Entries tagged with physicians - Channel 10

Doctor Google and Doctor Microsoft; if not them, who?

bcrounse — Tue, 14 Aug 2007 22:56:00 GMT

The Internet is abuzz today following a New York Times article by Steve Lohr about Microsoft's and Google's designs to change the game in healthcare. Readers who follow this Blog will understand very well where I come down on all of this. As a country, maintaining the status quo in our broken healthcare system (which really isn't a system at all) just isn't a viable option. We spend about twice as much money per capita on health than any other nation on earth, yet the US ranks far behind other countries in many of the ways we measure the overall health status of a population.

Do I think that some kind of universal, government-run healthcare fix is the answer to all of our problems? Absolutely not! One of the things I have learned as I have traveled around the world these past few years is that providing timely, cost-effective, equitable healthcare for an entire population of people is challenging no matter what payment system is in place. Healthcare is expensive and it doesn't matter whether the payor is government (we pay), employers (we pay) or private citizens (again, we pay); many of the miracles of modern healthcare have become so expensive and so out of the reach for people of ordinary means, there's just not enough money in any system to apply them universally and equally to every citizen. Therefore, healthcare always has been and always will be rationed in some way.

So, if how we pay for healthcare has flaws no matter what system is in place, we must find better ways and better systems to deliver more affordable and accessible care. I've taken a few hits for my positive stance on retail clinics, home health, patient self-service, physician-patient e-mail, personal tele-health services, and other modalities to provide health information and medical services in ways besides those that our current "system" provides. Many of my physician colleagues are on a war path against retail clinics. They are calling every state legislator and pulling out every tool in their regulatory armamentarium in an attempt squash the movement, but they will ultimately fail. Prohibition doesn't work. Retail clinics will thrive or falter based on the quality of services they provide and the value that their customers perceive. The whole reason this movement has gained a foothold is because medical professionals haven't been listening to their patients. Patients want healthcare to behave like other industries. It really doesn't matter who's paying the bill. We are all paying the bill, and we expect more than we have been getting considering how BIG that bill has become.

Doing something about this will take more than coming up with new ways to pay for healthcare as it is presently delivered. We need new care delivery models, staffing models, business models, and a bevy of contemporary information and communication technologies to truly revolutionize American medicine. Neither Google, nor Microsoft nor any of the other companies mentioned in Lohr's article can be your doctor, nor should they be. But these companies can and should help us with the technologies that will be needed to change the game. If not Microsoft or Google, then who?

Bill Crounse, MD Worldwide Health Director Microsoft

Extending and coordinating care with Unified Communication: The next wave is here

bcrounse — Tue, 31 Jul 2007 17:43:00 GMT

Ten years ago I co-founded a company with the aim to provide web-based medical information, secure messaging and virtual visits between patients and their personal physicians. Working in partnership with Microsoft we developed technology that was well ahead of its time, and also well ahead of the market's ability to absorb it. Quite honestly, the technology was also a bit too complex, too expensive, and too hard to use. But that was then.

Roll forward ten years. The technology has matured. Governments and payors around the world are looking for ways to provide health information and medical services more efficiently. Shortages and mal-distributions of qualified medical professionals, aging populations, and the increasing burden of chronic disease are creating a perfect storm in healthcare. A medical model that is solely dependent on physicians providing care to patients one-on-one, in city center clinics or hospitals, doesn't scale anymore and certainly isn't sustainable.

Earlier this year I posted a Blog on Unified Communications: The Next Big Thing in Healthcare. If you didn't read it then, please read it now to become better grounded on what I'm about to share.

Envision a world where modalities for both synchronous and asynchronous communication begin to merge on the desktop, or even on your Smartphone. Imagine being able to schedule a virtual consultation with a colleague or colleagues as easily as you schedule an appointment in Outlook today.

Picture yourself using rich audio and video to enhance the communication and collaboration. Think about how you could share applications on your desktop, work together on documents, or extend presentations in a lecture hall to hundreds or thousands of your colleagues wherever they might be.

What about patients? Depending on your specialty this may be more or less relevant. However, I don't think there is a clinician out there who wouldn't benefit from incorporating Unified Communications into their practice work-flow. UC opens up amazing possibilities for virtual visits, follow-up visits, medication checks, home care, wound checks, chronic disease management, mental health, nurse call centers, patient education, and more. As governments and other payors around the world begin to understand the economics and value proposition of extending care with this now-commoditzed technology, healthcare services will go through a remarkable transformation.

