A Blueprint for Healthier Healthcare IT

BILBAO, Spain — April 22, 2009 — Small budgets. Outdated technology. Pressing regulatory issues. Critical information scattered among multiple organizations. Employees squeezed for time. When it comes to challenges in combining technology with business, the healthcare industry stands out.

To address this, Microsoft has been drawing on its global experience in tackling the range of issues facing healthcare IT.



Tim Smokoff, general manager of Microsoft’s Worldwide Public Sector Healthcare division, says that Microsoft is helping customers and partners build e-health solutions that can handle the pace of change and varied landscape of the healthcare environment.

“Healthcare is traditionally years behind other industries when it comes to creating efficiency through technology,” says Tim Smokoff, general manager of Microsoft’s Worldwide Public Sector Healthcare division. “Our goal is to change that using what we’ve learned from customers. We’re taking a real-world perspective and putting it together in a way that organizations can really use.”

Based on its experience with health care, Microsoft continues to enhance its guidance and “solution accelerators,” to help customers and partners build e-health solutions that can handle the pace of change and varied landscape of the healthcare environment.

The work has resulted in two offerings to help healthcare organizations get the most from technology and position themselves for the future with a modern systems architecture.

The Connected Health Framework Architecture and Design Blueprint (CHF) is “technology-agnostic” guidance and best practices for building an agile and adaptable e-health infrastructure. Along with that is the Connected Health Platform (CHP), a set of assessment tools, deployment guidance and solution accelerators for building such an infrastructure on Microsoft technologies. Two weeks ago at the Healthcare Information and Management Systems Society (HIMSS) 2009 Annual Conference & Exhibition in Chicago, Microsoft released the latest versions of CHF and CHP.

Both offerings are available for free and can even be used to develop proprietary applications for resale. In Spain this week for the Local and Regional Government Solutions Forum (LRG), Smokoff say he’s hearing a lot of interest about the new offerings and their implications for helping public health organizations promote improved citizen health and wellness.

“If we want to accelerate the uptake of e-health applications, we need to freely distribute an architecture and design blueprint along with bits of code and guidance papers so that people can use them,” Smokoff says. “Partners can easily build their own versions and keep the intellectual property because CHF and CHP are free to use and open to innovate on top of.”

An Ounce of Prevention

Version two of the connected health offerings is widely expanded to cover the entire continuum of care, with an emphasis on promoting lifetime health and managing chronic diseases — areas where a great deal of savings can be achieved from automating routine tasks such as monitoring blood glucose levels in diabetic patients.

The extensions announced in Chicago include an enhanced design blueprint, which updates and expands the thinking about long-term care, social welfare, social care and other wellness programs, along with a number of new accelerators and guidance.

According to Smokoff, the changes were driven largely by a shift in philosophy surrounding healthcare in the Western world.

“For the most part, healthcare has been focused on waiting for people to get sick and then curing them,” he says. “So much of healthcare costs in developed nations result from the management of chronic disease such as diabetes, obesity and pulmonary disease. Today we’re shifting that focus toward prevention, and technology needs to keep pace.”

How can technology help manage disease and facilitate healthier lifestyles? According to Smokoff, as patients and doctors increasingly buy into the philosophy, a new class of applications is emerging to make better use of information about patients and their conditions.

“Information is a key asset in facilitating better health, but health organizations have too often kept data locked into their own systems and applications,” Smokoff says. “By liberating the information from those silos, you give consumers the ability to manage their own health, and you give organizations the ability to work cooperatively for better patient outcomes.”

Smokoff says personal health applications such as Microsoft HealthVault have been a hot topic that allow people to take charge of their health, but that is just the beginning of a transformation taking place in healthcare. New applications capable of freely sharing data might help coordinate complex procedures such as surgeries where the surgeon, anesthetist, nurses, patient and the facility itself all must be scheduled and briefed.

Applications can also be created to help patients manage a chronic condition over time. With diabetes, for example, it might track the patient’s historical blood glucose levels, logging each test daily and providing a picture that can identify trends and help to prevent an acute episode. Someone who could be diagnosed as “pre-diabetic” could use tools to track exercise, keep her metabolic index down, and prevent her from developing diabetes at all. Patients with health problems arising from obesity can track diet and exercise routines.

“It’s about capturing physiological information and providing the useful and personalized tools to help patients keep up with a specific dietary, exercise or drug regimen,” Smokoff says.

