Neupert On Health : global trends

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.

International Travelogue Part Two...

pnblog — Thu, 12 Feb 2009 22:09:00 GMT

Last week, I continued my round the world itinerary visiting customers, partners, and governmental agencies. I took an overnight flight from London to Bangkok on a Saturday—the plane was full, primarily of tourists taking advantage of what Thailand has to offer, despite the political turmoil. My day started with a random act of kindness—receiving a text message from someone who picked up documents I left on the train to London and offering to send them to me—remarkable! What many folks don’t recognize when looking at maps is how large, spread out and diverse Asia Pacific is. After arriving early Sunday morning, I caught up with my team on the ground, many of whom just came from Arab Health—a huge HIT conference. I then spent Monday in Bangkok with customers, Tuesday in Kuala Lumpur departing on an overnight flight to Sydney, and Wednesday to Friday in Sydney departing on an overnight/day flight to U.S. for a brief, but important meeting in Scottsdale, AZ on Friday afternoon before the last leg getting home to Seattle that evening. Amazingly throughout the 13 days, there were no big logistical problems (no lost bags, no delays over an hour, no lines over 30 minutes)—made it much easier to survive!

Here are a few of my observations from Asia Pacific—with more specifics this week to provide context:

Monday morning started with a visit to a large public hospital in Bangkok. They are at the same time very sophisticated from a diagnostic/therapeutic perspective (research lab, surgery center) and very antiquated from a work process perspective. They see a huge number of patients—both with appointments and not. Their “system” is primarily paper-based—the amount of forms and paper they have is overwhelming. Their whole system is based on queues—throughout the hospital, there are people waiting and standing in line. To get a pharmacy or lab item, a patient might go through three separate queues or tellers with an indeterminate wait time at each—identify/submit order, make payment, and draw or receive lab or Rx. I was struck by the incredible opportunity for the use of technology to improve the entire system—in terms of throughput and satisfaction, and ultimately patient care. Hospital management also sees the need and the opportunity— to invest in the information infrastructure as they have invested in the medical equipment infrastructure—but the implementation task seems daunting to all.

I spent the afternoon at Bumrungrad Hospital in Thailand where I have a development organization and key strategic partner. Bumrungrad is an amazing example of excellence—using technology to support clear outcomes—quality, efficiency, and customer satisfaction. Each time I’m there, they show me advances in infrastructure, workflow processes and facilities. It is great to have strategic partners who push the agenda for our products forward. Now they’re moving on to Bumrungrad Version 3.0—a whole new level of service and are again looking to IT to help. While they serve the local population, they serve an even greater number of foreigners—thousands and thousands of “medical tourists” from the US, Middle East, Europe, and Asia. Interestingly one of the key topics was how to leverage HealthVault in supporting the medical tourist and expatriate part of their business…something we have talked about internally but now have prioritized.

In Kuala Lumpur, I visited two private hospital groups, each of which is part of a larger conglomerate. They view healthcare as a growth portion of their portfolio and they have money. I enjoyed learning from them about their goals and approach, and explaining our strategy to them. The perceptions of what Microsoft is as a brand are so prevalent and ingrained—consequently, I have learned my most important objective is to communicate with folks that HSG is a serious and thoughtful player in health information technology. These private hospitals want technology partners to help them do a lot; —streamline their clinical and business processes, use clinical workflow tools to put guardrails on clinical processes, provide sophisticated BI tools and to stay on the leading edge. While they are focused on their enterprise needs first—our Health connected strategy—of connecting consumers to physicians to facilities—really resonated with them for their future business needs.

In Sydney, I met a very diverse group of folks—shadow ministers, MDs, CEOs of hospitals, members of the Clinical Excellence Commission, and members of the NSW health service. Australia has been pursuing leveraging HIT for several years. Some states are pursuing standardized Cerner implementations for hospitals and there is an institution named NEHTA that has been exploring the policy issues/standards around community or personal ehealth records. As I’ve noted before, the challenges in Australia are similar to the U.S. and Europe—leveraging information across the continuum of care, getting more out of their existing departmental systems, improving performance at the enterprise and system level and engaging consumers. The health of the healthcare system is a hot media and political topic—everyone is talking about the Garling report and what it means, physician concerns about the Cerner implementation in emergency departments and other specific bad ED incidents the media have publicized. While I get the scale benefits of standard software and standard rollouts by centralized and skilled service organizations—they frequently run into challenges in the healthcare domain.

