HealthBlog

Strategies to improve “operational efficiency” in healthcare organizations are a recurring theme here on HealthBlog.  That’s why I wanted to share a new article on Green IT written by my colleague Chris Sullivan who manages our US health provider industry for Microsoft.  I know that Chris and his team would be very pleased to work with you directly or point you to additional resources in your quest to drive greater efficiency in your organization—a mission, in these challenging economic times, that has never been more important.

Bill Crounse, MD   Senior Director, Worldwide Health  Microsoft

Going Green in IT

By Chris Sullivan

(first published in ADVANCE for Health Information Executives)

Going green isn't just good for the environment.

It can also make great business sense as the recession forces many industries to change the way they go about their business practices. Companies everywhere are looking to implement more efficient practices and reduce overall IT costs, and health care is no exception.

Contrary to a common misconception, health care organizations are not recession-proof. Many of our nation's largest hospitals and providers are not-for-profit and heavily rely upon donations and investments as their primary source of income. And with these funding sources drying up, health care providers are struggling to lower costs, reduce energy consumption and consolidate infrastructure. CIOs today have far less to spend on new IT investments; at the same time, they're tasked with using IT to significantly reduce overhead and operating costs.

In addition, the recently passed economic stimulus plan emphasizes the need for businesses to adopt green technology. Health care providers, in particular, have an enormous opportunity to pursue this goal by doing more with the technology in which they've already invested.

Many IT solutions that are helping health care organizations achieve these ends also provide significant environmental benefits, such as driving reductions in energy consumption, reducing travel and cutting carbon dioxide emissions. In short, being "lean and green" is good for both business and the environment.

It's not easy speaking green

It's important to note that there's no formal definition of green IT. It really boils down to using technology to reduce costs and overhead expenses, lessen the amount of waste produced, and mitigate the negative impacts of modern services, industry and manufacturing on the environment.

We lack clear metrics by which to measure both the  environmental impact of IT and the results of moving to a greener strategy. There are, however, emerging frameworks that can be useful, including the U.S. Energy Star system and the Climate Savers Computing Initiative, to name just two.

But, ultimately, green IT has to save dollars and help make IT sustainable. Health care organizations are taking advantage of the enormous opportunity to cut costs and reduce energy consumption, reduce employee travel and consolidate infrastructure to increase energy efficiency.

How can your organization ensure it's taking the right steps to meet its business and compliance needs as well as the needs of the environment?

The answer lies in implementing technology - including software, server and desktop virtualization and remote-access solutions - and best practices that enable the most efficient use of infrastructure, boost employee productivity and, at the same time, cut capital expenses and reduce the impact on the environment.

Big (Green) Brother

Aside from health organizations' need to lower costs and streamline business processes, they face additional pressure from the government, legislators and company shareholders to ensure that environmental responsibility is a guiding principle in corporate practices. To help meet these dual demands, software is playing an increasingly important role in reducing energy consumption and operating costs - and in cutting down the associated environmental impacts.

Software can be a critical tool for health care organizations in meeting these environmental challenges. Current software solutions can reduce energy use through power management, analyze operational or environmental footprints and their impact, and facilitate increased productivity through remote access, virtual meetings and paperless offices.

In this way, software is foundational to solving today's environmental challenges and enabling long-term sustainability. It's increasingly important to find new ways to reduce energy consumed by technology, rethink business practices and research new solutions.

Virtualization achieves real results

For many IT departments, the biggest obstacle in improving the  efficiency of their IT operations is the data center. In fact, it's estimated that just one medium-sized server has roughly the same annual carbon footprint as an SUV that gets 15 miles to the gallon.

Server virtualization is one of the most common ways health care organizations are going green. By virtualizing servers in their data centers, organizations lower the actual number of physical servers used, which not only reduces physical hardware costs but can also decrease the footprint of a data center.

A smaller footprint results in lower energy costs for infrastructure. In addition, there's not as much equipment to heat in the cooler months, or to cool when the mercury rises. With fewer physical servers, personnel costs can also be reduced, since fewer servers require fewer administrators, as well as less maintenance and upkeep.

According to industry researcher The 451 Group's recent report titled "Eco-Efficient IT," each server eliminated through virtualization can reduce power consumption in a data center by 200 to 400 watts. This is the equivalent of about $380 per year, per server, factoring in the energy costs of air conditioning to cool the unit. The report uses the example of a data center with 1,000 servers, which would represent an annual savings of more than $125,000.

Besides energy and cost savings, virtualization can streamline data center management and ease the burden on already strained IT departments. Virtualization can also ensure the security of your confidential data through a virtualized, mirrored backup and disaster recovery strategy.

One example is Houston-based KSF Orthopaedic, a health care provider that used server virtualization to lower costs, consolidate physical assets and implement a disaster recovery strategy.

KSF virtualized its server infrastructure, reducing the number of servers from nine to two. That level of downsizing allows the practice to be mobile when necessary. Anticipating the severity of Hurricane Ike in September 2008, KSF also utilized server virtualization to successfully provide access to medical records.

