HealthBlog

I'm writing today from Boston, Massachusetts, where I just delivered the opening keynote at the World Congress Leadership Summit.  The conference is being held at the new and very lovely Renaissance Waterfront Hotel.

If you've noticed a nautical theme on HealthBlog from time to time there's a very good reason for it.  I grew up in the Pacific Northwest in a fishing village on the waters of Puget Sound.  The sea is very much in my blood. I find that whenever I'm near a seaport and can smell the ocean air or hear the cry of a gull, I not only get nostalgic about my boyhood but I have an almost uncontrollable desire to get down to the water.  So after my keynote this morning, I took a long walk.  That's when it hit me; the connection (at least metaphorically) between today's topic on HealthBlog and the sea.

The theme at this year's Leadership Summit is "The Road to Interoperability".  My keynote on global healthcare industry trends was followed by a "reactor panel" moderated by Janet Marchibroda, CEO of the eHealth Initiative.  Panelists included Bill Beighe, CIO of Physicians Medical Group of Santa Cruz; Barbara Blakeney, RN, Innovation Specialist at Mass General Hospital and Past President of the American Nurses Association; and G. Daniel Martich, MD, CMIO and Associate CMO, at the University of Pittsburgh Medical Center.  In my presentation I had discussed the 5 global trends; increasing personal responsibility, "retailization" of health services, "commoditization" of services and providers, information everywhere, and globalization.  The panel reacted to my keynote by giving examples of how their organizations are being impacted by these global trends and what they are doing to address them.  The conference continued with a number of other presentations and breakout sessions on how to achieve interoperability in our health system, and what it will take to get us there.

In 2004, George Bush proclaimed that most Americans would have an electronic health record by 2014.  So here we are 4 years later, and despite a lot of focus on establishing the Office of the National Coordinator for Health IT, promoting the concept of a National Health Information Network and seeding Regional Health Information Organizations with millions of dollars in federal and foundation grants, one could argue that we aren't much closer to getting where we need to be than we were four years ago.  However, in those four years something else has emerged that is proving to be truly disruptive.  It's the idea of aggregating health information around the consumer as perhaps a better and certainly less costly solution than trying to interconnect every hospital, clinic, doctor's office, imaging center, lab, payer and other player in our complex ecosystem of care.  And what is at the center of this change?  It is patients and healthcare consumers themselves and the emergence of new technology models such as HealthVault, Google Health, Medical Record Banks, Dossia, and other solutions that appear to be leapfrogging the need for NHIN, RHIO's, or other efforts to hard wire a connection between every health facility.  If there is a buzz in the air at this conference it is that bow wave of new ideas.  This truly represents a "sea change" in our thinking on how to achieve a portable, always available, and interoperable "electronic record" for most Americans by 2014.  In fact, I now believe we may get there well before that date rolls around.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

Earlier this week we launched a redesign of the health pages on www.microsoft.com.  Those paying attention may also note that the site is now accessible through /health rather than only /healthcare although either address will take you to the new front door.  This subtle change acknowledges the fact that there is much more to health than just health care and that we are putting even greater focus on technologies and solutions that cross the entire spectrum of health, from enterprise organizations right down to individual patients and consumers.

The first thing you will notice about the new site is a redesigned front page enhanced by SilverLight, with further upgrades to come over the next several weeks.  It has much cleaner navigation to the various segments in our health-related lines of business.  This includes not only information about IT solutions for providers, health payers, and life sciences companies, but also solutions from our rapidly growing Health Solutions Group and their portfolio of products and services including the Amalga Unified Intelligence System, Amalga Hospital Information System, and HealthVault.  We have also added a direct link to solutions that address the business needs of Health and Social Service agencies as well as information that is of interest to health IT executives.  By following any of these links you can drill down on a wealth of information including solution descriptions, partners, case studies, white papers, web casts, and more to help you improve operational efficiency, delight employees and customers, and provide safer, higher quality and more satisfying care to your patients.

