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'm not an MD or DO; I work for an HMO in their Information Systems group. Like you, however, I have a passion for the topic of healthcare and I try in my own way to contribute to the conversation. Assuming your question "If not Microsoft or Google, then who?" isn't rhetorical, I'd like to answer it with a question of my own: where is Yahoo! in all of this?
The Marketing Pilgrim has a post hot on the heels of that NYT story that shows Web search bit-player Ask.com is jumping on the ehealth bandwagon, which shows that there's a relevant business model for "pure" Web companies; OrganizedWisdom is gaining traction - and attention - as an "online healthcare community," showing that the MySpace/Facebook model can be applied to healthcare.
No disrespect intended towards your employer, but Yahoo! is much more focused on these two areas ("pure Web" and social media) than either Microsoft or Google, yet Yahoo! Health is one of the few Yahoo! properties where user-generated content is secondary to content from paid "experts." And while they've *finally* started to add links to relevant Yahoo! Groups with their articles, that content is external to the site. Also, the whole of Yahoo! Health doesn't have a team blog, nor a link on the main Yahoo! page.
Any ideas on why a company that's staked its future on user-generated content and "the social Web" seems to be ignoring one of the most underdeveloped, yet potentially profitable, verticals in the market today?
Thanks for your comment. Although my question was a bit rhetorical, I didn't mean to limit the conversation to Microsoft and Google. There will be many players involved in transforming healthcare. The market is just too big for any one company to dominate. Yes, I expect Yahoo to be a player and also Revolution, WebMD as well as many of the traditional global healthcare companies like GE, Siemens, etc. Each brings something to the table. Change will be evolutionary, but I believe forces are now at work to bring changes sooner rather than later. As I've said before, it is an exciting time to be involved in healthcare IT. It is also exciting to see so many industry insiders (doctors, hospital administrators, nurses, clinical executives, CIOs, CMIOs) demonstrating leadership and a willingness to work with experts from other industries to improve the patient experience and the quality of care.
Bill Crounse, MD
Being a physician I truly think that retail clinics are a bad idea and cannot be clubbed in the same category with home health, patient self-service, physician-patient e-mail, personal tele-health services. While agreeing that physicians "haven't been listening to their patients", it seems that even a physician like yourself has not made the case as to why this has been happenning. The most important necessity for a decent conversation is time, and with progressive decreases in physician reimbursement and continued acceleration in costs of doing business, physicians (especially primary care physicians) have been forced to increase their volumes over time. As we all know, there are only a finite number of hours in a working day. So why is it surprising to anybody that contact time between physician and patient has decreased so much?
I am sorry to say that despite their size and reach, neither Google nor Microsoft nor Yahoo can bring about major change in healthcare because they cannot produce the principle product in this industry - medical care - which makes it imperative that the providers of care are appropriately recognized and involved in making it happen.
"Patients want healthcare to behave like other industries" is possibly true, but a majority also believe that physicians somehow should not follow strict business models when dealing with patients - for example, patients getting upset when asked for co-pays or patient-responsible payments will most often refuse as a first response. I would like to know how many folks will have any choice if they have to pay for other professional services such as an accountant or legal? Which professional will provide service accepting 50% of billed payments after a 30-45 day delay, with no guarantee of payment even after the waiting period?
Finally, I am very surprised when well-informed individuals toe the line that health care costs are too high. I am waiting for the day when people actually look at the "real cost" and admit that the real inflation is in the cost of "health insurance" not "health care". How can you say that the cost of purchasing health care is increasing when Medicare physician payments have remained stagnant at 2005 levels, and most private payers have pegged their rates to that of Medicare? In other words provider payments have actually fallen much below the Consumer Price Index over the past 5 years. Reforming the "system" should start with an honest look at the numbers first in order to have any legitimacy at all.
Here is some funny reading:
Why Microsoft and Google health plans are sick
As always, thanks for your contributions. My Blog is meant to be an open forum and as long as people are respectful of others it will remain that way.
I would like to point out that although it was Mr. Shihadeh who was quoted in the NY Times article (a sales leader yes, but also a career-long and very knowledgeable health industry IT executive), there is a lot more depth to our healthcare industry initiatives at Microsoft than one might gather from reading either the Times article or the response you posted from the Valley Wag.
In our Health Solutions group alone, there are at least a dozen physicians working on various aspects of our consumer health platform and our enterprise solutions. There are several brilliant physicians working on solutions at Microsoft Research. There are numerous other physicians, clinicians, and industry experts working all over the world in our Healthcare and Life Sciences group, our US Public Sector team, and our Worldwide Public Sector healthcare group.
