HealthBlog

The first program in our monthly video series at the intersection of health and information technology, Health Tech Today, is now live on the web.  A show like this takes a village to produce.  Special thanks to my colleagues at Microsoft, our production team at Pirhana Productions, and most especially thanks to all of YOU for your encouragement and support.  We plan to bring you a new show each month.  We welcome your ideas for future programs: thought-leaders you would like us to interview; people and organizations doing great work to improve the cost, quality and safety of care; and anything else that illustrates how software innovation is improving health around the world.  I hope you enjoy the show.  Comments welcome at drbill@microsoft.com.

Bill Crounse, MD    Senior Director, Worldwide Health    Microsoft

Health Tech Today is a monthly, online video series providing cutting-edge stories at the intersection of health and information technology.  The show features informative interviews with some of the world's top health leaders; compelling health-related personal stories; and the latest new technologies and IT innovations.

Watch Program Trailer Here

 
Program guests for launch show on November 10th 

ARCHBISHOP DESMOND TUTU: eHealth Initiative

He’s a recognized name around the globe; A lifelong defender of human rights and advocate for vulnerable peoples around the world. Archbishop Desmond Tutu joins Health Tech Today from South Africa to discuss how eHealth--the use of information & communication technologies in medicine--may be the key to improving access and solving chronic problems in global health care.

ANDREW CULL: Digital Paramedic

This 31-year old paramedic-turned-chief executive is breaking the mold dispensing emergency medical services around the globe—all coordinated by handheld devices, cell phones, and online software. Whether it’s rescuing a fallen climber in Nepal or evacuating a research scientist in the South Pacific, Remote Medical International delivers 24-hour service around the globe.  Health Tech Today reveals how information technology is helping this company experience triple-digit annual growth.

CORNELIA RULAND, Ph.D: Video Game Diagnosis

Doctors are receiving new insights into the symptoms of their young chronically ill patients—courtesy of an interactive video game. SiSom gives ailing children a voice in their treatment and helps their doctors care for them. Health Tech Today talks with the creator of the new technology, Cornelia Ruland, from her office in Oslo, Norway.

KIM PITTENGER, MD: Technology Transformation

He believes that much of the cost of medical care involves clogs in the flow of information—so his team turned to the lessons learned from the efficient production line system of automaker Toyota. The Medical Director of Kirkland, Washington’s Virginia Mason Medical Center, Dr. Kim Pittenger shows Health Tech Today how this production line revelation is transforming the patient’s experience.

DON DETMER, MD: Putting ‘Communication’ Into ICT

He says ‘communication’ is what is vitally missing at the intersection of health and information technology today. Health Tech Today hears why nationally recognized thought leader Dr. Don Detmer is advocating for stronger communication and collaboration solutions in clinical workflow.

CHRIS OTTO: Peace Of Mind Monitoring

It’s a dynamic personal health monitoring and alert system that is giving peace of mind to those who worry about their aging loved ones. MyHalo offers around-the-clock vital sign & activity monitoring by using body sensor technology combined with the Internet. Company CEO, Chris Otto demonstrates Halo’s technology on the set of Health Talk Today.

BILL CROUNSE, MD: Program Host, Executive Producer

HealthTech Today is hosted Bill Crounse, MD, who is also executive producer and creator of the show.  Dr. Crounse is a local and network TV physician journalist with more than two decades of experience. The program is produced by Emmy-award winning producer, Mark Stendal. Health Tech Today is taped at Microsoft Studios in Redmond, WA.  The show premiers November 10th.

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You can watch the entire program or individual segments of Health Tech Today starting November 10th, 2009, at www.healthtech2day.com.

Bill Crounse, MD    Senior Director, Worldwide Health    Microsoft

Health Tech Today—a new monthly, on-line video series at the intersection of health and information technology.  The show premiers November 10th, but you can see a video trailer of our first show right now (click on the link or program logo above, or watch it in the embedded player below).  Please help us spread the word.  Blog about it.  Tweet your friends.  Post information about Health Tech Today on Facebook.  Health IT has a new voice.  I think you’ll like what you see.

Bill Crounse, MD   Senior Director, Worldwide Health       Microsoft

Have you ever wondered why so many physicians resist going “electronic”?  Trust me, it is not because they fear technology.  It is not because doctors  and nurses are Luddites when it comes to using computers.  It is because they fear losing time.  It is because they resist using technology if it doesn’t, or they perceive it doesn’t, add value.  Even if “meaningful use” of electronic records translates to fewer errors, safer care, and higher quality; unless it also fits like a glove into clinical workflow, saving time and saving money, the trade-off just isn’t worth it in the minds of most clinicians.