Prior to Hurricane Ike, KSF leveraged Microsoft Server Virtualization. The practice's two-person IT staff consolidated servers in about 36 hours the Friday before the hurricane hit. Less than 48 hours after the storm hit, KSF was the only functioning orthopedic center in Houston, allowing it to perform operations on Ike victims and injured first responders with all their electronic records intact. KSF leveraged virtualization to become a greener organization and to be better prepared for the unimaginable.

Becoming 'virtual'

Another way health care is leveraging technology to go green is by utilizing Web conferencing, messaging and collaboration software to hold virtual employee meetings. This reduces the need for travel and cuts corresponding expenses from the budget.

Enabling virtual collaboration can also increase efficiency, since employees can connect with colleagues across town or across the country from nearly anywhere. In a 24/7 world, employees need to access information and applications anywhere and at any time, especially when it comes to health care. Implementing the ability for them to view clinical records and images while remaining connected with colleagues can increase productivity and lower costs.

Though this approach can involve additional security measures, it may be worth the extra effort if your organization's travel expenses are spiraling out of control.

Planting green technology on the desktop

Server virtualization delivers cost savings and environmentally friendly benefits, but it's often a "behind-the-scenes" solution that doesn't impact many front-line employees and caregivers. Desktop virtualization, another iteration of the technology, not only lowers energy costs but can increase productivity, slash capital expenses on PC hardware and ease IT headaches.

Desktop virtualization delivers on the promise of thin-client computing by centralizing management of all user desktop environments on a single platform contained and managed in the data center. Forrester Research recently published a report that compares thin clients to desktops, and found that thin clients consume between five and 60 watts per device compared with the 150 to 350 watts typically used by a desktop PC. For organizations that deploy thin-client technology, it's possible to see energy savings in the 24 percent range. And since thin clients last about seven years compared to the three or four years of a traditional desktop, that's less money spent on PC fleet upgrades.

Desktop virtualization also removes the need for each employee to have his/her own PC, which lowers both energy and maintenance costs. Employees can simply log into any terminal to access applications and data, thereby increasing their efficiency. IT administrators no longer have to waste time fixing or replacing broken machines; instead, they can focus on the centralized platform in the data center.

Security is another benefit gained from desktop virtualization. Since data's contained centrally, administrators don't have to worry that unauthorized users will gain access to unprotected employee PCs. Desktop virtualization also eliminates the threat of information theft and loss of laptops or mobile devices, since no data resides on such devices.

Growing green

As the health care industry evolves, it must leverage technology to reduce costs, increase efficiency and improve the quality of care.

In a recent report released by consulting firm McKinsey & Company, analysts reported that, based on projections from the United States Department of Energy, overall energy use in commercial environments will rise 1.6 percent per year for the next 22 years. The energy used in offices full of PCs and power-guzzling devices is expected to grow at twice that rate. If the projected growth is that high for office buildings and corporate centers, imagine the figures for health care organizations, clinics and hospitals which, in addition to PCs and back-end IT infrastructure, must power a myriad of medical devices.

And while reducing expenses is the leading reason corporations are seeking more environmentally friendly practices - with 55 percent stating that reducing their energy-related operating expenses is the main reason for pursuing green IT strategies - 50 percent say that "doing the right thing for the environment" is their top motivator. The growing awareness of environmental issues and the popular groundswell toward going green presents an incredible opportunity for health care organizations to contribute positively not just to the health and well-being of patients, staff and caregivers, but to the planet as well.

Software solutions, virtualization and virtual collaboration tools are key to developing strategies that will drive cutting-edge health care technology and help these organizations become leaner, greener and healthier.

An op-ed piece, No Country for Old Men, filed today on The Health Care Blog by health industry consultant and futurist, Jeff  Goldsmith, provides a brilliant review and excellent analysis of our past sins and possible future under health reform. Perhaps most telling is the frightening scenario he paints of doctors, especially primary care physicians, leaving the profession.

In a recent HealthBlog post that was also picked up by ABC News I provided some of my own thoughts on why "affordable" and "health insurance" shouldn't be used in the same sentence. It's really all about cost. Unless we figure out a way to substantially reduce the cost of just about everything related to healthcare (which like food is something that every one of us must consume) we are doomed to failure. But where to cut?

A lot of folks immediately point to greedy doctors. Yes, there are some of those, but if medical practice was so lucrative why a predicted shortage of physicians? A new MGMA survey of physician incomes ranged from a low of around $150,000 for primary care to $650,000 for neurosurgery. I don't know about you, but I want the doctor drilling into my head to be well paid. $650K doesn't seem like all that much for someone who trained for more than a dozen years and sacrificed all of his or her 20's and early 30's learning a trade. Likewise, $150K seems inadequate for people making life and death decisions after a minimum of 8 years of very expensive, post graduate education. Heck, they don’t even come close to qualifying as “needlessly wealthy” which has been defined by some people as those earning more than $250K per year.

I do know one thing. These days even the "needlessly wealthy" are having trouble saving for retirement, paying for college, and funding their future healthcare needs. To the idea of a public healthcare plan that would let me retire before I become eligible for Medicare and also be affordable, I’d say “sign me up”! The problem is, the math just doesn't figure without passing along much of the burden to someone else. And I just don't know who that someone else is going to be.

