Neupert On Health : health and software

Another milestone on the journey forward…

pnblog — Tue, 23 Jun 2009 03:43:00 GMT

Over three years ago, we started on a journey -- to empower consumers with tools to help make better health decisions and drive better health outcomes. We believed that the simplest, easiest way to start was to give consumers their data in a secure and private way, and allow them to share it from provider to provider, keep it in one place over time, and learn about it in order to make better daily health decisions. That simple idea was the beginning of HealthVault.

Back then, there were a lot of objections. Consumers don’t want their data. Consumers can’t understand their data. Their data might actually do them harm…blah…blah…blah…

But fortunately, things have shifted. Consumers have made it pretty clear that they want to be involved in their health – as evidenced by looking at social networking sites like PatientsLikeMe, the raw numbers of health Internet Searches, or research reports like The American Public on Health Care: The Missing Perspective, released by the CEG, Accenture and IOM:

· 78% of American favor giving doctors the ability to share access to their medical records if done with their permission.

· 66% said that they see the value in including their own information anonymously in a large database to help researchers.

And I’m happy to say for a number of reasons that consumer products like HealthVault and GoogleHealth continue to gain market traction.

Today marks another milestone – the first Industry-wide initiative to establish a “Declaration of Health Data rights” to support patients’ rights to access and share their own health information – https://healthdatarights.org will go live tonight, along with blog posts and endorsements from thought leaders and organizations across the country.

While we’re making change, and it's great to see so many organizations and thought leaders coming together, it’s important that we not stop here…that we continue to move forward—specifically by ensuring that consumer access to their data is included in the definition of “meaningful use.” While I’m optimistic about what I see -- what’s been laid out seems to focus on driving real outcomes improvement in the health care system -- we will not be successful without further refinements. Consumers cannot just be given access to data in static form, but must be provided with an electronic copy of their data so they can easily share it, use it, add to it -- creating a lifelong health data asset. In the end, consumers are the ones accountable for their own health.

The willingness to succeed is only exceeded by the willingness to prepare

pnblog — Fri, 19 Jun 2009 06:24:00 GMT

After many long months of discussion and debate, the first draft of Meaningful Use has come out. I’m optimistic about what I see -- what’s been laid out seems to focus on driving real outcomes improvement in the health care system.

It’s important that we keep this in mind -- that we’re not just trying to implement technology. We’re trying to improve the performance of the health system. And our willingness to succeed should only be exceeded by our willingness to prepare, and as part of that preparation, we must ensure that flexibility, scalability, and interoperability are inherent traits in the system. Why? Because, health is fundamentally data-driven. Nobody -- physicians, consumers, hospitals, insurance companies, governments -- can make good decisions without good data.

So driving data liquidity -- that is the ability for data to flow throughout the system -- has to be the critical focus. For years, we’ve been building systems in a “top-down” way to reach information, but what we need to do is build from the information up. One thing Carol Diamond said at a Health Affairs event that I attended with her really struck me -- the idea of bringing the question to the data -- leaving the data where it is and bringing the question/problem/issue to it. For a long time, what we did as an industry was use expensive research grants and complex tools to cull and compile data that was intended to answer one specific question, and by the time we’d sorted through the data enough to answer that question, it was either out of date or ten other, more pressing questions had popped up in the meantime. What we need is a system that unlocks all of the data that exists already in the health care sphere, and allows it to flow between silos so that when questions arise, we can bring those questions to the data for quick, evidence based answers -- rather than the other way around.

Given this, as discussions/refinements continue around meaningful use, I believe it’s critical for the following to be a part of the final definition:

· We can’t just capture data, it must be available in “real-time” in order make the right decisions and improve outcomes -- whether we’re talking about patients or populations.

· We have to enable 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’ve got to give consumers access to their data -- not just in static form -- but empower them with an electronic copy so they can easily share it, use it, add to it–creating a lifelong health data asset.

· We should accelerate the objective of having PHR access to EHR data to the 2011 Objectives and Measures. There is no need to wait until 2015. These technologies are available today and will bring real, sustainable benefits, not just for consumers, but for the overall health care system.

