Neupert On Health : Amalga

Aligning policy, technology, and business innovation – perspectives from the Connected Health Conference…

pnblog — Sat, 13 Jun 2009 01:59:00 GMT

We’re just wrapping up our annual Connected Health Conference. I wanted to share some insights and observations from the past three days. We had 925 attendees representing 409 organizations -- attendance more than doubled from last year, which is pretty amazing given that conference attendance is down all over the US… At this year’s conference, our Amalga and HealthVault customers and partners all came together for the first time. The most frequent comment I heard from attendees was excitement about the breadth of work we are doing and the new opportunities they see as a result. The main issue that came up over and over again was the importance of driving and aligning innovation in health IT, health policy (e.g. reimbursement strategies), and business.

This topic first came up during our opening keynote panel on Thursday with Professor Uwe E. Reinhard, Dr. David Kibbe and former HHS Secretary Mike Leavitt. Secretary Leavitt introduced the notion that advancements in reimbursement reform are needed as much as stimulus for technology adoption. According to Leavitt, health IT will become ubiquitous when consumers demand it from their healthcare providers. While I agree with Levitt about informed, engaged consumers being key drivers of change, I also think that physicians, industry and other partners must demand a smarter approach to reimbursement from policymakers. One place to begin innovating and experimenting with a better reimbursement system is at the state level. During this morning’s keynote, Dr. Mark Smith of the California Health Care Foundation, made several insightful observations about factors affecting HIT adoption such as; better, simpler solutions for physicians, a stronger voice for government as purchaser in mandating effective standards and a reimbursement policy that rewards outcomes vs. volume. However, as David Harlow pointed out during a conversation today, our tough economic climate makes it difficult for states to take the lead.

Dr. Kibbe emphasized the need for web-based tools that could be assembled in a modular way to qualify for stimulus dollars. Both Kibbe and Smith made the strong point that physicians haven’t adopted existing technology solutions for a reason and that any stimulus/policy reform needs to be flexible enough to allow innovation in solutions vs. trying to “jam” solutions that don’t meet current needs or practical market requirements. In speaking with our Amalga partners, they too are interested in understanding how meaningful use and certification will be defined and applied. Our customers shared many examples with each other of liberating and unifying data which makes measuring quality and proving effectiveness easier and automatic. As much as health IT has the potential to help cut inefficiency and improve operational throughput, we still need the right policy solutions to bring greater transparency to what patients are purchasing from their providers and that quality of those services…as Leavitt demonstrated humorously with his story about colonoscopy pricing.

You can see some of the highlights of the panel discussion as well as Mark Smith's keynote below.

Our commitment to connecting technology, policy and business innovations is central to our vision of unifying a fragmented health ecosystem. In his remarks, Microsoft Chief Research & Strategy Officer Craig Mundie highlighted the major role health plays in economies around the world and the huge opportunity for software to improve peoples’ lives. Our Connected Health Conference this week brought together many different "perspectives" from across the fragmented health ecosystem -- what really struck me was everyone's energy and desire to let innovation reengineer the health system. I hope that the public and private sectors can work together to drive real change. We all know that that it's not going to be easy, but it will -- and must -- happen.

Signposts

pnblog — Tue, 21 Apr 2009 20:57:00 GMT

I don't normally blog about our products per se, but today marks an important milestone for Microsoft shipping solutions that are important signposts toward the future -- the transformation of healthcare.

The first is the launch of the Mayo Clinic Health Manager powered by HealthVault -- the focus of this solution is to enable the 'family health manager' to organize her information in one place and receive customized recommendations. The second is New York Presbyterian’s realization of a ‘connected health environment’ that brings together information on the clinic or hospital side using Amalga and extends it to patients through the introduction of mynyp.org via HealthVault. Each of these solutions concretely demonstrates how collaboratively we can move health systems forward today -- connecting users with their clinical information and providing interactive, personalized tools to empower them further.

The HiTech stimulus and health reform policy debates acknowledge the importance of information technology in transforming the health system...however questions remain about the how and shape of that transformation. Last week, I finished the Innovator's Prescription by Clay Christensen et al., which I strongly recommend to folks trying to understand the types of disruptive innovation that can and should occur in the health ecosystem to improve outcomes and change the cost dynamic. The books brings a new vocabulary that can help advance the discussion -- and highlights the importance of new business models in creating innovation. We need a different business model to deal with chronic care and prevention. I am confident that technology in general and the type of technology we are building and deploying with these innovative leaders in particular is critical to enabling these new business models.

It is exciting to go from ideas -- to plans -- to prototypes -- to actually shipping solutions that tear down the walls of data silos and begin the journey of using liberated data to deliver new solutions for consumers/patients. We are still early in this journey, and I look forward to getting feedback from users -- consumers, clinical users and IT professionals -- on how to improve the capability and usefulness of our solutions.