Our present health system doesn’t “scale” for lots of reasons; access and cost among them.  Technology can help.  If a unit of health service can be delivered by telephone, e-mail, web visit, home test, home monitoring, retail medical clinic, or visiting nurse as a less costly or more efficient alternative to traditional office or hospital services, we should encourage it.  Organizations like Group Health, Kaiser, UPMC, Geisinger, and Mayo are already paving the way.   The health industry is ripe for disruptive innovation.  What’s needed are the appropriately aligned incentives that will move us in that direction.

Bill Crounse, MD  Senior Director, Worldwide Health    Microsoft

On Monday and Tuesday of this week I attended the 6th Annual Healthcare Unbound Conference in Seattle.  I was invited to speak on a couple of different panels during the 2-day event.  The effect of our soft economy on conferences was evident by the much lighter than usual turnout; or so I was told by conference organizers.  I was also struck by who wasn’t in the audience.  Clinicians were largely absent; perhaps too busy trying to keep their practices afloat in these challenging times.

Monday evening, I was invited to attend a dinner with my fellow panelists (Dr. David Kibbe, Ravi Sharma, Steve Adams, Martin Pellinat) and others to discuss the idea of clinical groupware.  If you are not familiar with that term, clinical groupware is described as a set of practice management, electronic medical record, decision support, prescription writing and other solutions that could be delivered to clinical practices as services over the Internet.

I like the idea of clinical groupware.  For some time now, doctors  have been pleading for lower-cost, flexible, easier-to-use and implement solutions for their practices.  This is especially true for smaller practices that don’t have, and will never have, IT support staff.  They want something that works more like cable TV.  You plug it in, get some basic channels, subscribe to the premium channels you want, and get on with your business.  Another analogy that has been used to describe clinical groupware is Apple’s successful iPhone.  You buy the appliance and download the applications you need.

Although the pure vision of clinical groupware is to deliver all of the software as “services in the cloud”, a blended model of some software on the local server or PC plus services in the cloud is probably better.  And either of these visions is likely better than most of the way-too-expensive, totally inflexible practice management and EMR solutions on the market today.  HealthBlog readers know that I have long advocated for greater commoditization of both ambulatory and hospital-based solutions.  I’d rather see more money going directly to patient care.

I believe there is a future for clinical groupware.  Physicians need better, more manageable and less expensive solutions than what the market is currently delivering.  I’m hopeful that portal initiatives, such as the AMA’s recent announcement about their partnership with Microsoft HealthVault, may one day evolve as a platform to deliver clinical groupware services.  In fact, HealthVault already serves as a platform for sharing health information, connecting devices, and providing services for consumers.  Clinical groupware offerings could be a very natural evolution of that platform.

Bill Crounse, MD  Senior Director, Worldwide Health  Microsoft

A Declaration of Health Data Rights

In an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

• Have the right to our own health data
• Have the right to know the source of each health data element
• Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form
• Have the right to share our health data with others as we see fit

These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights.

To learn more, visit http://www.healthdatarights.org/

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft

About this time each year, I reach out to my colleagues at Microsoft Research to see what cool projects they are working on that might have some direct or indirect application to health and healthcare.  A few years back we looked at technology they called “play anywhere”.  It was later renamed Surface Computing and today several of our partners are building health solutions that utilize the Surface user interface.

With that in mind, I’m pleased to show you my latest visit to Microsoft Research.  Once again, I was blown away by the projects I saw and how these software innovations might one day be applied to improve health and clinical computing around the world.

My first stop was to visit with Dr. Eric Horvitz, area manager for Microsoft Research.  I usually start with Eric because he is a fellow physician, and also because he is often at the center of some of the most thought provoking and cool research projects at MSR.  I wasn’t disappointed.  Eric showed us the next evolution of something we saw last year called situated interaction.

Eric and fellow researcher, Dan Bohus, have now applied the technology to an automated, robotic-like assistant that keeps track of Eric’s every move.  An on-screen avatar interacts with visitors outside Eric’s office just like a real-life receptionist might do.  Only this assistant has the brain of a computer and knows just about everything that is going on in Eric’s life based on years of real-time data.  She (it) even knows how likely it is that he’ll show up for a scheduled meeting.

My next stop was to see something called “What’s New on this Page?”.  Researcher Susan Dumais is working on technology that helps us pinpoint what data is new on a web page every time anything is updated.  You’d be surprised how many of the web pages you visit are updated every few seconds with new information.  Susan’s project shows potential for helping users who must navigate through large volumes of data separate what is new and important from what they’ve seen before.  I instantly thought of how such technology might be applied to laboratory and other clinical systems that constantly feed data into a patient record.  Such technology would show “What’s New on the Page”.

Our third stop was to visit with Tim Paek.  Tim is especially interested in mobile devices and applications.  He showed us how speech input on a mobile device can be used to search for the information we need.  As I was watching Tim find things on his mobile phone, I couldn’t help but think of how this might apply to busy clinicians looking for new lab results or other patient information while on the fly.

