Last night there was a question in the Presidential Debate on whether healthcare should be a privilege, a right or a responsibility in the U.S. McCain gave a nuanced answer -- but said it was a responsibility and Obama said he considers it a right for U.S. residents since we are a wealthy society. It is a really interesting question -- especially if you are like me -- a wanna be economist/philosopher. For those that want a long but illuminating blog post on the topic of rights and obligations -- see Maggie Mahar over at THCB.
Before we get to the question of rights however - we need to take a short detour into the world of economics. During the debate and throughout the policy community there is a conversation about employer paid health insurance, vs. universal government paid health insurance vs. individual paid health care (or insurance) along with the entitlement programs we already have -- Medicare and Medicaid, SCHIP and not to mention disability payments and other programs. People -- there is no free lunch here! One way or the other, individuals/citizens/consumers are paying for health care, period. There is no other funding source. YOU are paying for health care...maybe not when you consume the service -- but you ARE paying for health care. Here is how we pay for health care:
- Lower wages so employers can pay the premium on health insurance
- Medicare tax on wages
- Partial payment of premiums, co-pays and other out of pocket expenses
- Other taxes (income or real estate) so the States can fund their portion of health benefits for employees and for their entitlement programs
- higher prices on goods/services from businesses -- so that the businesses can pay their taxes
- and so on
So the individual citizen is paying for health care today -- whether directly or indirectly. It is too bad politicians or journalists don't make this point more often. So the question really comes down to one of who pays for whose health care? As a taxpayer and citizen -- in addition to being accountable for my families health needs -- how many additional folks should one be accountable for? The looming Medicare funding crisis is precisely this -- in the future the folks paying into the system won't be enough to cover the folks taking services out. (there should be a whole sidebar discussion of insurance here -- but later).
The economic detour was necessary to frame the philosophical question properly. Talking about healthcare as a right -- without understanding that it is an economic good that has to be provided and paid for -- is wrong. It is not like "free speech" or freedom of religion...which may have economic implications as 'rights' benefits of a better more transparent society) ...but certainly don't require specific resources to have the right or to compete for economic resources the way healthcare does.
I like to think I am as compassionate or more so than most people. I would love for everyone to have more economic goods -- more healthcare, more health, more economic security, more food, lower gas prices, lower house prices (well maybe not) -- but you get the idea. But the system of incentives you choose to deliver these goods (capitalist or socialist or communist) matters and matters a lot -- to the quality, quantity and prices of the goods available to share. We have learned that the form of economic incentives matters to the outcomes for society -- and directly to what society can invest in redistributing. While the concept of capitalism may be taking a beating in the popular press today -- I have yet to see evidence of system that works better -- and we should better remember that when we try to learn the real lessons from today's crisis.
More importantly -- healthcare is really complicated as an economic good in lots of ways. But the one that matters for this argument is that -- many of the behavioral choices an individual may make -- like smoking or not being compliant taking your drugs -- can dramatically increase the healthcare economic goods required over one's life. If healthcare is a right -- do I have the right to ALL the healthcare I can consume and NO accountabilities to society on how I consume it? If not, who decides? Hopefully you can see where this leads.
I may continue this thread at a later time -- so comment if you have something to add.
Calling healthcare either a right or a moral obligation -- won't help us think clearly about the path to reforming the system to deliver more value nor will it help us understand the harsh economic realities and incentives required to build a better, healthier society. We really aren't learning any good lessons -- economic lessons -- from the current financial crisis.
I have spent some time over the past several weeks to read and get educated about various health reform proposals. As can be expected - there is a lot of dialog on this topic given the political season. Health Affairs has some good articles up if you want to get informed about the Presidential candidates proposals. Maggie Mahar has a great post up at The Health Care Blog detailing some current thoughts of one of my favorite economists on the topic, Prof. Uwe Reinhardt.
However, the more I consider and read about the topic, the more skeptical I get about the prospects that we will have meaningful reform anytime soon...which is a real problem. I am concerned by both the lack of understanding and by the politics! I guess I am an naive idiot for being surprised.
