Author Archive
Healthcare Reform in China
Last week I reported on my informative trip to visit customers and partners in Japan. After returning home to Seattle, I thoroughly enjoyed having a few days off to spend with my family over the long Thanksgiving weekend. This week, my attention is drawn to China; not for a personal visit but rather to share some information from one of my colleagues.
It has been more than a decade since my last visit to China. Much has changed since then. But one of my team members, Ben Flock, with our US Health and Life Sciences group, wrote to me during the tail end of my recent visit to Japan. He asked if I could share some of his observations on how healthcare is changing in the world’s most populous country– China. He also wanted me to draw your attention to a meeting that will take place on December 11th, at Microsoft offices in Farmington, Connecticut.
Ben writes:
Recently, I had an opportunity to do a 2-month work rotation in China. My primary assignment was to experience China healthcare first hand, exchanging best practices and industry experiences. It was definitely an eye opening experience. Prior to the engagement, I assumed that China operated under a pure socialized healthcare model. What I learned is that they are actually operating under an emerging hybrid model that includes employer based insurance, tiered procedure based pricing, social service supplements, and incomplete population coverage models…very much like ours in the US. Every US based healthcare & insurance company is currently doing business in China or will be over the next year. Over the next few years, China will become a global focal point for healthcare business and technology advancement. I believe the effects of these advancements will have a long tail on how Healthcare operates here in the states.
If this topic interests you, I would like to draw your attention to the following meeting:
Microsoft Health & Life Sciences Industry Council
China Healthcare Perspectives
Thursday, December 11, 2008
2:00pm – 6:00pm
Overview
What was once a model based on pure social services, China’s Healthcare is evolving into a hybrid blend approach that includes a mix of government price controls, fee for service disparities, social security coverage gaps/limitations, and emerging “western oriented” privatized healthcare insurance. China is in the midst of healthcare reform…essentially a breakaway from traditional social service towards a new model that will better serve China’s population from a cost, quality, and availability perspective. Currently, China’s total Healthcare spending is 4.8% of GDP. Essentially the largest country (1.3B) has the lowest total per capita healthcare spend. But, China is committed to significantly increase its total spend…potentially reversing the model making China a healthcare leader. In this session, US & China based Microsoft representatives will share perspectives and insights on what we believe will rapidly became the next epicenter for healthcare innovation.
Discussion Topics
China Healthcare Overview – “The world is flat”
“The world is flat”… a cliché that people use to illustrate broad commonalities. It is often backed with very little evidence to prove its truth in a real world context. But use in relation to healthcare, and we believe it has real meaning. In this session, we will do a contrast/compare of Healthcare in the US to healthcare in China and put the cliché’ to the test.
A Real World China Healthcare Example…
Zhoungshan City Hospital is one of China’s highest ranked healthcare facilities from an overall quality and patient satisfaction perspective. In this session we will do a detailed walkthrough of their population coverage, operating principles, business workflows, and technology solution augmentations, giving you a birds-eye view of how Healthcare really works in China.
Emerging Technologies Sneak Peak: Microsoft Azure Platform Services
In this session, we will give a “hot off the press” high level overview of Azure Platform Services providing perspectives and insights to how they might be leveraged to improve global healthcare.
Speakers
![clip_image002[8]](http://blogs.msdn.com/blogfiles/healthblog/WindowsLiveWriter/China_11145/clip_image002%5B8%5D.jpg)
James Chen, Director Business Development, Microsoft China: As an experienced senior professional with 28 years who works in multi-national large corporations such as Microsoft, BellSouth and NEC. Strong experiences in strategic planning, investment, mergers and acquisitions, also in government relations, regulatory affairs, corporate communications and business development.
Ben Flock, Health & Life Sciences Industry Advisor: Ben is a technology leader and Healthcare Industry subject matter expert with over 21 years experience building architectural teams, technology practices, and business solutions delivery organizations.
Hong Chong, Architect Advisor: Mr. Chong is a business and IT leader with 18+ years of business and technology implementation experience with proven results. He has worked in the Health & Life Sciences industry, financial services, and professional services organizations leading strategy and architecture groups.
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Microsoft Office – Farmington, CT 74 Batterson Park Road Farmington, CT 06032 |
December 11 2 - 6PM |
Event ID: 1032395880 |
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Laying tracks for better health in Japan
This week I’m reporting from Tokyo and Yokohama. It is the second time in as many years that I’ve been invited to speak at an industry event here in Japan. Yesterday afternoon, it was my honor to provide a keynote for the 28th Joint Conference on Medical Informatics being held at the convention center in Yokohama adjacent to the InterContinental Grand Hotel.
On my last journey to Japan and again this time, I’ve been particularly impressed by two things. First, for a country with such densely populated urban centers Japan is spotlessly clean. Wandering around downtown Tokyo you rarely see even a gum wrapper. It’s like Disneyland only cleaner. Contrast that with most American cities. Second, the public transportation is fast, efficient and always on time. You can set your watch by it. So, it is surprising to note that in a country lauded for lean manufacturing and the “Toyota method” of continuous quality improvement, that healthcare and particularly the implementation of e-Health, lags behind many other developed nations. Japan has too many
hospital beds, and their lengths of stay are notoriously long; often twice that of American hospital stays. Also according to my hosts here, the Japanese are frequent fliers when it comes to utilization. Dialing 119 (911) to summon an ambulance for the most minor of complaints is almost a sport. Hospital based physicians are so overworked they are bailing right and left for outpatient practices leaving higher-paying hospital posts with vacancy signs. Making things even worse, say the locals, is an overall shortage of medical professionals in the face of a growing population of the elderly and more people with chronic diseases including obesity.