The last stop on this year’s visit to Microsoft Research is sure to be a crowd pleaser.  Researchers Hrvoje Benko and Jonathan Fay (of Worldwide Telescope fame) demonstrated what is known as the Omniprojector.  It’s a little like Surface Computing in 3 dimensions.  Whether applied to astronomy, graphics, or perhaps human anatomy I think you’ll immediately grasp how this technology might play out in clinical settings (radiology, pathology, etc.) and medical education.

I hope you enjoy this year’s visit to Microsoft Research.  You can watch each of the four segments individually by clicking on any of the screen shots of that segment.  You can watch the entire program (about 25 minutes) HERE or by visiting my House Calls for Healthcare Professionals site on Microsoft.com.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft

Healthblog readers know that I am a huge proponent for technologies that improve communication and collaboration between physicians and their patients.  Patients want to be able to reach doctors by e-mail.  They want access to their lab results and medical records.  They’d like to be able to schedule office appointments on-line and sometimes even “see” their doctor on-line. They want help managing chronic conditions and exchanging information with their physicians and other caregivers. 

You’ve read my rants on how far behind the health industry is, especially in the US, in providing these kinds of services to patients.  Where such services are offered, it is typically the large integrated networks and particularly staff-model HMO’s that have invested in the appropriate technologies to communicate and collaborate with patients on-line.  There are business and reimbursement reasons why this is so.  It is also the case because physicians in solo or small group practices haven’t had the IT experience or resources to match the capabilities of their much larger cousins.

An announcement today by the American Medical Association will go a long way in helping to level the playing field.  The AMA, in partnership with Microsoft HealthVault and portal developer, Covisint, will offer its physician members their own web portal.

The portal will make it possible for patients and their personal physicians to exchange vital healthcare information by connecting through HealthVault, a platform developed by Microsoft to store and maintain personal health and fitness info. Through this collaboration, physicians will be able to access self reported patient health information, once granted access by the patient, while providing patients access to vital information created during office visits.

The AMA has been working on this for more than a year, and it’s aimed at helping physicians better meet their practice-related needs. Primary offerings will include: clinical resources, practice and revenue management tools, e-prescribing and electronic health record applications and professional development resources. The AMA portal will also allow for personalized content, search capabilities and learning and networking opportunities, none of which requires great technological expertise to implement.

While attending the Microsoft Connected Health Conference in Bellevue today, I had an opportunity to sit down with AMA President Elect, Dr. James Rohack, to ask him some questions about the new portal and the kinds of services it will provide to physicians and their patients. 

“Many practicing physicians are feeling overwhelmed right now,” Dr. Rohack said. “They want help in meeting the demands of their day-to-day practices. Our goal is to provide them easy access to the tools and technologies that can help them, especially those who are looking to implement health IT into their practices. The AMA’s expertise is health care, but by collaborating with companies like Microsoft and Covisint, we can offer physicians sound IT solutions that keep health, patient care and medical practice at the forefront.”

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft

Politicians like to couple the adjectives “accessible” and “affordable” with the word “healthcare” when describing the goals of healthcare reform.  They say that with reform, all Americans will have health “insurance” and that it will be “affordable”.  I’d like to suggest that we eliminate the term “insurance” when talking about healthcare.

Insurance protects us from experiencing an unexpected loss that is greater than our ability or willingness to pay.  I spend thousands of dollars a year on home owners insurance to protect me from financial catastrophe if my house is destroyed by fire or an earthquake.  I spend thousands more to insure my automobiles against theft and collision.  In both cases, I am pooling my money with tens or perhaps hundreds of thousands of other people to protect me from a loss that statistically only happens to a very few those who are insured.

But healthcare is a different kind of animal.  Insuring people for healthcare expenses, especially with low deductible plans that cover almost everything, simply doesn’t pencil out and especially doesn’t if we try to affix the word “affordable” to the premiums needed to support such “insurance”.  How much would my home owners insurance cost if every covered home would one day burn to the ground?  How much would car insurance cost if everyone in the country drove a red Ferrari, and every red Ferrari got totaled?  To my perhaps simplistic way of thinking, that is the conundrum of health “insurance”.  We are asking for “affordable” premiums that will protect us from the financial burden associated with services that each and every one of us will need; services that will cost hundreds of thousands of dollars over the course of a lifetime.  In fact, I’ve read recent statistics suggesting that the average American will need $240,000 just to cover out of pocket healthcare costs not paid by Medicare between eligibility and death.  Affordable?  I don't think so.

When it comes to discussing healthcare, I think politicians need to start using a word other than insurance, and they certainly need to get rid of “affordable” in the same sentence.  Yes, there’s plenty of room to make healthcare “less expensive”.  Technology, preventive services, disease management, and process design re-engineering can make healthcare less expensive and more accessible.  But no country can deliver affordable healthcare, insured or not, that provides everything than can be done for everyone who wants or needs it.  Healthcare reform should not be debated without a healthy dose of “tough love” on basic economics and a whole lot more detail about what we’ll really be getting.  And for goodness sake, let’s stop talking about “affordable” insurance.  Am I missing something here?  I don’t claim to be an economist.  I’m just a doctor who gets really confused when people throw around terms that don’t “add up”.