This fear isn’t groundless.  The photo above was taken by my  colleague, Teddy Bachour, at a drive-through pharmacy near his home in Everett, Washington.  Everett is in the news today because the city and Washington State just lost a new Boeing 787 Dreamliner production line to North Charleston, South Carolina.  If ever a picture was worth a thousand words, this one of the sign on the pharmacy door says it all; “We have upgraded to a new pharmacy computer system to better serve you!  There may be added delays when filling your prescription”.

Don’t get me wrong.  I am perhaps the greatest proponent for ICT in the health industry.  But solutions that make clinical work even more difficult than it already is for busy doctors, nurses and other clinicians make no sense at all.  Too often, IT is promoted as a solution in and of itself before anyone asks “What problem is it that are we trying to solve?”

Next month, we launch a new monthly video program called Health Tech Today.  On our first program, you’ll meet one of my colleagues who works at a large, multispecialty clinic system based in Seattle.  The clinic is world renowned for modeling healthcare delivery after the Toyota production method.  If you think automobile manufacturing has nothing to do with healthcare, you’d be very wrong.  By taking some lessons from another industry, this clinic system not only embraces technology and electronic medical records, it is also extraordinarily efficient.

In fact, I once wrote a piece on this Blog entitled, “What if Disney Did Healthcare?”  When our first Health Tech Today show comes to the web (more information on that shortly)you’ll see how knowledge gained from Toyota and Disney are absolutely revolutionizing care delivery, patient safety, cost, and quality, not to mention the improved satisfaction of those delivering and receiving care at this clinic.  If you have any doubts about the value of appropriately conceived and executed IT when an organization first carefully considers “What is the problem we are trying to solve?”, this segment on Health Tech Today will make you a believer.

Bill Crounse, MD  Senior Director, Worldwide Health  Microsoft

This morning I had the pleasure of meeting with US state and local government officials at our executive briefing center in Redmond.  Although the briefing wasn’t confined to discussing information technology and healthcare alone, it should be no surprise that a frequent topic was health and healthcare reform.

I shared with the group some of my concerns related to US ARRA stimulus spending of $20 billion or more on health IT.  I made an analogy to a recent misstep in Ontario, Canada.  Much to the rightful ire of citizens in the region it has been disclosed that government spending on electronic records and health information exchanges in Ontario had exceeded one billion dollars, yet it seems that the province has very little to show for such spending.  An ensuing investigation has revealed  colossal mismanagement of government funds, bloated budgets, poor planning and even worse execution.  How can we avoid that from happening in America (or anywhere else)?  If a billion dollars had instead been spent actually providing care to citizens in Ontario, how much care would it buy?

For one billion dollars (one thousand million) you could purchase   and administer a heck of a lot of flu vaccine.  You could give prenatal care to more than ten million young women.  You could offer visiting nurse services to millions of senior citizens.  Ten thousand or more people could get a needed organ transplant.

Don’t get me wrong.  I’m not suggesting that we shouldn’t spend money on electronic health records and health information exchanges.  But I am strongly advocating that we must plan carefully for what it is we are trying to improve and be extremely prudent in how we spend.

America lags behind most of the rest of the industrialized world in the use of IT in healthcare.  Seventy-five to eighty percent of American clinicians are still practicing with pen and paper.  The health industry is woefully behind in its use of contemporary communication and collaboration technologies in clinical workflow, and I believe that little is more important for provisioning safe care than excellence in care team communication.

So, America has lot of catching up to do.  But we also have an  opportunity to learn from others on what not to do.  We must first focus on what outcomes we want to achieve.  We should be asking how we can leverage technology to make access to health information and medical services more efficient and do a better job delivering exactly the right amount of care, when and where it is most needed.  There is no question that we can use electronic health data to improve care quality and safety.  We can get a better grip on what adds value in health, and more importantly, what doesn’t.  However, we cannot afford to waste even a single billion dollars on this, and certainly not twenty billion dollars or more.  We must always ask the question, how many lives could we help if we spent the same amount of money delivering care?

It is time to get grounded before it is too late.  It is time to bring our best and brightest to the table and dismiss special interests.  It is time for more rational voices to be heard.  It is time to ask what we are trying to improve before we set out to improve it.  It is time to cast out technologies and processes that add little or no value, and embrace lower-cost, contemporary, flexible, commodity-based solutions and web services that actually improve workflow, make care more accessible, and contribute to lower cost, higher quality and safer care.  

Bill Crounse, MD    Senior Director, Worldwide Health     Microsoft 

With the launch of Windows 7 coming next week, I thought I would share an article that explores how Windows 7’s support for ‘touch’ will allow healthcare professionals to communicate better with patients and why I believe the operating system will help trigger a new generation of health IT solutions that will lead to improvements in clinical workflow.  The article is by technical writer Paul Curran and was first published in the United Kingdom following a phone interview he did with me.  I hope you enjoy it.

Bill Crounse, MD  Senior Director, Worldwide Health  Microsoft

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Whenever he ponders the future of clinical computing, Dr Bill Crounse says many images come to mind – and just as many questions: In 10 years’ time, will we still be using desktop PCs, computers on wheels, laptops and tablet PCs? Will the keyboard and mouse still be around?