To help combat these trends, the Japanese government has launched a campaign that stresses more personal responsibility in maintaining good health. It also asks employers to take a stance. For instance, employers must now measure the waistline of each employee and report results to the central health authority. They must also provide obesity management programs for overweight employees and will be fined if offenders don’t “measure down” appropriately. Somehow I don’t think this program would fly in America.
The Japanese are also very interested in the idea of promoting personal health records. Every government official and healthcare executive I meet wants to talk about HealthVault and Google Health. “When will we have something like HealthVault in Japan?”, they ask. They seem to agree that aggregating health data around consumers is a good idea and they are making plans to provide every citizen with a PHR.
I was also surprised to learn that home health isn’t popular in Japan, even though it would make perfect sense to move in that direction. My hosts were really keen to learn what other countries are doing and how home tele-health monitoring is being deployed to manage patients with chronic disease and assist the elderly.
Clearly the Japanese are placing some big bets and laying down tracks for a new approach to healthcare. If they do it as well as they keep their cities clean and their trains running on time, it should be something worth watching.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Windows Mobile – Facilitating Care at Home
Home care is one of the fastest growing segments in the health industry. It is estimated that each year, about 2.5 percent of the American population receives some kind of home care service from a doctor, nurse, therapist, or home care aide. All of this amounts to more than 429 million visits a year, and that number is growing rapidly.
With that growth, there is also a shortage of qualified nurses and therapists. It is also true that coordinating and documenting home care, and synching captured information across care teams, is a daunting challenge for the health industry. Data capture is often still done on paper requiring workers in the field to drive to an agency office each morning in order to file their reports, pick up new schedules, and coordinate the sharing of information. That results in a lot of inefficiency, not to mention excess travel costs, reimbursement delays, and possible errors
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With home care becoming ever more important in meeting the needs of patients, and playing a significant role in helping to control the nation’s escalating hospitalization costs, what can be done to modernize care team documentation, communication, and collaboration in the home care industry? How can we also help retain home care workers by giving them the very best tools to help them do their jobs, including contemporary IT solutions to help improve efficiency, make work easier, and facilitate caregiver collaboration?
These are the issues we address in the latest edition of my House Calls for Healthcare Professionals audio-cast series: Windows Mobile - Facilitating Care at Home. My guests include:
Guy Conces, chief technology officer, Homecare Homebase
Gracie Davis, RN, Encompass Home Health
Hemang Patel, mobility solutions specialist, Microsoft
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I hope you enjoy the program!
Listen (21:32 min): Windows audio format | MP3 format
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Video Gaming Graphics Supercharge Medical Imaging
Combine the graphics processing power of a contemporary video game with a CT scan, MRI or other medical image; wrap it up in a commodity-priced viewer, and what have you got? You’ve got FiatLux 3D.
I first met up with FiatLux 3D co-founder and CEO, Mary Frances Feider, a couple of years ago when the company was more of an idea than an actual enterprise. The vision was to develop a commodity-priced (at least compared to other imaging solutions), flexible, interoperable viewer for medical images. Furthermore, the goal was to take advantage of the founders’ prior engineering expertise in advanced video gaming graphics technology and bring to medical imaging the kind of experience one might more commonly associate with Halo. Fast forward to today, and the fruits of the company’s labors have arrived full force. 
Ushering in new possibilities for high-quality, affordable 3D medical image visualization, FiatLux Visualize™,which received FDA-clearance in August, sets new standards in 3D image quality and processing speed. The software takes advantage of DirectX game programming technologies and the untapped potential of today’s video graphic cards to deliver stunning image reformations from CT and MRI scans. The same sophisticated technology that propels realistic, detailed images of rockets and aliens through space in popular games is being applied to images of the human body in healthcare. According to Ms. Feider, FiatLux Imaging has introduced a revolutionary and much-needed new paradigm in advanced medical image processing.
IT Departments appreciate that the software runs on a standard Windows
machine without the need for expensive graphics cards. It makes possible anywhere, anytime 3D image analysis on a laptop, tablet, or even one of the new ultra-mobile Windows devices. Physicians like having a solution that runs as well on a laptop as their desktop, allowing them to view and manipulate medical images at the patient’s bedside or anywhere the need arises.
According to the company, FiatLux Visualize supports a range of today’s 3D and advanced 2D image processing protocols, including MIP, MPR, and advanced volume reconstruction that is comparable to high-priced, dedicated workstations on the market today. And they do all that for about $3000!
Ms. Feider noted that the company is growing especially in markets outside of the radiology department. They have found that some of their biggest fans are neurosurgeons, cardiologists, and orthopedists who use the viewer to help with surgical planning, diagnosis and patient communication. You can find out more by visiting the company’s website.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
News from the World of Health IT
I’m writing this entry from the World of Health IT (WOHIT) conference in Copenhagen, Denmark. The conference got underway early Tuesday morning. Yesterday, I was privileged to deliver the opening keynote at a Physician Symposium pre-conference that was held at nearby Herlev Hospital.