With Microsoft Unified Communications, and the newest versions of Microsoft Office, Office Communicator and Office Live Meeting, all of this is not only possible; it is easy, intuitive and downright spectacular.

Use it as a hosted service or bring it into your enterprise. Do live interactive programs or record them for on-demand viewing later. There isn't a medical school, hospital, clinic, or physician's office that couldn't benefit from the mind-bending possibilities this technology unleashes. Get ready for a new day in healthcare.

Bill Crounse, MD Worldwide Health Director Microsoft Corporation

Age and culture as impediments to the adoption of healthcare IT

bcrounse — Fri, 29 Jun 2007 04:09:00 GMT

A friend sent me a link to an article written for SearchCIO.com by senior editor, Kate Evans-Corriea. Ms. Evans-Corriea's article entitled "Age Does Matter" reflects on what she says was a common theme at Gartner's recent Symposium ITxpo. That theme is perhaps best captured in a quote from Gartner analyst, Tom Bittman, who says, "It's not the technology; It's not the process that's holding us back. It's the culture".

As I read the article, I couldn't help but think about a conversation I had just had with a colleague who currently serves as a hospital CIO. He expressed to me his total frustration with hospital culture and healthcare providers. In fact, he is so frustrated that after ten years on the job he is looking for another position; this time likely in another industry.

His hospital had recently purchased a very advanced surgical management system that included anesthesia scheduling and work-flow automation. The anesthesiologists at first welcomed these new tools, although one of the docs had initially pushed back because he had designed his own solution that he thought was a lot better than the vendor solution selected by the hospital.

Even so, after a few weeks using the new system, several of the older and most influential members of the anesthesia group simply proclaimed that they didn’t like what the hospital had purchased and would be going back to using their old paper processes. And, as my colleague noted, "that was that".

A similar scenario had recently played out in the radiology department. The mammography unit was asked to start using the hospital's digital PACS system. They prepared the docs for the fact that their productivity could initially fall by as much as 30 percent until they got used to the new tools and work-flow. The docs agreed to give it a try, but as soon as their productivity actually did take a nose-dive, they rebelled and refused to use the new system.

I know what you may be thinking. Screw the doctors! Tell them they have no choice but to use the new systems. As a doctor and a former hospital VP/CIO and CMIO, I know it's not that easy. Those doctors are the life blood of the hospital. It took years to recruit the physicians who run the mammography unit. And the anesthesiologists? They along with their powerful surgeon allies are responsible for most of the hospital’s profit margin.

The CIO also told me about his hospital's struggle to implement an electronic charting system in nursing. He said the VP of Nursing gives the initiative good lip service, but her first in command is a 50 year old nurse who has never worked anywhere else, and there’s a lot of passive-aggressive behavior going on in the rank and file. Since the nurses are all employees, you might think administrators could just lay down the law and mandate the use of the nursing documentation system. But you would be naïve to think that. The average age of nurses working at the hospital, especially as managers and unit leads, is 50-plus. There’s a huge nursing shortage with lots of vacancies in posted positions. They have a powerful union. It’s hard to tell them what to do.

I share this because it is so typical of the culture in healthcare, and not only here in America. It speaks volumes on the issue that Gartner is drawing to our attention; it isn’t so much about the technology as it is about the culture, and the need for more carefully orchestrated change management.

Of course some of these hassles will resolve as the “dinosaurs” retire. But based on what Gartner is saying the age and culture issue won't go away. Instead of “why must I use this computer instead of my paper” the argument will become “why must I use this (fill in the blank) instead of my computer"?

Bill Crounse, MD Worldwide Health Director Microsoft

Unified Communications: The Next BIG Thing in Healthcare

bcrounse — Thu, 22 Mar 2007 21:23:00 GMT

In previous Blog entries and on my House Calls audio-cast series, I’ve highlighted healthcare customers who are doing some outstanding work using Microsoft and Microsoft partner solutions to build portals that make key performance indicators, quality standards, and price standards more transparent. These same solutions are being used to automate clinical and business work-flow processes, manage documents, and generally improve collaboration across the enterprise. Today, I want to focus on what I see as the next really big opportunity in healthcare; Unified Communication.

