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.