This 700 bed teaching hospital occupies the tallest building in Denmark. At 25 stories it is also the 4th tallest hospital in the world. The title of my presentation was "How Commodity IT and the Net are Changing Medical Practice".
Later in the morning hospital staff demonstrated several full scale medical simulations in their "IT Exploratorium". This high-tech computer simulation training lab hosts 13 rooms on the top floor of the hospital. It is used extensively by clinical staff and medical residents at Herlev to learn new skills and practice procedures in a risk-free environment. Afternoon sessions at the Symposium included a panel discussion reviewing different perspectives across Europe on the Personal Health Record. Also yesterday afternoon, Microsoft held a special customer and partner event where more than 150 participants learned about some of our newest and most compelling solutions for the health industry.
Introducing the Panasonic Toughbook H1 MCA
Speaking of things that are new; one of the highlights of the WOHIT conference and exhibition was the official unveiling of Panasonic’s Toughbook H1 Mobile Clinical Assistant. I first hinted about the H1 on HealthBlog last month when I had an opportunity to keynote at a Panasonic customer event in San Diego. At that event the company had a few pre-production models of the H1 for people to see. But now comes the official release and its generating lots of excitement. What’s of most interest to me is not so much the device itself (although it is pretty cool). I’m pleased that the OEM community is finally realizing that healthcare is different from other industries and that healthcare workers need devices that are specially built to meet the unique requirements of patient care. You’ll recall that Motion Computing was the first manufacturer to release a device, the Motion C5, based on Intel’s MCA design criteria. Now Panasonic joins the line-up, with a device that is sure to please. It is rugged, ergonom
ically pleasing, comes standard with Windows Vista Business edition SP1, and because of it’s Intel Atom processor provides up to 6 hours of battery life. Panasonic was kind enough to provide a video for me to share with you. It runs a little long and some of the dialogue is cheesy, but if you want a good overview of the H1’s value proposition to the health industry, the video is well worth a look. To view it, just click on the picture to the right.
Microsoft EMEA Healthcare Users Group
Other big news at WOHIT is the announcement by Microsoft and The Healthcare Information and Management Systems Society (HIMSS) concerning a broad expansion of the Microsoft Health Users Group (Microsoft-HUG) to partners and health care providers throughout Europe, the Middle East and Africa (EMEA). Initially, Microsoft HUG EMEA will exist as an on-line community, hosted as part of the existing Microsoft HUG website. The site will include content, discussion groups and E-seminars from thought leaders in both the Healthcare and IT industries. The web launch is an ideal way for members in the region to access information and gain familiarity with a broad array of services offered by the Microsoft HUG organization. You can find out more here.
Tomorrow morning, I head back to Redmond, but the rest of the team will be staying on in Copenhagen. If you plan to visit WOHIT, please drop by the Microsoft booth and say "hello". While there, you can enter a drawing to win your very own Panasonic H1 Mobile Clinical Assistant.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
At Microsoft Health, We Make House Calls
OK. We don’t exactly come to your home in the physical sense, but we do make house calls. I’m pleased to introduce an updated and redesigned site for an on-going series of articles, audio-casts and videos that we call House Calls for Healthcare Professionals on Microsoft Health .
You can now access House Calls (and HealthBlog) directly from the Microsoft Health home page. Check out a brand new audio-cast with the CIO of Clarian Health as he tells us how his organization has improved customer service and significantly cut costs by following Microsoft guidance for infrastructure optimization and virtualization. Read a just released article that shares some new ideas on how healthcare 
organizations can more 
effectively manage relationships and build loyalty with patients, medical staff, and community members using Microsoft Dynamics CRM. And don’t forget to check out our inventory of interesting videos including my recent visit with colleagues at Microsoft Research as we examine cool new technologies that may one day find their way into healthcare.
And did I tell you we have video? Oh yeah, lots of video…………………………
So the next time you get a hankering for the latest information on IT solutions and innovations for the healthcare industry, I hope you’ll think about House Calls. It’s never been easier to invite us into your home.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Patient Heal Thyself
I’ve written and lectured extensively on worldwide health trends, one of which is “increasing personal responsibility”. In both private and public health systems there is growing recognition that we must do a better job engaging our patients in the the quest to lower healthcare costs and soften the toll of chronic disease. Depending of the health system and how healthcare is financed this may include putting some patients at greater financial risk for poor health behaviors, or creating tax incentives or other rewards that will encourage people to lead healthier lifestyles. Besides the pressing need to reign in healthcare costs, there is increasing concern about a shortage of qualified healthcare professionals to meet the demands of a growing elderly and world population.
One of my Microsoft colleagues in Europe, Dr. Octavian Purcarea, recently brought to my attention a rather unique approach towards getting patients to “take on more responsibility” for their care while lessening demand for services. He writes:
Talking about new business models – I have met with the Chairman of HIT Telecom from Kuwait who is also a doctor and director of a private clinic. They are trying to make a real revolution because, according to them, even with all the IT resources and telemedicine – the demand for qualified healthcare will be higher than they can offer. As a new approach, his clinic is training chronic patients for 3 months by giving them courses in anatomy, physiology, semiology, and pathology. Then the patients undergo a very tough theoretical and practical exam which will give them a certification allowing them to refill their prescriptions, modify their medications and avoid medical encounters. Moreover, they are able to treat other patients with the same disease. According to his preliminary observations, the economic impact is huge – with 40% reductions in cost and complications.