Designers, architects and engineers of healthcare facilities should always be looking to the future, says Dr Crounse. “So too should executives, managers and staff in our hospitals and clinics,” he adds. “It’s too easy to picture the future in today’s terms, but that might well lead us in totally the wrong direction.”

Over the span of his distinguished career, Dr Crounse has witnessed monumental changes in communication and collaboration - from the ‘while you were out’ phone memos stacked on his desk to the instant messaging, email, voicemail and web conferencing that now keep him constantly connected.

The propagation of medical computing began in much the same way as other industries, with workstations strategically placed around hospital wards, he says. “Then as laptops gained in popularity, they were mounted on carts to improve workforce mobility and provide for longer battery life. Next, tablet PCs took over as models designed specifically for healthcare began to emerge. Now, manufacturers are combining the best attributes of tablets and desktops in a new breed of computers on wheels.”

And now forward…

So what can we anticipate in the future? Dr Crounse expects clinical computing to look quite different.

“With the launch of the Windows 7 operating system (OS), you’ll certainly see more and more software applications take advantage of touch and multi-touch navigation married to increasingly sophisticated hand-writing and speech recognition technologies.

“For example, as the use of tablet PCs within healthcare continues to grow, many of us will welcome the improved hand-writing recognition facility in Windows 7. It also learns, so the recognition gets better the more I use it.” He says the same is true for voice recognition: “I just talk to my PC and it does what I want, from opening programs to dictating letters.”

The true party piece of Windows 7, though, is its support for touch - not just touchscreens but what has come to be called 'gesturing'; support for a sophisticated but more naturalistic way of interacting with technology.

“Clinicians are able to zoom in on an image by moving two fingers closer together, like they’re pinching something, or zoom out by moving two fingers apart,” says Dr Crounse. “They’ll even be able to move an image on the screen by rotating one finger around another, and right-click by holding one finger on their target while tapping the screen with another.” This sort of natural manipulation of text, images and multimedia will make computer equipment less obtrusive in the clinician-patient relationship; and should make technology accessible to many communities which use healthcare extensively, yet were previously somewhat overlooked by IT: for example the elderly.

Tomorrow’s world

Dr Crounse believes we’ll also see a transition to much richer displays in due course. “If you watch any of Microsoft’s ‘Future Vision’ videos, you’ll notice that large screen displays with touch screens are quite prevalent, as are smaller, pocket-sized devices that communicate wirelessly with their larger-screen cousins. You may have had an inkling of this future vision if you’ve ever played with Microsoft Surface, the multi-touch tabletop technology used in some healthcare kiosks.”

Dr Crounse says Surface technology is already making waves in  healthcare by changing the way doctors communicate with patients. He says it enables them to use a range of media elements to demonstrate complex medical procedures or conditions to their patients. By erasing parts of the heart, for example, a doctor can show a patient what theirs looks like compared to a healthy one.

Seamless workflow

“Now just imagine all of these things combined in an environment that lets you move seamlessly from one device to another and are ‘recognized’ by each device as you approach it,” enthuses Dr Crounse. “Perhaps you’ll be wearing a small Bluetooth enabled microphone. You’ll be able to touch items on the screen, gesture with your hand, or use your voice to open and close windows.

“You’ll be able to ask questions or give directions, and the computer will respond. You’ll use natural hand gestures or touches to navigate and move from one workflow to another. You’ll transition from a large screen display to a portable device in your pocket, then to another large screen on the wall - and pick up your work exactly where you left off each time along the way.

Dr Crounse believes these types of technology are advancing so fast that over the next decade 2D and 3D computer graphics will match reality. For instance, he says Microsoft Research is doing some very exciting work in artificial intelligence and robotics.

“Some of their most recent work incorporates human traits like emotion and empathy. I believe this is the future of clinical computing. In fact, I think we’re already seeing this natural evolution in the products and solutions now hitting the street and others that will shortly be coming to market thanks to enabling technologies like Windows 7,” he concludes.

For more information on Windows 7: http://www.microsoft.com/windows/windows-7/

Perhaps a problem with writing a blog is that your message may be reaching entirely the wrong audience.  One of my blogging colleagues, Barbara Duck of the Medical Quack, sent me an e-mail yesterday that illustrates my point.  Barbara said;

“With Health 2.0 reading this week, I got a little overwhelmed. I guess all of the technology is great but when you sit down and try to explain it to a group of doctors that only have a fax and maybe a computer or 2 in their offices that are still paper guys, well it’s not a pretty picture and literally scares them.  I did a talk a couple weeks ago and covered a few different areas and it was the first time any of them had heard of or seen HealthVault, so there’s a long ways to go.  Sometimes when you are communicating with all the brilliant minds on the web you somewhat may lose track or forget about the “real” world that is out there when it comes to technology…… One meeting with the real world cures that in a few minutes though.”