I am generally biased towards market based capitalism and individual rights and accountabilities. But as we all know -- markets have and require rules to properly function in setting prices and allocating resources (prime reasons why they are more effective than alternative economic forms). Look at Russia today -- without the rule of law -- they can't sustain their autocratic economy.
In the U.S. Health 'system' - we sometimes have the worst of both worlds. As Prof. Reinhardt points out -- there is no legitimate reason to tie one's health insurance to employment -- it has perverse consequences. We have rigid rules on the supply side (what Medicare will pay for, how Medicaid reimburses and so on) -- which contribute to a lack of innovation on supplying economically cost effective services (tele-medicine for example). Consumers are also legitimately confused on the demand side -- neither knowing what things cost or why they need to think about providing for their future health like they have to provide for their future retirement income.
The political debate is often framed around covering the un-insured. While an important consideration -- it is not the most important issue. The most important problem is how to create a framework where we get more value out of the current spend on health. This is the key economic and policy question. If we can improve the value delivered (health outcomes/economic inputs consumed) -- then there will be more dollars available to cover the disadvantaged (social, economics, genetics). If we can't improve the former (value delivered) there is little chance we can afford the latter (more coverage).
Many smart folks realize this -- but they have not figured out how to make this argument effective with political soundbites (neither have I). So the current political dialog is shallow and does not help frame the real debate we will have to have in the coming years.
The meltdown of the U.S. financial markets is instructive to health IMHO. Not that hospitals or doctors are using leverage inappropriately, as in the financial sector. But rather that the rules and incentives matter, that transparency matters (does anybody really understand pricing in hospitals?) and that a system out of whack (imbalances -- such as docs leaving private practice) ultimately leads to a systemic problem. Many recognize the 'system' is sick, many even understand how the trends are getting worse not better - but there is not a clear path forward because of the incredibly gargantuan, yet fragmented nature of the 'system'. Hence my current skepticism towards progress.
I love the fresh debate about standards and the evolution of Health IT raised by the three Health Affairs articles. I agree wholeheartedly with the perspectives of Carol and Clay - and frequently reinforce these comments to customers, policy makers and audiences alike.
- It's about the patient - not about the standards. Value in the form of patient care and business results can be improved by moving/reusing the data already in the system! There is no need to wait for 'standards'. Ultimately we need to be focused on solutions that provide value to patients….better quality of care.
- If it's about the patient, we need to empower consumers to be active and engaged participants in the system and they will demand 'connected' care and more health and wellness choices. They will increasingly make physician choices based on the ability and willingness of physicians to leverage communications/connected care to improve patient convenience and outcomes. In order to have more choice, consumers need to be able to access and leverage health IT solutions: the same ones that are being used by their physicians and other stakeholders across the spectrum of care.
- Health IT is a great enabler for many things (outcomes, safety, results, employee productivity, employee satisfaction) but not an end in itself. System design matters a lot - metadata is the answer to enabling exchange of info today to evolve to standard exchange tomorrow. Health IT is only one piece of the puzzle, but we can't wait for all the pieces to be in place; We need to start improving outcomes today. These beliefs have informed the design principles of the software products we introduced in the marketplace - both HealthVault and Amalga.
In addition to consumers as a change agent, I remain hopeful that the buyers of large health IT systems will wake up and demand more from their vendors; Not in terms of custom features, but in terms of a real commitment to interoperability and to unlocking the data that exists in systems already. Health IT buyers are critical stakeholders/components of the ecosystem and need to demonstrate leadership in getting us to real solutions that extract the value from HIT - and not let themselves be positioned as victims controlled by the vendors. Unlocking the data that providers and patients need to make the right decisions should be the priority, with the goal of improving patient outcomes.