Tear Down the Walls and Liberate the Data

pnblog — Sat, 04 Apr 2009 01:13:00 GMT

(cross-posted on Microsoft on the Issues)

In 1987, President Ronald Reagan gave one of his most well remembered speeches. Few of us could forget his words to Mikhail Gorbachev to “tear down this wall”—proving to be prophetic when the German Democratic Republic announced the re-opening of the border in 1989, and the subsequent destruction of the Berlin Wall. What followed? A new flow of people, ideas, commerce, and capital—creating the groundwork for unification and a better way of life in Germany and Eastern Europe, benefiting all of us economically and politically in unanticipated ways.

A similar type of disruptive change needs to happen in the health ecosystem today. Just as the free flow of ideas and capital were the foundation for dramatic improvements in society, so should the free flow of health data be the foundation for realizing a future of secure, personalized, data driven medicine in health.

Yet many outdated ideas and mechanisms stand in the way of change; the most important of which are the now impractical walls that were erected and still exist around patient-data. And all of us—IT vendors, providers, payers, pharmacy benefit managers, policy makers and others in the health ecosystem have enabled the walls to exist in spite of the obvious benefits to patient safety and the overall health economy.

Real-time, accessible, meaningful and comprehensive data is fundamental to health care as a whole–to make a diagnosis, provide quality care, pay the right bill, discover new therapies, and so on. What’s of paramount importance is liberating the data and making it available for re-use in different contexts. This is critical for improving outcomes, paying for value, creating a learning healthcare system, enabling discoveries and fundamentally changing the dynamics of the ecosystem. We should be treating health data as a vital asset—health enterprises and consumers—to drive an efficient, high-quality, value-based, evidence-focused future for medicine.

So why isn’t there data liquidity or the appropriate flow of data in the ecosystem? There are two major walls preventing the liberation of data and each is starting to have some cracks.

First, there is the “it’s-my-data” wall put up by hospitals, insurance plans, pharmacy benefit managers, and others. They believe there is some competitive advantage by keeping the data inside their walls. And there are lots of excuses supporting their position–patients don’t want it, they can’t understand it, it might do them harm blah, blah, blah. This wall is starting to crack. Many institutions recognize that the consumer has a right to a copy of their data and are making the appropriate connections to personally controlled health data repositories like HealthVault or Google Health. Many others are writing about it too—John Moore asserted in a recent post, “Personal health data belongs to the consumer and the consumer should decide how it is shared. This is a very radical concept that still has most providers, payers and other data holders shaking in their boots.”

The second wall is the “waiting-for-the-right-standards-set-by-government” wall. There are multiple excuses buttressing this wall; the core of which come down to technology, standards or policy excuses. Without debating each point–one inexcusable barrier is the IT enterprise system vendors who make it difficult or expensive to get access to the data, to separate it from the application. They believe that proprietary “lock-in” provides them with a strategic advantage. We’re all in business and need to create strategic value for our products, but let’s do it in the application layer—rules, workflow, user experience, price, or services—not by trapping patient data in a proprietary database structure.

Our customers and partners and their customers need to be able to re-use their health data, and in ways they haven’t always thought of or anticipated. They have to be able to build cross-vendor systems to improve care. If information can be made liquid—flowing from where it is generated to where it is needed, and combining it with other bits of information to provide a comprehensive view—it can be tremendously powerful.

We, in the IT industry, can step up and be a driving force in enabling data to become liquid—specifically, doing this by separating data from applications. This is one of the recommendations from a study by the National Research Council of the National Academies that takes a look at what types of computational technology and investments are best for improving health outcomes. Let the excuse not be that the data is trapped in systems that we built, that we have to wait for standards.

We need to enable this, and we can start to do it today. Just look at the Health Information Exchange in Wisconsin and CVS MinuteClinic. In the former, value is being added immediately to users in the ED, without requiring all the participating EDs to change their systems or to be standards compliant (or CCHIT certified). At MinuteClinics, summary after-visit health data are made available to customers online using the Continuity of Care Record standard.

There’s a proven model for extracting and transforming data in many ways—HL7 feeds, non-HL7 feeds, web services, database replication, XML and XSLT, and more—and along the way we can create value by interpreting the data and adding metadata. At Microsoft, we’re doing it today both in the enterprise with Amalga and across enterprises to the consumer with HealthVault. We hope other vendors follow this lead to drive better outcomes for patients, and we expect buyers of IT systems to demand vendors to meet this standard (excuse the pun). Where standards are available, we should leverage them, and where standards do not yet exist, we should output the information in a consistent consumable format for the install base.

I understand that there are many, many complicated aspects of this problem, including the need to reform our payment system. But we don’t have to work out everything first to begin building a better, more data enabled, data rich and accessible health delivery system now. David Kibbe did a nice job simplifying and laying out some core recommendations in his post, Five Shovel-Ready Health Care Reforms.