Next week I'll be in Boston to provide an opening keynote for the World Congress Leadership Summit on "The Road to Interoperability" where we'll be debating what "change looks like" in the world of Healthcare IT.  I hope to see some of you there.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation

Healthcare is a data intensive industry. But all too often, that data exists in silos. Health data also tends to be widely dispersed across multiple hospitals, clinics and providers. Data that exists in isolation or is impossible to access has little value. But today powerful software and solutions are available that can turn health data into information and information into knowledge; knowledge that not only improves business and clinical operations of our hospitals and clinics, but also the personal health and well being of patients.

At Microsoft, our goal is to improve health and the lives of people around the world with innovative software. Our Health Solutions Group is focused on solving some of the most difficult challenges faced by healthcare administrators, clinicians and patients themselves when it comes to managing and learning from, the massive amount of data in healthcare. In particular, the group has developed a powerful solution that helps turn data into knowledge for hospitals, health systems, clinicians and researchers. It’s a health intelligence platform known as Amalga. In addition, last October the group launched HealthVault for consumers; an on-line platform that provides a means to store, share and connect your personal health information in ways never before possible.

More than a dozen of this nation's leading healthcare organizations have enrolled as first customers and development partners for Amalga.  They range from large enterprise hospital systems and community hospitals to renowned academic medical centers and research institutions.

One of those first customers is St. Joseph Health System in Orange, California.  In this special edition of my House Calls for Healthcare Professionals series of monthly audio-casts, Larry Stofko, St. Joseph's Senior Vice President and CIO, discusses how his organization, their patients and community are benefiting from Microsoft Amalga.  Later in the program, I'm joined by two of my Microsoft colleagues to discuss not only Amalga, but also the latest news and developments regarding Microsoft HealthVault.  I hope you enjoy the program.

Stream the program here

MP3 download here

Bill Crounse, MD    Senior Director, Worldwide Health    Microsoft Corporation

Program Guests

Larry Stofko, Senior Vice President and CIO, St. Joseph Health System, Orange, California

Stephen Gordon, Sales Executive, Microsoft Health Solutions Group

Grad Conn, Senior Director of Global Consumer Health Strategy, Microsoft Health Solutions Group 

Last week I met with two company CEO's here in Redmond who wanted to show me their latest solutions for telemedicine, bedside monitors, and home health remote monitoring.  It should come as no surprise that neither company is based in the United States.  If you've been a follower of this Blog you know that I tend to see much greater use of telepresence technologies in healthcare beyond US boarders and especially overseas.  It's not that we don't have the technology in the United States, it's just that the business model for using it isn't as compelling as it is in countries that have more centrally managed, publicly financed health systems.

The first company I met with was TeleMedCare of Rosebery, Australia.  Professor Branko Celler, TeleMedCare CEO, is a bioengineer by training.  You might assume he was a physician when hearing him speak about the telehealth solutions his company has pioneered.  Throughout the demonstration of TeleMedCare's latest solutions and devices, their clinical rigor shined through.  Professor Branko (he still maintains a professorship at New South Whales University) is passionate about using technology to extend health information and medical services to people with chronic diseases.  He totally understands why such an approach not only saves money, but improves personal health and well being.  He cited numerous examples of this from the many pilots his company has conducted with patients in Australia and the UK.

I was particularly impressed by seeing the company's latest telehealth monitoring station in action.  The station is about the size of a small, flat screen television.  It can measure temperature, pulse, blood pressure, weight, peak flow, pulse oximetry, and glucose using a variety of attached and Bluetooth compatible devices.  The unit can also handle fall monitoring and social alarms, do health screenings and patient education, and provide medication management and monitoring functions.  With a built in camera and voice over IP setup, it can serve as a real-time telemedicine link to the patient's own healthcare providers.   The monitoring station was remarkably unobtrusive and simple to use.  According to Professor Branko, even elderly patients adapt to the technology with ease.

