This blog was also posted on the Microsoft News Center.

Following the Google Health announcement, a number of people have questioned whether Microsoft will continue to develop HealthVault without another vendor like Google to ‘compete’ against. The reality is that we’ve always viewed the status quo as our biggest competitor and Google as an ally in the movement to transform health care around the world – so we’re sorry to lose their voice in the discussion.

Since Google’s announcement, the two companies have worked together to create ways for Google Health users to transfer their data into Microsoft HealthVault. Today, we announced an option that leverages the Direct Project protocol for encrypted messaging to enable the data transfer with just a few clicks.

And what about HealthVault? Will Microsoft continue to invest? HealthVault is not peripheral to Microsoft’s health IT business – it’s core to our strategy and to what we believe is required to truly make a difference in health and health care.

In order to transform health care, I’ve said for a long time that data must flow across the system – from the hospital to the physician to the home. Health care should be a data-driven industry, and software is designed to manage data in efficient and effective ways – creating new insights that often lead to new ways of delivering care. Whether it’s a clinical pharmacist who needs access to a patient’s complete history or a patient who is tracking her diet, exercise and blood pressure readings to better manage her hypertension – having the right information at the right time is critical to decision-making about health and health care – and it’s the key to delivering better value.

To accomplish this, health care stakeholders need better systems in provider organizations and better systems for connecting caregivers with patients. Microsoft’s strategy and investments continue to be focused on delivering these systems – Microsoft Amalga, which is designed to help health systems streamline operations and connect care teams, and HealthVault, which enables engagement with patients. We believe these two platforms combined – Amalga and HealthVault – can transform care and create a patient-centric health system.

Getting there has been – and continues to be – hard work – and it’s not happening as fast as we’d like.

Because of how HUGE the health ecosystem is – trillions of dollars, hundreds of millions of consumers/patients, hundreds of thousands of physicians, thousands of hospitals, hundreds of insurance plans and so on – progress is hard.

But we are seeing changes. In the US, incentives are being realigned to foster engagement with patients and management of care beyond the walls of an organization. And the government is driving projects to support the flow of data across the health care system. The UK is also focused on some exciting ideas around transforming health care delivery. And we’re in conversations with a number of governments and large health care providers around the world about how technology can enable the flow of data across the health care ecosystem to better manage the health of a population – at lower cost.

So, for people wondering about the future of HealthVault and Microsoft’s ongoing commitment to health care, let me be clear. We continue to be focused on driving change in health and health care around the world through data liberation. This is the position we staked out 5+ years ago – and the ongoing focus of our investments.

Last week I participated in our fourth annual Connected Health Conference, held in Chicago. At this event we get together with hundreds of customers, partners, policy makers, and thought leaders from across the industry to talk about what’s going on in healthcare today – and what’s next.

A highlight of the conference for me was the opportunity to moderate a lively panel that included Phil Bredesen, Bill Hazel and Mike Leavitt . Given all the talk in Washington, DC and the states about how to rein in rising U.S. healthcare costs, it was great to hear from current and former officials from HHS and state governments on the forces driving evolving payment models and delivery system reform. They all agreed on this point – regardless of what happens with U.S. healthcare laws and regulations, the healthcare delivery system will change dramatically in the next 5-8 years because the current model is unsustainable. Mike Leavitt said it best – there is an “economic imperative” to change the healthcare system and “health reform is now economic reform.”

We need to drive additional value – better care for the same or lower costs – into our healthcare system. All the panelists agreed that to get to value, we must throw away the fee-for-service model, support greater transparency within the system, and enable innovation.  The fee-for-service rules have stifled innovation by reinforcing volume over value -- reimbursing on a per-procedure basis rather than on the number of patients who remain healthy year over year.

Phil Bredesen emphasized the need to re-introduce “economic tension” into the system. When businesses and consumers purchase goods and services, they typically have the opportunity to balance what they want to spend with the value they perceive. Without transparency around cost and quality, healthcare purchasers can’t make informed choices. Bredesen’s view is that transparency will generate the required tension – improving healthcare dramatically.

I asked the panelists where innovation will come from. The consensus was that states and employers will drive change because they are desperate to figure out how to balance their budgets. Bill Hazel told a story about a manufacturing company with a significant population of diabetics. They’re working with local healthcare providers to drive change in the system – to address high costs, high absenteeism and ineffective care. The employer was clear – if the U.S. can’t figure out how to provide better value in the healthcare system, the company will be forced to move elsewhere.

A focus of our Connected Health Conference is innovation in technology. Craig Mundie, Microsoft’s Chief Research and Strategy Officer, gave a great presentation on the future of technology and its potential impact on healthcare, and a number of our customers and partners demonstrated significant progress in using technology to drive change in care delivery.