I had the good fortune of participating in an Allen and Co. health 'event' last week. They brought together a small number of entrepreneurs and big company folk such as myself (and spouses) for an intimate few days of conversation, networking and recreation. Their formula really works for forming relationships and developing deeper understanding of others' perspectives. They also do an outstanding job with the execution -- so I found it well worth the investment in time.
Given the mix and high quality of folks -- we had engaging and wide ranging conversations with the following tidbits worth sharing:
- what is the future (and right) business model for diagnostics? how (and when) will diagnostics dramatically change the health delivery system?
- how the existing policy framework encourages (forces) entrepreneurs to exploit the mis-alignment of incentives (find the gaps with new middleware type solutions) vs. creating end-to-end value improvement.
- what will it take to get supply-side innovation and payment reform? is this even on the agenda of the presidential campaigns? why not?
- does the increased use of information technology lead to consolidation of the fragmented health delivery system -- or does it enable 'virtual' consolidation through information networks vs. business organization? or does it do both over time -- in phases?
- what form of evolution will emerging markets go through -- as they build both capacity and insurance systems? what would we advise them to do? and are there business opportunities for entrepreneurs or big companies only or both?
A funny incongruity, is I learned a lot about the development of a two-sided health specific market in today's connected Internet driven world -- while riding on horseback!
Last week, we hosted around 20 physicians from one of our Amalga early adopters for a two day, two-way conversation around what the most important challenges in health delivery are and how software can help address them. It was a very instructive conversation -- from which I learned a lot and met some talented, accomplished and interesting individuals.
Part of our objective was to imagine a future where software technology enabled new types of workflows and an extended delivery network beyond the hospital. There was a lot of energy and discussion about the shape of such a future (increase the focus on prevention - inside the hospital and as a core to the delivery network goals). As the discussion went on there was spirited debate about where to start, how to measure and how to pick goals that would really be transformational.
I am not prepared to go into the details of the conversation here -- but there were a few non-proprietary insights for me -- that are worth sharing:
First -- I have a much deeper understanding of the diversity of perspective, understanding and challenges -- of the various specialities and practice groups within a large delivery system. Given this beginning point -- and other factors such as physician model -- I appreciate the need for (and challenge) of leadership to enable change to really happen.
Next the dynamics of an "enterprise" health system seems more like a conglomerate than a traditional product focused enterprise -- even though they are serving a common customer and market. This makes goal setting, prioritization of metrics for performance and resource allocation much harder -- if you want to drive to a common vision.
We started the session listening to Dr. David Pryor from Ascension Health. Pryor described how Ascension set themselves an audacious 5 year goal (zero preventable medical errors) and then went about a series of process improvements to get there. It was fascinating to listen to him describe the steps, the challenges, what worked and most impressively the results they achieved in a relatively short timeframe in multiple different institutions. It truly is a remarkable story -- and given the organizational comments above -- even more impressive. It is great that he was willing to share their best practices openly.
All health delivery organizations face big challenges on multiple fronts. Everyone knows, that quality (outcomes) needs to improve and would reap large economic and social benefits. And clearly -- as Ascension has demonstrated - real progress is possible. In a truly competitive sector -- like banking -- the advancements of the certain organizations would ripple reasonably quickly through the sector (improve or lose share). This dynamic doesn't appear to be at work in the health sector. So it is going to be up to the leaders of our health delivery institutions -- to set audacious goals and drive to achieve them.
Today Tara Parker-Pope had a thought provoking column about the strains in the doctor/patient relationship -- and there are some good additional anecdotes and discussion on her blog, Well.
I have maintained for a couple of years that doctors are missing an opportunity to leverage their "trusted brand" (a.k.a the trusted relationship) by embracing basic Internet technologies to communicate more effectively, consistently with their patients. The simplest example is think of all the information a doctor's office has and needs to distribute to patients -- info about their disease (pamphlet anyone), info about the drugs they prescribe, info about what to do before the procedure, info about post-visit instructions and so on. The doctor could "push" this information to the right patients easily -- using a basic CRM type system. It may not be "personalized" -- but it would be relevant, timely, delivered in a form that patients could use/reuse the information and perhaps learn more, if they chose to in a self-directed way.