Barbara’s words ring very true.  Working at Microsoft, I get exposed to amazing technologies every day.  Some of that technology is still in our research labs.  Some of the tools I use  regularly to do my work aren’t yet available to the general public.  Then too, my job takes me around the world where I get exposed to advanced Information Communications Technologies in healthcare that are not yet widely available.

Yesterday I did a keynote for a national conference of clinical  case managers.  I’d say members of the audience were mostly female nurses between the ages of 40 and 60.  I’m sure a lot of the information I shared with them seemed more like Star Wars than anything close to the reality they work in every day.  I also encounter lots of physicians who are totally clueless that there will soon be penalties if they are not using electronic medical records.  And just like Barbara Duck has experienced, the majority of community physicians and other clinicians I meet have never heard of HealthVault, Amalga, Google Health, Keas, American Well, PatientsLikeMe, Navigenics, 23andMe, and so on.

Dr. David Blumenthal (I wonder if most docs have even heard of him) has announced a “workforce training initiative” to educate more health information management professionals with expertise in electronic health records and related technologies.  He says at least 50,000 new jobs are needed in the field.  I would add, based on what I’ve experienced, that we will also need training for perhaps ten or twenty times that number of people; i.e. most of the physicians, nurses and other clinicians who are currently practicing in offices, clinics and hospitals all over America.

It’s not that these folks have their heads in the sand. Most of them are working so hard day to day in patient care, trying to stay afloat and keep their practices from going under, that they literally don’t have time to come up for air.  So what happens when we expect them to use all of this technology and also give 45 million more people access to their services?  That is going to call for one hell of a training program!

Bill Crounse, MD    Senior Director, Worldwide Health    Microsoft 

This week I’ve been attending the 2009 Leadership Conference at the Grand Wailea on Maui.  On Tuesday morning I delivered a keynote address at this gathering of more than 300 health plan executives from the Western US.  The theme of this year’s conference is “Leading Change in the Health Care Revolution”.

My Tuesday morning session was followed by two distinguished speakers; Dr. Roy Schoenberg, CEO of Boston-based American Well Systems, and Michael Liebhold, senior researcher at the Institute for the Future based in Menlo Park.  At the conclusion of Tuesday’s sessions, Roy, Michael and I held a panel discussion to entertain questions from the audience.

You may recall Dr. Schoenberg and American Well Systems from one of my earlier blog posts.  I also featured American Well on one of my House Calls audio-cast programs last Spring.  As of January, every citizen in the state of Hawaii now has access to on-line medical services (telephone, messaging, and virtual web visits) from participating physicians.  Services are available twenty-four hours a day, seven days a week.  The technology powering all this comes from American Well and Microsoft HealthVault.  HMSA, a leading Blue Shield Blue Cross organization in Hawaii, sponsors the American Well service for their members.  On-line medical services are covered by HMSA after a small deductible. Those who are not insured by HMSA can also access the service and self-pay.  According to Dr. Schoenberg, American Well is receiving high marks from both  physicians and patients here in Hawaii.

You may also recall another recent post on HealthBlog about  Health ICT.  In that post I stated that it isn’t so much the “I” (information) that is missing from most Health ICT solutions these days as it is the “C” (communication/collaboration).  Well, it turns out that Dr. Schoenberg and American Well will soon address that missing link too.  Within the next few months, American Well is adding some very innovative services to their web platform that will enable care team collaboration.  Clinicians using American Well will be able to facilitate referrals on the system, and even hold virtual conference calls with each other.

In Hawaii, Aloha means both “hello” and “goodbye”.  So, Aloha to ICT of the past, and Aloha to a new benchmark for health ICT; one that better meets the needs of both clinicians and patients.

Bill Crounse, MD     Senior Director, Worldwide Health    Microsoft

No, I’m not writing this from some exotic location in France, although it might have been easier to fly to France than to get here yesterday.  This morning I presented a keynote at the 2009 Corporate Benefits Summit at the Château Élan Winery & Resort about 55 miles outside of Atlanta near the town of Braselton, Georgia.  I arrived last evening in the midst of one of the most horrific downpours in the history of Atlanta.  For a few hours, my direct flight from Seattle was diverted to Columbia, South Carolina.  I didn’t make it to Atlanta until the sun was going down.  Between the airport and the Château I saw lots of flooding and a few submerged cars, but fortunately I didn’t get stranded in the storm along the way.

The Corporate Benefits Summit brings together corporate  benefits executives and providers of benefits services to explore innovative and creative wellness programs that will secure high levels of participation amongst employees as a way to curb healthcare costs.  There is also significant focus on discovering effective methods to measure the ROI of such programs. My role was a keynote presentation on how the Internet, software and information technology are reshaping healthcare delivery and medical services around the world.  This included a brief introduction to Microsoft HealthVault and how the platform can be used to improve the health and wellness of employees and their families.