But, technology is only part of the story. As Leavitt explained, until recently “medical innovation” has been a new gadget, chemical or procedure. Now it’s about:

• Innovating around defining and demonstrating a value proposition for stakeholders – Pay $1 today and get $1.50 tomorrow.
• Innovating around collaboration – Networks of care teams are emerging, but successful collaboration requires the ability to split up a series of activities and a set of money in an orderly way.

It’s clear that change is coming. I’m excited about the potential to drive real value in the healthcare system – with innovative technology and innovative business models.

I spent most of this week at HIMSS in Orlando – a conference I’ve attended every year since 2006 – which gave me an opportunity to reflect on the significant changes I’ve seen in the healthcare industry over the last few years.

Four years ago at the HIMSS in New Orleans, Microsoft’s CEO, Steve Ballmer, gave one of the keynotes. Steve spoke about the proliferation of clinical data, the need to engage patients in managing their own health, the required move to a more collaborative approach to life sciences research, and Microsoft’s focus on helping to harness technology to drive improvements in health and healthcare around the world. One of the things Steve discussed is the need for “a different kind of working relationship between public and private people, between providers, insurance, and government to really develop and deploy the kind of interoperable systems that will let this vision happen.”

In 2007, when we started talking about different relationships among stakeholders in healthcare and highlighting the important role of consumers as well as interoperability – data liberation and liquidity – in transforming care, everybody thought we were crazy. And now – in the US, at least – it’s the law.

Meaningful use was once again a big topic at this year’s HIMSS since many organizations are focusing their IT investments in order to qualify for federal incentive payments. But, we need to recognize the vision behind the meaningful use of EHRs: an interoperable system of care that increases quality, safety and efficiency, improves care coordination, engages patients and their families in managing their health, enhances population and public health, and ensures adequate privacy and security. Meaningful use of EHRs requires moving beyond the traditional electronic medical record to enable the secure flow of data across the health ecosystem in ways that enable new delivery and payment models to flourish. This is the position we staked out four years ago – and the ongoing focus of our investments. 

Earlier this week we announced an alliance with athenahealth designed to drive better care coordination across outpatient and inpatient physicians and settings, a priority for health systems looking to form ACOs and qualify for pay-for-performance funds.  We’re connecting Microsoft Amalga with athenahealth’s hosted web-based services (athenaClinicals and athenaCollector) to enable physicians to see inpatient and ambulatory information in a single view. Microsoft and athenahealth decided to make these investments because they meet a need our joint customers – specifically, Steward Health Care System in MA (formerly Caritas Christi) and Cook Children’s in TX – have expressed.

Steward is focused on executing on programs like their Alternative Quality Contract (AQC) with Blue Cross Blue Shield of Massachusetts, which is a contract model designed to give providers meaningful incentives to improve the quality of care while conserving healthcare resources. To meet these objectives, Steward is looking to drive efficiencies and deliver truly coordinated care. At Cook Children’s, the goal is to improve the health of every child in their region by providing patients and physicians with access to an information platform that transcends physical location and has the capacity to evolve to meet changing rules and requirements. athenahealth and Microsoft are bridging the information gap – giving clinicians the ability to access patient information from anywhere, regardless of its origination, and enabling a new level of patient engagement.

In 2007, we knew it would take time for our vision to come to fruition – and we’re clearly still at the beginning stages of data liquidity and health information exchange and the innovation these changes will enable. And, the government and private insurance companies need to ensure that the right incentives are in place to drive this move toward greater interoperability and to avoid stifling innovation before it has a chance to take root. But, as these customers and others are demonstrating, the healthcare system can achieve our shared goals of better value – better outcomes for the spend – today by enabling the flow of data and collaborating across the healthcare system in new ways.

Almost two years ago on this blog, I issued a call for ‘data liberation’ – emphasizing that the free flow of health data should be the foundation for realizing a future of secure, personalized, data driven medicine.  A year later, I discussed the concept again as we began to see the idea of ‘meaningful use’ take shape – with its focus on data exchange for the benefit of physicians and patients.  I see an increasing amount of activity that keeps me optimistic about us realizing this vision for ‘connected’ health. Of particular note are the folks at the Federal level (HHS and ONC) who are increasingly grounding their initiatives in the same concept of data liquidity.  See the re-post below of a blog I wrote for “Microsoft on the Issues” on this topic.

Health has been a huge focus for the federal government over the past year – specifically, how to expand access and drive value: improving care for the same or lower cost.

The Office of the National Coordinator within Health and Human Services (HHS) successfully spurred the industry to action last year with its Blue Button Initiative and worked with private sector organizations to drive the Direct Project. The Direct Project is focused on using e-mail as a secure way to share health information. Microsoft was an early participant in this project along with other companies such as Allscripts, MedPlus and VisionShare.

Today in Washington D.C. at an HHS press event, we announced that next week we will be launching new functionality that wires every Microsoft HealthVault account to use online encrypted patient e-mail based on Direct Project security protocols. To start with, we will enable physicians to transmit a copy of a patient’s clinical information to a new email address created within HealthVault. This information can be read or saved to a patient’s HealthVault account to build their personal health record – a holistic view of an individual’s health history.  In the future, we expect to make this functionality available to providers and to enable secure messaging for physician-to-physician consults and for transfer of patient records. 

