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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.

The commodity storm; unleashing an EMR tornado for small physician offices and clinics

The commodity storm; unleashing an EMR tornado for small physician offices and clinics

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My latest travels took me to Louisville, Kentucky, where I provided a keynote for a breakfast event organized by Health Enterprises Network.  It was a gathering of more than 275 healthcare, business, and community leaders from around the central Kentucky region.

I don't know why, but I seem to have more than my share of perilous adventures on these trips.  Some of you will remember my hotel fire experience while speaking in New York City.  In Louisville, it was a brush with severe weather.  While I was across town enjoying dinner with a colleague, a tornado came precariously close to my hotel.  Management evacuated guests to the ballroom for cover.  When I returned to the hotel later in the evening we continued to have tornado warnings and very severe thunderstorms until the wee hours of the morning.  Needless to say, I didn't get a lot of sleep last night.

Earlier in the day following my keynote I had been approached by a physician who wanted to tell me about the EMR solution he had developed based on Microsoft Outlook.  To be honest, I frequently get contacted by physicians and business people who are anxious to show me their latest, greatest revolutionary new solution for electronic medical records.  I try to be polite, but I'm often thinking to myself "just what the world needs; another EMR!".  There are hundreds of EMR vendors out there.  Most of them, having just a handful of customers, pose a very real risk of going out of business at any moment leaving the physicians (and patients) who depend on them totally in the lurch.  But I think this story is a little different.

Urologist Dr. Michael Macfarlane handed me his card and briefly explained that he had developed an EMR solution to specifically meet the needs of solo and small physician practices.  It is based on Microsoft Outlook.  As the literature he handed me and his web site states, Outlook EMR is unique in that it harnesses the power and familiarity of one of the most popular and reliable information management systems on the market, Microsoft Outlook.   System requirements include Microsoft Small Business Sever (Premium), Microsoft Windows XP Professional and Office 2003 (Basic). 

This isn't the first time I've been exposed to EMR solutions that run on Microsoft Office.  In fact, when we released Microsoft Office XP five years ago we conducted a survey and contest to find out how physicians were using Microsoft Office in their practices.  We were actually surprised to learn how many physicians depended on Microsoft Office.  We were even more surprised by how many docs had tweaked it a bit to turn Office into a kind of low-cost, EMR solution for their practices.

Welcome to Office Online: (c) MicrosoftOf course, Microsoft Office out-of-the-box was never designed to be an electronic medical record solution.  But then again, I certainly understand why so many physicians have turned to Office for this purpose.  It is ubiquitous, easy to use, based on open standards, and very low cost compared to other solutions built specifically for the EMR marketplace.  Let's face it, physicians didn't become doctors due to their lack of initiative or intellect.

This isn't an endorsement of Dr. Macfarlane's solution.  I haven't taken it for a test drive.  But if you are the proprietor of a small physician practice or clinic and searching for an EMR solution, it is certainly worth a look.  From a global perspective as Microsoft's Worldwide Health Director I see this is yet another example of commoditization in the EMR business. It's something that needs to happen before we'll see universal adoption of information technology and electronic records in small to medium sized practices where 80 percent of American healthcare delivered by physicians takes place.  So to Dr. Macfarlane I can only say, "thank you and keep up the good work!"

Bill Crounse, MD    Worldwide Health Director     Microsoft Corporation

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  • (For my second blogg in almost as many days) Dr. Macfarlane's experience is exactly what the study of the economic history of innovation has found (eg Nathan Rosenber from Stanford).  The dynamic of innovation is by small, interative technical improvements, often opprtunistic steps, to make existing technologies better. Typically the adoption of innovation has been found to follow an "S" shaped progression with the initial adoption slow and haphazard as early adopters and producers grope with problems and large fixed costs of implementation. The typical dynamic of innovation continues and takes forms that standardize use, minimize upfront costs and specialized learning, and extends to complementary technologies. The recent failures of large scale RHIO's, as contrasted with Dr. Macfarlane's experience, implies EMR's are stuggling to move beyond the problem solving early adoption stage.

     Economic history has shown that innovations that survive and mature are those where there is fluid communication between producers and users for engineering tinckering and where the technology processes quickly take on standardized froms of operation. (Consider how Apple still makes and will always make shiny gadgets.)

  • Carl,

    Thanks for your comments.  You've hit the nail on the head.  A new day is coming in the EMR business that will bring lower cost, very powerful, standardized, commodity solutions for clinicians around the world.

    Bill Crounse, MD    

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