Bill Crounse, MD   Senior Director, Worldwide Health  Microsoft

How many times have you wanted advice from a doctor, but didn’t have time to drive somewhere to see one? How often has a medical question gone unanswered because finding a doctor to ask was just too much of a hassle? How frequently have you delayed medical treatment because you couldn’t reach your own doctor and didn’t know who else to see? What if there was a more convenient way to receive care for a minor illness or injury? Well, for citizens of the state of Hawaii, there definitely is another way!

In January, one of the largest health plans in the state of Hawaii, HMSA, launched a new initiative that provides on-line care to every citizen. Residents can get answers to medical questions or treatment advice for a minor illness or injury from a participating doctor using on-line web messaging, video visits, or the telephone. The sponsoring health plan even discounts fees associated with using the on-line service. Partners in this exciting new initiative include American Well Systems in Boston and Microsoft HealthVault.

This week, we have released a new audiocast for my House Calls for Healthcare Professionals series. It explores the new on-line service from HMSA and what motivated the company to offer it.  Participants in the discussion include:

Dr. Roy Schoenberg, co-founder and chief executive of American Well Systems in Boston.

Dr. Patricia Avila, Medical Director for on-line services at the Hawaii Medical Services Association HMSA, an independent licensee of Blue Cross-Blue Shield and one of the largest health insurers in the state of Hawaii. Dr. Avila is also a primary care and preventive medicine physician practicing in Hawaii.

Dr. James Mault, a Director for Microsoft’s Health Solutions Group representing Microsoft HealthVault.

To listen to the audio-cast, click HERE.  You can also download the program here.

Bill Crounse, MD  Senior Director, Worldwide Health  Microsoft

I’m in Los Angeles (Santa Monica) to speak at an event sponsored by Town Hall Los Angeles.  The topic is healthcare reform.  I’m sure there will be a lively debate with state and federal officials, representatives from the insurance industry, and provider organizations all participating in the discussion.

My role at the event is to discuss the place for information technology in healthcare reform and how an investment in IT will pay off dividends by improving the quality and safety of patient care and help lower healthcare costs.

I will point out that the biggest return on investment probably won’t come from electronic medical records alone.  Going digital in the health industry is something we should have done in America years ago.  We now find ourselves well behind other industrialized nations in the use of electronic records.  Yes, digital records can and will improve safety, prevent errors, reduce duplicative tests, etc.  Yes, thoughtful EMR implementation and meaningful use will improve productivity eventually.  But when I look the the value proposition for IT in health, I see far greater payoffs in other areas.  I’ve written extensively about information worker solutions and unified communications technologies and how these can streamline care delivery and care team collaboration.  More recently, I’ve been focusing on various location, tracking and sensing technologies and how they can be applied to improve patient flow, on-time delivery of services, staff productivity, and asset management.

Last week I attended a presentation by Microsoft partner, Versus.  To say that I was impressed by this partner’s work and growing body of customer evidence would be an understatement.

While location, tracking and sensing solutions using RFID, IRRD, and USID have been around for a while, the technology is finally coming of age in the healthcare industry.  Debating the merits of one technology over another or one vendor over another is beyond the scope of my Blog.  You’ll have to decide that for yourself.  But I will say that if you are not planning for the use of this technology in your hospital or clinic, you are missing a huge opportunity to lower costs, increase revenues and deliver better, more satisfying care.

Let’s be clear.  In the years ahead, no one is going to pay you more for what you do.  Remember, healthcare reform is about lowering the cost of care.  But savvy organizations are using the language and tools of industrial design and manufacturing to implement much improved work-flow processes in clinical settings.  The names of the organizations doing this are well known in the healthcare industry.  In the ER, OR, hospital ward and ambulatory clinic, they have installed location and sensing technologies to track the flow of patients, the movement and location of clinical staff, and the availability and location of needed equipment. 

They are eliminating phone calls and wasted time previously used to determine room, bed, or equipment availability.  They are seeing more patients in less time.  They are eliminating patient waiting and increasing the availability of staff and resources.  They are measuring and improving what previously couldn’t be measured.  They are improving patient safety by identifying and eliminating sources of infection.

Yes, it’s time to go digital in healthcare.  Yes, you need to be implementing an EMR.  But there is far more to be gained, and likely more quickly, by using IT in ways that you might not be thinking about if you are only focusing on the EMR.

Bill Crounse, MD  Senior Director, Worldwide Health  Microsoft

Let me be perfectly honest.  At some level, an operating system is just an operating system.  Whether you hang out in the C-suite, in the IT department, on the ward, or in the operating room; you just want your computer to work.  Having said that, I think anyone who truly enjoys computing as I do and how the personal computer helps us do our work (communicate, collaborate, locate the information we need, improve clinical practice, patient safety and the quality of patient care) will simply love working with Windows 7.  Why?

Windows 7 just works better.  And there are some features and functions that make our newest operating system especially compelling for the health industry.  I’ve been using the beta and release candidates of Windows 7 for several months now.  My experience, from installing it on multiple machines to using it at work and at home, has been nothing but satisfying.