According to Smokoff, standards and interoperability are a key element of the new connected health platforms. The new versions of CHF and CHP feature more code accelerators to help applications work well with information residing in many different places, and the architecture can be used with any software that supports Web services and services-oriented architectures (SOAs).

The new features, compatible with federally recognized standards, were demonstrated successfully in February at the Integrating the Healthcare Enterprise Connectathon 2009 in Chicago.

Tackling Healthcare’s Biggest IT Issues

While these kinds of applications are showing a great deal of promise in promoting “self care” and patient wellness over time, there is much that healthcare organizations can do to become leaner as well.

And according to Smokoff, there are many obstacles to overcome before the healthcare industry as a whole is able to really digest technology the way that other industries have.

For one thing, the sensitive nature of healthcare information and subsequent government regulation of how that data is used, which varies widely by country, creates an enormous emphasis on privacy and security that any enabling technology must fully address.

“Today regulation and innovation must work in harmony to allow connected care systems to free data so it can be used by individuals and their healthcare systems, while at the same time protecting the information from misuse,” Smokoff says.

In Germany, for example, information created inside a hospital cannot be duplicated and stored in another location, creating the need for technologies that can access patient data from various locations.

Such regulations, while critical to the industry, amount to additional hurdles for technology aimed at enabling healthcare information-sharing.

“Security of information is incredibly important,” Smokoff says. “It’s imperative to help the industry with this issue, so a big part of the infrastructure optimization outlined in the CHF and CHP deals with securing access and providing aggregated views of health information, whether it’s in the hospital environment or federated outside to other agencies for effective coordination and post-care.”

This issue of systems federation is another that looms large for healthcare. The industry consists of thousands of clinics, hospitals, laboratories and public agencies, each of which has its own systems and its own segment of a patient’s overall medical profile.

Complicating this issue is the prevalence of “legacy” technologies, outdated systems that may go as far back as the green-screen era but which still contain valuable and pertinent medical information on patients.

“Interoperability is probably even ahead of privacy and security as the biggest issue facing healthcare technology,” Smokoff says. “We talk about liberating data. There is a lot of information out there, but historically systems have not talked to each other. Only in the last couple of years have standards for healthcare interoperability been accepted.”

Smokoff compares the situation to railroads in Australia or the early American West, where different gauges of track meant that trains could only make part of a crossing before entire cargoes would have to be offloaded to another train.

“When these systems are not consistent, it becomes very costly to integrate them,” he says.

This issue is also gaining increased attention of late, as a new presidential administration looks at ways to reduce the cost of healthcare delivery in the United States.

“As the stimulus comes out, we have to focus on separating the data from applications and organizations, and using the technology capabilities we have now to give people a holistic view of their health history,” he says.

“To do that, the medical community also has to be on board, so another key element is, what is the incentive? For this to work, we have to look at rewarding doctors and clinics that are ahead of the curve in terms of technology and efficiency.”

Making the Rounds

Smokoff agrees that building better information and communications technology into healthcare is a classic technology story with the dual benefits of greater process efficiency, and better information, both of which help organizations do what they do best.

“There is a real need to help these organizations be more efficient,” he says. “We’ve seen so many systems that were built up piecemeal and suddenly the organization is juggling a dozen different applications. They’re burning their IT budgets just keeping the lights on.”

According to Smokoff, the architectures and toolkits provided by Microsoft can help reduce the cost of running a system while simultaneously improving its agility, allowing organizations to invest that savings into more innovative technologies to support practitioners, or to simply reduce IT budgets so more of that money can go elsewhere.

For most people who work in healthcare, though, the ultimate goal isn’t to “create efficiency” in and of itself, but to deliver the best possible care however they can. And it’s there that IT really has potential to make a difference, both in the lives of individuals and in the economies of nations. By providing more information, and better access to it, effective IT can actually facilitate better care delivery.

“With access to all the different information about a specific case, providers can make more informed decisions,” Smokoff says. “So by embracing these modern architectural principles, organizations not only save money, but are able to deliver better care.”

And with a renewed focus on wellness, technology has the potential to take things a step further and help people take charge of their own health.

Says Smokoff: “Even more importantly, by empowering people with better information about their own health, they too can take control, be more proactive, and hopefully lead healthier lives.”