5 million to the bottom line. Eric attributes this success to the fact that the solutions he designs using SharePoint Server and InfoPath are fast to develop and implement, highly flexible, and very intuitive for end users.

This is another great example of how commodity software is being used to address critical business and clinical processes in hospitals and clinics, at a cost that is affordable. And that means more money for what really counts in healthcare; taking care of our patients.

Bill Crounse, MD         Healthcare Industry Director        Microsoft