Do you think doctors use iPhones?

AdvancedMD dipped our toes in the mobile device world clear back in 2002, when we released our Handheld Charge Slips application, which runs on Windows Mobile PDA devices. It’s actually a pretty slick little app, but it hasn’t seen much adoption—perhaps because not many doctors use Windows Mobile PDAs.

So, what are doctors using? Well, I can’t find any stats on the subject, but it’s probably safe to say that doctors are as likely to gravitate towards whatever is “coolest” as anyone else, so I’ve been looking at general smartphone market share.

Worldwide, Symbian continues to dominate the landscape…but, according to Gartner, Apple iPhone market share grew from 2.8% in Q2 2008 to 13.3% a year later!

During that same year, BlackBerry’s market share grew from 17.3% to 18.7%

Perhaps more significant is a report from AdMob that indicates that the iPhone accounts for 52% of all mobile web site traffic in North America. So…people who browse the mobile web via smartphones (and, perhaps, those most likely to utilize a smartphone to perform clinical tasks) use the iPhone more to do that than all other phones combined. Geesh.

Oh, and that new upstart OS, Android? It already accounts for 13% of all mobile web traffic. That’s over twice the traffic generated by Windows Mobile OS. And AT&T doesn’t even have an Android phone yet.

To be fair, Microsoft knows they’re way behind the curve in this area, and that Windows Mobile 6.5 is only a (weak) temporary stopgap measure until they can get WM 7.0 ready to release. But they have a lot of ground to make up.

It’s also interesting to note that Epic and Apple are working together to get doctors at Stanford Hospital and Clinics, in Palo Alto, California, to start using their iPhones to access patients’ charts. That’s going to take some arm twisting!

Check out this article in the Washington Post for more examples of how doctors are using smartphones (especially iPhones and BlackBerrys).

For the foreseeable future, it looks like the iPhone is the smartphone to watch, with BlackBerry and Android fighting for second place.

Happy Anniversary to Me: 10 Years as Microsoft Certified Partner

On October 1, 1999, I took (and passed) Exam 176: Designing and Implementing Desktop Applications with Microsoft® Visual Basic 6.0, thereby officially becoming an MCP (Microsoft Certified Partner).

Years earlier, I had made a conscious decision to ride Microsoft’s coattails, having developed a fondness for Visual Basic as a quick and dirty development tool. Fortunately, I never had to build a Windows application using MFC or ATL, since my career has focused on middle tier and database code, with a few opportunities to play with .NET (C#) WinForm apps and VB6 ActiveX controls.

This certainly wasn’t the only road to follow, and I wouldn’t even say it was definitively “the best” choice. Many developers have built successful careers around Java, the “LAMP stack”, etc. But it’s worked out well for me.

In a few months (January 25, to be exact), I’ll celebrate my 10th anniversary of passing the last of four exams required to achieve Microsoft Certified Solution Developer certification.

A lot of water has gone under the bridge in those 10 years, and a lot of code (good, bad, and ugly) has fallen out of my head. Not a bad way to spend ten years.

MS-HUG Exchange 2009: Clinical Informatics Track Session 7

Building Clinical Solutions Using Microsoft Office, Microsoft SharePoint and the Connected Health Platform
Andrew Kirby, Director, Healthcare Solutions, Microsoft

In this session, Andrew Kirby was able to really demonstrate in an easy-to-consume, visual way exactly how heavily Microsoft is investing in the healthcare market.

Andrew spent a fair amount of time defining and describing Microsoft’s work on the Microsoft Health Common User Interface (CUI). Per the MSCUI website:

The Microsoft Health Common User Interface (CUI) provides User Interface Design Guidance and Toolkit controls that address a wide range of patient safety concerns for healthcare organizations worldwide, enabling a new generation of safer, more usable and compelling health applications to be quickly and easily created.

This initiative is a few years old, and I’m very impressed with the progress that they’ve made. The last time I visited the website, the collection of controls was limited to some very basic components like date pickers. They’ve made huge progress in the past year or two, adding very robust, feature-rich controls like a Medications List View and Patient Banner.

