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:

https://neupertonhealth.wordpress.com  

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.

"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.

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.

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:

• Health plans can reduce their costs by partnering with emergency departments to use health information exchange to access patient information at the point of care.  
• Providers can reduce the cost of caring for uninsured patients – and might also share some of the savings. In addition, providers can benefit from unlocking data, aggregating it, sharing it and learning from it – to provide care based on more complete information.
• Patients and their families can gain peace of mind knowing caregivers are coordinating care and making informed decisions – and not worry about piecing together their medical history in an emergency situation.

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?

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.

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.

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.

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.

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.