Healthcare is a communication intensive business. Good communication has a profound effect on the quality and safety of patient care. Communication also has a huge bearing on patient satisfaction. Yet historically, the options for how we communicate with each other in the healthcare industry have been somewhat limited. We are hampered by an industry that has far too long relied on old fashioned telephone, paging, fax, and mail (both postal and interoffice); not exactly the most contemporary communication infrastructure.

Today’s progressive businesses use a wide variety of tools and technologies to facilitate communication. Communication can be synchronous or asynchronous depending on the urgency or context of the message. Information can be relayed and exchanged by instant message, e-mail, telephone (including voice over IP), audio conferencing, or video conferencing. In addition, the concept of “presence” in communication technologies now allows us to know ahead of time if someone is available to receive a message or take a call. It also lets us set up rules on how, when, where, and on what devices we want to be contacted.

So let’s extend all that into the typical healthcare setting. No longer am I restricted to the telephone for communicating with colleagues or patients. Depending on the nature of the message, where I am and what I’m doing, I can decide to use either a synchronous or asynchronous mode of communication. No more waiting on hold or playing phone tag on the telephone. Furthermore, as communication technology converges to the computer and is increasingly facilitated by the Net, my choice of device is no longer restricted either. My office telephone, Smartphone, Pocket-PC, laptop, Tablet-PC or desktop PC will all be able to do the job for me whether it’s an instant message, e-mail, voice, or video communication that is required. This technology will also have a profound effect on the way we conduct meetings and do training in the future. The use of multi-media web conferencing and interactive e-learning technologies will absolutely explode in healthcare as we increasingly communicate electronically in the office and at home for grand rounds presentations, staff training, patient education, and more. Finally, advances in speech recognition and the incorporation of speech recognition technology into unified communications, will open up new vistas for securely accessing patient information and relaying clinical orders.

I’m not going to spill the beans on everything that is yet to come. But if you work in healthcare, or you are an industry vendor building communication and collaboration solutions for the healthcare industry, the future is blazingly bright.

Bill Crounse, MD Worldwide Health Director Microsoft

Doctors write their own prescription for healthcare IT

bcrounse — Fri, 16 Mar 2007 20:24:00 GMT

This past week I've come across two examples of why I believe we are finally at a tipping point in healthcare IT solutions; solutions that are meeting the expectations and work-flow requirements of clinicians. Both solutions were designed by clinicians for clinicians rather than by computer science engineers. That likely explains their success in delighting the clinicians who use them.

One of these solutions I've written about before on this Blog. It's the solution known as Azyxxi; a technology acquired by Microsoft about 9 months ago from MedStar Health in Washington, D.C. and currently in use across MedStar's seven-hospital system. We are now in talks with a number of customers who want to be early adopters of this technology. Earlier in the week, I accompanied our Azyxxi team for executive discussions with a few of those customers in Arizona and California. All I can say is that most everyone we talk with totally "gets" the clinical and business value proposition of Azyxxi and why this system delights clinicians and provides insight to information as never before. Stay tuned for more announcements about Azyxxi in coming months.

The other solution that warrants mention, just like Azyxxi, was born to address clinical work-flow requirements in a large academic teaching facility that weren't being met by the facility's existing vendor solutions. Doctors and residents at UCLA Medical Center were frustrated by not having adequate tools to access needed information and document their findings during patient rounding and for patient hand-offs at shift change. Once again, it was the doctors themselves using readily available commodity software that came up with the solution to address their own work-flow pains. Dr. Neil Martin, chief of neurosurgery at UCLA who I had the opportunity to chat with at HIMSS in New Orleans a few weeks ago, tells the story best in some recent correspondence with me. He writes;

Rounding and progress note generation is a time-consuming everyday requirement for any physician managing inpatients. It involves "hunting and gathering" the clinical data required for daily patient assessment (lab results, vital signs, test results, etc), making a rounding list with key information, finding all the patients, examining each patient and analyzing all the data, generating a daily plan, and writing a daily progress note. Much of the work for rounding involves low-cognitive-value clerical-level data retrieval, and transcription onto the rounding list and into the progress note. This is particularly time-consuming and onerous at tertiary academic medical centers (AMCs) with a large high-acuity patient population. Traditionally the clerical aspects of rounding and note generation have been done at AMCs by interns and residents - but with new mandatory resident work-hour limitations, the time available for this sort of clerical work has disappeared.

