In my last Blog posting I hinted that a "new day was coming in Healthcare IT". As HealthBlog readers may have surmised, I had advance knowledge of an announcement that was made late last evening and is hitting the press today. That announcement is the purchase by Microsoft of a company called Global Care Solutions (GCS) of Bangkok, Thailand. The company produces clinical and back office solutions for enterprise hospitals. In fact, it was developed in one such hospital; Bumrungrad Hospital. In case you don't know, Bumrungrad is one of the leading "destination hospitals" in the world. Each year, this Joint Commission accredited hospital treats more than 1.2 million people who come from 190 countries.
We've been working with Global Care Solutions and Bumrungrad Hospital for some time now. Bumrungrad served as a case study hospital in the early days of our health industry vertical here at Microsoft. We visited the hospital on multiple occasions and profiled it as a best in class example for the the use of SQL Server in an enterprise clinical setting. Years ago we were astounded by the simplicity of Global Care's solution that, even then, was a marvel of clinical and back office work flow automation. Furthermore, it did all this by necessity in many foreign languages. Today GCS is implemented in 7 hospitals around the Asia Pacific region. The system is a fully integrated suite of clinical and back office modules (50 applications) designed to run in a single database operating exclusively on Microsoft operating systems and databases.
People come to Bumrungrad Hospital from all over the world for treatment. Many people comment that the hospital feels more like a 5-star hotel than a hospital, and it runs just as efficiently. Part of the reason it runs so well is because of the advanced IT solutions developed by GCS. Initial markets for GCS will include hospitals that want to purchase and implement a full end-to-end system that rapidly brings them to a fully integrated and mature IT state, as well as newer hospitals that want an innovative approach with a fully integrated HIS suite on the Microsoft platform. This includes hospitals and health systems in SE Asia and other developing countries like China and India.
By working together with GCS and Bumrungrad, Microsoft adds to a growing portfolio of health industry solutions such as Azyxxi. Combined with and surrounded by our ubiquitous knowledge worker solutions, data analysis and reporting capabilities, world-class communication and collaboration tools, and other resources, I think it is safe to say that a new day in healthcare IT truly has arrived!
Bill Crounse, MD Worldwide Health Director Microsoft Corporation
Microsoft Announces Global Care Solutions acquisition and Bumrungrad Hospital Partnership
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So, Dr. Crounse, what do you have to say now? I was right all the time along in my previous posts when I was saying that Microsoft will eventually buy or develop medical records information system. Microsoft is here to compete with its customers and partners in healthcare IT domain. And, please, don't tell me and other readers of the blog that it is intended not to be used in the United States but in the rest of the world like India and China - this is just a lie. Microsoft will sell it to anyone who asks for it eventually. It is here to make $$$ one way or the other. Yeah, New Day in healthcare IT turns out to be Good Old Day of Bad Monopoly Business Practices :)
Monopoly business practices? Is it a good thing that hospitals are now spending tens or hundreds of millions of dollars on highly proprietary, non-standardized information systems that are too hard too use and don't talk to one another? Is it good thing that physicians are being asked to buy electronic medical records systems costing ten thousand to fifty thousand dollars a seat from vendors that all to often go out of business leaving their customers in the lurch? I don't think so.
The healthcare IT industry is simply going through a much needed and long overdue period of consolidation and commoditization. The result will be more powerful, more intuitive, standardized, and much more affordable solutions. And if those savings translate to hospitals actually having more money to spend on patient care instead of IT, I fail to see the problem.
Bill Crounse, MD
Q: "Monopoly business practices?"
Q: "Is it a good thing that hospitals are now spending tens or hundreds of millions of dollars on highly proprietary, non-standardized information systems that are too hard too use and don't talk to one another?"
A: It is a hospitals' call.
First, Microsoft will charge same money - read millions for its systems as well - be no fool. You know the price tag don't you?
Second, I don't see how Microsoft solution is not PROPRIETARY. IT IS. HOW IS IT STANDARD? IT IS NOT. Microsoft does not represent any standard body. Is it ANSI/ISO of some sort? IT IS NOT. How is Microsoft different in this respect from GE,Epic or Cerner? IT IS NOT. Both hire people from same universities for similar salaries. And ALL these companies are here to make $$$.
Thirs, there are _integrated_ solutions out there - Allscripts, Epic, GE Medical Systems, Cerner etc.
Q: "Is it good thing that physicians are being asked to buy electronic medical records systems costing ten thousand to fifty thousand dollars a seat from vendors that all to often go out of business leaving their customers in the lurch? "
A: Read my previous reply. I said, Microsoft WILL charge similar price - millions of $$$. I don't see how Microsoft can reduce price and help the situation. It is not a copy of Windows OS Vista, which costs ~$100 and is affordable by ALMOST anyone since development cost is amortized over number of copies sold, it is not even a SQL server/Biztalk license which costs ~$25,000 apiece and sold in MUCH LARGER quantities then healthcare information system/EMR. So, how do you justify reduced price here? Microsoft may do so only to kill off other vendors since it can afford losing money, but here is it to destroy its own ecosystem of partners/ISVs. This is exactly behavior exhibited by MONOPOLY.
As for vendors 'going out of business' - GE Healthcare has been in this business for long time and still is and is not going out of it any time soon, same for Epic (in this business since 1970's), Allscripts etc. They ARE NOT going out of business - it is a very lucrative business to be in and very profitable too - that is why Microsoft is jumping on the wagon too.
I hope I explained it clearly. Any other questions?