· We must ensure that we do not have an overly-prescriptive certification regime that focuses on certifying features and functions every-other-year. This will produce the unintended consequence of stifling innovation. Software vendors will be forced to develop towards a certified feature list rather than look for new and better ways to improve clinical processes and health outcomes,

The foundation of success is based upon data liquidity, and so it must be central to our thinking as we prepare for the future.

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.

Connect Consumers with “Meaningful Use”

pnblog — Sat, 28 Mar 2009 01:41:00 GMT

The current hot, behind-the-scenes, debate in HIT is around how “meaningful use” of HIT will be defined for purposes of the incentive payments provided in the HiTech portion of ARRA. Since there is a lot of money at stake and a lot of interested stakeholders, I am sure it will be an energetic debate.

Hopefully the definition of “meaningful use” will include some concept of improved health outcomes (Message to Washington - Its all about the Outcomes ). I know this presents many challenges, and I don’t pretend to have the complete answer on how to best define “meaningful use”.

As Zeke Emanuel remarked at our IOM meeting this week, specific suggestions are much more effective than general principles in rule-making – so I’m taking to heart his recommendation.

My simple, concrete, critically important and specific suggestion for incorporation into the definition of “meaningful use”? Make sharing data and actionable information with consumers a required condition of “meaningful use.” Specific and simple. I can add lots of characteristics to it – near real time, two-way sharing, portable, and so on – but the essential point is that consumer access to their own data has to be DEFINED as part of “meaningful use.” Consumers are the ones ultimately accountable for their health. If we don’t include them, we will miss this historic opportunity to create a new ‘platform’ for transforming care in innovative ways.

We need to think bigger. Folks in Washington talk about HiTech portion of ARRA as being a down payment on the future of health delivery. I am not sure what that means myself. But if it means we are building a platform for transforming care or creating a learning health care system – I know it must include connecting the last mile, which means incorporating the consumer and the home into the platform – by design.

The formal definition of meaningful is: full of meaning, significance, purpose, or value.

The key word for me in this definition is value. Unless the definition of meaningful use is extended to include the consumer, real value in way of improved health outcomes or return on this huge investment will never be realized.

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

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.

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.

Rush to Reform

pnblog — Wed, 17 Dec 2008 20:50:53 GMT

I haven't posted for awhile -- mostly because I have been busy with customers, development projects, and the impact of the economic crisis -- but also because I’ve felt that there has been so much noise and anticipation around the priorities of the incoming Administration that reading seemed more valuable than posting.

It is clear that 'reforming the health system' is a priority -- and that’s positive. Daschle has promised lots of conversations in homes around the country on this important topic, which may be illuminating and instructive for all (or not). Certainly the industry stakeholders -- executives, pundits, vendors etc. -- are all lining up their policy principles, suggested areas of priorities, options for reform and the like. You can read them everywhere--in the news, at conferences, and in blogs.

In the current bailout climate, which I fear is corrupting the minds of many otherwise thoughtful people; the risk of well intentioned changes having negative unintended consequences (economic sink holes as well as lack of systemic improvement) is high.

Despite the risks, I remain encouraged that some positive things can happen. No matter what priorities and tactics within health reform are chosen, substantial health information technology will be a necessary ingredient. There is a growing consensus that increasing health data liquidity/exchange is the first order priority (see here and here for recent examples). This is the position we staked out three years ago, and the ongoing focus of our investments.

Refactoring the question of HIT and health reform from "subsiding EMR adoption" to "incenting the use of shared data and personal, connected tools to improve care" is real progress. There is lots of valuable electronic health data today. The first investment priority should be to get more value (reuse vs. re-create, physician/consumer access and use of data in decision making) out of what exists already, instead of funding more source systems..

My last thought for the morning on HIT and health reform isthat the technology question should also be refactored. Rather than focusing on infrastructure investments(more EMRs, more HIEs, build it and they will come dreams here-- this is input focused), the appropriate focus should be choosing an outcomes goal -- say reduce diabetes by 50% in 5 years. Let innovative people inside and outside the industry pull the right technology into adoption to meet an ambitious goal. Yes, changes in reimbursement need to happen for this to work, but this is true in all cases. The technology exists today. The real adoption challenge is not about incentives to buy it, but rather about rewarding those who use it well to achieve better outcomes -- for patients, for themselves and for payers.