It’s easy to “geek out” over the control toolkit, but I think most of the real value comes from the Design Guidance. It is always a few steps ahead of the control toolkit (because the design gets fleshed out and validated before controls are built), but, more importantly, it provides a deeper view into the rationale behind the design of the controls.

The Patient Journey Demonstrator is used to showcase the controls and design guidance principles and could really be used to design a full-featured EMR, at least the UI.

MS-HUG Exchange 2009: Day One Closing Keynote

Life on the Front Line – Perspectives on the Role of the CIO and the Evolution of IT
Tony Scott, Corporate Vice President and CIO, Microsoft

At Microsoft for about 10 months, 3 years at Disney.

Microsoft CIO Scorecard columns:

• Q2 Value
  • June Value
  • July Value
  • August Value
• Q3 Value
• Baseline
• Target
• Stretch (goal)
• Owner
• Level
• Definition

Four roles commonly served by CIOs:

• Embedded CIO
  Works with non-IT colleagues: Focused on strategy, business process execution and innovation, new product development and compliance.
• Enterprise Process CIO
  Manages enterprise business processes such as sourcing, facilities, operations, shared services (often non-IT tasks).
• Customer CIO
  Works with external customers/partners to sell and provide IT/products.
• Services CIO
  Provides IT services firm-wide to support internal staff.

Fix processes, then enable with IT.

MS-HUG Exchange 2009: IT Pro Track 3

Interoperability with Health Information Exchange
Jesús Hernández, Executive Director, Community Choice PHCO
Ravi Mallikarjuniah, Delivery Manager, iLink Systems

Community Choice PHCO is a healthcare network that operates in four rural counties (Okanogan, Chelan, Douglas, Grant) in central Washington. They have implemented an interoperability infrastructure that communicates with Microsoft HealthVault and the Washington Health Record Bank.

A Health Record Bank is a community repository of patient health records. The health record banking movement is being driven by the Health Record Banking Alliance, and appears to provide functionality that is similar to the commercial PHR initiatives (HealthVault, Google Health), and regional health information networks (e.g. UHIN in Utah, THIN in Texas), as well as the national health information network (NHIN—see NHINWatch, a Healthcare IT News site that tracks progress of the creation of a NHIN).

I’m not sure exactly how these various healthcare repositories are ultimately going to work together, or where there is duplication of effort.

More information:

• Wellsphere Blog
• Puget Sound Business Journal: “Washington state helps patients and clinics to ‘bank’ health records”

MS-HUG Exchange 2009: Day 1 Developer Track Session 1

Solving the Difficult Problems of Healthcare and Life Sciences with the Latest Generation of Microsoft Technologies 
Timothy J. Huckaby, CEO, InterKnowlogy

Timothy logged into The Scripps Research Institute production site to demonstrate the same WPF application he demoed at the Microsoft Connected Health Conference a few months ago. (The code is available on CodePlex.)

He also showed a video of the Surface version, which only took one developer a weekend to port.

Another WPF application, Angiographer, was created by InterKnowlogy for Intermountain Health Care.

Quote: “If last year was SharePoint hysteria, then this year is Silverlight hysteria.”

Silverlight 4 is coming in October, and will further blur the distinction between Silverlight and WPF.

MS-HUG Exchange 2009: Opening Keynote

Enabling the Possible Today
Chris Sullivan, US National Director, Providers, Microsoft

Chris showed this video, which I hadn’t seen in this form before:

Productivity Future Vision

Pretty cool. I sort of reminds me of the Popular Science magazines I used to love as a kid that featured visionaries’ ideas of what the future might look like (flying cars, planes that fly above the atmosphere, etc.)

Like any vision that looks far into the future, it should be taken with a grain of salt, but Microsoft does have some real evidence to support their vision. Some of that evidence is presented here.

Bing: A “Health Solution”?

