There’s never been a more compelling time for computers in the practice of medicine. There has been an explosion in the amount of information and scientific knowledge that physicians must know in order to practice medicine today. That task becomes even more challenging as genomics and personalized medicine enter the mix of care. In addition, in many developing countries there are severe shortages of qualified healthcare professionals. What medical care there is must often be provided by lesser-trained individuals.

In this special video edition of our on- going House Calls for Healthcare Professionals series, Microsoft's worldwide health director, Bill Crounse, MD, takes a look at computer software called NxOpinion. Using this software, physicians and other caregivers can more accurately assess a patient’s symptoms, arrive at the correct diagnosis, and deliver the safest and most appropriate treatment.

Bios:

Dr. Joel Robertson is the innovator and driving force behind the creation of NxOpinion. With more than 20 years of experience consulting with senior executives, companies and health care facilities to improve their performance and achieve better results, as CEO and Chairman of Robertson Institute, Dr. Robertson currently oversees several medically focused companies in the U.S. and abroad. He holds a Bachelor of Science in Pharmacy from Ferris State University and a Doctor of Pharmacology from the University of Michigan.

Del. J. DeHart, M.D. is an infectious disease specialist in private practice. He also serves as Associate Professor of Medicine, College of Human Medicine at Michigan State University, where he obtained his medical degree. He serves as Medical Director for NxOpinion, Robertson Research.

M.U.R. Naidu, M.D. is the Dean of the Nizam's Institute of Medical Sciences (NIMS) in Hyderabad, India, which is dedicated to providing medical care, educational and research facilities in the field of medical science. Dr. Naidu set up the clinical pharmacology research center at NIMS and is actively involved in research and education for the government of India with multiple publications. He has served as the coordinator of research and testing for NxOpinion, coordinating testing in rural health care workers as well as helping to improve usability and culture and language sensitivity issues.

D. Prasada Rao, M.D. is a cardiothoracic surgeon who serves as a Director at the Nizam’s Institute of Medical Sciences in Hyderabad, India. He is also on the Rural Health Initiate Board for the Government of India and on the Board of Ayorgi Sri, which is their new Medicaid system. He is considered one of the highest ranking physicians in India.

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

Are you a healthcare industry solution vendor? Do you want worldwide recognition for your company's good work and the solutions you build using Microsoft technologies? Would you like an opportunity to win prizes including a roundtrip for two to Paris and a guest spot to judge at the Imagine Cup 2008? If so, Microsoft's Developer and Platform Evangelist group (DPE) has started up a new industry solution showcase and contest that I believe will be of great interest to readers of my Blog on Channel 10.

For a little inspiration, visit the Microsoft ISV Showcase. You'll see some examples of the terrific work being done by our ISV community to change the world of healthcare (as well as education, clean technologies, and manufacturing). Check out the video from Vital Images, a company that is using Microsoft platform technologies as a base to give doctors a revolutionary new view of their patients, and a powerful way to save lives. The ground-breaking software creates colorful 3-D images from CT, MRI and PET scans, allowing problems in the heart, lungs, colon, and brain to be detected quickly, affordably, and less invasively. Also, take a look at some of the other healthcare ISV solutions that are featured in the showcase.

With that under your belt, jump to the CONTEST and enter your healthcare solution that is making, or has the potential to make, a difference in the lives of people around the world. Good luck!

Bill Crounse, MD    Worldwide Health Director  Microsoft Corporation

My colleagues at Microsoft Research asked me to spread the word about an announcement they made on Monday during their External Research & Program’s Faculty Summit. Faculty Summit is the premier event hosted by ER&P for academic researchers and professors to meet with Microsoft researchers and product group engineers for in-depth presentations and discussions of computing problems and research trends. The conference brings together approximately 350 academics from 175 leading institutions worldwide.

During the Summit, Microsoft Research outlined the research agenda for the next year by announcing 11 new RFPs. These are research grants open to anyone, two of which focus on healthcare (outlined below).

Cell Phone as a Platform for Healthcare

Goals:

· Explore applications and evolution of the cell phone for healthcare services.

· Incubate, develop, and disseminate to the worldwide academic research community new healthcare services prototypes and mobile technology tools.

Solution Statement: What medical applications are relevant, worldwide, for ‘smart’ mobile phones (application and web-enabled) in rural, and urban, communities? What are the appropriate services and infrastructures to be created to provide affordable and accessible healthcare services?

Personalized Medicine: Improving Genome-Wide Association Studies

Goal: Genome-Wide Association Studies (GWAS) is an area that would greatly benefit from having computing improvements for researchers. Focus areas for improvement include:

• Improvement of HapMap (tools for data collection, etc.)

• Standardization of genetic data collection, semantics and DB schema

• Improvement of Algorithms (particularly for in multi-allele disorders) accuracy, performance (e.g., parallelization, HPC)

• Genomic Data Visualization

Solution Statement: Genome-Wide Association Studies (GWAS) are defined by the NIH as any study of genetic variation across the entire human genome that is designed to identify genetic associations with observable traits (such as blood pressure or weight), or the presence or absence of a disease or condition. GWAS are laying the groundwork for personalized medicine. What is needed to put this data as quickly as possible into the hands of a broad number of researchers so that they can advance the state of the art in this area.