My second meeting was with a company I've been following for some time.  That company is QualiLife, one that I've written about previously on this Blog.  QualiLife is based in beautiful Lugano, Switzerland.  I've met with QualiLife CEO, Claudio Giugliemma, on several prior occasions here in Redmond and also in Zurich.  In our meeting last week, Mr. Giugliemma updated me on his company's latest technologies including their new patient bedside counsels.  These flatscreen devices provide hospitalized patients with music, television, movies and patient education on demand, Internet access, e-mail, messaging, and voice and video communications.  In a federated network, doctors can do virtual rounding on their patients from anywhere.

QualiLife got its start by developing computer software for people with disabilities.  By applying this discipline to their bedside counsel solutions, the company offers a user interface to its applications that makes them accessible to anyone regardless of age or disability making this the ideal solution for hospitalized patients.

Unified communications technology is now being combined with smart software, affordable base stations, and a full array of connected physiological monitoring devices for use in the home, hospital, and everywhere in between.  This signals the beginning of a revolution in telehealth; an independence day or sorts for telepresence in healthcare.  It's time to celebrate.  And for my US readers, Happy 4th of July!

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

"In a controlled nonclinical trial setting, RFID technology is capable of inducing potentially hazardous incidents in medical devices. Implementation of RFID in the ICU and other similar health care environments should require on-site EMI tests in addition to updated international standards".

So concludes a study published in the June 25th edition of the Journal of the American Medical Association.  In the study, incidents of electromagnetic interference with medical equipment were far more common with passive 868-MHz chips than active 125 kHz RFID systems.  The median distance at which all RFID incidents occurred was 30 cm with a considerable range up to 600 cm.  41 medical devices (IV pumps, anesthesia machines, monitors, defibrillators, etc.) were tested using both chips.  The results included a total of 34 incidents of reproducible electromagnetic interference, 22 classified as hazardous and 2 as significant and 10 as light.

The results of this study are cause for concern and may prompt some hospitals to seek alternatives to RFID for real-time tracking of equipment or staff especially in critical care areas of the hospital.  One such alternative was brought to my attention during a recent visit to hospitals in Norway.  At the grand opening of the European Center for Health Innovation in Oslo, I met briefly with Ragnor Bo, CEO of Sonitor.

Sonitor is a physician-founded company that has pioneered the use of ultrasound in an indoor positioning system that can automatically track precisely, by room, the real-time location of moveable equipment and people in complex indoor environments.  Mr. Bo handed me one of the company's patient wrist bands (pictured).  The bar-coded band has a light-weight ultrasound tag.  The tag is housed in a disposable outer case that also contains a small battery that powers the device.  Similar tags and receivers can be used to precisely pinpoint the location of equipment or personnel within a room or even focused sub-zones of  room.   USID, as the technology is sometimes called, is much better than RFID for room-level location because ultrasound waves, unlike radio frequency energy, don't go through walls or floors.  The tags are also being applied in scenarios that enable proximity log-on to computers or other equipment.

A detailed review of USID is out of scope for this Blog.  However, you can learn much more by visiting Sonitor's web site.  They also have a very nice animation that illustrates why USID is better than RFID for precise room location tracking.  I suspect the article in JAMA will only accelerate Sonitor's success in the marketplace; success that has already placed the technology in 27 hospitals,  23 of these in the United States.

Bill Crounse, MD   Senior Director, Worldwide Health    Microsoft Corporation

I'm back from my travels in Norway.  While I was gone, we published a compelling case study that illustrates how software can be used to improve patient care in busy clinical settings. 