The message seems to be, “Patient heal thyself!” (and once trained to do so, perhaps help heal some others too). Maybe this isn’t such a bad idea in a world struggling to pay for, and provide care for, all those who need it.
Next week I’ll be at the World of Health IT in Copenhagen, Denmark, where I’ll be delivering a keynote address at the WOHIT Physician Symposium on November 3rd. I hope to see some of you there.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Health 2.0 What are we really building?
Today, I am reporting from the Health 2.0 Conference in San Francisco. More than 950 business, clinical, and technology luminaries have gathered together for the second annual conference organized by Indu Subaiya, MD, and Matthew Holt of THCB fame. I was invited to speak on a panel reviewing the findings of a first-of-its-kind multinational survey commissioned by Edelman Public Relations that reviews the dynamics of "engagement" in health. It explores the changing roles and relationships among digital channels, sources and tools in five key national markets around the world. There’s good news in The Health Engagement Barometer survey for physicians. Despite all the "new media" and channels for digital health information, people still place a high degree of value in expert opinion, and the health expert they trust most is usually their personal physician.
As I write this piece looking out the 19th floor window of my room at the W Hotel, a large yellow constructions crane interrupts my view of the Bay Bridge, water and mountains beyond. It strikes me as the perfect metaphor for Health 2.0.; It is rising up all around us, but where is all this technology taking us? Are patients better served and is care being improved because of health-specific search engines, patient and disease social networking, on-line personal health records, and retail genetic testing? Or is the plethora of health information that is now available to patients only frustrating them because the health delivery system and their personal physicians are so unprepared to deal with it? How will an industry being rattled by shortages of skilled labor and a burgeoning populating of aging patients with chronic diseases respond to an ever-increasing demand for services? It certainly won’t be able to respond using the work-flow and business models of the past. Telling patients they must make a phone call, book an appointment, drive across town, wait in a waiting room, and wait again in an exam room for 5-10 minutes with their doctor just won’t cut it anymore. And yet, if we don’t make changes to a reimbursement systems that only pays doctors for seeing patients one on one in an exam room somewhere, how can we expect the health delivery system to incorporate and embrace new models of care?
Having information is good. Turning information into knowledge is even
better. But what happens when we need to act on that information and the system that is in place is unable or ill equipped to respond? It’s not exactly like you can write your own prescription or perform your own surgery. You need to enlist the help of a medical professional, and all the Health 2.0 in the world won’t get you what you need unless there is somebody at the other end of the line who is being paid to help you. Health 2.0 will only transform healthcare delivery when the delivery system itself is transformed. Pioneering young doctors and entrepreneurs like those at Hello Health (Dr. Sean Khozin, pictured) and especially more enlightened and progressive payers are very much needed if we are going to change the status quo. We must reward clinicians who harness technology to deliver the most appropriate level of care for their patients when and where it is needed. Until we do, we’ll just keep adding fuel to the demand side of the equation while totally frustrating everyone on both sides of the equation.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Are Healthy Employees More Productive?
Are healthy workers more productive? That is one of the questions being explored today at the international meeting of the Institute of Health and Productivity Management (IHPM) in Scottsdale, Arizona. I’m here to deliver the opening keynote at this gathering of health benefits managers, HR administrators, prevention specialists, clinicians and others. My colleague Louis Burns, VP of Intel’s digital health group (picture below), followed my presentation with a
terrific talk about the impact of elder care on today’s working population and how various technologies, many of them very simple, can be harnessed to help keep Mom and Dad healthy and living independently. Mr. Burn’s address melded well with the themes in my presentation about global health trends and the impact these trends will have on health and healthcare delivery.
Many people who don’t know about the deep investments Microsoft is making in solutions for the health industry get a bit confused when they meet me or read my title; senior director, worldwide health. Especially at a conference such as IHPM, they assume that a medical doctor working at Microsoft must have something do do with our employee wellness or benefits program. Of course, that is not what I do. But I do have a lot of interest in corporate health and wellness programs and how technology can be leveraged to improve access to, and outcomes from, these initiatives.
The exhibit hall at IHMP is teaming with companies big and small that offer health screenings, wellness and prevention programs for major corporations. We all know that lifestyle contributes to many if not all of our most pressing chronic diseases. And this is no longer a problem confined to America. Mr. Burns outlined a new mandate in Japan that will require all employers to regularly measure their employees’ waistlines and face fines if programs to trim the fat aren’t working.
While I don’t expect American companies to follow suit, obesity is a leading risk factor for chronic disease, decreased productivity, and absenteeism. Perhaps 
that’s why I was especially intrigued by a solution being offered by an Australian company called DeskActive. I first met up with the company’s CEO, Josh Swinnerton, in Redmond last week. It turned out that he and I just happened to be going to the same conference, IHPM, where DeskActive was an exhibitor. I snapped a photo of Josh in front of his stand. The premise behind the company is to get all of us who are chained to a computer all day to focus a bit more on physical activity and health. DeskActive has developed a novel program to engage computer users while they work, encourage breaks, and foster simple exercises that can be done to improve health and well being. Their solution also helps benefits managers monitor how their workers are doing and helps pinpoint problems before they occur. To learn more, you can check out their web site.