Like anyone else, I prefer a desktop that is visually pleasing to use. Windows 7 is extraordinarily fluid in the way it moves between applications, and provides real-time thumbnail views of all my open applications.  The graphics are simply stunning.  The eye candy will please you every time you fire up your machine.  But pretty is only skin deep.  What else will excite you?

Enterprise users will find a lot to like.  With DirectAccess, Windows 7 makes it easy to connect to corporate resources without going through a Virtual Private Network.  Windows BitLocker™ protects sensitive data (which is just about everything in healthcare) on internal and external drives while advanced network backup and Encrypted File System also protect sensitive data. BranchCache™ decreases the time remote workers need to open files running on the corporate network.  AppLocker helps IT staff prevent unauthorized software from running on corporate machines. Tablet PC users will enjoy significantly improved hand-writing recognition.  Like many physicians my hand writing is terrible, but Windows 7 is truly amazing in its ability to recognize my scribble. It also learns.  The recognition gets better and better the more I use it.  The same is true for voice recognition.  I just talk to my machine and it does what I want, from opening applications to dictating a letter.

Multi-language user support comes built in.  Windows 7 also  dramatically increases color support for applications (diagnostic, microscopic, etc.) where more accurate color rendition is critical.  The new OS also supports Touch and MultiTouch for a coming generation of machines and screens that will enable vast improvements in the ways we interact with images, graphics, and applications. There are new drivers to support both physical and role-based sensors (like RFID, USID) and new “PlayTo” streaming media capabilities as well as improved support of various media formats.  Developers and IT managers will also appreciate improved support for virtualization and federated search capabilities.

You can learn much more about Windows 7 by visiting resources on the web.  And, if you are anything like me, you’ll want to take the release candidate for a test drive.  You can do that here.

Windows 7—A Healthy Choice for Healthcare.

Bill Crounse, MD  Senior Director, Worldwide Health    Microsoft

Liked. WTN on Window Mobile platform improves care quality, significantly lowers cost.  That might have been my tweet on Twitter.  But here on HealthBlog I have the luxury of sharing much more about this innovative approach for managing patients with chronic, non-healing wounds.

Every clinician understands the challenges associated with wound care.  The  process is slow, time-consuming, complex, and expensive.  Non-healing, ulcerations and wounds are associated with a variety of chronic conditions including diabetes, peripheral vascular disease and stasis.  Non-healing wounds are also associated with immobility due to aging, injury, paralysis, or other co-morbid conditions.  Many of these patients end up being hospitalized to treat secondary infections, or to provide the intensive regime needed to heal chronic ulcerations or wounds.  Hospitalization itself is risky as it exposes these susceptible patients to dangers they might not otherwise encounter in their home environment such as MRSA.

I was therefore delighted to learn about the good work being done by Wound Technology Network using the Windows Mobile platform.  As described on the company’s web site;

Wound Technology Network is a physician-based system, with a revolutionary new program that benefits patients, doctors and healthcare payers. WTN is the Nation’s only physician network-based telehealth comprehensive wound management system.

WTN designed a technological platform that vertically integrates a network system of wound healing services. This technological platform allows WTN to deliver all the advantages of physician-based services across the entire continuum of care. WTN achieves this through consistent utilization and adherence to evidence based clinical care, implemented across a digital infrastructure. The system has markedly decreased healing times as well as the costs of quality care with dramatically improved outcomes.

What I especially like is WTN’s use of mobile phones and cellular networks to connect wound care providers to expert resources and specialists.  Windows Mobile devices help caregivers capture information at the point of care, transmit data and incorporate it into the medical record for continuity of care, and support caregiver collaboration with two-way audio and video streaming.

To help you understand how Windows Mobile supports WTN and their network  of would care specialists, we’ve prepared a video (click on image to the right) .  As they say, “a picture is worth a thousand words”.  And, having a moving picture (even if on a tiny screen) is breaking new boundaries in the provision of advanced wound care services for patients.  Special thanks to Hemang Patel, mobile solutions specialist, Microsoft Health and Life Sciences, for his collaborative work with WTN.

Bill Crounse, MD  Senior Director, Worldwide Health    Microsoft Corporation 

The World Health Organization has raised their alert level to Phase 5, meaning that a pandemic outbreak of swine flu is imminent and just one step away from Phase 6 which would indicate that a worldwide pandemic is underway.   Also, the CDC has reported the first death associated with the Type A N1H1 swine flu virus in the United States; a toddler from Mexico who died in a Texas hospital.  Swine flu is now suspected in 11 states, including 6 cases here in Washington State.  The total number of US cases has surpassed the 100 mark and is expected to go much higher.  Cases are also being reported in 6 European nations, Canada, Mexico, New Zealand, the Middle East and possibly in Asia.

How can public health officials and hospitals around the world respond to such a crisis?   What tools can be deployed to help local, regional, and national authorities monitor the spread of a disease and mobilize resources to deal with it appropriately?  How do you monitor the pulse of a pandemic?

For one hospital in Northern California, the answer was clear.  El Camino Hospital, a community hospital located in the heart of Silicon Valley in Northern California, found the tool they needed in the Microsoft Amalga Unified Intelligence System.  El Camino is an early adopter customer for Microsoft Amalga, a data aggregation and analysis solution originally developed by clinicians at Medstar Health’s Washington Hospital Center in Washington, D.C.