At Microsoft, we published dozens of health industry case studies every year.  But it's not every day that we get quotes like this one.  "In three days’ time, Microsoft and Orlando Software Group were able to provide us with more business intelligence and insight than we were able to achieve in two years of study."  Those are the words of Dr. Christopher DeFlitch, Director and Vice Chair of the Department of Emergency Medicine at Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania.  Dr. DeFlitch is a strong advocate for process modeling and analytics tools in managing core process redesign initiatives in healthcare delivery systems.  Recently, DeFlitch and his associates learned about ProcessView, a design and analysis tool and add-in to Office Visio Professional 2007, from Microsoft Certified Partner Orlando Software Group.  They used the software to simulate and analyze complex and time-critical processes involved in properly diagnosing and caring for acute coronary syndrome patients arriving at the ED.“In about three hours, we were able to create a top-level process flow diagram for the overall process,” says Frank Kapper, Vice President and principal partner of Orlando Software Group. “We found there were 88 unique workflow paths, and within that, 15 workflows occurred 90 percent of the time.” With this information, the department was able to focus on the highest-occurrence workflows and make sure it had the proper staffing, equipment, supplies, and other resources.

There is a whole lot more to this story than I am able to cover on my Blog.  You can read the full case study here.  Any physician, nurse, or administrator charged with improving clinical workflow and quality of care outcomes will benefit from reading the report.  It's just one more example of how software can be applied to solve some of healthcare's most pressing issues in caring for our patients.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation 

My Norwegian healthcare tour comes to a close today.  On Wednesday we visited with physicians and executives at Asker and Baerum Hospital. We also participated in the grand opening of the European Health Center of Excellence.  On Thursday, we met with officials representing the 15 hospital trusts in the South East Norway Regional Health Authority and toured the new $1.6 Billion Akershus University Hospital.

Asker and Baerum is a more typical Norwegian community hospital and certainly less glitzy and grand than the newer facilities we visited.  However, the physicians at Asker and Baerum were absolutely delightful and extraordinarily engaged in our discussions about clinical information systems and the opportunity to use IT to improve care quality and safety.  I especially enjoyed meeting a young doctor, Arne Soraas, who was responsible for the intensive care unit.  Dr. Soraas and his peers have developed on-line tools and workarounds that help solve workflow issues not addressed by their core clinical systems.  All patients at the hospital have an electronic chart, but we agreed there were many opportunities to improve staff productivity and access to information at the point of care.  It was refreshing to see physicians so engaged and interested in using computers in the care of their patients.  Could it be that this new, young generation of doctors, physicians who literally grew up with the PC, will take this industry where it needs to go? The hospital lacked a wireless network, and we all agreed the physicians would be better served when mobility is added to their solution mix.  In the meantime, they are quite happy using their clinical work stations.  A recently added speech recognition system helps speed data input.

Wednesday afternoon I provided a keynote for the grand opening of the European Health Center of Excellence.  The Center is a joint project of HP, Cisco, Imatis, Telenor and Microsoft.  It features a two-bed hospital room mockup with some of the very latest solutions for patient monitoring, bedside patient entertainment and communication systems, and caregiver collaboration solutions.  Visitors to the center will have an opportunity to "test drive" and learn more about these technologies as they plan implementations for their own facilities.

On Thursday afternoon, we visited the new Akershus University Hospital.  Like St. Olavs Hospital in Trondheim, this is a full replacement program for the university's old facility.  The new hospital is designed totally around the patient experience and offers amazing architecture, soothing environments connected to nature, and of course, a lot of high-tech, digital technologies.  The cost of the new facility will be offset in part by expected increases in staff productivity and streamlined operations from the hospital's advanced IT solutions and improved clinical workflow.  The entire project has been guided by the hospital's own employees and division leaders with a lot of input from patients.  Everyone is looking forward to the grand opening of the university hospital's new facilities.

I would like to give special thanks to my Norwegian hosts.  In particular I would like to thank Dr. Jan Stomer in Tromso for his generous hospitality during my visit.  I would also like to give special recognition to my Microsoft colleagues Jan Rylund and Helge Blindheim for their tireless efforts in planning the agenda, meetings, tours, and entertainment for my visit to Norway.  You guys rock!