Chris showed a slide that listed 4 “Microsoft Health Solutions”:

• Amalga (HIS)
• Amalga
• HealthVault
• bing

He didn’t explain how a search engine is a “health solution”, but it’s probably related to the consumer healthcare content that’s available when you search for, say, “influenza”:

On the right side of the screenshot above, you’ll find the bing search results, much like you’d expect from Google. On the left side is a list of links that will take you to articles, symptoms, etc., that have apparently been collected/acquired by Microsoft and hosted within the bing infrastructure.

Oh, and check this out:

Take that, Nintendo!

Microsoft Connected Health Conference: Keynote Day 2

The first keynote speaker on Friday was Mark D. Smith, M.D., M.B.A., President & Chief Executive Officer of The California HealthCare Foundation.

If you ever get an opportunity to hear Dr. Smith speak, take it! He gave probably the best keynote talk I’ve ever heard: Funny, educational, and mildly provocative.

It’s clear that Dr. Smith has extensive real world experience in healthcare, and he has an extremely engaging way of presenting his point of view.

It’s interesting to note that Dr. Smith is on the Google Health Advisory Council…not insignificant, since the Connected Health conference was largely a marketing vehicle for Microsoft’s HealthVault.

My favorite part of Dr. Smith’s talk was when he put the following Los Anglees Times excerpt on the screen:

This year or next, Congress will almost certainly enact a comprehensive medical insurance plan to provide coverage for almost everyone in the country…

[The president] has submitted his proposals for reorganization, Sen. Edward M. Kennedy and others have offered theirs. There is no argument about the need for reforms; everyone agrees our present system is unsatisfactory. Rather the debate will be the scope and methods of change.

The funny thing about that editorial is that “the president” is not Barack Obama—it was Richard Nixon, and the editorial was written in 1971.

Some key points I picked up:

• There are three primary things that we need to get right, as we work for healthcare reform:
  1. Reimbursement policy
  2. Comparative effectiveness
  3. Recognizing the need to promote new things in healthcare
• New things:
  • OpenTable: Essentially allows small restaurants to provide online services that rival those of chains. Someone needs to do the same for independent physicians – so that they can provide services similar to those offered by Kaiser Permanente and the Mayo Clinic.
  • WebMD
  • Neighborhood clinics that provide convenient urgent care service, so that patients don’t have to visit the ER
• If we let librarians control the rate of uptick in search engines, or we let travel agents drive the uptick in travel sites, or we let bank tellers drive the uptick in banking sites, we’d be in the same place we are with consumer-enabled healthcare today.
• There are some things that we needed doctors for 30 years ago, but we don’t really need them for any more. Dr. Smith was involved in a pilot of an automated, kiosk-hosted system that diagnoses urinary tract infection. It worked very well, and patients’ satisfaction with the automated system was far greater than their satisfaction with live doctors. In fact, when asked about their “satisfaction in time with the doctor”, only 17% of those who saw a live doctor expressed high satisfaction, vs. 60% of those who used the kiosk…even though they had no time with the doctor at all!
• How do standards develop? Windows – Wi-Fi – Walmart
  • Windows: A company or individual “wins” market share and unilaterally established a standard
  • Wi-Fi: A group of smart people get together every year in Las Vegas, and come up with the “a” standard, then the “b” standard, then the “g” standard, then the “n” standard…
  • Walmart: A buyer in the marketplace decides they need something, but no one is doing it, so they demand it from their suppliers. Walmart says, “We want RFID, so if you want us to sell your toilet paper, put our RFID on it.” Toilet paper manufacturer says, “OK”.
    Medicare (the government) is the WalMart of healthcare…but they are trying to be Windows.

Dr. Smith praised Phreesia, a popular high-tech replacement for the clipboard. Over a million check-ins have been processed in 49 states, and not a single doctor has ever met an employee of Phreesia.

The philosophy of Phreesia and other upstart HIT companies: “We’re going to assume that we’re not going to be able to change doctors’ behavior. Instead, we’re going to insinuate ourselves into their workflow and help them do things that they need to do anyway.” No army of IT geeks required.

What is important to encourage HIT adoption?