Are healthy employees more productive? You bet! And with that in mind, I’m going to put on my sun screen and take a long walk around the golf course before it gets dark. Never let it be said that I don’t practice what I preach.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Computer Software Matches Donors, Saves Lives
Last week I had the pleasure of visiting my alma mater, The Medical College of Ohio. It doesn’t go by that name anymore. Today, due to a recent merger with the University of Toledo, it is known as the UT College of Medicine.
I was invited to the university to receive the medical college’s "distinguished alumni award". The award was presented to me Friday evening during the school’s homecoming gala by Dr. Jeffrey Gold, provost and executive vice president, and Dr. Lloyd Jacobs, president of the University of Toledo. The recognition was a great honor for me, although it was a bit like getting a lifetime achievement award that is hopefully being received long before the job is done.
While at the university I also delivered a couple of lectures at the health sciences campus. It was terrific to be in the company of students, medical residents, and faculty. We had stimulating discussions about advancements in information technology and how all of this will impact medical education and the future practice of medicine.
SOFTWARE SAVING LIVES
I was also fortunate to have a private meeting with Dr. Michael Rees (seen here lifted up by his grateful patients) professor of urology at UT College of Medicine. Dr. Rees is a kidney transplant surgeon who has developed software that helps match "paired living donors". As Dr. Rees explained, it costs about $80,000 a year to provide life sustaining dialysis to a patient with renal failure. A kidney transplant costs about $100,000, if an organ is available. A donated kidney that comes from a cadaver will last about 8 years. A kidney that is provided by a living donor will last about twice that long. Clearly, kidney transplants save money, and receiving one from a living donor is the better option. However, making that option available is often a challenge.
For instance, a wife (Donor 1) may be willing to donate a kidney to her husband (Recipient 1), but because of antibodies, blood type or other issues, the kidney isn’t a good match. What then? Perhaps somewhere else in the country there is a husband (Donor 2) who is willing to donate to his wife (Recipient 2) but again, there isn’t a good match. But what if Donor 1 could donate to Recipient 2, and Donor 2 turned out to be a good match for Recipient 1? Two families would benefit. Furthermore, Dr. Rees says some people are willing to give up a kidney to help a complete stranger, provided that someone in the stranger’s family is willing to "pay forward" with a donation of their own.
The computer program developed by Dr. Rees, with assistance from his computer scientist father, factors in a number of variables such as the donor and potential recipient’s age, how long the recipient has been waiting for a transplant, the physical location of donor and patient, blood types, antibodies and other factors to "optimize" all possible combinations for this life-giving transaction. The software program is so complex that 600 matched pairs will bring down most ordinary computers, necessitating more powerful high-performance computing for full optimization.
Dr. Rees is hoping to identify and process 400 living donors and patients who would be willing to participate in his paired donor program. The program currently has 134 pairs. At that level of participation, a logarithmic explosion in matched pairs becomes apparent, and a kind of daisy chain of life-giving transplantations could happen. The program has already helped many people and has been featured on national news programs. Dr. Rees gave one example of a recent living kidney donor who, with the help of the computer matching program, set off a daisy chain of transplants that benefitted 10 families.
WHAT YO
U CAN DO
To continue his work, Dr. Rees needs funding. He has already completed version 2.0 of his software. Now, he needs financial support to recruit and process more paired donors in order to reach that magical number of 400. If you happen to be a tech millionaire or billionaire this would be a very worthy cause for your philanthropy. Or perhaps we can raise what is needed virally if bloggers simply unite across the blogosphere and spread the word (please link to this post).
Dr. Rees needs to raise $1.3 million ($650,000 per year for 2 years). His Alliance for Paired Donation is a 501c3 organization, so any donations would be tax deductible to the extent allowed by law.
If you are serious and want to learn more, contact me by using the E-mail button at the top of this Blog and I will put you in touch with Dr. Rees. Your donation will save lives!
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
The Economic Crisis and Healthcare Reform
A video commentary from Microsoft’s Senior Director for Worldwide Health
Test Drive: A more standardized, contemporary and intuitive user experience for clinical systems
My team in the UK has just released the latest update to our Common User Interface initiative. If you’ve never taken the CUI for a test drive, you are in for a treat. Just visit the Patient Journey Demonstrator to experience for yourself what happens when a large team of clinicians and software developers work collaboratively to design a better, more standardized front end to clinical systems.
Why is this such a big deal for clinicians? Let me use an example from my own back yard. Like most metropolitan areas, the Puget Sound region has many hospitals and health systems. Over the course of my own career, I have worked at three of them. Many of our community based physicians and particularly the specialists find themselves serving on the staff of more than one hospital. For instance, I might live in Bellevue and be on staff at the hospital there but I might also be on staff at the hospital just up the road in Kirkland. In fact, those two hospitals share about 50 percent of their medical staff. I might also drive South to Renton now and then to see patients in that community’s hospital. In addition, I might call on hospitalized patients in downtown Seattle. Guess what? In each of those facilities, I will encounter a completely different hospital information system. Consider also the plight of registry nursing staff or other locums workers who travel between all the hospitals and clinics in town. There again, they likely will encounter a completely different electronic record system in each institution.
I think doctors and nurses are very smart people, but how can they become competent on that many different systems? How can we expect them to do their work so many different ways and worse yet, how might this compromise patient safety? Is it any wonder that community physicians simply fold their arms and say “no” to using this dog’s breakfast of systems?