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

The past few days of travel in Norway have been truly eye opening.  After leaving Tromso on Monday, we headed to Trondheim where I had an opportunity to hold meetings with clinical and administrative leaders and take a tour of St. Olavs Hospital.  The hospital is nearing the tail end of a rebuilding project that started in 1999 and will finish in 2012.  They started with the notion that the patient would be at the very center of everything in the design of their new facilities.  Some 5500 employees now work at St. Olavs.  The campus includes, or will include, a heart-lung and emergency center, a women's and children's center, and centers for neurology, gastroenterology, mobility, and psychiatry.  There is also a knowledge center, patient hotel, lab and supply center.

The various buildings on the sprawling campus are connected by an underground tunnel system.  Supplies zip around on laser controlled robotic  pallets that greet you and kindly ask you to step to the side if you happen to be in their way. Lab samples and small supplies are routed by an extensive pneumatic tube system.  Patient rooms are private and arranged in small clusters.  The rooms feel very home-like and have all the modern conveniences including flat-screen bedside monitors that provide access to television, e-mail, movies, Internet, and a variety of other services.   All data, telephony, voice and video are IP.  The hospital also has a reasonably contemporary clinical IT system.  All patient records are electronic, although paper still exists in places.  The day I visited, they were in the process of turning off all hospital printers as one more step in the transition to a fully digital campus.

I had a nice visit with one of the staff physicians, a geriatric specialist, Dr. Sletvold Seksjonsoveriege.  He took me on a tour of a typical patient floor.  He admitted that the transition to digital hadn't been easy, especially for some of the older members of the medical staff.  None-the-less, he applauded the progress that had been made and the improvements in patient safety and care quality.  He said that younger members of the staff were eager for even more technology.

If you happen to find yourself in Trondheim and want to experience a truly contemporary and increasingly digital healthcare delivery system, take at look at St. Olavs.  You will leave feeling quite optimistic about the future of healthcare.

Next time, I'll tell you about some of the other healthcare facilities I visited on my trip to Norway and the grand opening of the European Health Innovation Center in Oslo.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

High quality healthcare today can only be delivered by multidisciplinary teams consisting of doctors, nurses, pharmacists, therapists, social workers and others.  This often includes caregivers who work out in the community and in patients' homes.  But such "teamwork" can lead to fragmented information and work processes that put quality at risk with duplication of patient records, unnecessary tests, and prolonged hospital stays.  Effective caregiver collaboration requires an integrated information environment. Clinicians need access to patient information from a variety of locations. The information must always be up to date, and the exchange of information from one caregiver to another must be done securely. In addition, the tools that enable such exchanges and collaboration must be familiar, affordable, and easy to use.

In the latest edition of my House Calls for Healthcare Professionals audio-cast series we examine how contemporary information technology is being used to solve this problem at Eastern and Coastal Kent Primary Care Trust in England. We reveal how healthcare workers in the field can communicate and collaborate with each other and with their hospital or clinic based colleagues more efficiently, no matter where they might be? We make the case that this kind of facilitated collaboration contributes to improved patient safety and caregiver satisfaction. 

This special program examines how one division of what is perhaps the world’s largest healthcare delivery system, has solved their need to improve collaboration across multidisciplinary care teams.  My guest is Julie Ansell, a clinical specialist in intermediate care at the UK National Health Service’s Eastern & Coastal Kent Primary Care Trust.  Also joining me on the program is Ray Jordan, solutions director with Microsoft partner D2i Solutions Ltd.

To listen to the audio-cast click HERE.

Also available for MP3 download

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

I am writing this from Tromso, Norway, where later today I will deliver a keynote address at the Tromso Telemedicine and eHealth Conference.  Preceding me on stage is Dr. Clayton Christensen of Innovator's Dilemma fame.  I believe my message on healthcare delivery innovation and the power of commodity IT will reverberate well with what Dr. Christensen has to say.