If you’re interested in any more detail, please contact Tami Begasse: tami.begasse@microsoft.com.

Here’s your chance to help change the world in healthcare.

Good Luck!

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

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

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

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

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

Over the past few years Microsoft partner, Motion Computing, has focused on serving the healthcare industry. In February at HIMSS, the company introduced an entirely new category of Tablet PC: the Mobile Clinical Assistant, also known as the C5. In March, Motion introduced a new full-sized Tablet PC, the LE1700, that not only has a touch screen but is fully capable of running Windows Vista with Aero glass graphics.

In this special video edition of House Calls for Healthcare Professionals, Microsoft's worldwide health director, Dr. Bill Crounse, and his special guests take a look at these exciting new Tablet PCs from Motion Computing and discuss how these devices are being used by clinicians around the world.

Joel French, is Vice President of the Health and Life Sciences group for Motion Computing, Inc. Mr. French is a leader in wireless products and services designed for mobile professionals in vertical industries.

Dr. Michael Blum, is Associate Clinical Professor of Medicine, a practicing Cardiologist, and Chief Medical Information Officer for the University of California San Francisco Medical Center.

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

In previous Blog entries I've talked about the next wave in remote physiological monitoring. Mobile technologies, devices and web services will soon allow us to remotely monitor patients suffering from chronic diseases or elderly people living alone in their homes. The devices and technologies will be easy to use and ultimately quite affordable as the devices and services become commoditizied.

One of my colleagues on Microsoft's Channel 10, Laura Foy, recently produced a short video with David Bychkov, CEO of a company called Exmocare. Exmocare is the first of what will surely be a number of companies offering the kinds of devices and services I've been discussing on this Blog and elsewhere. Their Bluetooth enabled Exmocare watch can connect seamlessly with a Windows Mobile Smartphone, Pocket PC, home computer, Xbox, Media Center PC or other device.

It continuously records heart rate, heart rate variability, galvanic skin response, and movement. Using various algorithms it determines parameters of physical and emotional wellness and activity and reports these via Bluetooth to a Smartphone or other device linked to the Internet. Medical personnel or family members can log into a secure web site to receive reports on the person being monitored. The system can also be set to send out alerts to those monitoring someone via e-mail, IM, or text messaging should the watch detect physiological readings or activity levels that are out of range.

This is just the beginning of a new era of technologies that will help us extend care into the home and bring peace of mind to those of us concerned about aging parents who live far away. Unified Communication technologies will augment these services with on-demand video and multimedia conferencing from a Smartphone, notebook or desktop PC, Xbox, or digital television.

While the first devices to hit the market will be a bit bulky and expensive, they will be arguably less expensive than the cost of live-in helpers and caregivers while providing a sense of safety and connectedness for those being monitored.
 
Be on the lookout for many more devices and web services that will facilitate health and wellness programs in the home and connect us to medical professionals and other experts. As an aging baby boomer, I take a great deal of comfort in knowing these technologies will be ready for me and my family in the very near future. There is also a virtually unlimited potential for these devices and services to meet the healthcare needs of emerging and underserved markets around the world.

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

One of the big announcements during HIMSS last February was Microsoft’s acquisition of a company specializing in medical search. That company is called MedStory. Recently, I caught up with MedStory founder and CEO, Dr. Alain Rappaport, M.D., Ph.D., for a conversation about his company and why he decided to join forces with Microsoft.

Prior to founding MedStory, Dr. Rappaport was the co-founder, president and chief scientist for Neuron Data, a world leader in artificial intelligence and other business-critical software components. That Dr. Rappaport’s roots are embedded in the science of artificial intelligence made all the more sense as we discussed his vision for MedStory.

Dr. Rappaport likened the healthcare industry today to that of American manufacturing in the 80’s. All of us old enough to remember will recall that the American automobile companies and other manufacturers were getting clobbered by much more nimble competitors overseas (particularly the Japanese) who started using computers and technology to optimize the supply chain and their manufacturing processes. American manufacturers have now narrowed the gap. Productivity has improved and they are turning out higher quality products, but we continue to pay a price for falling behind in the 80’s. According to Dr. Rappaport, American healthcare is now where manufacturing was in the 80’s, and the time for change is upon us.

Realizing that healthcare is an industry that is driven by information, Dr. Rappaport turned his attention to improving how both consumers and clinicians alike will find the information they need. It is not enough, he says, to provide links to information. Search engines must become intelligent enough to understand a user’s “intent”. “We need a web that knows versus one that just links”, said Dr. Rappaport. “We are moving the center of gravity of search to return an understanding of what the user wants. Our core objective is to provide meaningful information that is also actionable.”

Asked why he decided to team up with Microsoft, Dr. Rappaport said it was the opportunity to engage with customers and partners all around the world who are now coming forward to help us innovate and use this technology. “Even in parts of the world where populations are medically underserved, providing relevant and timely information, will make a difference”, he said.

I, for one, very much agree. I’m thrilled to have Dr. Rappaport and his distinguished colleagues join us on our mission to improve the quality and safety of patient care, and the satisfaction of those giving and receiving that care.

Bill Crounse, MD    Worldwide HealthDirector   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