The NYT editorial yesterday chastising physicians and the U.S. health system for not adopting electronic medical records adds a new MSM voice to the debate regarding technology as the no-brainer foundation of health reform.    Naturally this is a frequent topic in the trade mags/blogs in my inbox.   The chief implication in the MSM editorial however is that "public financing" is the key factor that would accelerate EMR adoption in this country, as it seemingly has in other countries.    Not surprisingly, there is also an active number of bills in Congress looking to increase the government spend on health information technology -- with varying formulas and priorities.

There is no doubt that if the government provides a lot of financing for EMR adoption by physicians that there will be more computers in doctor's offices and hospitals.   The real question however is will the right technology investments be made that generate the most value - for the physician, for the citizen/patient and for health outcomes.    Unfortunately, the health IT landscape is littered with large, often government sponsored projects, that consume resources but fail to deliver the expected outcomes for a variety of reasons -- poor design, lack of adoption by users, too slow, automate the wrong things and so on.    Just spending more money on information technology -- without looking at all the factors driving behavior in our health ecosystem (payment reform in terms of what we pay for and who pays it and consumer expectations) is unlikely to achieve the expected outcomes.

Clearly, I believe information technology is a critical component of improving health outcomes...or I wouldn't be investing time and resources in building solutions.   Further, I believe that payers need to work with providers to finance investments in improving health outcomes -- of which information technology is a key factor.  At an early stage, some good work is going on with good early results, such as in Massachusetts.   Given that the Federal government is involved as a payer in a significant portion of health spend (nearly 40% by some accounts) - it needs to participate in the solution or other payers won't.

So what is my main point?  We (our government) has scarce resources...they should use them wisely and carefully.    I want to make sure that investments in information technology have a high return to users, payers, citizens and health outcomes.   There is lots of electronic data out there today -- medication histories, lab results, diagnostic images -- and just making these available to physicians and patients alike at the point of decision making -- may generate desired outcomes (lower cost and better care) at a much lower technology spend level.    Yes, paper charts are archaic and sub-optimal and will ultimately be replaced by digital systems.    We can achieve our shared goals of better "value" from our health system (better outcomes for the spend) -- faster and cheaper -- by unlocking the digital data that already exists (Esther Dyson made this call for data liquidity several years ago) and incentivizing physicians and consumers to use the data.    Let's not be satisfied with waiting for EMR adoption to happen.

Last week was the HealthVault Solutions conference held by my team.   The metrics were great -- lots of new applications launched and partners signed, attendance oversold, 600 people, 285 different organizations etc. -- but the story is not in the numbers.   What excited me was the energy in the room -- the passion of the people who work in health and want to be part of doing better for consumers.   Many participants came up to me at the end of the first day (after 2 hour demo session) and said they were really starting to get it -- the benefits of a personal health data platform -- with multiple applications sharing data as determined by the user.   Getting it is a good sign.   Dr. Mehmet Oz, who was the keynote speaker the next morning, took the energy level up a notch and raised the stakes.    Dr. Oz shared his sweeping vision of empowering consumers (YOU) to improve health -- but the key learning for me was -- to truly engage consumers you must connect with them emotionally.   Reason by itself -- don't smoke you will get cancer, don't eat too much you will get fat -- simply is not enough to change behavior.    Personalization, connectivity are key -- but we have to be able to connect at the emotional level with users - -this is a new set of challenges.    We also announced the winners of our innovation fund - the HealthVault Be Well Fund.    We were astonished by the diversity and quality of responses -- and excited to inform the winners, so we can get started on the 15 exciting projects.

Yesterday, Microsoft hosted the Center for Health Transformation (CHT) meeting on our campus.   CHT is led by Newt Gingrich -- he is a tireless champion for change and for raising our expectations for results from the health delivery system.    CHT does good work stimulating ideas, motivating policy makers to learn and be thoughtful when approaching health and creating connections between their members who are doing good work.    Newt was a judge on the HealthVault Be Well Fund panel.  Many U.S. ecosystem players participated and exchanged ideas -- sharing ways that IT plus leadership can improve overall results in the health delivery system -- like Gary Kaplan CEO at Virginia Mason, an integrated delivery system in Seattle that has utilized the "Toyota Lean" for system improvement.  Given the fragmented nature of the health ecosystem -- these stories of best practices and improved results -- need to be told and retold and retold -- to motivate additional champions how to change and give practical examples of how to make progress.

