The leadership for the new Microsoft/GE joint venture is getting firmly in place and as noted in my last post, I have now transitioned to be a consultant/contractor.
I remain focused on the intersection of information technology and health to improve health around the world; if you want to follow my ramblings going forward – you can find me here:
Yesterday we announced an exciting new chapter in the Microsoft in Health story. Microsoft and GE Healthcare (GEHC) are forming a joint venture – with equal investment from each ‘parent’ – that will offer advanced IT solutions to healthcare organizations.
Microsoft’s vision for health has always been ambitious – ‘Improve health around the world, through software innovation.’ This joint venture represents a doubling down on our commitment to healthcare.
The complementary strengths of Microsoft – platform and ecosystem development – and GE Healthcare – clinical applications and workflow expertise, global sales force and domain knowledge in healthcare – will help us get there faster. Of course, Microsoft will also continue to offer our core technologies to healthcare organizations, working with partners to deliver innovative solutions for health and health management. And we’ll keep investing in HealthVault to support patient engagement and personal health management.
The new company we’re planning to create will combine real-time data analysis with knowledge management tools to build a platform and set of applications that will improve patient care and reduce costs. The healthcare industry is the largest sector of almost every economy. It touches every citizen – and it consistently under-invests in IT.
But healthcare information is getting more and more digital. For better patient care to happen, data needs to move with the patient. Unfortunately, almost all systems are built around an institution rather than a patient, so it's hard to separate the data from the application and make it available within and across organizations.
The new company’s collection of assets, Microsoft Amalga, GEHC Qualibria and the future apps we want to build on those platforms, will give people access to digital data and make it reusable. It's a hard problem that nobody has really solved. So we’re going to work together to build a robust, data-driven platform that enables us and third parties to create the next generation of clinical applications. GEHC is bringing a level of knowledge and capability around building apps – and determining which apps are the right ones to get started with – so that we can make the platform more compelling in the early stages.
Other HSG leaders and I had the opportunity to talk with many of our customers about the announcement. It was great to hear their enthusiasm for the deal -- after we assured them that we’re committed to delivering on our product roadmaps. They totally get the need for differentiated apps to help showcase the value of the platform and understand that healthcare needs to move toward population health management.
So, pending regulatory approval, the new company will launch in 2012 and will be headquartered near the Microsoft campus in Redmond, Wash., with a big presence in Salt Lake City. Our goal is to get the venture off to a fast start with a great set of products, employees, customers and partners.
As the leadership team for this new venture takes its place, I'll move to a role where I advise and make recommendations based on my learnings and experience. I'm committed to making this new company a success, and I’m committed to making the transition as smooth as possible for all involved.
My wife and I recently became “empty nesters” so this is a great moment and a wonderful confluence of events that will let me take a step back – and think about what my next chapter will be.
In past blogs, I have frequently discussed the need for the consumer to be a more active participant in the health ecosystem. I passionately believe the citizen/consumer has to be accountable for their many personal health decisions – such as lifestyle, smoking, nutrition, activity levels and the like. It is simply not right or fair that the additional health costs of others’ lifestyle choices be a financial burden on all of us. The most recent government forecast for Medicare expenditures says on page 44:
"Total Medicare expenditures were $523 billion in 2010 and are expected to increase in most future years at a somewhat faster pace than either workers’ earnings or the economy overall. Based on the intermediate set of assumptions and current law, expenditures as a percentage of GDP are projected to increase from the current 3.6 percent to 6.2 percent by 2085."
And then the report goes on to say Part B expenditures are substantially understated in the forecast!
Let me be clear – I am NOT saying that all health costs or even that the rise in health costs are all the result of consumer lifestyle choices – they are not. But they do play a part – and if we are ever going to solve our financial crisis in the US – we need to get more value (better health outcomes at the same or lower cost) out of our huge and growing health expenditures. This will require reform across many fronts – payment reform, physician culture and importantly, consumer engagement and accountability.
So with the above context in mind, I read with interest this Forbes article by Leslie Michelson, What Steve Jobs’ Death Can Teach Us about our Own Health Care. I encourage you to read it. Michelson’s basic premise is that the approach Jobs took to making a critical health decision was flawed, and because he took nine months to try alternative options prior to surgery, surgery ended up not being enough. More importantly, Michelson’s point is that making medical treatment decisions is ‘different’ than everyday business or life decisions and that you need a framework (and support) for making them. They are different for two key reasons – one, the overwhelming emotional stress associated with them (in the case of life-threatening issues) and two, the specialized knowledge and collaboration required.
Despite the fact that I believe many other business or life decisions are high stress – I completely agree with him. Making decisions about health is different and requires a different decision framework. Personally, I have been dealing with health decisions related to a parent-in-law. The decisions (where to go, who to see, what to do next) are just hard, and the health delivery system is neither helpful – nor designed to be – in guiding patients through the decision-making process.
Michelson’s first step in the framework is to get an ‘accurate and complete diagnosis.’ Sounds right to me – but in my experience, even after many doctors, specialists, innumerable diagnostic tests and biopsies, plus a few hospital stays – we still don’t have even that. We have met many caring and thoughtful people along the journey, but we haven’t really had much help in how to think about and approach the key decisions – and nothing about how to deal with inability to diagnose.
I believe one of the big areas for innovation in health is in consumer decision making and behavioral insight. Dartmouth has long been a proponent of ‘shared decision making’ and has set up a Center for it. There clearly is a lot to learn just in the basics. However, I think the knowledge and possibilities for innovation are going to explode as the infrastructure is put in place now for an explosion of data and more closed loop feedback systems. With EMR data flowing into patient-centric data platforms like HealthVault – which are increasingly being connected to mobile devices or home health devices with masses of data points around activity, diet, pill taking, lifestyle preferences – we will be able to use ‘big data’ tools and machine learning to identify what works for which groups. It will be very exciting. As Glenn Reynolds over at Instapundit frequently says about innovations – faster, please.