Within a matter of hours, clinicians at El Camino modified a few fields within Amalga to capture information specific to possible flu cases coming through the hospital’s busy emergency room.  The result is a real-time dashboard that is keeping hospital officials appraised of possible swine flu cases at El Camino and will help them respond appropriately should one or more cases be confirmed.  Clinicians are praising Amalga for the solution’s flexibility and the way it can be adapted to meet specific organizational needs as they arise.

Microsoft has announced plans to provide guidance to other Amalga customers so they too can immediately begin using the solution to monitor flu activity.  This could prove especially valuable where Amalga has been deployed to gather community-wide clinical data.  One example of that is the Wisconsin Health Information Exchange where more than a dozen emergency rooms in the state are now able to share real-time clinical data thanks to Microsoft Amalga.

For more information about the Amalga Unified Intelligence System, click here.  Also note that Microsoft is holding a special conference in Bellevue on June 11th and 12th to discuss the importance of liberating data across the entire healthcare system and connecting the ecosystem entities.  For more information about the Microsoft Connected Health Conference or to register, click here.

As Microsoft has done many times in the past during natural disasters or disease outbreaks, the company is also assisting the CDC and the government in Mexico in getting out needed information about the current swine flu pandemic.  To learn more, you can watch this report from Seattle’s NBC affiliate, KING-TV.

Bill Crounse, MD     Senior Director, Worldwide Health      Microsoft Corporation

Today, I will give a luncheon keynote at the annual Council on Employee Benefits gathering at the Four Season’s Hotel in Westlake Village in the suburbs of Los Angeles.  Last evening, I joined the group for what turned out to be a very memorable evening at the Ronald Regan Presidential Library and Museum in Simi Valley.  It was an absolutely beautiful evening and a very special treat to literally dine beneath the wings of Air Force One.  If you ever find yourself in the area, I would highly recommend a visit to the Presidential Library.

Being at the library and museum after hours afforded an opportunity to really  examine the memorabilia, life, and times of President Reagan.  Regardless of political persuasions, I think most of us would agree that Ronald Reagan was not only a charming man, but someone who lead an extraordinary life.  It got me thinking about the situation in which we presently find ourselves.  What will it take to extract America from this terrible economy?  How much of it is due to sins of the past come home to roost versus fear and doubt about the future and our ability as a nation compete globally?  And what about healthcare?  What kind of system do we really want?  Do we want a system that provides a safety net of care for everyone?  Or do we simply limp along and make some minor adjustments?  Remember, that one in eight American jobs depends on healthcare.  In every town across America, healthcare is one of the top employers.  We will be tinkering with a system that is a significant force in the American economy.

Other developed nations manage to provide a safety net for citizens and do so for far less per capita than we presently spend in America.  We can have universal care and we can have more affordable care, but it is also important to level set on what that really means.  It does not mean that everyone gets everything they want any time they want it or need it.  It wouldn’t mean that everyone has access to the most expensive and heroic treatments.  It is not likely that million dollar cancer regimens, organ replacements, and bionic limbs could be provided to all.  Certainly we would need to adjust our expectations about care at the end of life.  The emphasis of our healthcare system would need to shift away from sick care and focus more on prevention.  There would likely be some kind of rationing of the most expensive and experimental treatments based on co-morbid disease, life expectancy, and other factors.  We couldn’t just demand treatment no matter what the cost and expect government to pay for it.

Here at the CEB event, where the setting is truly inspiring, there is a lot of focus on what will happen to  healthcare in America.  Will health insurance through employers continue to be the model?  You may be surprised to learn that even in many European nations that have socialized healthcare, private insurance is frequently in the mix and often provided through employers.  Private insurance exists because people want more than the government can or will provide for them.

I don’t claim to have an answer about what kind of health system is best for America.  There are advantages and drawbacks to every system around the world.  It is clear that we need some kind of change.  The question is will we be better off, happier, and healthier as individuals and as a nation when that happens?  Time will tell.

On a related note, you may enjoy reading a piece from my colleague Peter Neupert on his Blog Neupert on Health.  It is entitled “Tear Down the Walls and Liberate the Data”.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation 

I’m writing this today from the beautiful Hyatt Regency Century Plaza in Los Angeles; just a stone’s throw away from the tony enclave of Beverley Hills and Rodeo Drive.  From my room on the 18th floor of the hotel I look out at the MGM Tower and the Fox studio lot.  The setting seems appropriate for the 2009 MGMA Academic Practice Management Conference where I will deliver a keynote address later this afternoon.

The MGMA Academic Practice Management Conference is a gathering of several hundred  business managers representing America’s teaching hospitals and medical schools. I arrived in time yesterday for the opening keynote by Dr. Atul Grover, chief advocacy officer and strategist for the Association of American Medical College’s advocacy agenda.  Dr. Atul provided a riveting, and often comedic, history of America’s healthcare reform efforts over the past 50 years.  It reminded me of a movie plot, and a bad one at that. Clearly, the Obama administration’s focus on healthcare reform has these guys wondering if government will be friend or foe when it comes to supporting academic medicine.  The economy is already taking its toll on this group, at least as measured by conference attendance which organizers tell me is down almost 50 percent from previous years.