I first learned about "information therapy" and the key role it played in improving outcomes from the founders of Healthwise -- and they are still pursuing this mission, with an expanded set of services. When you think about -- you want information from the doctor -- and we know from our consumer market research -- the consumers want "trusted information" -- but they also want a lot more than the 2 minutes, shorthand version today's economic model supports in the typical office visit or phone call.
The opportunity is physicians could differentiate their services, extend their reach beyond the office visit and improve the value of their services (and customer satisfaction measures) -- if they could figure out how to deliver "information therapy" or other content they believe in -- to their patients. If physician offices were like other small/medium sized businesses -- they would have figured out how to do this -- like many successful businesses in other industries have done.
I am sure lots of docs have done some really great things - but why isn't it more widespread? My hypothesis is -- the economic motivation is not there. Because of the fee for service, bureaucratic nature of physician reimbursement -- the innovative doc can't capture the incremental value being delivered. See my previous post on the need for supply side flexibility to stimulate innovation -- this (information therapy, relationship management, brand extension) is precisely the type of service obviously being demanded by consumers -- but is not being 'supplied' by physicians - because they don't have the tools/flexibility to capture the value (or even experiment to find out).
Today the MSM had a good article from one of the premier journalists covering health, Milt Freudenheim about a CMS pilot project around the "medical home" -- which is simply a vehicle to motivate primary care doctors to provide 'better' care to patients with chronic or complex diseases. The basic premise is that physicians can provide care that is both more effective (better outcomes) and costs less over the long run (prevents unnecessary acute problems) by 'monitoring' consumers during their every day life and not just when they visit the doctor with a problem. Microsoft has actually designed HealthVault to enable this kind of 'connected care' using the Internet to enable communications and by enabling personal health devices to make it brain dead easy to get objective information from consumers on a regular basis.
The real question in my mind -- is why there has been so little innovation around how doctors figure out how to 'package' a bundle of services for consumers and charge them for it?
My wife likes to remind me of lots of examples where 'bundles of services' are both performed better than in traditional health delivery and consumers willingly pay for them. The most obvious example is with veterinarians. We have three dogs (just exiting the puppy stage -- all at 2 years old -- it is a long story). We have a vet that makes house calls, has an electronic medical record for each of them, calls to make sure the Bella is taking her pills and that Mac's ear infection is clearing up -- makes sure that the routine vaccinations are done on time and so on. She always calls to follow up on any given problem. It is easy to connect with her by email or phone - -very unlike most folks experience with primary care. Why is that? It is not that we value pet health more than human health? My hypothesis is that the vet business is largely a cash business -- and as a result it invests in technology and services (bundles) to attract customers in ways that a fixed price, reimbursement driven business does not.
John Goodman at NCPA has written extensively on this topic, you can learn more here. The main point is there is not enough innovation on the supply side -- and one sees a lot more innovation (better outcomes at declining vs. rising prices in health) in the cash based businesses like cosmetic surgery and LASIK. In general I think he is right -- and it has deep implications for future policy.
I also give credit to Chuck Kilo at Greenfield Health - who first convinced me (after beating me up in an argument) that true reform in health care had to start with how physicians were paid -- perhaps an obvious insight but one that is often missing in the debate of how to get to a better 'system' than where we are today.
The Freudenheim article points to the problem of a declining population of primary care docs -- and one of the reasons is the 'system' puts them in a box where they don't make enough money, they can't do a good job and to make more money actually means doing a worse job, not better. How is that motivating or attractive? I gave a speech a year ago -- to the American Society of Clinical Endocrinologists -- and foreshadowed the benefits of connected care through HealthVault (though it wasn't launched yet). Many, many docs came up to me afterwards and said yes, they were using Excel or forms or other systems to get data from patients remotely - -but they were making less money while delivering better care -- how does this scale?