At this point, most people recognize that software technology can be a catalyst for connecting the health ecosystem and transforming the ways we manage and deliver healthcare. Healthcare should be a data-driven industry, and software is designed to manage data in efficient, effective – and new – ways. Whether it’s a surgeon who needs access to a patient’s complete history, or a patient who is tracking her health and diet information to better manage a chronic condition – having the right information at the right time is critical to decision-making about health and healthcare – and it’s the key to delivering better value.

Historically, the data has been hard to get. Within the hospital, it is trapped in siloed systems that support different departments but aren’t connected. Within the physician’s office, it is trapped on paper, in hundreds upon hundreds of file folders. For the patient, their personal health data is often inaccessible – since the data is typically collected and stored at the point of care.

At Microsoft, we talk about the need for “data liquidity,” which translates into liberating data from across the health system so that individuals can start engaging with the information and using it in meaningful ways.

The Direct Project is designed to address part of the issue as an easy, secure way to exchange health information. The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send encrypted health information directly to known, trusted recipients over the Internet. This can be physician-to-physician; physician- to-public health authority; physician-to-patient; and on and on.

With the Direct protocols in place, patients can more actively engage with their providers in the ongoing management of their health. And these protocols enable improved care coordination across the health system. Physicians can more easily communicate with each other about patients, and patients can share their personal health information as they move across encounters with different healthcare providers. Putting patients at the center is the vision behind Microsoft HealthVault – so it has made sense for us to be an early participant in the Direct Project.

Step by step, we are liberating the data and bringing patients and their healthcare providers one click closer to the information they need to improve health and healthcare.

I think we all would agree that finding cures and improved treatments options for cancer are a moral imperative. They will have a dramatic impact not only for those fighting the disease, but also for the families, friends, healthcare providers, and other caretakers that support them in their battle.   Personalized molecular medicine provides a promising path forward in cancer care, but accelerating this research requires the brightest minds, great laboratories, cross-disciplinary collaboration, rich software tools and LOTS of relevant, annotated, real-time data.   Today we are missing the “LOTS of data” piece, because our health information technology (HIT) and consent systems are not effectively connected for either the improvement of care or the acceleration of research. 

Estimates in the U.S. indicate that more than 1.5 million will be diagnosed with – and more than a half million people will die of – cancer in 2010. And, as of 2007, 11.7 million Americans were living with the disease. Of those 11.7 million cancer survivors, it’s estimated that only 5% are enrolled in clinical trials, and only 15% are being treated at major research centers – which means more than 9 million people with cancer are not part of formalized research.  This is a highly motivated community, many of whom would welcome the chance to participate in research that could help their children, or their children’s children, receive more effective treatments if they suffer from the disease.

In partnership with the National Cancer Institute (NCI) and SAIC we have built a prototype to demonstrate that we can solve this problem now. Earlier this week at the Partnering for Cures conference in NYC, Ken Buetow, Ph.D., Director at the Center for Biomedical Informatics and Information Technology at NCI and Dr. Jon Handler, from Microsoft’s Health Solutions Group, presented a jointly developed prototype that showcases the potential for information technology to accelerate personalized healthcare research and improve clinical care.  Dr. Buetow talks here about the information challenges faced by researchers, providers and patients, and looks at the potential for technology to drive meaningful transformation in support of these stakeholders’ needs. 

The prototype uses Microsoft HealthVault and the Patient Outcomes Data Service (PODS) created by NCI to collect provider and patient-generated data on cancer diagnoses, treatments and outcomes. Since PODS and HealthVault are easily accessible outside research centers, the prototype highlights ways to engage a broader set of clinicians and patients in research – making it easier to reach those 9 million people who are not currently represented in research studies. In addition, gathering regular reports from patients on their experience with cancer treatments – for example, tracking daily pain levels, sleep patterns and mood – can provide researchers and clinicians with a richer set of data for understanding the impact of cancer treatments, particularly among certain patient sub-types and populations. 

Using Microsoft Amalga, this data can be made anonymous and aggregated with data available in other research databases to create a disease registry that enables more complete analyses of the efficacy of cancer treatments.  Providers and patients have the opportunity to not only contribute their own information to benefit others; they can also view trended data from across similar patient populations, enabling shared decision-making around diagnoses and treatment plans.  

While the prototype we built focused on cancer research, there is potential to use HIT to further the personalization of treatments for other diseases  – Parkinson’s, Multiple Sclerosis, and Alzheimer’s – and begin to see how we can use the power of technology to create closer connections and valuable feedback loops across providers, patients and researchers.  Ultimately we hope this will translate to people arriving at critical insights more quickly and partnering with each other to not only improve the care of the individual patient, but also to find cures for cancer and other devastating diseases.