• For providers: Simplicity, adaptability (us to them, rather than the other way around), functionality
• For patients (aka “consumers”, humans):
  • Value (“what does it help me do?)
    Most of us are healthy. HIT promoters don’t recognize that what is of value to most (reasonably healthy people) is not the archival and retrieval of claims data. We need to solve problems that regular people, who see their doctors once a year, need solved.
  • Security
    Security is always measured relative to the value. We’ll give up some privacy if enough value is there.
  • Beauty (“elegance'”)
    Things that have elegance (like the iPod) have uptake among consumers. How do we provide things that consumers want, instead of what we want?

And, finally, addressing the adoption of EMRs among physicians, even in light of the HIT stimulus money:

“How do you deal with a market where free is not cheap enough?”

Microsoft Connected Health Conference: Keynote and Panel

Gary Baluta, our Director of Product Management, and I are attending the Microsoft Connected Health Conference today and tomorrow. I’m a little surprised by the level of attendance. I was expecting a couple hundred IT geeks to show up, but clearly I didn’t anticipate the level of interest across all levels of healthcare in what Microsoft is doing with HealthVault and Amalga.

Perhaps the most interesting thing I’ve heard so far is the announcement from the president-elect of the AMA…but more on that later…

Peter Neupert, Corporate VP of the Health Solutions Group at Microsoft, opened the conference with a brief keynote, then kicked off a panel comprised of Uwe Reinhardt, an economics professor at Princeton; Governor Michael Leavitt; and Dr. David Kibbe, a prominent physician in the EHR space, and Senior Advisor to the AAFP.

Quotable Quotes

Dr. Reinhardt:	Healthcare in the United States is “like being pushed into Macy’s, blindfolded, and being asked to buy a shirt.”
	“If you teach a parrot to say ‘supply and demand’, you have an economist…”
Gov. Leavitt:	“There is no ‘healthcare system’ in America…it’s a ‘healthcare sector’ that we’re trying to transform into a ‘system’.”
	“What if buying a car was like buying healthcare? After you bought a car, you would receive one bill from the tire manufacturer, another from the company that made the steering wheel, etc.”
	“The problem [preventing healthcare reform] isn’t a lack of political will. There is an overabundance of political will. Whenever reform is suggested, people unholster their political wills and aim them at each other.”
	“One man’s waste is another man’s living.”
Dr. Kibbe:	“What happens [to healthcare in the United States] if we don’t reinvigorate primary care? In the United States, 30% of physicians are primary care providers, and the other 70% are specialists. In other industrialized countries, the numbers are reversed.”

The panel discussion was very interesting and, to be honest, the fact that we have people as smart as the panel members contributing to the healthcare reform discussion is very encouraging. Now if we could just get about 535 people on Capitol Hill to butt out…

Following the panel (and a brief Q&A session), Dr. James Rohack, President-Elect of the AMA, was introduced, and he reacted to the panel. Then he announced a partnership between Microsoft and the AMA to provide data stored in HealthVault to physicians via a portal that will be released by the AMA in early 2010.

I think this is a pretty big deal. For decades, small players (EMR/EHR and portal companies, for example) have been attempting to transform healthcare at the grassroots level, and have had very little success (as measured by penetration into the physician market).

I have to believe that a partnership between two huge players like Microsoft and the AMA will be much more effective at getting technology into physician offices. Think about it: Once the AMA tells physicians to start using their portal to acquire healthcare information about their patients, how many doctors are not going to do it? Especially if the portal is provided for free, or for a reasonable fee (no mention of cost was made).

This has to be seen as a major coup for Microsoft, in its competition against Google Health. Google Health has been harshly criticized for basing its medical records, in part at least, on billing records (the ICD-9 codes reported with procedures). That highly publicized criticism, along with AMA’s endorsement of HealthVault, could be huge.

There is perhaps no bigger opportunity in the world than to transform healthcare.

Information technology will play a central role…and software will be the catalyst for innovation.

Health is one of Microsoft’s top investment areas.