We need a more standardized, and certainly more contemporary user interface to clinical systems. A doctor or nurse the world over should simply be able to move from one hospital or clinic to another and use the electronic record system to do their work without additional training. After all, the practice of medicine is pretty much the same everywhere. Why are we clinicians asked to perform and document our work so many different ways on so many different systems?
We are making the CUI development tools and controls freely available to software developers around the world. You can visit www.mscui.net to learn more. See for yourself some of the most contemporary thinking in user interface design. Demand more from your vendors!
I believe we will never succeed in getting all clinicians off of paper until we have reached alignment on a universal yet highly flexible, more contemporary and intuitive front end to clinical systems. Fellow clinicians, unite!
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
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For those of you who are more technical and want to dive deeper, here is additional information on the latest release of the CUI.
V1.5 of the Microsoft Health Common User Interface (MSCUI) has been released to the web on www.mscui.net and http://www.codeplex.com/mscui.
MSCUI provides User Interface Design Guidance and Toolkit controls that address a wide range of patient safety concerns for healthcare organizations worldwide, allowing a new generation of safer, more usable and compelling health applications to be quickly and easily created.
This offering is aimed at user interface designers, application developers and patient safety experts who want to find out more about the benefits of a standardized approach to user interface design.
This is the fifth release of MSCUI since we launched in July 2007. In that time we have seen over 285,000 unique visitors to the site, 24,000 downloads of the Design Guidance and 14,000 downloads of the Toolkit.
There are 4 key elements to this new release:
- Publication of new and updated Design Guidance:
- New Micro Patient Banner guidance
- New Displaying Graphs and Tables guidance
- Updated Time Display guidance
- Updated Date and Time Input guidance
- Publication of 6 new Controls for Silverlight 2 and WPF:
- New Silverlight and WPF PatientBanner controls
- New Silverlight and WPF AddressLabel controls
- New Silverlight and WPF ContactLabel controls
- New Silverlight and WPF GenderLabel controls
- New Silverlight and WPF IdentifierLabel controls
- New Silverlight and WPF NameLabel controls
- Updates to the award winning Patient Journey Demonstrator which showcases CUI design guidelines, controls and future UI concepts in a Silverlight 2 application.
- Publication of our new Team Blog, where we will be communicating on a wide range of topics.
Crossing the chasm to digital health with unified communications
More than two decades ago I recall visiting a prominent upscale department store that was located in the town where I did my medical training. I was there to buy a gift for my wife’s birthday. It was the most elegant store in the city with only the finest quality merchandise. I found what I wanted and made the purchase. To my surprise, the store clerk made a record of the transaction on a carbon-paper receipt. With pen in hand, he laboriously wrote down my name and address, a detailed description of the item, the price and sales tax, my phone number and more. Keep in mind that even two decades ago most retailers had long given up such practices. I guess this particular store thought that the manual, hand written receipt somehow set them apart from their competitors. Perhaps they thought that the the old-fashioned paper receipt was quaint Perhaps they believed it added a special, personal touch to the transaction. But at the time I remember thinking that they probably wouldn’t be in business too much longer. Needless say, the store closed not too long after that.
In my e-mail today were several new reports on the dismal uptake of electronic records by American physicians. Having practiced medicine for almost 20 years, I sympathize with my colleagues. EMR solutions are expensive; more expensive then they ought to be. Most EMR systems aren’t all that easy to use. There is a learning curve and some initial lost productivity which may or may not be made up on the back end. Most of the devices (computers) that are used to capture clinical data weren’t really designed for the highly mobile, always-on, somewhat messy world of healthcare. They were designed to be used in offices, at a desk, or while standing in a particular place. They sometimes don’t work very well in unplugged, disconnected environments. They certainly aren’t friendly to workflows that require lots and lots of data input. None-the-less, computers and electronic records can add value by helping to reduce medical errors, improve care quality, and even lower some costs by eliminating the processing and storage associated with paper records.
Although I believe we are getting very close to the kind of EMR software and hardware solutions that really meet the needs of most clinicians, sometimes I think we are missing an opportunity in healthcare by focusing too much on the EMR (especially CPOE and decision support) and not enough on some of the more logical, less expensive and valuable technology solutions for today’s busy clinicians. We all know that healthcare is a business that hinges on good communication and collaboration with care teams and patients. With that in mind, I would like to draw your attention to a new white-paper, “The Role of Unified Communications in Healthcare Service Improvement”—written by IDC’s Health Industry Insights senior research team and commissioned by Microsoft. You can download it here (XPS or PDF).
The white paper highlights the increasing importance of unified communications in the healthcare industry and what I believe is one of the most compelling yet often overlooked opportunities in health . The report offers insights and guidance to healthcare providers who are evaluating investments in communication technologies. It illustrates how unified communications can bring together all the ways we communicate on to a unified platform for messaging, e-mail, calendaring, scheduling, voice mail, telephony, audio, video, and web conferencing. This is technology that strikes a bulls eye by bringing sanity and order to all of the synchronous and asynchronous ways we communicate and collaborate in clinical practice. It doesn’t really demand that you turn your office upside down. It does offer an opportunity to vastly improve productivity, satisfaction, and bring order to the lives of clinicians and everyone else who works in healthcare.
