HealthBlog

Governments begin to take note of a new model for health information data sharing and exchange

2009-07-10T22:53:25Z

On July 22nd of last year I made a post on HealthBlog titled “ A possible sea change in the way we share health data ”. I wrote this entry while attending last year’s World Congress Leadership Summit in Boston. Here’s part of what I said in that post: “In 2004, George Bush proclaimed that most Americans would have an electronic health record by 2014. So here we are 4 years later, and despite a lot of focus on establishing the Office of the National Coordinator for Health IT,...(read more)

Going Green in Healthcare IT and improving organizational efficiency along the way

2009-07-08T17:57:41Z

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...(read more)

Health Reform—neither brain surgery nor rocket science

2009-06-29T18:06:38Z

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"...(read more)

Is it time for “Clinical Groupware”?

2009-06-24T21:14:24Z

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...(read more)

Join the revolution—Your data, your rights

2009-06-23T05:30:25Z

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,...(read more)

Promising New Projects at Microsoft Research May Lead to Better Healthcare

2009-06-16T03:44:10Z

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. ...(read more)

AMA and Microsoft join forces to improve communication and collaboration between doctors and patients

2009-06-11T16:56:09Z

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. ...(read more)

Affordable Healthcare Insurance—Say What?

2009-06-09T21:18:06Z

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

Technorati Tags: healthcare reform,healh insurance,Obama,Microsoft,health IT,affordable healthcare

A New Milestone for Healthcare On-Line

2009-05-28T17:14:00Z

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

Technorati Tags: Internet,Microsoft,American Well,HMSA,Hawaii,HealthVault,on-line healthcare,eHealth,telemedicine,healthcare reform

Thinking Beyond the EMR. Why location, tracking and sensing technologies may provide a higher, faster rate of return.

2009-05-22T00:49:00Z

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

Technorati Tags: Microsoft,Versus,RFID,USID,IRRD,location services,sensors,industrial redesign,industrial engineering,EMR,health reform,eHealth

Windows 7—A Healthy Choice

2009-05-13T18:19:56Z

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

Technorati Tags: Windows 7,Health,Healthcare,IT,Microsoft,Operating System,User Experience,MultiTouch,Web,Internet

Windows Mobile Medicine

2009-05-05T17:32:29Z

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

Technorati Tags: health reform,Microsoft,WTN,Windows Mobile,Web,Internet,telemedicine,telehealth,wound care,EMR,care quality

Monitoring the Pulse of a Pandemic

2009-04-30T15:45:00Z

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

Technorati Tags: Microsoft,Swine Flu,CDC,El Camino Hospital,Pandemic,Amalga UIS,ER,N1H1

Healthcare Reform--What would Reagan do?

2009-04-21T17:35:30Z

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

Technorati Tags: healthcare reform,health,IT,Ronald Reagan,CEB,health insurance,internet,presidential library,politics,Microsoft

Coming Soon! Healthcare Reform. Will it have a happy ending?

2009-04-20T18:25:39Z

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

Technorati Tags: healthcare reform,MGMA,academic medicine,medical schools,universities,Fox,MGM,Hyatt Regency,Internet,software,health IT,Obama,stimulus package,Microsoft