- Steve Balmer
CEO, Microsoft

Engaging with Microsoft: Conferences, Forums and Summits

Let me say first of all that Microsoft feeds you better than anyone I know. My favorite part of the annual MS-HUG Tech Forum in Redmond are the meals.

Kind of funny: A co-worker and I were driving around in the Microsoft campus a few years ago and he chuckled when he saw one of these vans:

You know, Microsoft Analysis Services, Microsoft Reporting Services, Microsoft SharePoint Services, and now Microsoft Dining Services…

Anyway, in addition to great food, Microsoft serves up some great content (no pun intended) at their events.

Some of the best used to be their “Ready to Launch” events, where they would go across the country (and around the world) booking big movie theaters and filling them with developers and IT geeks, and giving away software.

Sadly, these events are a thing of the past—perhaps (as suggested by some Microsoft employees I spoke to recently) a victim of economic turmoil.

Also cancelled (or, more accurately, changed from an annual to a bi-annual event) is the 2009 Business Intelligence Conference. I went to last year’s conference and it was really excellent.

Apparently, they announced most of the really cool stuff coming out in SQL Server 2008 R2 next year, so there wasn’t a real need for a conference this year. Much of the content they would have had will be incorporated into the SharePoint Conference and PASS Summit Unite.

My other favorite events:

• MS-HUG Exchange (formerly MS-HUG Tech Forum)
  This is a free event hosted by the Microsoft Health User Group, which merged a couple of years ago with HIMSS. It’s only a couple of days long, but is very focused on how Microsoft technology is being used in healthcare. It usually features “marketecture” from Bill Crounse, MD, Microsoft’s worldwide health senior director, as well as case studies from various healthcare institutions.
• PDC
  Last year’s PDC was phenomenal. They had some pretty incredible technologies to introduce (Azure, Office 14 for Web, Surface, etc.), and the training sessions were very well done. I hadn’t attended a PDC for about 10 years, and I was impressed at how it has evolved.

Engaging with Microsoft: Case Studies

One of the tools that Microsoft uses to get its story out is case studies. As a “Microsoft Shop”, AdvancedMD has been featured in two case studies, both of which were driven and sponsored by Microsoft.

The first was a collaborative effort between a writer contracted by Microsoft and a couple of us (Ken Meyers, former VP of Operations, and myself), and it gives a broad view of our interactions with Microsoft, and how we leverage Microsoft technologies:

• Hosted Solution Offers a Better Option for Medical Practice Management

The second is a case study of Women’s Healthcare Associates, an AdvancedMD customer in Houston, Texas:

• Beyond the Exam Room

The final sentence in the introductory paragraph pretty much says it all: “Just ask Lourdes Rubio, who, as Practice Manager for Women’s Healthcare Associates in Houston, Texas, lost more than U.S.$150,000 in insurance claims due to bad software.”

So, why bother with case studies? They end up on Microsoft’s website, where they can be searched, but it’s doubtful that many prospective AdvancedMD customers would do that.

A couple of weeks ago I went to the local Microsoft Sales office (near the Salt Lake City Airport) to meet with a couple of ISV evangelists, and was surprised to see this one-page summary of our case study on the wall of the lobby (along with a dozen or so others):

To be honest, I’m not sure that we’ve really taken advantage of the case studies that Microsoft has done about us. We should probably have a few boxes of copies that we could deliver to prospects…but, since we do most of our business over the phone and Web demos, printed documents don’t fit into the equation very well.

So, here’s the really sad thing about this blog post: I can’t tell you how to get Microsoft’s attention to get a case study written, because I wasn’t involved except for a brief interview.

Speaking of which…I had to laugh the first time I saw my quotes in the case study. The writer did a GREAT job of making me sound eloquent. I did actually say everything in the case study that was attributed to me, but I’m pretty sure the words weren’t mine. Probably for the best.

In any case, I seem to recall that our PR company contacted Microsoft and set the wheels in motion. If we are successful in becoming a managed account, I would imagine that this kind of thing will become just part of relationship.