Today, I had the honor of participating in a Consumer Health IT Summit at the Department of Health and Human Services in Washington, DC. It was great to see health IT stakeholders coming together to help drive the industry toward a more patient-centric health system, and I applaud the leadership at HHS and ONC – particularly folks like Aneesh Chopra, Todd Park and Farzad Mostashari – for drawing attention to the need for patient engagement and ‘data liberation.’ And, as always, the showmanship of Farzad, Todd and Aneesh made for an entertaining event!
At the event, HHS announced that they are releasing a PHR Model Privacy Notice for PHR vendors – or personal health platforms like HealthVault – to use to communicate to consumers their data sharing and security policies. We intend to post our PHR Notice on HealthVault.com as soon as the HHS web tool goes live later this week. We have been very focused on transparency and making it easy to understand how we approach privacy and security since we started working on HealthVault – because we know that transparency is required to enable trust. This notice offers another way to communicate our privacy and security practices, so we will use it and encourage our partners who build HealthVault apps to use it also.
I was excited to participate in today’s event, however – as readers of this blog know – I have been talking about data liberation and patient-centric healthcare for a long time. The free flow of health data is the necessary foundation for a healthcare system based on value – high-quality, cost-effective, personalized medicine. But enabling access to data is a necessary – but insufficient – condition for getting patients engaged. Data liquidity is important because it brings patients and their healthcare providers the information they need to improve health and healthcare, but patients must be inspired to use the data – not just store it on their PCs.
That’s why, although I was glad to be part of today’s event, I want to challenge ONC and the private sector to do more. Engaging patients is critical to driving value – better outcomes at lower costs – in our healthcare system. We need to move from expecting clinicians to do everything to a world where patients are empowered – and expected – to share decision-making and to be responsible for managing their health.
Two examples of connected data enabling better outcomes and higher satisfaction are studies we conducted using HealthVault – one with the Cleveland Clinic and one with Kaiser Permanente Colorado and the American Heart Association. The studies were designed to see if the use of at-home medical devices (such as blood pressure cuffs, scales, glucometers, etc.) help patients and their physicians work together more efficiently to manage chronic conditions. The results suggest that at-home medical devices – connected to cloud-based services for storage and sharing – can help patients and doctors work together to better track chronic conditions, coordinate treatment schedules, manage medication regimens and schedule timely interventions. Ultimately, these improvements could help create a more efficient healthcare system and healthier, more satisfied patients.
In order to move consumers to participate in managing their health, we need to motivate them with a call to action that is relevant, meaningful and actionable. My recommendation is that the CDC and HHS work with the private sector to create a campaign like “Know Your Numbers” (building on Dr. Oz’s work) or “Know your Meds” to begin educating consumers on the importance of understanding and managing their health.
Imagine if the government organized a group of great consumer companies – Nike, Apple, Starbucks, Microsoft – and got us to work together to create a campaign with a clear call to action around managing your health. If we could do this in a sustained way over a period of time, I’d bet there’d be some impact.
The idea behind today’s Consumer Health IT Summit was a good one – but let’s not stop here. The real value – for consumers and for the health system – will come when we create compelling ways for consumers to engage in managing their own health.
The results of a recent peer-reviewed study conducted by Humana Inc. and Wisconsin Health Information Exchange (WHIE), a long-time Amalga customer, are both exciting and important.
They’re exciting because the results begin to prove what many people involved with health information exchanges have long theorized – that providing a more complete view of a patient’s medical history at the point of care helps doctors make more informed decisions that can improve the quality of care while reducing waste. Humana and WHIE achieved an average cost savings of $29 per emergency department (ED) visit when doctors queried the WHIE for information about the patient’s medical history upon registration. Redundant testing represents a huge strain on the healthcare system, and as the study demonstrates, can be reduced when ED clinicians have the right information at their fingertips. This degree of savings, if extrapolated across all of the emergency encounters in the country (120 million per year), could potentially yield $3.5 billion in savings annually. You can learn more about how these savings were achieved by reading a blog from Ed Barthell, MD, director, Microsoft Health Solutions Group.
The study results are important because they demonstrate the power of the public and private sector working together to drive greater efficiency and value in the healthcare system – by enabling an open, secure exchange of data. From the beginning, WHIE leaders recognized that the exchange needed to focus on the ends – rather than the means – of health information exchange: improved care of individual patients and data to support initiatives to provide better care across populations. WHIE implemented Amalga to support a regional data aggregation strategy as a core component of the solution – in contrast to many other HIEs that concentrate only on point-to-point messaging.
In addition, aligning innovation across health IT and business, WHIE and Humana were able to establish a symbiotic relationship that can serve as a model for state and community HIEs across the country – a model that benefits the payer, the provider, the patient, and the public. Specifically, WHIE and Humana have shown:
And, although it wasn’t covered in this study, the WHIE also demonstrates how a community-based HIE can help protect populations by allowing the near real-time analysis of cohorts and the ability to identify trends and epidemics as they emerge.
Perhaps most important, the Humana and WHIE study presents a model of sustainability for HIEs. If payers can realize a greater than 2:1 return incenting hospitals to use health information exchange, as Humana has, there’s reason to believe similar payer-provider partnerships can create sustainable HIEs across the country. And, imagine how much progress we could make on ‘bending the cost curve’ if we liberated the data across the entire system?