There are other innovations going on outside of retail clinics and cosmetic surgery...but they don't get a lot of attention - perhaps they should. I learned quite a bit about the economics of a physician practice from a real innovator on the delivery side (also in Seattle -- where concierge medicine got started); his name is Garrison Bliss and his latest venture is Qliance. There is a whole society for folks trying to innovate on the supply side - -and they deserve support...because it may be innovations on the supply side -- some that will work and some that won't -- that will help us find the real answers to the dilemmas of improving health delivery and outcomes.
I haven't blogged recently, because I took my family to Moscow and St. Petersburg to learn and experience more about this fascinating country with a rich and proud history – a trip that I highly recommend.
While I was there -- I decided to learn a bit about their health system and its challenges. As is well known, Russia has substantial long-term challenges related to a projected decline in population and a relatively low mortality age. The country is using its new wealth to address health infrastructure needs -- but as in most countries, the health system is big; it sits under different sets of jurisdictions (fragmented); and is largely operated at the local level.
I had the opportunity to visit a leading oncology hospital outside Moscow (#62). It is set in a tranquil, park-like setting outside the suburbs and has multiple buildings on this relatively small campus. Its new surgery center (less than 3 years old) is outfitted with modern equipment and a local vendor-driven, HIS-like system of which they are very proud. Parts of the long-term bed facility were under construction.
The HIS system was built on Windows and uses Citrix terminal servers. They demoed it and its broad feature set to me for over an hour, putting up with my incessant questions about how things worked. They showed it to me in a small auditorium setting, which is used every morning by the head of surgery to go over the previous day’s results and today’s planned surgeries. The system was pretty complete -- managing the obvious things like patient registration and patient data, up to and including identification of which patients should be prepped for discharged that day or the next day. Reducing the length of a patient stay (the Russian average is much longer than in US) is one of the priorities of the administration, in order to reduce service wait times.
More interesting than the HIS system, was speaking with the deputy director of the hospital, who is still a practicing physician. We had a very engaging discussion, which made it clear that he was quite proud of his facility, of the improved results he had been able to accomplish over the last few years, and the fact that an executive from Microsoft was interested in learning from him. He opened a fresh bottle of a Russian brandy drink (it was late in the day) to share over our conversation. He was proud that their HIS implementation had enabled him to operate the facility more effectively: manage drug costs better (major expense), manage his resourcing better, be able to tell which docs were doing well and which ones weren't (to intervene), and to improve overall capacity…the key basic things he needed to improve results.
His main point was that he needed to get more done, (i.e. see more people, get wait lists down and so on), without any additional funding. It was about managing priorities and resources to get the most out of them. Now maybe that shouldn't be surprising -- but it was striking to me nearly 8000 miles away from home, in a dramatically different environment and economic/payment system -- that the needs were similar and that IT was being used effectively by pioneers to improve their results in meaningful ways.
The NYT editorial yesterday chastising physicians and the U.S. health system for not adopting electronic medical records adds a new MSM voice to the debate regarding technology as the no-brainer foundation of health reform. Naturally this is a frequent topic in the trade mags/blogs in my inbox. The chief implication in the MSM editorial however is that "public financing" is the key factor that would accelerate EMR adoption in this country, as it seemingly has in other countries. Not surprisingly, there is also an active number of bills in Congress looking to increase the government spend on health information technology -- with varying formulas and priorities.
There is no doubt that if the government provides a lot of financing for EMR adoption by physicians that there will be more computers in doctor's offices and hospitals. The real question however is will the right technology investments be made that generate the most value - for the physician, for the citizen/patient and for health outcomes. Unfortunately, the health IT landscape is littered with large, often government sponsored projects, that consume resources but fail to deliver the expected outcomes for a variety of reasons -- poor design, lack of adoption by users, too slow, automate the wrong things and so on. Just spending more money on information technology -- without looking at all the factors driving behavior in our health ecosystem (payment reform in terms of what we pay for and who pays it and consumer expectations) is unlikely to achieve the expected outcomes.