From Coding Horror: "The Web Browser Address Bar is the New Command Line"

Jeff Atwood's Coding Horror blog is always a great read, but I particularly enjoyed this post, which contains the best catalog of cool Google tricks I've ever seen.

To wit:

weather San Francisco
CSCO
time London
san francisco 49ers
5*9+(sqrt 10)^3=
Henry+Wadsworth+Longfellow
earthquake
10.5 cm in inches
population FL
Italian food 02138
movies 94705
homes Los Angeles
150 GBP in USD
Seattle map
Patent 5123123
650
american airlines 18
036000250015
JH4NA1157MT001832

Wordled: 7 Months Later

I just Wordled this blog again, to see how well it would reflect shifting topical focus over time.

Here’s the new Wordle:

Compare that to the last time I Wordled the blog, back in August last year. It’s clear pretty quickly that my focus has moved from Agile, BI, and SQL Server to “Engaging with Microsoft”.

Engaging with Microsoft: Become an MCP

It’s been almost 10 years since I became a Microsoft Certified Professional. At that time, four tests were required, including two that related to building Enterprise-grade software, and two for specific development technologies (I chose VB6 and SQL 7). It took a fair amount of effort, but for the most part the exams covered concepts that an experienced developer would know without studying anything (although I did have to study for the SQL exam).

So, what have I gotten out of it? Nothing really material, but I do believe that it can help a job candidate stand out.

As an employer, I would never hire anyone just because they had MCSD, MCSE, MCAD, or MCDBA behind their name…any more than I would hire anyone just because they happened to have a degree from a prestigious school.

But the hiring process is essentially a process of gathering a dozen or more different pieces of information (aptitude test results, references, employment history, education, certification, personality fit, etc.), and certification certainly is a strong indicator of commitment to a career path, and dedication to a goal.

I would highly recommend to anyone who is committed to a career in IT (as a system admin, DBA, developer, or any similar career path) that they get some sort of certification. If you’re established in Microsoft technology, then the MCP program makes a lot of sense. Otherwise, there are other well-respected certifications out there (like A+, Security+, and CCNA) that could provide a similar “feather in your cap”.

For more information:

• Microsoft Certified Professional program website
• “10 Best IT Certifications”

Windows Server 2008 R2: 64-bit Only

Microsoft has announced that Windows Server 2008 R2, the server companion operating system to Windows 7, will run only on 64-bit processors. According to the web page describing improvements to Scalability and Reliability, "With customers being unable to purchase a 32-bit server CPU for over two years, the performance and reliability advantages to moving to this architecture were too beneficial to ignore."

That's pretty cool. We've known for a long time that the most recent version of Exchange, Exchange 2007, would run only on 64-bit servers, and Microsoft announced at PDC 2008 (and on this blog) that SQL Server 2008 R2 (due to be released in the first half of 2010) will be 64-bit only.

Looks like the 32-bit server is dead.

So...will the Standard Edition of SQL Server still be limited to 4GB of RAM? That would be pretty lame, but it's probably true.

Windows 7: To Be Released in Q4

InformationWeek is reporting that Microsoft has announced that Windows 7 will be released some time in the 4th quarter. And, according to some insiders I spoke with recently, it will, in fact, be called "Windows 7".

So...to recap, Windows was numbered for versions 1.0-4.0, then was named by the year of (planned) release with 98 and 2000, went to 2-letter names for ME, CE and XP, expanded to a full word for Vista and Mobile...and now has come full circle to "7"...without the ".0". I can't imagine the marketing brainpower that must have gone into that cycle.

Anyway, here are some other key points from the InformationWeek article:

• "It's unclear whether Microsoft will release the operating system just in time for the holiday season, or earlier in the quarter, perhaps during October."
• "According to a recent report, an executive with computer manufacturer Acer has said the company plans to begin selling laptops running Windows 7 by Oct. 23."
• "Early test versions of Windows 7 have been getting generally positive reviews, and a number of organizations testing Windows 7 have told InformationWeek that the operating system also does not suffer the application and hardware compatibility problems that Windows Vista did at this point."
• Microsoft has said that "the Windows 7 Release Candidate code was closer to what would be shipped than any previous version's Release Candidate."
• Windows Server 2008 R2 will be available at the same time as Windows 7, and the RC is available now.