One last comment:
Seems like Microsoft can not develop software by itself anymore and falls into business of buying out others. It is truly a marketing/sales and not a software company any longer. It is clear now why good engineers don't want to work for it. Buying someone else and re-branding under Microsoft is very smart indeed! Being utterly sarcastic...
This comment addresses points made by Guest. First, responding to 10/30 post, Guest ponders whether Azyxxi is ultimately condemned to follow a long line of huge HIT snafu's, like the Epic failure in Kaiser's Sisyphusian efforts to implement global HIT. Second, is the purchase of Global Care really just a vertical integration towards an EHR, thus competing with MS's vendor customers. And, third, why does MS buy rather than develop (in other words, are MS engineers really that lazy)?
HIT operates in highly complex, process-critical medical environments so that accumulating glitches can catapult into severe and catastrophic disruptions. (How about the debacle of Cedars Sinai's $34 million CPOE goof where nobody bothered to check whether it would fit the work-flow.) Moreover, since the processes of health care are embedded in a mix of cultures – that is the practice specialties, payment systems, organizational and institutional structures, and the technology experience; it follows that successful HIT applications must be "friendly" with the culture of the health care delivery.
I offer four observations: 1) Azyxxi, Dr. Macfarlane's individual EMR solution (10/19), and Global Care were all developed by users; 2) As such, the development processes included extensive "learning by using", problem solving engineering to best fit the technologies to the needs of the users (check out Prof's Paul David and Nathan Rosenberg extensive study of innovation); 3) Therefore, all of these technologies will likely succeed within their cultures, at least until better technologies appear (note that for the snafu technologies there was a Grand Poo-ba that imposed HIT constructions, perhaps with limited fitting into the cultures); by the same reasoning, it is a big stretch to think that the Global Care is generalizable as an EMR system. And 4) the MS strategy of buying successful applications is a great strategy; obviously, MS is well positioned as the primary tool maker to ID the best applications.
If I were an EMR/EHR vendor I would be less worried about MS becoming a competitor than the competition from the ingenious Dr. Macfarlane's, whether as individuals, small and large groups, or large networks, who understand that the HIT tools can be cobbled into solutions to fit their processes and culture.
Thanks for sharing your wisdom. Guest has an axe to grind, and my words will never convince him otherwise. I will leave it to the voice of the customer, and the many innovative leaders and teams around the world who are building and deploying fantastic solutions using our technologies. I maintain that commoditization will happen and is happening in the industry. There is evidence all over the world. Prices will fall, and everyone will be better served.
Bill Crounse, MD
I am an engineer and know this industry very well. Better then you can imagine :) So, you don't have to convince me in anything. Good grief :))) Whole HSG division of Microsoft working on something which could have been done by a handful of people in ~ 1 year time frame without any acquisitions. What a waste of resources!
If what Guest says is really true, "which could have been done by a handful of people in ~ 1 year time frame", why does he not go ahead and have a go at it... especially since he is an engineer and knows the industry so well....
Thanks for the comment. I welcome all comments on this blog so long as folks are respectfull to others and to each other. Guest is entitled to his opinions. What ultimately counts is how customers respond to the healthcare solutions and services offered by Microsoft and our partners. I would add that healthcare is a huge and complex industry. There's plenty of room for creative people and companies around the globe to add value.
Bill Crounse, MD
:)))) junkfellow, you never worked at Microsoft, did you?
My comment was not intended to hurt or mock Guest. I just wanted to highlight that it takes more than just a handfull of dedicated engineers and developers to implement and deploy, an incredible healthcare solution, across the globe.
Guest, appologies if i offended you.
It would be interesting to know, if microsoft plans to make it's HIS solution, a product (like money), or it will handle each implementation as a project (like most vendors do).
There is nothing special about health care needs or workflow, nothing that other industries don't have. I think Guest is right that with development tools available today modeling a business process is easy. You can have a product out of the door in a year or two. What makes HIT stand out is business logic. That knowledge is proprietary to many companies and is different in different environments. When you copy the logic - that is when you "steal". What wrapper you put around it does not really matter.
I myself am from HIT industry and listen with some disbelief Microsoft's statements about not stepping on each others foot with partners, niche vendors, etc. Words don't mean much, what matters is what they do. And that clearly points in direction of providing affordable off-the-shelf, modular HIT suite for mid size hospital. Large size hospitals and specialty places will always be projects, you hardly can develop something that will fit every clinical need - practically impossible. But the mainstream can be easily covered with a modular product where you pick and choose the functionality and grow the system as needed.
Personally I welcome the change. I think it is inevitable that health care gets demystified, it is just a business as any other industry, and should be governed by the same rules. Products that provide benefits to customers succeed, the rest should go away. But please Microsoft don't try to convince us that these recent acquisitions are a "friendly move" for the rest of industry, more like "friendly fire"...
With best wishes,
High School Teacher Shares Her Tragic Story in the Public Schools to Promote Electronic Medical Records
My name is Eunita Harper Winkey a high school teacher and the Founder/President of ATWINDS Foundation “A Teacher’s Work Is Never Done Services.” I’m a victim of medical errors and I share my tragic story in the public schools to help combat the issue with America’s poor healthcare system. ATWINDS mission is to raise awareness that research study shows that "Medical errors are a major cause of injury and death in the United States. The now-famous report by the Institute of Medicine estimated that 44,000 to 98,000 people die in US hospitals each year as the result of medical errors. (This means that more people die from medical errors than from motor vehicle accidents, breast cancer or AIDS.)" We also are advocating for Electronic Medical Records. For more information visit medicalrecordawareness.com and atwindsfoundation.org.