At UCLA Medical Center, we have designed and deployed a software application that automates rounding list generation, and provides a templated daily progress note partially auto-completed with data (labs, vitals, etc). The automated list/note application saves interns and residents 45-90 minutes per day for each clinical team. When the time-savings associated with this application became apparent to the interns and residents, its use expanded from 100 users to more than 1200 in less than a year, with very little in the way of formal announcement or training - the spread was by word-of-mouth and was virtually "viral". More than 25 clinical service teams now use this application for rounding daily. Interns, residents, and many attending staff physicians now use and depend on this application. A modified rounding application has also been developed for ward charge nurses - and this is currently in a pilot phase. A conservative estimate is that this application at UCLA saves more than 7300 hours of clinician time annually, with a value of approximately $ 365,000/year. In this presentation we will describe the application, discuss its development, and examine its current real-world clinical utilization at an academic medical center.

Dr. Martin will be a featured speaker at the HIMSS Summit in San Diego in June. If you want to learn more about the good work of Dr. Martin and his colleagues at UCLA, be sure to attend his session.

It is thrilling to be involved in an industry with so much potential to improve the quality and safety of patient care, and the satisfaction of those receiving and giving that care. It is also thrilling to see so many of my clinician colleagues using their deep clinical experience and healthcare industry knowledge to drive innovative new solutions to market.

Bill Crounse, MD Worldwide Health Director Microsoft Corporation

New Audiocast: Asklepios--Hospital of the Future

bcrounse — Sun, 22 Oct 2006 20:40:00 GMT

As I've traveled the world, I've come to appreciate the fact that some of the most innovative work in healthcare information technology is happening outside of the Unitied States. One such example is the Asklepios Hospital near Hamburg, Germany. In this month's edition of my audiocast series, "House Calls for Healthcare Professionals" we visit with an administrator and a clinician at the Asklepios Hospital to find out more about what they've done and why the hospital has been designated a "hospital of the future". We also hear from representatives of Microsoft and Intel who partnered wth Asklepios in the design of their contemporary healthcare IT infrastructure and applications. I hope you enjoy the show.

Bill Crounse, MD Healthcare Industry Director Microsoft Corporation

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Asklepios hospital in Germany: Hospital of the future
This program is also available in MP3 for download.

In February 2005, the Asklepios Group, a privately held clinic and hospital system operating in Germany, opened a brand new facility: the Asklepios Hospital Barmbek in Hamburg. The new hospital combines architectural, organizational and information technology-related innovations. It’s been called a reference center for a "hospital of the future." Hospital executives say the new facility is based on the tradition of the past and the medicine of the future. The Asklepious Future Hospital initiative was initiated by the Asklepios Group in cooperation with Microsoft and Intel.

Panel guests:

Dr. Tobias Kaltenbach, CEO, Asklepios Clinics, is responsible for the company's operative business units in West Germany, including information technology (IT) and facility management. He received his degree in engineering management from the University of Hamburg and his doctorate in management from the University of Cologne with a thesis on "quality management in hospitals."

Dr. Siegbert Faiss, Chief Physician, Department of Gastroenterology and Hepatology, Asklepios Klinik Barmbek, has also worked as Senior Physician and Consultant at the Department of Gastroenterology at the University Hospital Benjamin Franklin in Berlin. Dr. Faiss received his degree in medicine from the University of Ulm in Donau, Germany.

Sharad Gandhi, Director, Digital Health Group - Intel EMEA, is responsible for strategy, business, sales and marketing for Intel’s success in Health care. He holds graduate degrees in Physics from Bombay University and in Electronics and Communications Engineering from Indian Institute of Science, Bangalore.

Neil Jordan, Senior Director, Microsoft Worldwide Health Industry, is responsible for formulating and executing on Microsoft’s worldwide strategy for delivering value across the healthcare provider institutions in the global health market, from the latest high-tech urban hospitals to rural clinics in developing countries.

Additional resources: downloads

Grand Opening Announcement (76.3 KB Word file)
"Hospital of the Future" Showroom (5.85 MB Portable Document file)
Asklepios intern newsletter – Barmbek Special (2.66 MB Portable Document file)
eHealth Interoperability Platform brochure (2.41 MB Portable Document file)