Neupert On Health : technology investment

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.

Interesting week of interactions

pnblog — Sat, 02 May 2009 21:36:00 GMT

It has been an interesting week for me, participating in three different events in the last seven days. With HIMSS at the beginning of the April -- it has been a real opportunity to get a snapshot of what folks are thinking, planning and worrying about in these hyper-active times of HiTech and health reform.

Thursday, I was on a panel at the Markle Foundation’s Connecting for Health event -- talking about ARRA, meaningful use and certification. I have to give a lot of credit to the Markle folks and participants for driving a very well thought out set of principles and priorities for ONC to consider in defining both meaningful use and certification, and more importantly reminding everyone of what the goals of HIT are all about -- better health outcomes. They had an impressive crowd of thought leaders at the event (which shows the interest in getting meaningful use defined right) and they have a broad and growing group who are supporting their consensus position. You can read more about it here -- and Microsoft is supporting the recommendations, along with many others.

Last Friday and Saturday, I participated in Innovation 2009, hosted by Health Evolution Partners, led by David Brailer. The participants and speakers were fabulous (and I'm not generally a fan of conferences). The discussion centered around new business ideas, how to innovate, the challenges facing large companies and the policy frameworks required to get the U.S. to the promised land of better health outcomes at the same or lower costs. I am an entrepreneur at heart (this being my 5th start up), so it was really exciting and a bit unexpected to hear from the many companies doing innovative and very focused things in the broad health ecosystem. I won't enumerate them here -- but suffice it to say the number of follow up actions I left with from this conference exceeded HIMSS -- which had a 1000 times the attendance. (Perhaps this is an indication of where innovation is happening). We had lots of discussion about the need for health reform -- that it should encourage innovation in multiple directions (care delivery, payment, new entrants). And a very real fear was raised -- that reform could actually stifle innovation. One discussion point was the 'public plan' option being floated by the administration and a prominent spokesperson said implementation of that "would be a catastrophe!"

On Monday and Tuesday, I participated in the Milken Institute Global Conference. They also do a great job of getting world class speakers, but given there are over 3k participants, it was a very different feel than Innovation 2009 with less than 200. The Milken conference is broad -- finance, credit, energy, international, education and health. What really strikes me is the number of folks that go to the conference that are really interested in the challenges and opportunities in health. I was fortunate enough to participate in a great conversation between Elias Zerhouni (former head of NIH), Jamie Heywood (founder of patientslikeme.com and super smart guy), Anne Wojcicki (founder of 23andme.com and super smart gal), and others about the critical challenges in the current paradigm of clinical trials and therapeutic discovery. Increasing the rate of discovering what works in health (precisely identifying the disease, finding targeted cures, providing feedback loops) is critical to addressing the cost crisis, the quality challenges and improving health outcomes. Here again, the system is failing (FDA, large drug companies) because the framework, institutional infrastructure and information platforms aren't flexible and adaptive enough to deal with the real needs of today. As a result, new groups are forming to find ways to innovate either around or completely alongside the existing institutions to accelerate knowledge -- like Alpha 1, patientslikeme.com, collabrx and many others. It is interesting to note the role of philanthropy and foundations in changing how the science and infrastructure is being driven -- groups like the Canary foundation and FasterCures and of course the Bill and Melinda Gates Foundation.

The flu pandemic has been the center of the news and was certainly a topic in all of the conferences above. From helping to prevent pandemics, to accelerating knowledge and understanding, to improving health outcomes and increasing access to quality health care -- information technology and platforms -- are critical.

Health Affairs event and special issue on Health IT

pnblog — Wed, 11 Mar 2009 07:20:00 GMT

Today I spoke at a very well attended Health Affairs event in Washington DC -- originally designed (months ago in a different time warp in HIT light years) to discuss lessons learned by folks leveraging HIT in effective ways, along with the usual challenges, issues and opportunities. Naturally the discussion was hijacked by the implications, potential consequences and opportunities raised by the ARRA stimulus act and the HITech portion of it in particular.

There is much to report from the event -- because there were a lot of smart and thoughtful panelists -- and because the issues are at the same time complicated, familiar and not super well understood. I don't have time to cover them all in this post.

There is a strong consensus (it showed up in comments from many panelists) around the theme I care most about -- which is we must focus on the outcomes one wants to achieve (better health outcomes at the same or lower cost) and then encourage innovation between providers and technology suppliers to deliver those outcomes. Said another way -- technology is a tool (a means) and not an end in itself. This is why health reform and the health stimulus have to be intertwined and self-reinforcing. Just spending money on HIT is not going to lead to the 'down payment' (i.e. future savings) that Obama believes it is.

Mark Smith brought this to life most effectively in his remarks -- that by adding a computer to Kramer's bookstore you don't end up turning it into Amazon.com. Kaiser reported in the article summarizing the experience in Hawaii with KP Healthconnect (EMR) -- that family practice office visits went down by 25+%. For Kaiser, an integrated delivery network and health plan -- that is a benefit to their bottom line. (I should note patient satisfaction went up in this period because needs were met by phone/email -- a totally win/win situation for Kaiser and consumer alike). For a more typical, small office family physician -- that is a disaster...because revenues are tied to visits. To succeed, we have to change the paradigm of healthcare away from the tyranny of the visit based payment system (Kramer's bookstore) and reward longitudinal care systems (future amazon.com). If we spend a bunch of money automating existing systems of care -- and not enabling new platforms -- we have missed the huge opportunity to make a difference.

Carol Diamond made the subtle, but I think hugely important point that has not fully sunk in to the folks waiting at the starting line of the HIT land rush -- that the public is going to expect accountability for improved outcomes with the stimulus spend. Health touches everyone -- and if the country spends $30+Billion dollars on 'investment' and the average citizen experience with the health delivery network is no different and costs continue to rise -- there is going to be accountability for where did the money go. She is rightly trying to focus the minds of the folks with the wagons -- better pick your spots wisely -- just getting a homestead isn't good enough -- it had better be productive land.

My biggest ah-ha moment came a few hours after the event in a conversation with the CEO of a large player in the healthcare supply chain. I realized that a significant portion of the Health Affairs event, the broader conversation about overall HIT investments and the specific conversation I was having ALL ACKNOWLEDGED and CONCLUDED that individuals (people, patients, consumers, whatever label we want to use) have a right to a personally controlled health record and that the personally controlled health data management platform is a critical component (perhaps a necessary component) of ANY FUTURE HEALTH IT SYSTEM and probably any payment reform system.

The ah-ha point is -- Microsoft has made a difference -- a huge difference -- by taking the leadership role it did 3 years ago by investing in building, defining, evangelizing, shipping and refining a personally controlled health data management system, HealthVault. We have a long way to go to make it easy, ubiquitous and fully connected -- and to deliver the value I know it will to consumers/patients in their everyday health lives. But I know it is a good and innovative idea and one that has changed and framed the debate in a positive way. While I have always believed that -- to see the effect and reality of the impact -- made my day.

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.

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.

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.