The investments being made by Microsoft to develop health industry solutions here at the company and through our extensive ecosystem of partners are very substantial. The work that is referenced in Mr. Lohr's article in the NY Times is just the tip of the iceberg.
Bill Crounse, MD Worldwide Health Director Microsoft
My thoughts on the article:
Regarding Robert Nadler's post (above) I would refer readers to two different initiatives that clearly show how Microsoft is closely aligned with the goals of NHIN, how we embrace world-class open standards in the healthcare industry, and what we are doing to improve patient safety through the design of a standardized (common) user-interface for clinical systems.
See http://blogs.msdn.com/healthblog/archive/2006/11/22/the-connected-health-framework-a-service-oriented-architecture-for-health-it.aspx for information on our vendor agnostic Connected Health Framework and Architectural Design Blueprint.
See http://blogs.msdn.com/healthblog/archive/2007/07/13/a-common-user-interface-to-clinical-systems-making-it-real.aspx for information about our work with the National Health Service on the design of a common user interface.
Worldwide Health Director
While I find the healthcare debate very interesting, I think more focus should be placed by people of all views on reducing preventable disease. A couple weeks ago on C-SPAN I saw some guests on the morning show discussing the issue. According to them largely preventable chronic diseases like diabetes and heart disease make up a huge percentage of the overall cost of healthcare. If we as a country are facing a healthcare cost crisis down the road, the first step in reducing future costs should be to go right to the future source of healthcare costs, the patients. While we debate healthcare delivery options and costs, we should all agree that we should invest now to stop the childhood obesity epidemic and get people in the habit of making healthy choices. I think the food industry has made a merely token effort to get people to make healthy choices and the government needs to educate people to the reality marketing and the decisions they need to make to live long healthy lives. What they're doing now isn't working and I would like to see some fresh ideas on the topic from our leaders.
I fully support the notion that we need to put much greater emphasis on prevention. Here again, we must first address the perverse incentives in American healthcare that reward doctors for treating disease rather than preventing it. Technology will play an ever-increasing role in helping us manage individuals and populations who suffer from chronic disease, but we'll never get ahead of the curve unless we get on top of the lifestyle and other factors that contribute to the skyrocketing incidence and prevalence of the most common chronic diseases.
Doctor Google and Doctor Microsoft; if not them, who?
Well said. I absolutely agree a change is in order. I am a newly qualified medical doctor that grew up in the United States, trained in Poland and did my residency in England. I now work for a Norwegian company, representing my profession in the work of eHealth and standardization. Comparing my experiences and work in other countries, I agree with you that the US falls short of providing citizens with essential quality care.
I look forward to the future, where health care personnel will be integrated through a variety of advanced and secure paperless platforms. The electronic patient journal, summary care record, ePrescribing, and offering patients help via an online health portal is the way forward--worldwide.
New forms of interaction with the patient are vital to improve quality care, irrespective of where. From offering convenient retail clinics to incorporating smarthouse technology into the home for chronic management-all the while, providing support along with medical care.
Tomorrow's patient won't care where they get medical attention, what they will want however, is: affordable, convenient and effective care. Today's health care system puts limits and out of reach options on forms of care to a large percentage of our population.
Medical professionals haven't been listening to their patients. Fortunately, it's my generation that will have technological tools to facilitate the road ahead.
Thanks for your comments, Jessica. The hope of our profession rests with dedicated, compassionate young people such as you who are willing to embrace technology and develop new paradigms for the delivery of patient care. Working together we can truly improve health around the world.
Its good to hear from the new Medical Doctor. While agreeing with Dr. Gabin's ideas and ideals, I must point out that the critical point in her resume is that she is employed by a large corporation, hence making such ideal scenarios plausible.
With Tech companies nickel & diming the physician-customer and litigation-hungry sentiment (at least in the US) there is no real way that such an environment can be realized in the near future. Just as a reminder, any quality service deserves quality reimbursement. So one cannot expect quality care when the quality of reimbursement keeps deteriorating and the cot of doingbusiness keeps increasing. I am afraid idealism doesn't work in such an environment.
Thanks for your comments, Arvind.
I think you'll find me squarely on your side of the reimbursement debate. I've spent a great deal of my career as an advocate for physicians and for appropriate reimbursement of services including the provision of their cognitive services by telephone, e-mail, tele-visits, etc. Progressive governments and payors around the world are beginning to understand the value equation in extending physician services by means of technology and appropriately rewarding them for their participation.