Clearly, I believe information technology is a critical component of improving health outcomes...or I wouldn't be investing time and resources in building solutions. Further, I believe that payers need to work with providers to finance investments in improving health outcomes -- of which information technology is a key factor. At an early stage, some good work is going on with good early results, such as in Massachusetts. Given that the Federal government is involved as a payer in a significant portion of health spend (nearly 40% by some accounts) - it needs to participate in the solution or other payers won't.
So what is my main point? We (our government) has scarce resources...they should use them wisely and carefully. I want to make sure that investments in information technology have a high return to users, payers, citizens and health outcomes. There is lots of electronic data out there today -- medication histories, lab results, diagnostic images -- and just making these available to physicians and patients alike at the point of decision making -- may generate desired outcomes (lower cost and better care) at a much lower technology spend level. Yes, paper charts are archaic and sub-optimal and will ultimately be replaced by digital systems. We can achieve our shared goals of better "value" from our health system (better outcomes for the spend) -- faster and cheaper -- by unlocking the digital data that already exists (Esther Dyson made this call for data liquidity several years ago) and incentivizing physicians and consumers to use the data. Let's not be satisfied with waiting for EMR adoption to happen.
Last week was the HealthVault Solutions conference held by my team. The metrics were great -- lots of new applications launched and partners signed, attendance oversold, 600 people, 285 different organizations etc. -- but the story is not in the numbers. What excited me was the energy in the room -- the passion of the people who work in health and want to be part of doing better for consumers. Many participants came up to me at the end of the first day (after 2 hour demo session) and said they were really starting to get it -- the benefits of a personal health data platform -- with multiple applications sharing data as determined by the user. Getting it is a good sign. Dr. Mehmet Oz, who was the keynote speaker the next morning, took the energy level up a notch and raised the stakes. Dr. Oz shared his sweeping vision of empowering consumers (YOU) to improve health -- but the key learning for me was -- to truly engage consumers you must connect with them emotionally. Reason by itself -- don't smoke you will get cancer, don't eat too much you will get fat -- simply is not enough to change behavior. Personalization, connectivity are key -- but we have to be able to connect at the emotional level with users - -this is a new set of challenges. We also announced the winners of our innovation fund - the HealthVault Be Well Fund. We were astonished by the diversity and quality of responses -- and excited to inform the winners, so we can get started on the 15 exciting projects.
Yesterday, Microsoft hosted the Center for Health Transformation (CHT) meeting on our campus. CHT is led by Newt Gingrich -- he is a tireless champion for change and for raising our expectations for results from the health delivery system. CHT does good work stimulating ideas, motivating policy makers to learn and be thoughtful when approaching health and creating connections between their members who are doing good work. Newt was a judge on the HealthVault Be Well Fund panel. Many U.S. ecosystem players participated and exchanged ideas -- sharing ways that IT plus leadership can improve overall results in the health delivery system -- like Gary Kaplan CEO at Virginia Mason, an integrated delivery system in Seattle that has utilized the "Toyota Lean" for system improvement. Given the fragmented nature of the health ecosystem -- these stories of best practices and improved results -- need to be told and retold and retold -- to motivate additional champions how to change and give practical examples of how to make progress.
The last two days I have been participating in the 4th annual Pacific Health Summit. The mission of the PHS is to bring leading scientists together with policy makers and industry to tackle hard problems in Global Health. It is a fascinating conference because of the mix of people (scientists, ministers, NGOs, industrialists) -- all of whom bring a real passion to helping "improve" Global Health -- but start from very different perspectives and world views. This years theme (selected a year ago) was around nutrition and the twin challenges of under nutrition (hunger, nutrient deficiencies and their impact on health status) and over nutrition (obesity, diabetes and the impact on health status and costs). The timeliness of the topic -- given current events -- only raised the level of urgency and passion behind the conversation. I won't even attempt to do justice to the theme in a brief blog -- given the complexity and interdependencies of the key threads -- I'm sure a final report will be published. I can report a few surprising data points for the benefit of others:
- despite the lowest incidence of obesity -- Japan implemented a national policy in April to focus on prevention because of current costs and the need to change trend lines. This means that all people in Japan ages 40-74 are required to get an annual checkup. One panelist -- Takemi-san a former vice-minister of health -- described how he had made a public promise to lose 10 kilos - -and this became a big and frequent media event (waist measurement and weigh in). But he achieved the goal!