What else is topical at the event?  If you are like most people, especially younger people, you probably haven’t given much thought to your retirement.  There are just too many other things calling for your attention and your money right now.  But unless you work for the government or one of the few corporations still offering a pension, hang on to your socks.  According to Steve Wetzell, Executive Vice President of the Health Care Policy Roundtable, most Americans are ill prepared for the new reality.  Mr. Wetzell affirms something I addressed on HealthBlog not too long ago.  The average American retiring at age 65, will need between $100,000 and $400,000 dollars just to cover out of pocket medical costs not covered by Medicare.  And that doesn’t include any additional costs associated with long term care.  He also mentioned that most of the health reform legislation now under consideration by Congress calls for means-testing Medicare benefits.  If you have a little money behind you, plan on shelling out even more of it for things Medicare won’t cover.  The bottom line: get a government job or just plan on working forever.  That may be the new reality.

While here, I also ran into a colleague I hadn’t seen for several years.  Dr. Michael Taylor is medical director for health promotion at Caterpillar, Incorporated in Peoria, Illinois.  You might not think that a company focused on heavy machinery would be a leader in health promotion and wellness programs for its employees.  However, Caterpillar has a long history of excellence in developing disease management programs that are improving the health and productivity of its workforce.  Dr. Taylor admitted that the recent economic downturn has thwarted some of his good work, but he is confident when things turn around (as they always do) that his company’s programs will be leading the pack.

In fact, if there is an overarching theme here at the Corporate Benefits Conference it is the value that healthy, productive employees bring to the workplace.  And in a workplace where people will likely be toiling well into what we used to call “the retirement years”, keeping folks healthy is not only the right thing to do, it is the fiscally prudent thing to do.

Next time around, I’ll be sharing highlights from the Health Plan Leadership Conference in Maui, Hawaii, where I will deliver a keynote address on September 29th. I know……. it’s a tough job, but somebody’s got to do it.  Until then, 

Bill Crounse, MD  Senior Director, Worldwide Health,   Microsoft 

Last Friday, I had an opportunity to spend part of the afternoon with Dr. Don Detmer (right) during his visit to Microsoft Research.  If the name isn’t familiar, Dr. Detmer is a surgeon and the immediate past president of AMIA, the American Medical Informatics Association. He is also Professor of Medical Education at the University of Virginia.  You can learn more about his distinguished career here.

As fellow clinicians and champions for greater use of ICT (Information Communications Technology) in health and healthcare, Don and I hit it off immediately.  We also agreed that the missing piece in the use of ICT in clinical medicine today isn’t so much the “I” but rather the “C”.  In fact, when Don talks about CT he doesn’t mean those big pieces of imaging equipment that scan your body; he’s talking about Communication and Collaboration technologies for clinical workflow.

You see, we’ve gotten pretty good at capturing data and storing it electronically.  Where things still break down is in how we use that data and share it to improve care quality and patient safety and avoid the inherent costs associated with not doing so.  How is all that data helping us if we don’t have equally powerful tools to make sense of it all and more importantly, to communicate what we learn across the care team and to our patients?  Furthermore, how does all this electronic information we are capturing contribute to clinical research and scientific discovery?

Let me refer to something going on in my own family to illustrate the point.  Two weeks ago, my elderly Aunt who seldom has headaches said she was having, “the worst headache of her life”.  When it persisted after administration of the usual remedies and she also began to experience visual symptoms, I could only recommend that she immediately consult her physician or go to the ER.  It was after hours and her personal physician wasn’t available so she went to the ER.  The doctors there were sufficiently concerned that they ordered a CT scan of her head (not the one pictured above).  My Aunt was told that the CT appeared to be normal, but might not show acute thrombotic changes or very small hemorrhages.  They also recommended a consultation with an ophthalmologist the next day.  The eye doctor didn’t find anything wrong with her eyes, but proclaimed there was definitely something going wrong in her head.  My Aunt said that her eye docotr ordered lots of blood work and told her to follow up with her personal physician.  More than a week later, she’s still waiting for someone to tell her what is going on in her head.  It seems her family doctor is waiting to receive information from the ER, imaging center, and laboratory.  In other words, the data is available, it’s just not being communicated.  Clinical workflow is broken because the community physicians caring for my Aunt don’t have the communication and collaboration infrastructure to work seamlessly as a care team.

The above is but one small example that reinforces the point on which Dr. Detmer and I so vehemently agree. It’s not so much about the “I”, it’s about the paucity of CT in clinical practice.  And, I don’t mean computed tomography!