Tromso is a town of about 60,000 residents in Norway's north.  It is so far north, on the same latitude as Barrow, Alaska, that the sun never sets during the summer months and likewise never rises during the winter.  Tromso is also home to the University of North Norway, the northernmost university in the world.  The university was founded in the early 1970s with a medical school to help secure Norway's northern regions with a sustainable population of physicians. The university has since expanded to offer degrees in fishing management and oil and gas engineering; degrees perfectly aligned to the region's natural resources.  This might be the last place you would expect to find an internationally renowned research center for telemedicine and e-health but that is exactly what is here.  Tromso is home to the internationally recognized Norwegian Center for Telemedicine, chaired by Dr. Steinar Pedersen.

I had an opportunity to tour the telemedicine center with Dr. Pedersen and university hospital with Dr. Jan Stormer.  I have long known that Europe's Nordic countries lead the rest of the world in the use of electronic medical records.  That is not to say that I didn't find any traces of paper in the university hospital. There is certainly room for even greater automation and improvement in clinical workflow, but I must also say that the hospital is a modern marvel of clinical IT.  I had a nice conversation with a young orthopedic physician, Dr. Petter Gjessing (pictured), who lauded the hospital's clinical systems but as a young man who has grown up with computers, clearly yearns for even better solutions that are more contemporary, powerful and user-friendly.

  The research, services and programs offered in by the Norwegian Center for elemedicine are no less remarkable.   While many countries are only now exploring home health monitoring, ehealth applications for the management of chronic disease, virtual clinical visits on the web, and cell phones and cellular networks as a platform for tele-health services, the telemedicine center in Tromso has been breaking new ground for more than a dozen years.  I was especially impressed by a tele-dialysis program developed by the center that is moving dialysis from hospital and clinic into the home.

This evening we head to Trondheim and later to Oslo where on Wednesday we will hlep open the European Center for Health Innovation.  Stay tuned for more.

Bill Crounse, MD    Senior Director, Worldwide Health   Microsoft Corporation

On a recent post titled "Improving Preventive Care Compliance" I nudged my clinical colleagues to be more proactive in reminding patients about needed preventive services.  I made comparisons to service notifications that are typical in other industries and the relative paucity of this practice in clinical medicine.  I also provided an example of how technology is being applied to help doctors do a better job.

One of the great things about blogging is its worldwide reach, and the great feedback that I receive on what I write.  A young physician named Jessica read my post and provided what I think is an important perspective on the topic of IT and barriers to wider adoption by physicians.  If you are an IT professional or a developer of health IT solutions, this is definitely worth a read.  I'm sure Jessica speaks for all clinicians on why IT adoption is a two-way street. 

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Dr. Crounse:

As a doctor myself, I am pleased to see this comparison. It is all logical and certainly a great solution for automating routine documentation. There are certainly challenges, however, and the statement you made below, Bill, urged me to comment (although a bit off topic of the article.)

You commented "so doctor, no more excuses!"

I recently attended an eHealth conference in Gothenburg, Sweden (www.mie2008.org) which was a great gathering for the scientific eHealth community, as well as a chance to meet with the vendors of Scandinavia that are well represented in this area of development, whether in the hospitals, primary care setting or even in the community. My bottom-line observation was, eHealth is gaining speed!

Anyhow, I was particularly impressed with a lengthy chat I had with one of your IT savvy partners from Microsoft Sweden. He was the "how and why" guy. So basically, he was talking to me about "How can hospitals, healthcare professionals use what they have more effectively?" and "Why are we so inefficient with what we have and what we use today and is there anything hospital IT departments can do to effectively adapt to end users needs without implementing a whole new operating system? Is the change that is needed based on workflow patterns and training to effectively use what we have? Simply synching outlook for appointment challenges between the ward and the out-patient clinic, bed-managing through an interactive network, etc.

And this is where I got interested...and where I need to reiterate that it is not just about "So doctor, no more excuses"...but also about "So IT technician of the hospital, WHERE ARE YOU?

To give everyone an example,

As a junior doctor for the NHS (in the UK) we received an induction, where  apart from standard information about hospital policy is given, the IT specialists of the hospital give a training session, which was superb...but not enough.