If you want to avoid a demise like that department store I mentioned at the beginning of this piece, then please don’t put off going digital in your practice too much longer. On the other hand, there are some things you can do today that will immediately improve the way you work as well as your patients’ perceptions about your practice. And perception counts for a lot more than you might think. Just ask the unemployed sales clerks from that formerly proud, but now defunct retailer near my medical school.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Can Workflow Reengineering Improve Patient Care?
The past two days I’ve been hanging just outside of San Diego at the beautiful Rancho Bernardo Inn and Spa. I was invited by Panasonic executives to deliver a keynote address this morning at a retreat for some of the company’s healthcare customers and partners. I was given the 8:00 AM time slot on the agenda. The night before the group was treated to a lengthy cocktail reception followed by dinner, wine tasting and a cigar bar. After an evening like that, I was genuinely wondering if anyone would show up for my presentation. And just for the record, I didn’t smoke any of those cigars. I am, after all, a doctor.
Despite my reservations about the prior evening’s impact on attendance, the conference hall was packed this morning. It must have been the bountiful breakfast that dragged them out of their beds. Following my address on the impact of commodity software and the Net on medical practice, the president of Panasonic Computer Solutions Company, Rance Poehler, reviewed the merits of his company’s ToughBook line of laptop computers. 
I must admit that I was quite impressed by the information Mr. Poehler shared with the group. Healthcare demands devices that are not only mobile, but rugged as well. We clinicians have a propensity to drop things one in a while. Panasonic is projecting that healthcare will become a billion dollars business for the company, and I’d say based on the strength of their current and future product line, they’re in fine position. According to Mr. Poehler, Panasonic’s devices have a failure rate of just 2.5 to 5 percent depending on model. Yes, these laptops are a bit more expensive than devices from other companies, but according to information shared with conference attendees, many of the other well known brands have first year failure rates as high as 25 percent. Even at 3 years out, Panasonic claims a cumulative failure rate of just 15 percent.
The company attributes the low failure rate of their laptops to good design and the fact that their devices are "ruggedized". They also say product quality is high because they maintain full control over their manufacturing processes; something few, if any, of Panasonic’s competitors do. Panasonic products are built in Panasonic factories. When you factor in total cost of ownership, Panasonic appears to be a good fit for healthcare.
In November at the World of Health IT conference in Copenhagen, Denmark, (where I will be speaking at the Physician Symposium) Panasonic will unveil their much anticipated Mobile Clinical Assistant device based on the Intel design; a device similar to Motion Computing’s popular C5 and F5 models and solidly built with healthcare in mind. I’m thrilled that computer manufacturers are finally rising to the occasion by bringing us solutions that meet the unique demands of healthcare.
If Panasonic’s success in delivering high quality products to market is due to tight control of its manufacturing processes, one could wonder if healthcare providers could learn a thing or two by applying some of these manufacturing best practices to patient care. It turns out they can.
We have just released a new audio-cast in my House Calls for Healthcare Professionals series that examines how healthcare organizations can improve throughput and quality using workflow reengineering processes developed by other industries. My guests include Dr. Christopher DeFlitch, Director and Vice Chair of the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania. Also joining me on the program is Frank Kapper, Vice President and principal partner of the Orlando Software Group along with my colleague Ingo Heel, Microsoft Industry Sales Director for LEAN.
Find out how Hershey Medical Center has applied workflow process reengineering to their emergency room services to optimize operational efficiency and improve patient care. The program is available for streaming or download by following these links:
Applying analytics tools to boost organizational efficiency and optimize patient care: Streaming audio or MP3
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
“Think Green” with IT infrastructure optimization
As someone who has straddled the roles of physician, hospital vice president, CIO and CMIO, I know all too well the scenarios that play out every year at budget time in the hospital board room. Radiologists want the latest scanners. Surgeons are demanding new anesthesia machines. Nurses are requesting next generation infusion pumps for the ICU. Oh, and you Mr. CIO, you’d like to buy new servers, upgrade the network, deploy wireless, and institute a data recovery center. Guess who usually wins this boardroom grab for the gold? Not you Mr. CIO. You are usually last on the list.
How many times have you been challenged to do more, with more? I suspect not all that often. Healthcare is a challenging business with most hospitals running on thin margins, if they have margins at all. When there is money for capital improvements, the first priority is patient care and the expensive technology that enables it.
So where does this leave the CIO? How do you manage the demand for better IT? How do you meet the ever-increasing expectations of doctors, nurses, and other staff? What tools can be applied to drive greater efficiency into your operations? How can you get more from the hardware and software you buy? How do you get greater flexibility, redundancy, and reliability from your IT systems? How do you manage power consumption, and comply with your organization’s green imperatives? How do you do more with less?
The cover story in the August 2008 edition of Hospitals and Health Networks focuses on the national environmental movement and how hospitals are finding themselves at the center of this imperative to "think green". The timing was right in step with a new article I just released as part of my House Calls for Healthcare Professionals series. The title of the article is Laying a Foundation for Better Care; Optimizing your healthcare IT infrastructure for improved performance and lower costs. It’s a strategy that helps you squeeze quite bit more from what you have and manage it all much more efficiently. It is also a strategy that pays off handsomely by reducing the power load from all those servers in your data center.
To learn more and read what some of our customers are saying about the savings that can be realized through infrastructure optimization, click here.
And the next time you find yourself in the board room making a plea for what you need, just say "it’s for the environment". Think green! Now who could argue with that?