Bill Crounse, MD  Senior Director, Worldwide Health    Microsoft

On my HealthBlog post of June 24th I posed the question, “Is it time for Clinical Groupware?”  Well, apparently the answer is YES!  Since June, a number of my colleagues have come together to form what is now known as the Clinical Groupware Collaborative.  The Collaborative’s mission is to promote lower-cost, flexible, easier-to-use and implement healthcare ICT solutions. Although the pure vision for clinical groupware is to deliver many of the ICT solutions a medical practice, clinic or hospital might need as “services in the cloud”, a blended model of software on local servers or PCs plus services in the cloud is probably more realistic.

For those of you interested in learning more about the Clinical  Groupware Collaborative and what you can do to participate, some of my colleagues will be hosting an informal get together on Tuesday, September 22, 2009, between 6:00 and 7:30 PM at the Hilton San Diego Bayfront Hotel, Aqua Room 304.  The gathering will take place immediately following the close of the DMAA conference (DMAA: The Care Continuum Alliance).

Members of the Clinical Groupware Collaborative working group who will host the meeting are:

Vince Kuraitis, Prinicipal, Better Health Technologies

Steve Adams, CEO, RMD

John Haughton, MD, MS; CEO, DocSite,

Ravi Sharma, CEO, 4Medica

Martin Pellinat, CEO, VisionTree

Here is some additional information to answer questions you might have about Clinical Groupware.

Q. What is Clinical Groupware?

Clinical Groupware is a new and evolving model for the development and deployment of health IT platforms and applications, the characteristics of which include use of the Internet and the Web as a platform, explicit design for health data exchange and online communication among providers and patients/consumers, a modular or component architecture upon which applications can be aggregated to meet specific clinical and workflow tasks; while allowing interface standards and protocols for data exchange to emerge in a market-driven manner.   Clinical Groupware applications can be distributed as software-as-as-service, and are intended to support today's mobile health care environment by supplying the right information, at the right time and the right place.

Advocates of the Clinical Groupware approach are not limited to software developers and technologists, but also include practicing physicians, executives and managers from health care provider organizations and care management companies, patient advocates, and leaders in life sciences, home monitoring, and medical device manufacturing firms.

 
Q. What is the Clinical Groupware Collaborative? 

What unites the members of this collaborative is a shared desire to see the growth in the acquisition and use of affordable, easy-to-use, and interoperable EHR technology, especially among the  very large group of "non-consumers" who have found legacy EMRs cumbersome, expensive, and technically challenging to use.

The CGC is in a formative stage.  To-date, representatives from over 40 companies have expressed interest.  The Collaborative is working to be formally incorporated before end of 2009.

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So, if you are attending the DMAA conference, or you just happen to be in the San Diego area, check out the Clinical Groupware Collaborative.  You’ll be glad you did!

Bill Crounse, MD  Senior Director, Worldwide Health     Microsoft

As reported by HDM on-line, the Office of the National Coordinator for Health Information Technology has published additional information on a $598 million grant program to fund the creation of about 70 Health Information Technology Regional Extension Centers.  The centers will help hospitals and physicians select, acquire and use electronic health records systems.

No doubt some serious education and hand-holding will be needed as more physicians and hospitals take the plunge into electronic medical record systems and “meaningful use”.  If taking the plunge is anything like what I saw and heard during a visit to my own doctor last week, doing your EMR homework before you buy is an important step if you hope to swim rather than sink.

  My doctor belongs to a very large, multi-specialty group practice.  Like most large clinic systems in America this group practice, which also operates a hospital, has been using electronic records for some time.  Even though the multi-specialty clinic drives most of organization’s business, they decided to purchase a health information system that is better known for running hospitals than outpatient medical centers.  As long as I’ve known my doctor, he’s been complaining about the EMR system he is forced to use in the clinic.

And it’s not just my doctor who does the complaining.  On my visit last week, the first thing his assistant did while checking me in was to verbally assault the blankity-blank computer system. She clicked furiously on the screen multiple times waiting for the system to respond.  Just entering my vitals seamed to require clicking through endless screens.  It took a ridiculous amount of keyboard work.  “I hate this system”, she said.  “It is always slow, especially when we are busy.  And several times a day, it just goes down”.

She eventually got through all the screens and entered my data, although I noticed that she took down my chief complaint and medication list on a sheet of paper perhaps to enter that information into the computer later.  My doctor came into the room, asked me a few questions, and did a cursory exam.  Mainly I was there to get some prescriptions renewed.  My doctor also decided to order a few lab tests on me while I was there.  On my last office visit, he had ordered lab work on the computer.  This time he used a sheet paper.  Before I even had a chance to say something about this he blurted out, “I suppose you noticed that I’m back to ordering lab work on paper.  We tied CPOE (computerized physician order entry) but it just took too long!  The clinic docs revolted, so now we are back to doing it the old fashioned way.”

Of course, I could have predicted all of this.  There are much better solutions on the market for ambulatory patient care than what my doctor is being forced to use .  There are far more intuitive and responsive EMR solutions.  There are also solutions that are more accommodating to clinical workflow and mobile scenarios using Tablet PCs and other wireless devices.  But my doctor’s group practice spent millions of dollars on what they have, and I’m quite certain they won’t be trashing it anytime soon.

