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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

Telemedicine, e-mail and messaging "oh my"!

Telemedicine, e-mail and messaging "oh my"!

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I wanted to draw your attention to a just released interview I did with Digital Healthcare and Productivity.  In it, I talk about one of the most worrisome trends I see in US healthcare; how far we are falling behind the rest of the world in the use of information technology in the industry, including the provision of health and medical services via the web.

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 

 

  • We need a National Policy that ensures there is High Speed Broadband Access for all Americans, with a special emphasis on the rural and underserved areas of our Country. For ideas on how this can be achieved check out CWA's website at www.speedmatters.org

  • I read the article by Dr Crounse and listened to a very informative talk at last years American Telemedicine Association meeting in San Diego and would like to make a couple of comments.

    Having been closely involved in the development of technology for healthcare in the UK and the USA for several years I would like to highlight some lessons learned by comparing both experiences, and appreciate some feedback about challenges that impede progress.

    1) As most people know, the UK Healthcare system is undergoing significant change resulting in a multi billion $ investment in healthcare IT. For innovation driven SME's this has been a major challenge with all of the investment focused on getting the basics right. The Connecting for Health Initiative, driven from the NHS plan is well meaning and is not without its critics, sometimes for good reason, but no one can blame the UK government for taking on this massive challenge. Everyone has a better way to do it and everyone is ready to jump on any issue and be the prophet of doom. However, there are some excellent things happening that go largely unreported.

    Our approach to being a new company developing a totally new technology platform seven years ago in a market dominated by the major players was different and it needed to be. We took the view that the "logical" approach would be for the NHS / DOH to develop storage, messaging and infrastructure as their primary tasks before getting down to applications software. We also took the rather cynical view that the program would overrun in cost and time rendering innovative clinical applications software a moot subject. We also understood that the major players in that market would win the business and they did, any company wishing to enter that melee would have to do so through the so called LSP's (consortia to deliver regional solutions). This meant that our business success would be dictated by third parties and subject to sub- sub- sub contracts, not attractive to those nice VC people putting their hard earned cash into our business, or indeed my sanity as a business / technology pioneer. So our approach was to develop a workflow management applications software platform using  .NET and our own SOA approach. The rationale behind this was that we could connect distant locations and route that information to a server and on to a clinical interpretation location. This has the effect of completely automating the patient care pathway. The UK Department of Health was interested in this approach to address the problem of Diabetic Retinopathy which they were committed to solving for the 1.4 Million patients in the UK with diabetes. This project was outside of the CfF and LSP core tasks but had a $50M budget attached to it. The technology developed proved to be world class and we presented the technology to the thought leaders in the US.  This is where the contrast is so stark. (No pun intended)

    2) The US approach to addressing preventative healthcare is of course radically different both in terms of delivery and resource. The pioneers of technology adoption in the US turned out to be the top university medical schools, the military and the VA. The standard of clinical practice in the US is clearly the best in the world with brilliant clinical innovators and certainly the best research base anywhere, however there is of course no central policy unit that allocates resources or defines standards and methodologies in the US for preventative healthcare initiatives. I have to say that the Universities and the US Army and Navy have been outstanding in grasping the issues and supporting the initial programs to the point at which most payors now approve the process and the reimbursement. Medicare and the VA however has been a different experience entirely.

    With Medicare there seems to be some "resistance" to the entire concept of preventative healthcare technology despite the plethora of literature that underpins the evidence base. With the popualtion is getting older, the economic burden of healthcare now exceeding 15% of GDP how do the policy makers think this is going to change without technology adoption and innovation? Our industry holds the key to solving this problem.  

    So, our US go to market strategy was adapted to a model where we provide the connectivity and administrative services under a Software as a Service model. The SOA approach meant that we could place image and data capture services at remote locations and the image evaluation and reporting in an Ophthalmologists office some distance away. This gained immediate traction particularly with primary healthcare groups who have a significant problem managing patients with diabetes and are incentivized to improve services through Bridges to Excellence and P4P programs. So we have a cost effective technology built on a well proven platform that is already supporting the health of more than a million patients. So you can understand that Medicare is highly enthusiastic about the approach - Wrong. There have been mutterings in certain states hinting that for unarticulated reasons this practice will be stamped on.

    So we have 20 million people in the US with diabetes, most of whom are not receiving an eye exam but are fully entitled to it, unable to access a system that would help prevent or defer blindness, save money and improve the practice of medicine. I can't help but think that Homer Simpsons' standard reaction would be somewhat apposite here!

    So I am intrigued to know how to affect or influence policy when the irrefutable evidence is in support of an innovative technology solution that is proven to work. We are not talking about routine screening here, we are talking about automating an end to end healthcare process that bridges primary, secondary and tertiary healthcare. We are connecting up the bits of an entire clinical process. Its a glowing example of what can be achieved through partnership between industry and medicine.

    If the answer really is hire a lobbyist and add a significant number to the p&L so be it, but I can't help thinking there must be a better way. There must be fundamental common goal between industry and clinical leaders to establish standards, work with health providers and merge technology with the practice of modern medicine.

    Apologies for the length of this note, but I really would like to hear from folks who have identified with this issue and have found effective ways of moving their cases forward.

    Gerry Skews

    Founder - Digital Healthcare

    e-mail. - With a name like mine its not hard to find

  • Hi Bill,

      Singapore can do it probably it's because of the vision the leaders have in mind, and due to the fact that it's a very small country, that make the executions of plans much, much more easier, if to compare to US. Probably, you shld just compare the Silicon Valley with this island-nation, both are about the same size..

  • Singapore has typically proven more agile in such circumstances. The US is certainly not above picking up some of their "lessons learned".

    Carmelo Lisciotto

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