- China too has started a new program to prevent obesity -- as part of an overall approach to public health. The program's essence is its simplicity -- healthy weight and healthy blood pressure. They determined that if they could motivate everyone to eat 40kcals less/day -- they could dramatically change future trend lines. So they ask people to eat 2 less bites off of their dinner plate.
- India -- while being a food exporting nation -- has roughly 40% of children under 5 being under-weight. This data point was used to demonstrate that "point solutions" or "simple programs" don't work -- that behavior change at either the national or individual level require comprehensive approaches (education, training, incentives, etc) that also take into account culture and traditions.
The role of nutrition in Global Health is clearly important -- and impacts costs and outcomes throughout the system -- from childhood development through to the management or prevention of chronic conditions. One key takeaway for me is that it will require leadership (at multiple levels) and new forms of collaboration between the private sector and the public sector to sustainability address this issue.
We are hosting the second HealthVault Solutions conference June 9 &10 in Bellevue. The amount of effort and activity on our part -- and on the part of our partners who will showcase their web applications at the event is truly remarkable. As a startup guy most of my career -- this infectious enthusiasm and passion by all the folks involved -- generates the endorphins that make startups and innovation so much fun.
For those that know me -- my primary focus is always on the next problem, on identifying and working on the things we can and must do better and not looking back at the accomplishments or progress. As I prepare for this event however -- what really strikes me is the progress we, along with our partners (and others) are making towards the vision of empowering consumers and physicians to use the Internet effectively as a tool to improve health.
A year ago -- we had working code and a beta environment for our very early partners. Nothing available to the public. Lots of talk and ideas here and in the industry at large - but not much tangible. Today we have over 30 web health applications that copy data to/from HealthVault and enable users to reuse their health information in new ways without the burden of re-entering it all the time. We also have 50 personal health devices from weight scales to glucometers to peak flow meters and more that connect directly to HealthVault -- which makes it so much easier for people to use this information to understand how to stay well or to use it in communicating with their physician. In addition to our efforts -- Google Health is also now available to consumers.
Because of how HUGE the health eco-system is -- trillions of dollars, hundreds of millions of consumers/patients, hundreds of thousands of physicians, thousands of hospitals, hundreds of insurance plans and so on -- progress can be hard to notice in the early phases. First -- we can celebrate the many partners that saw the vision early and have already built connections with HealthVault and we love them. But I can also see a big difference in the conversation we are having with stakeholders in the eco-system and it is evolving from the tire-kicking phase to the "how can I get involved to help my business or my customers" phase....which to me indicates momentum is building and building fast.
Every once in a while it is nice to look back and recognize that the vision we have around HealthVault -- of building a consumer-centered health platform -- which lots of stakeholders will use to help consumers and themselves -- is really working! Now, back to working on the things we can do better.
I am blogging to add my voice and perspective to the very important discussion of how to improve health around the world. I believe software and communications can make both incremental and transformational improvements to the delivery of health care -- in developed and emerging countries. To be sure, software is just one factor -- in many places, basic infrastructure improvements like clean water, proper waste disposal systems, basic supplies are way more important and high value than software, I get that. What I know is 'great software' and I can see how it, along with leadership in health organizations, can make a real difference.
The perspective I bring is that of a business person, entrepreneur and software guy -- one that has seen software and the Internet transform the way we work, the way we communicate, the way brands are built and the economics of many industries -- but not yet health delivery systems. There are lots of reasons why this is true -- which I hope to address when building products and solutions for the marketplace.