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
It’s Time to Go Digital in America’s Ambulatory Surgery Centers
Tomorrow I fly to San Francisco to provide a keynote presentation at the annual meeting of the California Ambulatory Surgery Association, also known as CASA. I’m looking forward to the trip not only to meet the membership of CASA, but also to have dinner with my daughter who is located in the Bay Area. For that reason alone, speaking at an industry conference in San Francisco is always an easy "yes" if I have room in my schedule.
So what am I going to say to the membership of CASA? Consider this. According to a 2008 national survey of ambulatory surgery center administrators conduced by Renaissance Research, 82 percent of America’s centers are still doing their work on paper. In other words, only 18 percent of centers say they are currently using an electronic record system. Stated reasons for this included the lack of an interface with administrative software, lack of capital investment, and lack of personnel to implement IT systems.
Of course, the 82 percent "no EMR" figure pretty much matches the state of the state across all of America’s physician practices which puts us behind nearly every other industrialized nation on earth. But compared to other kinds of medical facilities in America, ambulatory surgery centers are perhaps more vulnerable to another alarming trend; the globalization of care. After all, what is it that ambulatory surgery centers do? They provide out-patient, elective surgical procedures. And what kinds of services are more and more Americans seeking from providers based in other countries? What is it that fuels medical tourism? And what did more than 750,000 Americans leave the country to get done last year alone? Outpatient (and inpatient) elective surgery!
A study by Deloitte that was recently published in The Economist suggests that by 2012 as many as 10 million Americans will be seeking medical treatments overseas each year. That number is expected to rea
ch 15 million by 2016. The net loss to the American medical economy is estimated at $162 billion. Medical centers in places like South Korea, India, Mexico, Thailand, the UAE, and elsewhere will be providing high-tech, high quality care at just 15 to 30 percent of the cost for similar services in America. And because these state-of-the-art
, foreign facilities like Bumrungrad in Thailand or Wockhardt in India have all-digital records, they will be able to mine their data to provide complete cost and quality transparency in comparison to their American competitors. Their IT investments and competencies also set the stage for them to use the most contemporary web-based technologies to recruit patients, monitor outcomes, and excel in customer relationship management.
Many surgeons in the desert Southwest have already told me that their fiercest competition comes not from colleagues across town, but from facilities located across the Mexican border. You’ve probably seen ads from some of these centers in frequent flyer magazines and newspapers. You can expect the competition from such centers will only increase as millions more aging Americans seek ways to take the the bite out of ever-increasing, out-of-pocket healthcare costs.
So, what will I tell the membership of CASA? Unless you find a way to beat these competitors at their own game by being just as good and being able to prove it, just as digital, and just as efficient; in the years ahead you may very well find a dwindling supply of patients to grow your business.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
Microsoft HUG–Wish you were here Day 2
If you want to go straight to the really sexy stuff, scroll toward the bottom of this entry and see the photos and video of Microsoft Surface in Health. If you want a more complete view of the day’s proceedings, read on.
Yesterday ended with a very nice cocktail reception held at the Microsoft Conference Center; the site for our annual Microsoft Healthcare Users Group meeting in Redmond. I always look forward to the social events around our conference as an opportunity to catch up with good friends and business associates from around the country and the world.
Turning Health Data into Knowledge
Today kicked off with an opening keynote by Steve Shihadeh (left in the photo) VP of Sales and Marketing for our Health Solutions Group. Steve spoke on “The Transformative Power of Technology at the Intersection
of Physicians and Patients”. He was joined on stage by Dr. Clyde Wesp, CMIO for St. Joseph Health System in Orange, California. You may recall that St. Joseph Health System was recently featured on my House Calls for Healthcare Professionals audio-cast series when their CIO, Larry Stofko, spoke about the value his organization is experiencing with Microsoft Amalga.
Later in the day, conference attendees received a briefing on Microsoft’s Connected Health Framework and Platform in a presentation that was anchored by our senior technical strategist, Teddy Bachour. You can update your knowledge on that topic by visiting a previous HealthBlog posting with links to additional information on the Microsoft Developers Network, MSDN.
Facilitating Caregiver Communication and Collaboration
Both yesterday, and again today, conference attendees were treated to presentations given by my colleagues in our Unified Communications group. HealthBlog readers know that I am a huge proponent for the use of UC in healthcare. Our UC technology brings together messaging, e-mail, telephony, voice, video and conferencing. For developers, our UC platform enables a high degree of customization to better meet the unique requirements of healthcare. I was honored to join my UC colleagues on stage to review the huge opportunities afforded by Unified Communications that will fundamentally change the way care teams communicate and collaborate with each other and their patients. You can learn more by visiting one of my previous posts on this topic. You can also watch a video we produced that will help you envision the possibilities.
The Big News is Surface in Health
Although there is much more that happened at Microsoft HUG, it is beyond the scope of HealthBlog to cover it all. But I wanted to leave you with what I consider to be one of the highlights of the show and that is Surface Computing in health. Until recently, our Surface team has been focusing on other vertical industries. But from the first time I saw surface in Andy Wilson’s lab at Microsoft Research, I knew it had healthcare written all over it. It has taken some time to bring together the right developers and partners to apply Surface technology in health, but we are finally there.
I was thrilled to be asked to participate in the closing keynote at Microsoft HUG where we unveiled