You can learn a lot at an event like this by visiting the conference exhibit hall.  At this particular conference, there isn’t the usual focus on EMRs, medical equipment, or even pharmaceuticals.  Instead, it is all about how to get paid for what you do.  At least two dozen exhibitors are here promoting their “revenue cycle enhancement” services or medical coding and billing solutions.  It makes you realize how much money is spent on solutions and services devoted to nothing more than processing payments for healthcare.  It seems to me there must be a better way, but I’m not sure we are going to find it with healthcare reform legislation from politicians in Washington.  Have the many reforms to our tax code made filing your tax return any less painful? I think not! Is there at least 30 percent administrative waste in our healthcare system?  I’d say yes; possibly more.  Do I think anyone in Washington D.C. is going to fix it?  Sadly, no. 

Later today, I move across town to the Four Seasons Hotel at Westlake Village where I will join the Council on Employee Benefits for their annual conference.  I deliver a keynote address there tomorrow before returning back to Seattle.   It should be an interesting contrast moving from a conference where everyone is focusing on how to get paid more, or at least not less for what they do, to one focusing on how to pay less for healthcare, or at least pay no more. And so it goes…… just like a twisted movie plot.

Bill Crounse, MD     Senior Director, Worldwide Health      Microsoft Corporation

For HealthBlog readers who were unable to attend HIMSS in Chicago, I thought I’d provide a recap of the presentation I gave in the Microsoft Theater.  The title of my presentation was aligned to our mission statement, “improving health around the world through software innovation”. 

The new administration and our challenging economy will force significant changes in American healthcare.  Clearly, our present system with its spiraling costs and uneven quality isn’t sustainable.  Unchecked, our healthcare expenditures will top 20 percent of GDP within the next few years.  We already spend twice as much per capita on healthcare as most other developed nations creating a sink hole for American businesses that compete globally.

The American Recovery and Reinvestment Act will pump hundreds of billions of dollars into the economy.  About $20 billion will go towards health IT.  While there is no question that America needs to go digital in healthcare and lags behind many nations in our use of IT in health, the real savings will come from how IT helps transform where and how we deliver care, and perhaps also by whom.

First of all, contemporary IT solutions will help move more care out of hospitals  and clinics and into other settings including the home.  Even though I am a primary care physician, I’ve been a proponent of the retail clinic movement in America.  Delivering care that is both convenient and at a price point people can afford is a much needed solution.  Retail clinics, especially when they are managed or affiliated with community providers, are a terrific alternative for people needing quick, competent care for minor health issues.  I am also a big fan of home health and I hope the new administration will resist and temptation to cut reimbursements for home health services. IT solutions will enable increased connectivity between home health nurses, community physicians, clinics and hospitals making it possible to monitor patients in their homes and provide needed information and support between in home visits.  Finally, I see a promising future for high-tech, healthcare kiosks located in the workplace, pharmacies, airports, hotels, and other settings where people gather.  The airlines have trained just about everyone how to use a kiosk, and I expect a lot of health information and medical services will be delivered by kiosks in the future.

Information technology is also creating new possibilities for how we deliver  care.  The Internet and a wide range of commodity-based communication and collaboration tools are opening new avenues for healthcare delivery.  If the government and other payers will create the appropriate incentives and start paying clinicians for cognitive services provided by messaging, telephone, e-mail, web video visits, etc., we can significantly reduce the number of people who pack our clinics and emergency rooms seeking advice or reassurance for minor health issues.  This is already happening in the state of Hawaii where one of the largest eHealth pilots, sponsored by HMSA, is now up and running utilizing services from American Well and Microsoft HelathVault.  How we deliver care will also change as the filed of genomics expands and our need for care becomes more predictive and preventive.  Here again, trials are already underway at the Scripps Research Institute where on-line access to genetic testing through Navigenics and personal health data acquisition and storage on Microsoft HealthVault are testing the waters for this new era in healthcare.

Finally, information technology also provides some interesting possibilities related to who delivers care in America.  Although this is likely to be one of my most controversial thoughts, it is clear to me that our present system for delivering care doesn’t scale.  I would urge medical educators, licensing boards, and policy makers to think deeply on how we can streamline our training programs to pump more caregivers into the workforce.  A system that is dependent on people needing 8 to 12 years of post graduate education not only doesn’t scale, but excludes far too many people from having the opportunity to participate.  I believe contemporary information technology, powerful software, artificial intelligence and a globally connected society will enable new categories of healthcare workers.  These workers will be able to diagnose and treat patients and even do procedures having had less, but much more focused training, than workers today because they will be aided by intelligent software, sensors, and devices.

Software innovation only sets the stage for all of this to happen.  We must remain focused on the outcomes we hope to achieve.  However, I firmly believe that information technology will enable new opportunities to transform healthcare including where and how services are delivered, and perhaps even by whom.

Bill Crounse, MD      Senior Director, Worldwide Health       Microsoft Corporation