So, let this be a warning.  Do your homework.  Select a system for your practice with the research and care you would put into making any large, really important purchase for your home or business.  Don’t delegate this to your staff.  It is your responsibility.  You, your staff and your practice will be greatly impacted by the decisions you make.  So maybe, just maybe……. a visit to one of those government funded “extension centers” would be a good idea before you take the plunge.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft

When you think about the future of clinical computing, what images come to mind? In five or ten years, will we still be using desktop PCs, computers on wheels, laptops and Tablet PCs?  Will the keyboard and mouse be as prevalent as they are today?  What kinds of devices and interfaces will clinical staff be using?  How will device and workflow changes impact the design of our healthcare facilities of tomorrow?

Designers, architects and engineers of healthcare facilities must always be thinking about the future.  So too, must the executives, managers and staff of our hospitals and clinics.  It is far too easy to imagine the future as we experience the world today.  But that may lead us totally in the wrong direction.  Over the span of my own career, I’ve noted monumental changes in business communication and collaboration; from telephone “while you were out” memos stacked on my desk after lunch to instant messaging, e-mail, voice mail, and web conferencing that keeps me continuously connected no matter where I am.

Medical computing stated out much as computing did in other industries, with desktop workstations strategically placed around the hospital ward.  As laptops gained in popularity, they were mounted on carts with wheels to improve workforce mobility and provide for longer battery life.  Tablet PCs became popular particularly as new models designed specifically for the healthcare industry became available.  More recently, some manufacturers have combined the best attributes of Tablets and Desktops into a new generation of “computers on wheels“.  But what can we expect in the future?

I believe clinical computing may look quite differently than it does today.  I think we’ll see a transition to much larger displays that take advantage of touch and multi-touch navigation married to increasingly sophisticated speech recognition solutions for data input.  If you’ve seen any of our “future vision” videos, you’ll note that large screen displays with touch screens are quite prevalent in the scenarios we paint.  So too are smaller, pocket-sized devices that communicate wirelessly with their larger-screen cousins whenever more screen real estate is required by the user.

You might have had a premonition of this future vision the first  time you saw Microsoft Surface, or dare I say, the first time you played with an iPhone.  With the launch of Windows 7, you’ll see more and more software applications and computer screens that take advantage of “touch” as a user interface.  With Windows 7, if you've got a touch-screen monitor, you can just touch your computer screen for a more direct and natural way to work. Use your fingers to scroll, resize windows, play media, and pan and zoom. Windows 7 also introduces support for new multi-touch technology, so you can control what happens on the screen with more than one finger. For example, you can zoom in on an image by moving two fingers closer together, like you're pinching something, or zoom out by moving two fingers apart. You can rotate an image on the screen by rotating one finger around another, and can right-click by holding one finger on your target and tapping the screen with a second finger.

Now imagine all of that combined in an environment that allows you to move seamlessly from one device to another and being “recognized” by each device as you approach it.  Perhaps you’ll be wearing a small Bluetooth enabled, bone conducting microphone.  You will touch items on the screen, gesture with your hand, or use your voice to open and close windows.  You will ask questions or give directions and the computer will respond.  You will use natural hand gestures or touches to navigate and move from one workflow to another.  You’ll transition from a large screen display to a portable device in your pocket to another large screen on the wall and pick up your work exactly where you left off each time along the way.

I believe this is the future of clinical computing.  In fact, I think we are already seeing this natural evolution in the products and solutions that are hitting the market and certainly in those that will shortly be coming to market.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft 

T.R. Reid’s August 23rd op-ed piece in the Washington Post, “5 Myths About Health Care Around the World” explores many of the common myths Americans believe about health and healthcare systems in other countries.  Opponents of health reform in America often point to these myths as concrete reasons why we shouldn’t model changes to the American system after health systems elsewhere.  The myths are:

1. It’s all socialized medicine out there.
2. Overseas, care is rationed through limited choices or long lines.
3. Foreign health-care systems are inefficient, bloated bureaucracies.
4. Cost controls stifle innovation.
5. Health insurance has to be cruel.

You can find out why these common myths don’t hold water by reading Mr. Reid’s article.  But if I may, I’d like to add one other myth to the list:

    6.  America leads the world in the use of ICT in health.

In fact, nothing could be further from the truth.  Anyone who has traveled extensively or spent any amount of time living abroad already knows that America has fallen behind many other countries in Europe, parts of Asia and elsewhere in public transportation, cellular technology, utilities infrastructure, and in many cases standards of living; although that last one is debatable depending on what kind of standards you have come to expect.  And while America does offer highly advanced medical diagnostics and therapeutics (if you can access them), we lag well behind many other countries in our use of information and communications technology (ICT) in health.