Engaging with Microsoft: Certified Partner Program

As I mentioned in a previous post, AdvancedMD has been a Microsoft Certified Partner since 2003 and a Gold Certified Partner since 2006. Both programs are available to any company that works with Microsoft, and both are fairly inexpensive (in the $1,500 range, including sales tax).

All you really have to do to be a Certified Partner is write a check, but the benefits are significant. A small company with 25 employees could get a five-fold ROI on Small Business Server and Office alone.

Becoming a Gold Certified Partner takes more work, in the form of “points” that you accrue through “competencies”, customer references, certified products, etc. It isn’t as difficult as it may seem. First of all, Microsoft really wants you to be a Gold Certified Partner, so they’ll cheat for you from time to time in the form of “promotions” that give you competencies for free, or that relax the requirements. There’s still plenty of work to do, but it isn’t out of reach for most companies that really use Microsoft’s products and services.

Here’s an example of a competency that we’ve held for the past few years:

The three little guys with checkmarks behind them represent three AdvancedMD employees that are Microsoft Certified Partners with a qualifying certification (MCSD, MCSE, etc.). (Getting a few of your developers and IT staff certified is almost a must for Gold certification.) The CD represents a “Tested Product”. In our case, AdvancedMD was tested to work well with SQL Server.

For us, getting our application tested against SQL Server every two years (as required to maintain the ISV competency) is the greatest cost to remain Gold certified—probably a week, on average, of a couple of developers’ time.

The benefits in software licenses, though, far outweigh the costs: We get 135 licenses for each of nearly every software package you would need in a business office (including Windows, Office, MapPoint, Project, etc.), and 35 licenses for Visual Studio for Developers (including a license for Team Foundation Server for each location). I haven’t taken the time to get a precise inventory of the software that we use, but I would guess we’re over $250K, with potential for another $100K or more if our staff knew what was available to them. Not bad for $1,500 a year!

We get a lot of other benefits besides software licenses. You can find those on the Partner website, linked below.

Two sites that every Microsoft shop should know very well:

Partner Program Website

This site demonstrates just how serious Microsoft is about working with its partners. I would imagine that they spend more on this site than AdvancedMD’s annual gross revenue.

Of particular interest is the Partner Program Value and Benefits page. It includes the oddly elusive Software Licensing for Certified and Gold Certified Partners page…for some reason it always takes me a long time to find this page when I need it. It lists all of the free (for training, demo, and internal use) software you get as a partner.

MSDN

Aside from comprehensive developer-oriented documentation, this is where you can download all of the software that you are entitled to as a Certified Partner.

The screenshot to the right will give you an idea of the huge variety of downloads available, just under Operating Systems. My nostalgic side desperately wants to download MS-DOS 6.22 and Windows for Workgroups 3.11. (But where is Windows ME? Hmm…)

Windows Live Writer

For anyone who blogs (or tries to), if you haven’t already looked at Windows Live Writer, you should.

I’ve always been annoyed by Blogger’s online posting mechanism. It always seems to be inserting vertical white space where I don’t want it, and it provide an intuitive way to insert images and tables.

Windows Live Writer is pretty cool…and the only way I post these days. And it’s free…

Engaging with Microsoft

AdvancedMD has been a "Microsoft shop" since our inception back in 1999. Over the years, we've had plenty of opportunities to interact with "the Borg" (or M$, or whatever the kids are calling it these days), and our relationship has taken on several different forms.

At one point, we were one of 50 healthcare vertical ISVs being managed by a guy out of Redmond who helped us secure co-marketing dollars, subsidized training, Toshiba tablets, and other spiffs I can't think of right now. By late 2003, though, we were dropped as a managed account because we weren't a Gold Certified Partner yet...and then the program was morphed into something different altogether, so, by the time we were Gold certified in 2006, there was no program to get back into.