I started my first shift as a junior doctor on a night shift. I was fully supported by my senior doctor staff, nursing staff to be effective and prepared for all encounters. But when I needed to sign-in for the first time onto the computer system to check lab results of an ill patient...I reached a dead-end, no IT tech was available to authorize my newly created account...

My battle didn't end there and I was one of the few doctors (who bothered) to approach the IT department of my hospital pertaining to my disruptive work-flow experiences.

First of all, it was a challenge to get a computer engineer/technician on the phone. After so many attempts I began to wonder WHY? So I once brought it up with my colleagues during lunch, who one of which had a mobile number to one of the IT techs that was kind enough to help out the junior staff. It, furthermore, generated a heated debate with all doctors at lunch that day wondering, "What do the IT technicians do day in and day out in a busy hospital?" Surely I would list supporting end-users with the services they are implementing a key task within their work list.

Second of all, it would be of great benefit to see the health care environment working together on this enormous 'change-of-paradigm-within-the-healthcare-system' sort-of project.

Doctors are often considered as the ones not wanting the technology. Being brief, this is not true. However, I can sympathize and even agree with my senior colleagues and non-IT approving ones that without support and incentives, this will never win the approval of key end-users.

I conclude with my statement for hopes of a diplomatic discussion with the IT health techs out there reading Bill's Healthblog..."Where are you guys?"

I can imagine you have lots to do with supportive, technical aspects of the job but I would encourage you to provide better service to end-users...whether through brief workshops during lunch or through a user info-line hospital staff can reach!

Kind Regards,

Jessica Gabin

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Thanks for keeping folks on "both sides of the isle" on their toes, Jessica.  Your comments are very much appreciated.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation

Last week I received a postcard from my auto dealer. It was time to bring my car in for service.  They also send me email reminders and call me should I fail to make an appointment.  I get similar reminders from my dentist.  I even get reminders each year from the city letting me know it is time once again to test my lawn sprinkling system for "back flow".  On the other hand, I cannot remember the last time I got a notice from my doctor that it was time to come in for a checkup.  I guess he's got so many patients that he doesn't need the business, or maybe he doesn't really care that much about keeping me healthy.  One could wonder!

That's why I was particularly pleased to see a new case study from one of our customers.  It concerns a health plan that's been using our unified communications technologies to improve patient outreach and compliance around preventive care services.  The health plan is Care1st in Monterey Park, California.  Working with technology partner 4PatientCare, they implemented an automated interactive patient communication and scheduling system based on Microsoft Office Communications Server 2007.  According to officials at Care1st, the solution has dramatically increased the number of people who are getting appropriate initial health assessments and needed preventive services.

The unified communications solution contains an automated decision tree which gives patients different action options when they receive a call from Care1st reminding them of available services.  They can schedule an appointment for a specific time and date, or let their provider know that they would like an initial health assessment but are not yet ready to make an appointment.  In all, there are more than 100 "nodes" on the decision tree to accommodate nearly all of the possibilities that the system might encounter when interacting with a Care1st member.  Patient like the system because it is so easy to use.  According to Care1st, the automated system does a much better job of documenting their patient outreach activity and is also saving money compared to what was previously spent for patient calls and reminder mailings.

So doctor; no more excuses!  You can read the full case study and get more information about unified communications solutions from Microsoft and our partners here.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation

Last week I was invited to provide the luncheon keynote to a group of hospital and health system executives in San Francisco.  They had gathered under the auspices of The Leadership Institute to share best practices and hear from a select group of outside speakers.  Institute meetings are closed to non-members.  This provides an opportunity for individuals attending the meetings to share information with each other in complete candor.  Even as an invited speaker, I wasn't able to attend other sessions on the agenda although I did receive an invitation to join the group for dinner the evening after my presentation.  This not only made way for some great business discussions, but also gave me a chance to get to know some of the members I hadn't met before.  I'd like to share their names and titles with you, but even that would be breaking protocol with Leadership Institute rules.  Let's just say this group represented some of America's finest and best known healthcare organizations.  Many of the names would be familiar.