Throughout much of Europe, nearly all clinicians use electronic  health records.  Compare that with less than 25 percent of clinicians here.  Because payment systems in other countries incentivize more efficient ways to deliver health services, you will tend to see more widespread use of telemedicine and remote patient monitoring solutions than you typically will find in America.  There is also more widespread use of hospital information systems that use highly flexible, less expensive commodity software components and web services architecture instead of highly proprietary, legacy technologies that are remnants of a bygone era in computing.  Clinicians love these newer systems because they are easier to learn and use.  Administrators love them because they are less costly to acquire and maintain.

We still have an opportunity to regain America’s lead.  Let’s hope we make some good decisions in the months and years ahead.  I’ve had an opportunity to meet with many innovative companies and individuals who are working very hard to move America in the right direction.  I think we’ll all get there a little faster if people can just let go of some of the myths that are holding us back.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft 

Please take a moment to read this excellent Blog post sent to my attention by Jake Poore.  How many of us or our family members have had similar, but hopefully less dire healthcare encounters?  How many others must needlessly die or be injured because of poor communication, fragmented records, and broken processes in hospitals and clinics?

“Just call me, Eddie”

I need to write about this, because this day still haunts me, years later. And it is amazing the clarity I still have of the entire day, of every word said, and how it made me feel.

My dad had a heart attack the same week President Clinton had been scheduled to have his heart surgery, but Clinton had to wait an extra few days until the blood thinner had left his body (important to note). My dad was on a fishing trip vacation with friends out of his home state at the time. His closest family and friends were hundreds of miles away. When he was rushed to the local emergency department and immediately admitted to the Intensive Care Unit, where the nurse gave him a blood thinner IV and said it would help with his heart palpitations. As it turns out, he had to have heart surgery, immediately, to save his life.

I flew from Florida to Michigan to be with him prior to his surgery. While he was waiting for surgery, he joked a lot with all the nurses who came into his room. Each nurse he met would call him, “Mr. Poore”, and he would immediately say, “please just call me, Eddie”. They would always reply, “Okay, Eddie. And I’ll make sure the next nurse knows that too.” Of course, the next nurse would come around and again address him as “Mr. Poore”, and Dad would reply, “Just call me, Eddie,”and this new Nurse would say, “Okay, Eddie. I’ll tell the night nurse”. They never got it right. After a while, my Dad became really frustrated and a bit concerned about his care team.

Personal Jewelry

Each employee who entered my Dads room would also tell my Dad that he would need to take off his two gold necklaces prior to surgery and they would offer to take them off him right then and send them to security for safe keeping. My father was very attached to each necklace (one from his mom and the other from his deceased wife, a nurse) and did not want them taken off, ever! It was agreed (by one nurse) that the necklaces would be taped to his leg during the surgery so that he’d always have them on him. This too, of course, was never communicated to other medical staff, and every time someone new walked into his room, they would kindly suggest that he would have to “take off those gold necklaces”, finally my Dad just freaked out!

I would watch his monitor above his bed: His blood pressure would rise, his pulse would rise… there were clinical implications to their poor team communication.

The two most important things to him were his good name and his gold necklaces and they couldn’t get either of these right.

Finally, now in surgery, as I am saying my final ‘goodbyes’, a nurse anesthetist came up and said, “Hi, Mr. Poore (not "Eddie"), I’m the nurse anesthetist. Do you know what I’m going to do?” My father replied, “Put me to sleep, I guess”. And she continued, “Yep, that’s right. And I see you have some gold necklaces on….” While she was still speaking, My father turned to me with a huge look of fear on his face and said, “Oh lord, they can’t even get these necklaces right, Jake!” That was almost the last thing he said on this earth.

My father died on the operating table that day. After his surgery the doctor didn’t even come out to talk to me. He sent one of his assistants out instead. When I asked what happened, we were told, “your Dad couldn’t hold his sutures, he was bleeding to death.” I asked if the blood thinner he was given the day before had anything to do with that, and she said, “Blood thinner, what blood thinner?” I couldn’t help but saying, “You guys didn’t even communicate the name he wanted to be called or stop asking him about his gold necklaces, maybe you didn’t communicate the blood thinner, either.”

Thanks for sharing this, Jake.  Your story breaks my heart; maybe because my grandfather, who had a genuine fear of doctors, was named Eddie.  How many other “Eddies” will it take?

I’m not certain that electronic medical records would have prevented what happened to Eddie or will prevent every medical error, but having access to all of a patient’s information at the point of care would prevent most of them.  That, along with vastly improved caregiver communication and collaboration tools and better solutions to manage decision support, clinical workflow processes and quality would go a long way in improving patient safety.  Paper kills.  So does apathy and ineptitude.  The time has come for an information technology revolution in healthcare. 

Bill Crounse, MD   Senior Director, Worldwide Health  Microsoft