I have argued previously that HiTech should focus on investments which leverage existing digital data sources and drive better health outcomes. With the dollars that are being allocated to EMRs, it’s critical that the data is liquid and that the consumer is connected to the data in a meaningful way

I understand that this kind of disruptive change can be uncomfortable because the forces unleashed can lead to unpredictable results for specific stakeholders. But like the fall of the Berlin Wall, it is clear that the most important stakeholder—the citizen or patient—will be better off, and the other key stakeholders—providers, payers, policy makers, etc.—will participate in a healthier ecosystem. There will be profound, new opportunities for everyone in this future.

The time for excuses is over. Let’s tear down the walls and get the data flowing. We can do it now.

Message to Washington -- It's all about Outcomes

pnblog — Sat, 17 Jan 2009 00:35:00 GMT

Yesterday, I testified before the Senate Health, Education, Labor, and Pensions Committee, otherwise known as HELP. You can see a video of my testimony here. Before getting to the substance, I need to highlight how I continue to be awe-inspired about how our government works -- in a positive way. Any body can walk into the halls of Congress and sit in and listen to a hearing. Folks from all walks of life have input via a variety of means -- and while I get it's not perfect and can be better -- I remain proud of our democratic system and feel honored to be able to contribute/participate in it.

My main message to the Senate was: We should really focus on the health outcomes we want to achieve, not just on the technology itself. What the health system needs is to adopt technology in ways to deliver better outcomes, better chronic care management, better hospital effectiveness. We really want to make sure that we have the leadership focused on encouraging the usage of technology to achieve certain goals, like better chronic care management.

We were the only technology company testifying, and I think people were surprised to hear us saying that technology isn’t the silver bullet. It's not that Microsoft doesn't want to see spending on health care technology. Far from it. We just want to see smart spending, on technology that will really have impact. When we decided to go to the moon, we didn't say let's build a great rocket...we said let's go to the moon...I feel a little bit of the conversation has been about let’s build a great rocket and hope we get to the moon.

The other witnesses included Health Leadership Council President Mary Grealy, National Quality Forum President Janet Corrigan, Permanente Federation Executive Director Jack Cochran and Valerie Melvin, Director of information technology for the Government Accounting Office. Their comments were unexpectedly aligned with mine -- namely take a holistic view; incenting the adoption of technology is not a silver bullet; and, we must have reform of the payment system too. So at a high level -- folks understand the challenges of creating the right kind of change in the complex health ecosystem. Where the differences lie -- is how to get started. Unfortunately as is often the case -- the stimulus bill (big incremental spend investing in health IT) is separate from the activities around health reform. Getting the spend without the right payment system reform -- could lead to the unintended consequences the panel was cautioning against.

The legislation is being drafted now -- that is why the hearing was held on a day when there was a lot of other activity going on in the Senate. There is a clear sense that something big will pass in 2-3 weeks - which is like moving at the speed of light. I am sympathetic to the challenges of the staffers trying to find the right language -- it is not easy to figure out how to guide the spend of $20billion over two years! The scale of spend is still hard to put into perspective for me -- in my last post I tried a per physician number, so this time let's try per day -- it is $27M/day! I am very confident there is lots of low hanging fruit to generate a return on investment in the health system (waste, overuse, misuse, error reduction) that technology can enable -- but still $27M/day!

Since I spend the bulk of my time building software -- decisions about features, hiring great people, how and where to sell -- the hardest question from the staffers to answer is - how do you recommend we spend the money?

My answer is in my closing remarks with the five key things that I think the government needs to focus on:

1. Encourage innovation in health IT by setting out objective goals and criteria, not by mandating specific technologies or development models.

2. Reward innovative doctors who make the Internet the foundation of the patient-physician connection.

3. Provide incentives for sharing data.

4. Focus on making data interoperable today, not waiting for standards tomorrow, and insist that vendors separate data from applications.

5. Enable the private sector to develop an information infrastructure that connects data, systems, and people.

These are really critical, so we don’t end up in the wrong place. They’re based on our learnings as we’ve delved into this complex world of health.

One final thought -- surely it is an exciting time to be in the health information technology business! I personally got passionate about trying to really contribute and make a difference in HIT from my time on the President's Information Technology Advisory Council (PITAC) in 2003-2005. As co-chair of the Health Subcommittee -- we published a report titled Revolutionizing Health Care Through Information Technology with key recommendations for the government to consider. While my depth of understanding has gone up dramatically, what I find is both fascinating and perhaps cautionary -- is the discussion is largely on the same key issues/recommendations. This time there is a lot of money at stake -- but it goes to show that change is hard and probably slow.

I had a great exchange with Fox News --- video embedded below.

You can also read more about Microsoft's general views on a number of topics here.

Diverse real world problems

pnblog — Mon, 11 Aug 2008 08:00:08 GMT

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.