The public debate about health policy and the role of government in the U.S. over the next 18 months is going to be significant in defining priorities and the nation's options for the future. The questions are very complex -- and we all have opinions about what is most important or most broken about our health system -- but unfortunately the debate is generally not fully informed about the complex trade-offs involved in the dynamics of the health ecosystem. I certainly don't claim to have all the answers, but I do hope to contribute to the debate.
One example came up this past week when the CBO published a report about the value of information technology in the health delivery system. The headlines that the report generated focused on the fact that technology "by itself" was unlikely to generate substantial savings -- well like, duh! Technology "by itself" can't accomplish anything. The 'headline only' discussion misses many key points both in the report and left out of the report -- about the real, tangible benefits of the appropriate application of technology -- in terms of improved safety/quality and lower costs. Many examples of good results are documented in the report even.
There are legitimate questions about how to generate the benefits (better quality, lower costs) of HIT, about who recognizes the benefits (buyer of HIT or payer/user of the health system) and about the overall costs/challenges to implement complex HIT systems in hospitals. If anyone thinks we can improve health costs or quality by using only paper based systems -- I'd like to understand their argument. I don't believe it and don't suspect many others believe it. Consequently, the real question is not "whether HIT investments or not", but rather what investments generate the most value (what works) and what can be done to get more of what works. As I stated previously -- it is the combination of leadership and software - that leads to benefits in better health outcomes and lower costs -- see this article by John Glaser on this point.
The day this debate above about HIT value hit the headlines -- I was participating the Future in Review conference, hosted by Mark Anderson. The contrast could not have been more striking -- the participants were describing real and potential solutions to delivering value in health. William Haseltine described the great work he is doing in India -- to dramatically lower the cost of certain surgical procedures -- CABG and cataracts were examples. His examples of practice design, workflow specialization and component parts demonstrated huge cost savings and comparable or better quality results -- which he hopes over time to export to the U.S. Roy Schoenberg of American Well talked about making real time, on demand communications with physicians a reality in the next several months. This will make a difference.
The exciting thing is that there is innovation everywhere -- and motivated entrepreneurs and leaders that will figure out how to make stuff better.
I recently traveled for two weeks in the Asia Pacific region on Microsoft Health related business. I was fortunate to meet with a broad diversity of folks -- from Minister's of Health, to CEO's of leading private and public hospitals, to GP's interested in how technology can help them and even to citizens with concerns about the capacity and capability of their health delivery systems. Interacting with these passionate, dedicated and talented folks is one of the great parts of my job.
I returned with the following observations:
- while everyone I talked with sees the potential for health information technology to improve health delivery and outcomes -- the real challenge each of them faces is what practical steps to take to realize this potential for their institution or system. Another way to say this -- is how to spend money most effectively to get results.
- the need and desire for a "citizen-centered" health data platform was clear in nearly every country and type of system...which was a bit of a surprise to me. In Australia the buzz was about how at the recent 2020 summit held by the new prime minister folks had talked about a "healthbook" like service to facilitate better care and outcomes -- but patient controlled. In Singapore, they currently have a tender around a patient-centered PHR platform pilot. In emerging market countries -- they recognize the need for an online portal -- to help with both education and data sharing. In China -- they have several pilots ongoing.
- that managing chronic conditions across the hospital and physician boundary is a problem and priority in most places
- that every country -- whether developed or emerging -- whether publicly well funded or mostly private pay -- has a difficult time figuring out how to prioritize and to incent prevention -- those behaviors that would prevent bad health events or outcomes.
So I see many similarities regarding the challenges and opportunities of health delivery systems in the U.S. and in other parts of the world. However, I had a wonderful philosophy professor in college that taught me the true insight comes not from seeing the similarities but in understanding the differences (which apparently is true with regard to our DNA as well). The differences are real and vary by country and system type. A quick trip is too short a time to fully digest these differences. The good news is there are many who believe that software can help the health delivery system do a better job in terms of outcomes, satisfaction and capacity and want to work with Microsoft to figure out how best to do it for them.
