Neupert On Health : Healthcare solutions

Reflecting on the healthcare system while waiting at the hospital for a loved one

pnblog — Wed, 30 Sep 2009 03:12:00 GMT

Often when we talk about healthcare reform, it can be a rather abstract discussion -- you watch some tv show with ‘experts’ reflecting on some 20 page bill or hashing through the merits of a public insurance option. Last week, however, all the intellectual and abstract ideas were brought into something very personal for me and my family.

My wife had a Hysterectomy, and I spent three days at Swedish hospital in Seattle caring for her. With all the waiting time, it was hard not to reflect on the experience and think about it in the context of health reform. I’m happy to say that my wife is now recovering on schedule, and she’s given me permission to share the story and my insights.

Once she had decided surgery was her best option, we became even more avid information seekers; we shopped for the procedure with the best outcomes and then the surgeon with the most experience and best quality results for this procedure. The best available counsel we found was for a Robot-Assisted Hysterectomy because there was less risk, less pain and faster recovery times vs. the alternatives. We didn’t have to shop for ‘price’ (thanks to Microsoft’s benefit plan, but that is a different future post)…but even if that were the case, we probably would have chosen a more ‘expensive’ option if it meant less risk and more productive days -- getting back to normal life as quickly as possible.

We all know that surgery can be pretty scary. Throughout the experience, everyone from the doctor’s office to the staff at Swedish helped to make the experience a positive one, allaying any fears and making us feel comfortable and confident. We often forget that healthcare is truly a people business. In just three days – the number of different people we dealt with was amazing -- five docs, seven nurses plus the ancillary folks (lab techs, transport and other helpers). They all took time to connect with our emotions while doing their jobs.

Swedish is leveraging technology to improve their systems. You see it throughout the organization, starting in the lobby, with signs advertising the hospital’s new EMR system. During the course of our stay, when there was time I asked various staff members about their experience with the new EMR, and they were positive about the system because they had all the information in one place. While a common complaint was that the data entry took them more time, they felt overall it made them more productive and effective.

This highlights that we need to remember that technology is a means to an end. It is NOT the introduction of technology that will make a difference, but rather how leadership leverages the right technology to make a difference…in both quality results and economic outcomes.

I also saw a real focus on patient safety, starting with the pre-op processes. Each member of the care team carefully checked her arm band, her chart and asked several specific questions to be sure she was getting the right action. For us, the repetition became frustrating, but if this process were to improve patient safety, then it would be worth it. Despite the technology investments, the core safety process was in the human factors.

After the surgery was completed, she spent two days recovering in the hospital. This was a day longer than originally planned due to very low blood pressure and a declining hematocrit. While I used the guest Wi-Fi for work and email, it was even more critical for answering key questions about her condition, the trade-offs, the next steps – which helped me to get some context and understanding to a) engage more thoughtfully with the care team about questions/choices and b) assure my wife about what was going on during the long time periods when neither doctor or nurse was around. I think hospitals should consider leveraging their video and wireless infrastructure more effectively for patient specific education and connecting with their care teams. This is potentially a big opportunity for improved patient compliance and care team coordination.

Because the low blood pressure persisted, I called her primary care physician to get her baseline BP. If we had stored this information in HealthVault, I wouldn’t have had to make the call – I would have just been able to look it up. Furthermore, I would have preferred to have gotten her discharge information automatically transferred to HealthVault. We were given paper copies. This should be easier.

So, what’s the moral of this story?

· We can’t lose sight of innovation and there’s a risk that could happen if the government were to become the primary funder of health.

· Technology is a means to an end, but we have a long way to go to figure out how to use it smartly.

· We can’t lose sight of how important the personal aspect of healthcare is. The emotional support and human caring delivered by the care team was the critical component of our overall satisfaction.