I concluded my trip in Scottsdale, AZ, where I had the opportunity to address a small group of CEOs at the Health Management Academy. It was a great interaction about how technology has changed many industries. I had the opportunity to use my personal history to tell the story of how connecting vision, technology folks and domain experts has powered positive and sustainable change—which I have had the good fortune of doing at Microsoft, at MSNBC and at drugstore.com. It was fitting to conclude the trip back in the U.S with leaders dealing with the challenges in their organizations and the economic climate. Increasingly I see the local market separating into two segments—while all are focused on cost containment—some are primarily hunkering down and others are seeing the current climate as an opportunity to invest in transformation. Obviously I believe the right technology is critical to both groups.

Let me wrap with a side comment. I’m over 50 years old and have been traveling internationally for nearly 40 years. Even though there have been many articles and books written about how the world is flat, it is remarkable to me how much the world has changed in this relatively short period of time...and yet, in some respects I believe the change is just starting. From the ease of staying in touch (my kids could call/text me anytime—didn’t need to know where I was at all)—to the ability to stay connected to important events in the U.S. (Superbowl started at 6am local time in Bangkok with Thai announcers and a pre-game show)—to physically getting from place to place—it is all steadily improving and becoming part of the norm. In the same 13 day time frame, I worked out on four separate continents—ran in the cold in London’s Hyde Park and in the heat around the Sydney Opera House—and collected all the workout information on my HealthVault compatible Polar heart rate monitor and watch.

International Travelogue

pnblog — Mon, 02 Feb 2009 00:50:00 GMT

After my visit to Washington D.C. and the U.S. Senate, I thought it might be instructive to visit other parts of the world to gain additional perspective on the challenges the global economic crisis is posing to health systems. For the last five days, I have been in Western Europe visiting four different countries and interacting with health system CEOs and CIOs, ministers of health, leading social service bureaucrats and members of the Microsoft health ecosystem.

Here are some observations worth sharing:

Everywhere there is a deep interest in personally controlled health records - more than I anticipated, and despite the fact that some early projects in the category have performed poorly and have low adoption. Stakeholders recognize that citizens/consumers need to be actively engaged in their health in order to improve the results and economics of the health system. They view personally controlled health records as an important tool to motivate and engage them. They don't see other options that can accomplish this goal.
Privacy is a major issue surrounding the sharing of health data -- either in the professional arena (insurance, provider to provider, provider to pharma) or in the case of professional to consumer. Many have concluded (as we have in the design of HealthVault) that personally controlled health records are the best solution (but not the only one).
Health systems and their funders are looking for ways to connect the health delivery system across institutional boundaries -- from GP systems to hospitals and specialists. No one is doing it well yet. They see it as critical to delivering better outcomes and containing costs, and they acknowledge that seamless data sharing is critical to enable new work flows. Unfortunately there remain many barriers to this seamless data sharing -- some technical, but mostly economic fear of existing stakeholders around loss of revenue or the implications of transparency on business practice/quality of delivery.
The payment systems inhibit innovation in many cases or drive it in others. In some markets, governments are pinning their hopes on private insurance as a vehicle for innovation and focus on wellness/prevention while in other markets the government is directly trying to tinker with the payment schemes to encourage new behaviors by the provider organizations. From an economics perspective -- what strikes me as the real problem and challenge with these approaches is that the feedback loops are long and indirect, and consequently the cycle time of improvement will be incredibly slow. This is why price mechanisms in the capitalist system are so important - real time feedback mechanisms with the ability to self adjust.
The people with whom I met had an informed interest in what was going on in the U.S., particularly around the stimulus bill for health IT and about the prospects for health reform. They are watching to see the impact. What surprised me was the low esteem in which most regarded the U.S. health system...based on the statistics around health spend as a % of total GDP spend and reported health outcomes. I acknowledge that the U.S. system has many flaws, is broken in many ways, and has lots of waste that should be eliminated. But I have always been a bit of a skeptic that the statistics on outcomes really tell the full and complete story around quality of care delivered across different societies. I am not sure that the perception of others really matters in this case in terms of the U.S. needing to fix the problems regardless -- but it bothered me enough to flag it and put in my "think about it later" list.

Some I visited are surprised to learn that Microsoft is investing in health specific software and services solutions. Others are challenging us to do even more to bring ease of use, effective application integration and user interface innovation to the health worker desktop today! Most are hopeful that the next round of technology and software investments really help improve the working environment on the front lines of health delivery and health outcomes.

Next stop -- Asia Pacific. Given our ambitious goals, I often tell my team that time is our enemy when it comes to success. Ironically, I have turned the motivational saying into a concrete reality as my itinerary has three of the next six nights aboard planes. whoops

Russia Visit

pnblog — Tue, 22 Jul 2008 06:39:57 GMT

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.

Inaugural Post

pnblog — Mon, 19 May 2008 08:11:00 GMT

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.