Today, I'm talking with some ISV evangelists at Microsoft to try to get some more focused attention again (and whatever else they'll give us). Since I'm in the middle of that process, I thought it would be interesting to chronicle our past and present experiences with Microsoft, and perhaps provide some useful tips for engaging effectively with such a huge organization.

Over the next few weeks I’ll try to cover topics like these:

• Certified Partner Program
• Conferences, summits, MS-HUG Tech Forums…
• Online resources

ICD-10 coming...CMS helping to prepare

There has been a lot of talk over the past few months about the CMS-mandated migration from ICD-9 to ICD-10, along with the separate but related adoption of ANSI 5010 for electronic claims.

Much of that talk has been around trying to get the compliance date of October 1, 2013 moved back a couple of years, but it's looking more and more like that won't happen.

CMS has made some good information available on their website, including (brace yourself) a crosswalk table that translates back and forth between ICD-9-CM and ICD-10-CM and -PCS. It's called the General Equivalence Mappings (or GEMs), and this guide answers 10 questions about what the GEMs are, how they came about, and how to use them.

This isn't for the faint of heart, but I'm sure our Engineering team is going to have a great time building tools into AdvancedMD to help our customers navigate the switch. We'll need to put those tools in place well in advance of the October 2013 deadline and provide training to our users.

CMS will be hosting a telephone conference on May 19th to discuss the implementation of ICD-10 and explain how the GEMs work.

SaaS in Tough Economic Times

If you google "saas recession" (as I just did), you'll find dozens of articles published throughout 2008 and into 2009 that suggest that SaaS companies will thrive in a difficult economy.

"SaaS is also popular on Wall Street these days. Companies such as Concur and Salesforce.com haven't missed earnings estimates, mainly because they have predictable revenue streams." - "A Recession-Proof Corner Of The Tech Sector", Sramana Mitra, Forbes.com Commentary, January 18, 2008.

"As IT is tasked to do more with less, that's an opportunity for SaaS to get a foot in the door." - "Is The Recession Good For Saas?", Andrew Conry-Murray, Information Week blog, May 2, 2008.

"In bad economic times many companies will want to preserve cash. Those companies will heavily prefer the SaaS model." - "Is SaaS Recession-Proof?", Paul Massey, GLG Group's The Expert Network, January 15, 2009.

"So, are managed services and SaaS the perfect antidote to a sick economy? I think not. But if I had a few extra bucks for tech investments, the most compelling bets remain SaaS, managed services and open source." - "Recession Proof Software? Try SaaS, Managed Services and Open Source", Joe Panetierri, Seeking Alpha, January 15, 2009.

We've seen some very encouraging signs at AdvancedMD, including a very strong sales month in January. (Of course, it's difficult to know whether strong sales are tied more to our business model and the economy or stronger sales efforts...but I believe both are in play.)

A worrisome aspect of the SaaS model is that, because it relies on continuing recurring revenue, it depends on the success of customers. In other words, absent new sales, if 10% of your customers go out of business, you've just lost 10% of your revenue. (On the other hand, a 10% dip in revenue is far preferable to the kinds of dips experienced by on-premise software companies.)

What that means to AdvancedMD is that we need to have even greater interest in our customers' financial success. Since we're so deeply embedded in their cash flow, we are in a unique position to help our customers reduce costs and maximize reimbursement.

Past efforts in this area have produced features such as online eligibility and claim scrubbing (known to our customers as eEligibility and Claim Inspector, respectively), as well as extensive auditing of claims volume and exclusion data to identify opportunies to reduce rejections and minimize A/R aging.

Our most recent release introduces significant improvements to takebacks, one of the most time-consuming aspects of medical billing. This should result in much greater efficiency for many of our customers, allowing staff to focus on revenue generating activies such as collections and denial follow-up.

Throughout our history, we have focused heavily on "getting the doctor paid", perhaps at the expense of flashier features. We have done so without any foreknowledge of the current economic troubles, but our customers are benefiting from that focus, as well as the ability that our SaaS technology model allows us to respond to shifting economic conditions.