This experience reinforced for me that a ‘healthy’ health ecosystem requires consumer choice -- it is a critical component to the effective functioning of markets and innovation. We made the decision to ‘save time/hassle’ vs. saving dollars as we do in other aspects of our lives. This really drove home for me that the debate about ‘rising health care costs’ doesn’t really account for improved patient outcomes in terms of fewer lost days of work/productive living. I am all for comparative effectiveness of various options and knowing what things cost, but it needs to include patient values -- like less pain and getting back to normal faster -- or it may lead to bad unintended consequences. I am more concerned than ever that increased government financing of health will ultimately lead to fewer consumer choices and will stifle future innovation with tangible economic benefits.

I haven’t received the multiple confusing bills and outrageous line items of detail from the hospital stay yet. Nonetheless, when it comes to getting a quality outcome from an advanced surgical procedure, I prefer the current U.S. health system with all its flaws to the alternative future of less consumer choice and innovation.

Individuals and Personal Responsibility May Be the Tipping Point in Health Reform

pnblog — Thu, 13 Aug 2009 05:16:00 GMT

The latest turn in the healthcare debate is the increasingly sensational coverage of town halls happening across the country. While they’re described as rancorous and sometimes violent, I’m pleased to see my fellow Americans so passionate and involved in one of our country’s biggest long-term challenges. For most of us, we think of health care personally -- it’s about my relationship with my doctor or my insurance company -- versus considering the system as a whole.

But this dynamic seems to be changing. There are a number of forces -- the media and current political agenda, technology trends, the economy -- converging on Main Street that are pushing people to get educated and more engaged in Congress’ proposed changes than they ever have before. Our sensational media machine is in full swing highlighting healthcare across every communications vehicle available 24/7. Technology’s influence over other industries has created consumer expectations for more convenience and value from healthcare. And the downturn in the economy has forced many to face the stark realities of healthcare tied to employment. So perhaps out of all this turmoil will come something good -- people coming together around the cause of improving the healthcare for today and tomorrow.

What many fail to understand is that the personal connection people have with their own healthcare is the very core we need address in order to make some of the greatest changes to the system. People make choices every day that impact their health – and the system as a whole. The diabetic who decides to not follow the course of action prescribed by his doctor costs the system. This is evidenced by two studies I read this week. The first is from the CDC, which states something we all know – that by losing weight, not smoking, getting exercise and sticking to a good diet, we will dramatically lower the risk of chronic diseases, such as diabetes and heart disease. Imagine the impact we could have on the system given that 70% of current costs stem from six chronic disease states.

The second from PricewaterhouseCoopers highlights some stark realities:

About half of surveyed individuals indicate their current lifestyle was less than healthy
90 percent said they would become active in improving their health if they were diagnosed with a chronic illness, which is obviously too late
Disease management programs are rarely used -- employers report than less than 15 percent of eligible patients participate in the programs
25 percent of surveyed individuals are not more involved in their healthcare because they don't know where to go for good information
15 percent aren't more involved because they aren't interested
25 percent of people in poor health are not involved in their healthcare and treatment choices

The juxtaposition of these two studies really brings to light for me how much our reform efforts need to focus on our citizens -- educating them and involving them in the health system in very different ways than they have been in the past. For the health system to work for all, economic incentives and costs need to be aligned with consumer behaviors and choices. We can’t continue to support the diabetic’s decision to make poor choices and drain the system for all of us. There have to be some consequences for actions. If something’s free, I think we all know that there is a strong possibility that people will not appreciate its value. We can look to many examples of this over time.

While we can argue that patients absolutely need to step up and do more for themselves (and their children), we also have to acknowledge that our system hasn’t been designed to support them. We have a provider-centric system, not a patient-centric one. Today, the average time a physician spends with a patient is 18.7 minutes. There isn’t a lot of room in 18.7 minutes for much “education.” In Maggie Mahar’s new documentary, one physician describes how he’d love to spend time with the diabetic educating him on how he needs to get involved, but he gets paid more to do procedures.

“We are paid to do things to patients,” said one doctor. “We are not paid to talk to them.”

In addition to patients needing to take more responsibility for their own health, our government needs to set up (or get out of the way) a new framework that will enable "healthy" markets to develop new value chains to deliver services like education, motivation, etc. at lower costs than high-cost professionals. We need highly educated physicians focused on the right things -- like diagnoses, solving major health crises, etc. If we look at chronic care today, much of it is about helping patients stick to a particular course of action prescribed their physician. But today’s chronic care "business model" is based on physician and hospital care -- acute care. A totally different type of "business model" or offering is required to keep people well. We’ve already seen innovation like this in other health related-areas like veterinary medicine, dentistry, and cosmetic surgery where consumers have taken more control of their on-going care.

The decisions we make today will impact generations to come -- financially, socially, and medically. We have an opportunity to come together, influence our elected officials and shift the debate in Washington to drive real change.

Navigating through the noise to find the signal

pnblog — Wed, 13 May 2009 06:04:00 GMT

I don't know about you -- but trying to keep track of and make sense of the company announcements, the many awareness events designed by politicians and the folks hoping to influence the policy makers, the work being done by folks at HHS and the Hill to create new rules and policies and the press and punditry all commenting on all these activities -- makes my head feel like it is going to explode!

Just look at the past two weeks. IBM said they were going to finance $2B of HIT spend to enable health systems to bridge the 'donut hole' in the stimulus package, complementing their earlier announcements this year of health ‘innovations’ through their partnership with Google and Continua. GE followed with an announcement of $6B of investment, financing and 'innovations' that will lead to even more billions of savings in the U.S. health sector...and they will help underserved health markets globally at the same time! At a White House event this past Monday, a group of health industry stakeholders promised trillions in future savings by restraining price increases and 'doing better’. And Tuesday, there was another White House event on health -- featuring the role of employers. Cecily Hall, a colleague of mine at Microsoft, attended and explained some of Microsoft's innovative health benefits around clinically driven weight loss and mobile medicine. I don't know how many billions of savings this event will lead to -- since I'm still on yet another plane, but given I have a 'healthy imagination' -- I am confident the projected savings will be significant.

The choices we make about the future of our health system matter a lot for the future welfare of our country -- so I hope we have an informed and fact based debate that goes beyond the sound bite outline that seems to be shaping up in both the media and the political arena. Health touches everyone. We have all been to the doctor and had our own or extended family based experiences, and so we all have our opinions about what works and what is broken in our healthcare system. Consequently there is a lot of 'noise' about both the challenges and the ways to fix the healthcare system -- some that ignore basic laws of economics.

For whatever reason -- a generation of employer sponsored health insurance, government programs, no checkout lines in the doctor’s office – has caused people to make a fundamental mistake, to think of health care as something 'unique' and to suspend the principles of economics when they conceptualize and think about the problem. The price of healthcare is not your co-pay...no matter what the public perception is. Providing universal insurance and covering everyone will not fix the health system by itself...and in fact may exacerbate critical flaws that exist. No matter HOW it is funded (cash at checkout, employer payroll costs or taxes); individuals are paying for their health care...just like they are paying for their retirement income or car insurance. There is no economic free lunch here -- that a government run, single payer system or other construct makes it either free or creates 'more healthcare' for folks to consume. It doesn't. Yes, the societal question of income re-distribution remains (namely am I paying for my health care AND your health care or just mine). But we should not confuse how to organize a sixth of our economy around income re-distribution goals...think of how clear, fair and effective our income tax system is.

Educating the public around the principles that health is an economic good and that individuals are indeed paying for their own health care, albeit in hidden ways, would go a long way to improving the probabilities for a more efficient, intelligent health system coming out of the reform debate.

If we acknowledge that health, that is the delivery of health care services and the prevention of illness, are economic activities -- then we can ask the question about what is the best way to organize that economic activity to create value -- value for producers (doctors, hospitals), value for consumers (patients, employers, payers), and value for society (more quality life years). It is not a zero sum game. In most of our economy, we expect market mechanisms -- things like prices, product or service innovations, or profits -- to allocate resources, improve productivity, lower costs and improve quality over time. In health, many of these important factors are constrained or hidden given the structure of the payment system and the role of the government in setting the rules of the game.

In applying the principles of economics to the health reform debate, it is important to be consistent and not selective. There are many stakeholders in the dialog who believe that the problems are the result of for-profit companies (insurance, pharma) and that non-profits and government are a priori better (better use of resources and results). This perspective is simply wrong and not supportable with an analysis of the facts. Participants are optimizing given the rules/framework they understand -- and here the government is setting the rules (taxes, reimbursement, CMS) and must take accountability for the consequences -- intended and unintended just like in the housing boom and financial crisis. One of the really hard challenges in health is measuring the right outcomes/results. Does pay for performance mean the physician ‘checked all the boxes’ for documentation or that we got more health for a given set of inputs? In the end, not-for-profits are economic actors too -- no margin, no mission -- they have to pay market prices for inputs and charge market/regulated prices for outputs. They raise money in the capital markets (debt) and mostly try to optimize like for-profit enterprises.

Today's health system in the U.S. is a regulated system....and it many ways it doesn't work so well...but perhaps better than our 'facts' acknowledge. Everyone acknowledges that we need to get more 'value' out of the resources we have put into providing health care. Everyone acknowledges that there is no 'silver bullet' or no easy fix to the multiple challenges that exist in delivering and paying for health. Nearly everyone acknowledges that 'cash based' segments of the health system (cosmetic surgery, corrective eye surgery, dentistry, veterinary) have done a better job innovating and delivering better quality and lower costs than the more heavily regulated segments of the system. Unlike other industries -- a lot of the challenge in health is we don't know enough -- about disease, about what treatments really work, about what to do when -- and so on. Consequently, we need a system and framework that allows and incents systematic learning and improvement, discovery of new diagnostics and therapeutics and the best systems to deliver them.

So let's have a real conversation about how to build a framework for a health system that works.

History Doesn’t Have to Repeat Itself

pnblog — Fri, 01 May 2009 23:17:00 GMT

(cross-posted on Microsoft on the Issues)

My family and I just got back from a vacation in Mexico, so the news that’s on everyone’s mind—the spread of H1N1 Influenza A—is weighing even more heavily on me. With the media hype machine driving minute by minute coverage, it’s hard not to think about devastating epidemics and pandemics of the past—typhoid fever, smallpox, bubonic plague, cholera, Spanish Flu, typhus, tuberculosis, malaria, HIV/AIDs—illnesses that spread uncontrollably and killed millions.

While we should be concerned, we should also remember just how far we’ve come in facing these challenges. Today, the Internet, blogs, instant messaging, and other technologies can disseminate information about new threats and new medical knowledge faster than ever before. Technology gives us the opportunity to face these crises better than we have in the past.

Yet we still have a long way to go. The identification of threats and the transmission of basic information remains a fundamental challenge. News of the recent outbreak broke on April 24^th—18 days after public health officials started investigating unusual cases of respiratory illness in Mexico. Eighteen days doesn’t sound like a long time, but in the world of infectious diseases, it can be the different between life and death. According to The Rapid Syndrome Validation Project, a delay of even one day in detecting certain diseases like smallpox could mean the "…difference between the loss and salvage of as much as 90 percent of an exposed population.” I think we all can agree that we can do better than 18 days.

And now as the disease progresses, do we have the right information platforms in place to enable front line workers and public health folks to gather, transmit, analyze data, and ultimately act? We have a highly fragmented health system in the US, and it is much more complex when you look globally, where we have language barriers and in many regions, no infrastructure in place. Since SARS and the anthrax attacks, there have been a lot of pilot projects and investment in infrastructure – but perhaps not yet enough. More importantly, I believe that a “separate” infrastructure for public health (or the buzz word ‘bio-surveillance’) isn’t the best approach because systems that aren’t used every day are never up to date. Just look at the challenges and barriers to the CDC’s BioSense National Program—a program with admirable goals, but limited results in terms of hospitals actually reporting data. A better approach is to have flexible enterprise data systems that allow for the re-use and re-purposing of data quickly and easily, because these are the types of systems that enable us to prepare and respond to these by definition unknowable future issues.

I do what I do because I believe that technology, if employed correctly, can be a transformative force. It can act as a key enabler to improve surveillance, diagnosis, treatment monitoring and prevention. The people on the front lines managing this crisis are doing an incredible job, under intense pressure. I have to say how impressed I am with the professionalism and commitment of these public health officials—internationally and in the US. I’m proud of the work that Microsoft is doing to support them –working closely with local and international authorities to provide technologies and products to support the effort to combat this threat. One example is the work the Internet Explorer team has done to enable people to put Centers for Disease Control health tips and news updates at the top of their browsers through a new swine flu “Web slice” for Internet Explorer 8, now available at www.ieaddons.com.

We have great people. Great technology exists from Microsoft and many other companies. The threats aren’t going away. Time to build a platform to ‘really’ deal with them.

The Truth About Health IT Standards – There’s No Good Reason to Delay Data Liquidity and Information Sharing

pnblog — Sat, 24 Jan 2009 03:26:00 GMT

David C. Kibbe and Peter Neupert

Now that the Obama administration and Congress have committed to spending billions of tax payers’ money on health IT as part of the economic stimulus package, it’s important to be clear about what consumers and patients ought to expect in return—better decision-making by doctors and patients.

The thing is, nobody can make good decisions without good data. Unfortunately, too many in our industry use data “lock-in” as a tactic to keep their customers captive. Policy makers’ myopic focus on standards and certification does little but provide good air cover for this status quo. Our fundamental first step has to be to ensure data liquidity – making it easy for the data to move around and do some good for us all.

We suggest the following three goals ought to be achieved by end of 2009:

Patients’ clinical data (diagnoses, medications, allergies, lab results, immunization history, etc.) are available to doctors in 75% of emergency rooms, clinic offices, and hospitals within their region.
Patients’ doctors or medical practices have a “face sheet” that lets any staff member see an all-up view of their relevant health data, including visit status, meds, labs, images, all of which is also viewable to patients via the Web.
Every time patients see providers, they are given an electronic after-visit report that includes what was done and what the next steps for care will be according to best practices and evidence-based protocols, whenever these are applicable.

Some who view this seemingly humble list of achievements will say that we can’t do it, because the standards aren’t ready, or the data is too complex. They’ll say that delays are necessary, due to worries about privacy or because too much data is still on paper.

We disagree. We believe that where there’s a will, there is going to be a way. And we already know most of what we need to know to achieve these goals. We know that:

huge amounts of digital data exist, already formatted electronically, but scattered across many proprietary systems (meds, labs, images).
software and the Internet makes it possible—in a low cost, lightweight way—to get data out of these databases to the point of decision making (to the ER doctor, the patient/consumer, or the primary care physician).
people are hungry for information in whatever form they can get it:

Getting it on paper is better than nothing
Getting it quickly is better than getting it late
Getting it in non-standard digital format is better than paper (software is pretty good at transforming non-standard to standard formats)
Getting it in a standard format is better
Getting it in a structured, standard format is best

An integration “big bang” -- getting everybody all of a sudden onto one, single, structured and standard format—can’t and won’t happen.

We don’t have to wait for new standards to make data accessible—we can do a ton now without standards. What we need more than anything else is for people to demand that their personal health data are separated from the software applications that are used to collect and store the data.

This idea of separating health data from the applications is very important, and a better way to frame the discussion about how to achieve data liquidity than is the term “interoperability,” which we find cumbersome and opaque. Smart people, armed with software, can do incredible things with data in any format – so long as they can get to it.

Customers of health information systems want to re-use their health data, and in ways they haven’t always thought of or anticipated. However, many enterprise system vendors make it difficult or expensive to get access to the data—to separate it from the application. They believe that proprietary “lock-in” allows them some form of strategic advantage.

We understand that IT vendors are in business, and need to create strategic value for their products. And we are very much in favor of that—in rules, in workflow, in user experience, price and flexibility, and so on. However, vendors should not be able to “lock” the patient or enterprise data into their applications, and thereby inhibit the ability of customers and partners to build cross-vendor systems that improve care.

It’s possible for vendors to provide value without the need for lock-in. There are lots of examples of this, for example, the Health Information Exchange in Wisconsin and CVS MinuteClinic. In the former, value is clearly 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. This is where the low hanging fruit is.

There’s already 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 wecan create value by interpreting the data and adding metadata. Microsoft is doing it today– both in the enterprise with Amalga and and across enterprises to the consumer with HealthVault. We hope other vendors follow this lead to drive better outcomes for patients.

Unlike the physical world where there is a need for dejure standards—think railroad tracks—in the software world, there is much more flexibility and the standards that work are the ones that evolve from USAGE and market acceptance.    The certification and standards road equals conferences, press releases, “connectathons”, caregivers-turned-bureaucrats. The outcomes road equals immediate benefits to actual caregivers AND learning we can apply to the next round, and the next, and the next.

We have given the industry decades to make this happen --- and just in the last 1-2 years have people finally gotten fed up and just started moving. Our great risk here is that the people lobbying for dollars and certification today are the people who are invested in the old road. With the amount of money we are talking about, we run the risk of just giving them another decade to delay and plan.   Instead, let’s put the dollars into rewarding behavior and outcomes, and let the people who live with the problems every day figure out how to solve them.

When we set out to go to the moon in the 1960’s we didn’t say “let’s build a great rocket.”   So, too, in this case we shouldn’t say “let’s buy a great IT system.”   Our measurements should be tied to what we want – better care, informed by the data that is just out there waiting for us to use it.

David C Kibbe MD MBA is a Family Physician and Senior Adviser to the American Academy of Family Physicians who consults on health care professional and consumer technologies. Peter Neupert is Health Solutions Group Corporate Vice President at Microsoft.

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.

Before you finalize your Health IT shopping list

pnblog — Mon, 12 Jan 2009 17:23:18 GMT

The mad dash for health reform continues in earnest as stakeholders from all parts of the health ecosystem work to inform, engage and encourage the incoming Administration. The need for reform is obvious and the dialog is positive -- I continue to worry that 'soundbite solutions' will get in the way of a serious discussion of principles, desired outcomes and alternatives to achieve a good return on investment on 'change.'

As a business guy -- one that has worked on startup initiatives over most of my life -- I tried to put into context what it means to invest an 'incremental $50B' in health IT. It sounds like a lot of money -- something on the order of $83k per practicing physician -- we ought to be able to do something spectacular for that kind of money.

There is a new study out 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. I recommend folks read it (full disclosure I was both interviewed and a reviewer). Many folks I talk with in the computer science industry recognize the huge benefits that will be gained in medicine and health outcomes with thoughtful investments in information technology. Many (myself included) are technology optimists and believe that information technology will ultimately disrupt and transform health delivery.

But to achieve this transformation -- we have to acknowledge the reality of the institutions and systems currently in place; we have to invest in the new kinds of architectures and IT systems that will deliver real value over time. This report is bi-partisan and a timely reminder of key principles by experts -- one that I hope informs the health reform spending debate before folks finish their HIT shopping list and count too much on electronic health records as a simplistic cure-all.

The study acknowledges the need for comprehensive patient data, empowerment of consumers/families with personal health information and for flexibility in systems design to enable new advances in biology to be integrated effectively -- among many other principles.

Here are a few of the topline recommendations (pages S-9 and S-10) from the report I chose to highlight because they are so important and often get lost in the 'soundbite solutions' debate:

incentivize clinical performance gains rather than the acquisition of IT, per se
encourage initiatives to empower iterative process improvement and small-scale optimization
develop the necessary data infrastructure for health care improvement by aggregating data regarding people, processes, and outcomes from all sources.
insists that vendors supply IT that permits the separation of data from applications and facilitates data transfers to and from other non-vendor applications in sharable and generally useful formats

If the country is going to invest $50B in incremental health IT -- we all want it to be invested wisely. The question is; what will generate the most benefit and how can we accomplish it? We should be building an asset with this investment - and the asset is not an application per se -- but a health data asset that can be used to improve both individual outcomes and the performance of the institutions and the system overall. Individuals should be encouraged to create and manage their health data asset and to learn how to share it to achieve better outcomes and interactions with the health delivery system. Similarly - health enterprises should invest in building and sharing health data assets that enable them to have a culture of process improvement over time.