MARCH 2009 FEATURE ARTICLES
SPECIAL INDUSTRY WATCH
Peter Neupert
Corporate Vice President, Health Solutions Group, Microsoft Corp.
Re-inventing Healthcare
Building a connected, scalable, patient-centric health IT system.
Software and the Internet will transform healthcare as they have so many other industries, opening new ways of working, new ways of communicating and new economics. The future will bring a dynamic, patient-centric health system that re-invents how physicians provide care and individuals manage their health — a totally connected and security-enhanced network enabling the seamless exchange and reuse of health data.
In this new world, we’ll see patients as consumers — experiencing more control, more convenience, better service and better value for what they spend. We’ll see physicians as knowledge workers — professionals getting the right data in the right format at the right time with computer-assisted decision support to provide the best treatment and preventive care. We’ll see new interactions among the members of the system — physicians, patients, pharmacies, researchers and insurance providers benefiting from a new flow of data to make better, faster decisions. We’ll see the extension of healthcare to the virtual space — patients getting care when they want it, wherever they need it, thanks to virtual doctor visits, medical homes and personalized medicine based upon genomic data. We’ll see a learning healthcare system — one that measures everything, identifies errors and makes improvements in order to deliver value, as indicated in the Institute of Medicine Roundtable on Evidence-Based Medicine 2008 report, "Learning Healthcare Systems Concepts." Everyone in the ecosystem will be more securely connected. Health data will be the asset that drives efficient, high-quality, value-based, evidence-focused medicine.
So, what is our blueprint to realize this vision? When America wanted to go to the moon, NASA didn’t focus on building a rocket. It set the goal of "landing on the moon" and used money, technology and innovation to achieve it. As we look across the healthcare industry today, we can see examples of successful organizations employing the same kind of approach — considering outcomes, applying the right technologies and innovating. We should expand on these successes and embrace their core ideals by doing the following:
We must drive the right health outcomes and payments to encourage innovation: We must build an industry focused on lifelong wellness. We should reward doctors who provide preventive care and allow them to innovate in delivering care in new, connected electronic ways. Under today’s fee-for-service system, with prices set by Medicare or insurance companies, most physicians can’t innovate in how they package services nor are they motivated to leverage low cost, convenient technologies such as e-mail. In contrast, cash-based micro systems like cosmetic surgery or veterinarian services have seen huge innovation in the bundling of services and the use of technology to deliver value. Feedback from the marketplace comes quickly, allowing them to continue to innovate.
We must connect and share data more securely within and between health organizations: Having access to a lifetime record of treatments, prescriptions and tests will allow individuals and providers to make better medical decisions, reduce wasteful spending and increase quality, according to the Booz Allen Hamilton report "Toward Health Information Liquidity: Realization of Better, More Efficient Care From the Free Flow of Health Information." Health data is and should be treated as a valuable asset. Our current system is built on the idea of a specific provider prescribing specific treatment for a specific condition. Patients’ health data is locked inside each provider’s silo, without being connected or shared. Physicians are forced to make decisions without all available data, or else waste time and resources attempting to aggregate data. MedStar Health’s Washington Hospital Center estimates that 60 percent of a clinician’s time is spent searching or waiting for information, with only 16 percent spent on direct patient care, as described in the Microsoft Health Solutions report "Helping People Live Longer, Healthier Lives."
We must empower consumers to be stewards of their own health data: Just as credit scores and histories represent a lifetime of active and passive financial decisions and transactions, so should health data. We must help consumers build their health data into a lifelong asset, manage it over time and share it with those who support their decision-making; and we should begin today with the data that already exists electronically. Consumers are ready: 78 percent of Americans favor providing doctors with the ability to share access to their medical records if consent is obtained, and 66 percent said that they see the value in including their own information anonymously in a large database to assist researchers, according to the report from the Council for Excellence in Government et al., "The American Public on Healthcare: The Missing Perspective." To enable this connected, patient-centric system, the public and private sectors need to take several key steps:
Encourage innovation in health IT by setting objective goals and criteria, not by mandating specific technologies or development models: Technology solutions are a means to an end. The focus should be on setting broad health outcome objectives — for example, increasing compliance with treatment in hypertensive and diabetic populations up to 90 percent by 2012 — and then applying technology to achieve those goals. Hundreds of innovative health IT products and services are available on the market today, and many companies are investing large sums to develop new technologies and solutions. Even as they compete, however, companies are collaborating to enable their products to work together and share information regardless of their underlying development, licensing or business models.
Reward innovative doctors who make the Internet the foundation of the patient to physician connection: Today’s patients demand access to up-to-date information about their conditions, appropriate treatments, pre-procedure instructions and post-visit follow-ups. The Internet is the most efficient way for doctors to provide this trusted information. However, the fixed-price nature of reimbursement means that innovative doctors have no incentive to deliver this kind of service. Physicians should be encouraged to embrace Internet technologies that allow them to communicate more effectively and consistently with patients.
Provide incentives for sharing data: It is critical to seamlessly and securely connect data and empower individuals to take control of their health. Those in the public sector should facilitate the transformation of health data into a vital asset by removing barriers to data sharing, and by providing incentives for data exchanges that reduce cost, increase value and improve quality. To facilitate this, a foundation of trust must also be established — health data is highly sensitive, so consumers and healthcare providers will only share it if they trust that the privacy of the data will be protected.
Focus on making data interoperable today, not waiting for standards, and insist that vendors separate data from applications: Today, data is too often used for a single application or purpose, then thrown away once that purpose is complete. We can use metadata — the details that describe the data and how it has been captured — to ensure that data is kept alive and made available for reuse, no matter what its original purpose. By insisting that vendors supply IT that allows data transfers to and from other non-vendor applications, we can get data moving between different systems today, without waiting for standards that might take years to complete. Better use of metadata will pave the way for integrating legacy data with standards-based data once these standards are more widely adopted.
Enable the private sector to develop an information infrastructure that connects data systems and people: To move from today’s fragmented system to tomorrow’s connected network, we need a technology infrastructure that allows data to flow freely throughout the system and be re-used. Without it, we’ll succeed only in re-creating our disconnected paper system in the virtual space. This infrastructure must: 1) be flexible, to enable many different players across the ecosystem to do what they need to do; 2) be interoperable, to leverage existing standards and infrastructure investments; 3) be scalable, to adapt to the rate of medical and technology advances; and, 4) be more secure and private, to foster consumer trust.
In this way, people across the public and private sectors will be able to come together and focus on the right outcomes and the right supporting technologies. Real change will come from this combination of leadership and technology.