The last two days I have been participating in the 4th annual Pacific Health Summit.   The mission of the PHS is to bring leading scientists together with policy makers and industry to tackle hard problems in Global Health.   It is a fascinating conference because of the mix of people (scientists, ministers, NGOs, industrialists) -- all of whom bring a real passion to helping "improve" Global Health -- but start from very different perspectives and world views.   This years theme (selected a year ago) was around nutrition and the twin challenges of under nutrition (hunger, nutrient deficiencies and their impact on health status) and over nutrition (obesity, diabetes and the impact on health status and costs).    The timeliness of the topic -- given current events -- only raised the level of urgency and passion behind the conversation.     I won't even attempt to do justice to the theme in a brief blog -- given the complexity and interdependencies of the key threads -- I'm sure a final report will be published.    I can report a few surprising data points for the benefit of others:

• despite the lowest incidence of obesity -- Japan implemented a national policy in April to focus on prevention because of current costs and the need to change trend lines. This means that all people in Japan ages 40-74 are required to get an annual checkup.    One panelist -- Takemi-san a former vice-minister of health -- described how he had made a public promise to lose 10 kilos - -and this became a big and frequent media event (waist measurement and weigh in).   But he achieved the goal!
• China too has started a new program to prevent obesity -- as part of an overall approach to public health.   The program's essence is its simplicity -- healthy weight and healthy blood pressure.    They determined that if they could motivate everyone to eat 40kcals less/day -- they could dramatically change future trend lines.  So they ask people to eat 2 less bites off of their dinner plate.  
• India -- while being a food exporting nation -- has roughly 40% of children under 5 being under-weight.   This data point was used to demonstrate that "point solutions" or "simple programs" don't work -- that behavior change at either the national or individual level require comprehensive approaches (education, training, incentives, etc) that also take into account culture and traditions.

The role of nutrition in Global Health is clearly important -- and impacts costs and outcomes throughout the system -- from childhood development through to the management or prevention of chronic conditions.    One key takeaway for me is that it will require leadership (at multiple levels) and new forms of collaboration between the private sector and the public sector to sustainability address this issue.

We are hosting the second HealthVault Solutions conference June 9 &10 in Bellevue.   The amount of effort and activity on our part -- and on the part of our partners who will showcase their web applications at the event is truly remarkable.    As a startup guy most of my career -- this infectious enthusiasm and passion by all the folks involved -- generates the endorphins that make startups and innovation so much fun.

For those that know me -- my primary focus is always on the next problem, on identifying and working on the things we can and must do better and not looking back at the accomplishments or progress.    As I prepare for this event however -- what really strikes me is the progress we, along with our partners (and others) are making towards the vision of empowering consumers and physicians to use the Internet effectively as a tool to improve health.   

A year ago -- we had working code and a beta environment for our very early partners.    Nothing available to the public.  Lots of talk and ideas here and in the industry at large - but not much tangible.   Today we have over 30 web health applications that copy data to/from HealthVault and enable users to reuse their health information in new ways without the burden of re-entering it all the time.    We also have 50 personal health devices from weight scales to glucometers to peak flow meters and more that connect directly to HealthVault -- which makes it so much easier for people to use this information to understand how to stay well or to use it in communicating with their physician.    In addition to our efforts -- Google Health is also now available to consumers.

Because of how HUGE the health eco-system 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 can be hard to notice in the early phases.   First -- we can celebrate the many partners that saw the vision early and have already built connections with HealthVault and we love them.    But I can also see a big difference in the conversation we are having with stakeholders in the eco-system and it is evolving from the tire-kicking phase to the "how can I get involved to help my business or my customers" phase....which to me indicates momentum is building and building fast.

Every once in a while it is nice to look back and recognize that the vision we have around HealthVault -- of building a consumer-centered health platform -- which lots of stakeholders will use to help consumers and themselves -- is really working!   Now, back to working on the things we can do better.