The next morning, as I sat in my room at the Huntington Hotel on Nob Hill pondering the terrific view and the many conversations I had had with LI members the day before, I was feeling pretty good about leadership in American healthcare.  These are not the men and women who legislate, capitate, and squeeze the system for all it's worth.  These are the people charged with meeting ever increasing demand for care in their communities in the face of labor shortages, budget shortfalls, cranky providers and increased scrutiny at every turn.  They are also grappling with a pressing need to modernize care delivery and the tools they must use to survive in a healthcare world that is increasingly global and competitive.

It was most reassuring to learn that many of these executives are well-traveled.  I speak and write a lot about the growing competitive threat to American healthcare coming from Mexico and overseas.  My concern wasn't lost on this crowd.  Many of them had personally visited the sites I reference in my lectures and have seen firsthand the digital infrastructure and modern IT investments being made by their foreign competitors; investments that are driving cost and quality transparency breakthroughs and enabling global outreach.

As you might expect, there weren't too many Gen Xr's and Y's in the crowd with the exception of my daughter who lives in San Francisco and works for Google/YouTube.  The Leadership Institute was kind enough to include her as my guest at their dinner.  Actually, I think everyone at our table enjoyed the conversation as it turned to what our kids are doing and how they all work and play a bit differently than their parents.

Hospitals and health systems would be well served to harness the energy and wisdom of our youth.  These are, after all, their future customers.  And, I'll bet they see the world a bit differently than the digital immigrants found in most hospital board rooms today.  Tapping into the thoughts of a new generation of physicians and patients might very well help set the course for a new era in American medicine that is more high-touch and certainly more high-tech from an IT perspective.  Who knows, doctors might even learn how to "text" their patients and one another instead of playing phone tag all day.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

On several occasions, I've told you about some excellent work that is being done to help define a common user interface for clinical applications.  This work addresses the important patient safety and user dissatisfaction issues that arise when clinicians are forced to use software applications in clinical practice that all look and behave differently.  Imagine moving from hospital to hospital or clinic to clinic and encountering an entirely different user interface and clinical system each place you work.  It would be like asking accountants to be equally proficient on a wide variety of spreadsheet applications or writers to know how to expediently edit on every kind of document software on the market.   That just wouldn't work.  Clinical work-flow is no different.  We clinicians need standardized applications and a common user interface to help us practice medicine safely and efficiently, no matter where we are.

As far back as 2005, Microsoft started working with developers, clinicians and other experts in the United Kingdom's National Health Service to define a common and more standardized user interface for clinical applications.  In July of 2007, Microsoft made this work available free to developers around the world by launching an initiative and web site known as MSCUI (Microsoft Common User Interface).

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.  The newest release of this work, V1.3, 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.

There are 5 key elements to the newest release:

1. The announcement of a new Technology Strategy moving to Silverlight 2 and Windows Presentation Foundation for all future controls, samples and demonstrators.
2. Publication of an interactive Delivery Roadmap outlining what guidance and controls we will be developing, when and how the community can engage.
3. Publication of new and updated Design Guidelines.
4. Publication of a new Medications Listview control for Silverlight 2 and WPF.
5. Launch of a new Patient Journey Demonstrator which showcases CUI design guidelines, controls and future UI concepts in a Silverlight 2 application

I think clinicians and developers alike will be especially thrilled to see the CUI design work and future concepts featured in the Patient Journey Demonstrator.  To my way of thinking, this is what clinicians have been waiting for all along.  This is truly an advanced look at the next generation of clinical systems, and the kind of software we'll be using to care for our patients in the years ahead.

My congratulations and thanks to colleagues Andrew Kirby, Su Brown, and the CUI Clinical Applications & Patient Safety team in Microsoft Services UK for another great release of the Microsoft Health Common User Interface.  You can learn more about MSCUI by visiting the web site or watching this video I did last summer with Microsoft UK services director, Andrew Kirby.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation