REDMOND, Wash., Aug. 21, 2003 — In an era of digital technology, when automation of routine tasks drives productivity and information is traded at lightning speed, one industry still generates more than 60 million pages of paperwork a day.
That may not sound like the business model of an industry that constantly redefines itself, making things once thought miraculous routine. But buried under all that paper is the U.S. healthcare sector and its key participants: doctors, nurses, drug researchers, insurance providers and, of course, patients.
However, with the release of the new Microsoft Office System later this year, the prognosis for the U.S. healthcare industry’s paperwork problem is optimistic.
“Healthcare workers are the ultimate information workers,”
says Ahmad Hashem, M.D., Ph.D., Microsoft’s global healthcare productivity manager.
“They are constantly receiving information from multiple sources, including patients, labs, medical journals, drug reference books and colleagues. They also have to deal with a ton of paperwork, such as documentation of patient care, the billing process and policies and procedures. The question is how do they keep track of it all?”
The answer, says Hashem, is the forthcoming release of the Microsoft Office System.
“The new Microsoft Office System addresses the unique needs of the healthcare industry,”
says Hashem.
“Where Office used to be a client suite of software in a box, it’s now a complete platform of programs, servers and services. Users can still perform a variety of tasks with it out of the box, but now they can also customize their own applications around it.”
Several enhanced features and innovative add-on options, developed in conjunction with Microsoft industry partners, are designed to greatly improve personal and organizational productivity and automate virtually all of the paper-based processes that impede quality patient care, slow research and innovation and increase administrative costs.
All Gain, No Pain
The three main segments of the healthcare industry — treatment and care providers, pharmaceutical companies and health plans — all share what Hashem describes as
“common industry pains.”
These include rising costs; staffing issues;
“disconnectedness,”
or the inability of information systems to communicate with each other, even within the same institution; agility and innovation, which Hashem defines as the need to respond quickly to changing market dynamics; and regulatory compliance, which requires being able to navigate successfully through an alphabet soup of oversight agencies.
Hashem says these pains can be remedied by applying the appropriate new Microsoft Office System products. For example, Microsoft Office InfoPath 2003 addresses the problem of
“disconnectedness,”
while at the same time having a positive effect on rising costs and staffing issues by lightening the paperwork load.
InfoPath uses eXtensible Markup Language (XML) to create data that is easily transferred among different systems, either internal or external. That means a hospital’s billing system can communicate with its medical-records system, and both can communicate with the systems of health-insurance providers or pharmaceutical companies conducting clinical drug trials and research.
Moving Mountains of Paper
While 60 million pages of paperwork a day may sound like a lot, it’s just the tip of the paper iceberg for the healthcare industry. That figure represents only the number of medical claims processed each day, at a daily price tag of US$125 million, according to the magazine Health Management Technology. Physicians wrote more than an estimated 4 billion prescriptions in the U.S. last year. At any given time, some 12,000 clinical drug trials are under way around the world, each of which can generate upwards of 1 million pages of documents to support the U.S. Food and Drug Administration’s new drug application submission process. With 95 percent of the clinical trial process done manually and on paper, it’s easy to understand why many new drugs take from 12 to 17 years to reach the marketplace, and why they’re so expensive when they do.
What’s more, that mountain of paper doesn’t even include everyday items such as patient charts, treatment plans, referral letters, lab reports, memos and administrative policy and procedure manuals.
With the Microsoft Office System, almost all of this paper can be eliminated, according to Hashem.
Instead of handing a patient a clipboard laden with forms to be filled out by hand, doctors and hospitals can now have patients complete the forms electronically at a small workstation or on a Tablet PC.
“Providers can create electronic documents and establish validation rules so they get clean data,”
says Hashem. For example, if a patient mistakenly enters his or her year of birth as after 2003 or omits their ZIP code, the system will prompt the patient to correct or enter missing or invalid data.
Furthermore, because information is saved in XML format, it can be shared among systems.
“The data is entered once and feeds multiple systems and different parties,”
says Hashem.
“If a patient has a new address, instead of having to make that change in 20 different systems, the information is changed in only one place and it will update multiple systems all at the same time.”
Lightening the administrative burden can also cut costs, increase productivity and have a positive impact on staffing issues.
“There’s a critical nursing shortage in this country that’s made worse, in part, by the inefficient use of a nurse’s time,” says Hashem. “As much as 40 percent of a registered nurse’s time in a hospital setting involves non-direct patient care activities, so it’s vitally important that we find ways that enable nurses, and all healthcare providers, to devote as much of their time as possible to patient care.”
The results of a May 2003 survey by the Healthcare Information and Management Systems Society (HIMSS) confirm this view. Nearly 53 percent of the respondents – who included healthcare-industry workers, consultants and vendors – said technology would have a “great deal of impact” on increasing worker efficiency to mitigate healthcare workforce shortages. Another 42 percent said technology would have
“some”
impact on workforce shortages. Nearly 60 percent of the respondents thought that nurses (32 percent) and doctors (27 percent) would be the two staffing areas most positively affected by technology improvements.
A Portal to Improved Patient Care
The Microsoft Office System, coupled with add-ons provided by partners, delivers a portal solution that can provide clinicians and researchers instant access to the information they need, including the latest medical journal articles, drug reference information and patient handouts.
Using the Microsoft Office OneNote application, a doctor or nurse may record notes on a notebook or Tablet PC, by keyboard, handwriting, or using audio or video. The notes are stored centrally and can be found and shared easily. A
“Look Up”
feature enables users to get additional information by highlighting the word or term and right-clicking the mouse. Healthcare professionals are immediately presented with a
“Research”
tabbed screen that allows them to retrieve information stored on the machine, from the institution’s intranet or from the Internet.
“If a nurse were examining a patient and decided she needed more information on something like severe acute respiratory syndrome (SARS), she can simply highlight the term, click the mouse, and the Microsoft Office System automatically takes her to a Web site from the Centers for Disease Control with more information about SARS. Clinicians don’t have to leave the examining room to get that information; it’s available to them wherever they are.”
Physicians, nurses, pharmacists and researchers can also access information about medications, complete with pictures, dosages, prices and recommended usages from Clinical Pharmacology through Microsoft’s industry partner, Gold Standard Multimedia. If a patient is taking several medications at the same time, clinicians can quickly check on potential drug interactions to ensure drugs are not prescribed in dangerous combinations. Following the examination, the physician is able to print out information on how the patient is to use the medication.
Clinicians and researchers also have instant access to more than 900 leading medical and health journals in over 100 medical specialties through an optional feature offered by Microsoft partner Ovid Technologies. If a doctor is writing a patient note about a herniated disk, he or she simply highlights and clicks to initiate a search of current articles.
“Healthcare professionals’ productivity has to take into account the holistic environment,”
says Hashem.
“They need to be able to author information using keyboard, pen and voice; access information from multiple systems; communicate with patients, health plans and clinical trial coordinators; and collaborate with other professionals.”
Productivity and collaboration are also improved through the use of Microsoft Office SharePoint Portal Server, which enhances the features and functionality of the new Microsoft Office System. This technology, which requires Microsoft Windows Server 2003 in combination with Microsoft Office System, empowers healthcare and pharmaceutical professionals to create shared workspaces from within any Microsoft Office application. Meetings may be scheduled and conducted, information stored and shared, and calendars viewed to check participants’ availability for scheduling.
“People will now be able to have more productive meetings,”
says Hashem.
“Users can create virtual workspaces and can store all the documents that are relevant to that meeting. For clinical drug trials, this will be invaluable, as it enables researchers to store data, progress reports and regulatory procedures.”
With the Information Rights Management feature of Microsoft Office System, the security of data and information is assured. The owner of a document sets its security parameters and decides who is authorized to read, modify, copy, print and forward the document, even if it is e-mailed. Users can also set an expiration date after which the recipient no longer has access to the document.
“In healthcare, we deal with sensitive patient information, clinical research and other confidential information,” says Hashem. “The ability to protect that information from inadvertent use is extremely important.”
Collaboration Partners
Part of what makes the Microsoft Office System a powerful solution are the range of innovative add-on features developed in conjunction with a number of industry partners.
“We see the Microsoft Office System as a platform for innovation, and our partner add-ons enhance the entire spectrum of what we are striving to deliver to the healthcare industry,”
says Hashem.
DataLabs Inc., based in Irvine, Calif., has developed a modeling feature for use with Microsoft Office Visio 2003 that helps pharmaceutical companies conduct clinical drug trials faster by automating the most time-consuming paper-based processes.
“Usually, when a drug company wants to conduct a clinical trial, they have to write a protocol, which is a very long, narrative document that details the trial’s criteria, how many patients will participate, how often they’ll be seen and all other relevant data. Then they have to build databases to manage the data,”
explains Richard Gleeson, vice president of Enterprise Solutions at DataLabs.
“What we’ve been able to do using the 2003 release of Microsoft Office and Microsoft Visio is give users a graphical drag-and-drop way to model that protocol,”
says Gleeson. DataLabs’ custom stencil and shapes, used with Visio, enable drug-company researchers to design protocols as visual graphic documents instead of as narrative accounts. They can build and model the study, set up schedules for study participant visits and create forms.
The Visio document may be stored in a Microsoft Office SharePoint virtual workspace, where team members can collaborate, review the protocol and model, check forms and perform all necessary tasks electronically. When the protocol is finalized, users can export and import XML documents to create databases and review and store information.
“We’ve been able to compress the process and move the pharmaceutical industry off paper,”
says Gleeson.
“We’ve totally skipped that step of manually creating the repository, the forms and the checks. That was done upfront with the Visio document, and that’s what the trial’s doctors, clinical psychologists, monitors and investigators use to enter their data.”
Merck & Company’s Human Health Division, a DataLabs customer, has realized real business benefits with the DataLabs-Visio solution.
“DataLabs’ Visio-based study designer tool has enabled Merck to set up clinical trial studies more quickly with fewer resources,”
said Jim Karkanias, Executive Director of CDP Operations in the U.S. Human Health Division of Merck & Co., Inc.
“Because this tool is so easy to use, we were able to reduce our dependency on technical skills for the design and construction of the study databases while reducing staff training time.”
Microsoft also partnered with Ovid Technologies, a New York-based, internationally recognized medical information services company, to develop a solution for clinicians and medical researchers who need fast, accurate answers throughout their work day. The Ovid solution delivers immediate access to more than 900 peer-reviewed medical journals within the Microsoft Office System.
“This electronic journal solution takes what used to be one or two or three subscriptions that an institution would purchase and make available in the library in paper copies, where they could only be accessed one at a time, and makes these subscriptions available on every machine throughout the institution,”
says Bette Brunelle, executive vice president of Products and Services at Ovid.
“We’ve taken it one step further, right into the physician’s workflow.”
Beyond delivering articles, the Ovid solution also helps doctors make the right diagnosis. If doctors are examining a patient and need to see pictures of chickenpox or smallpox so they know what they may be dealing with, they can enter search terms through Microsoft Office System’s Ovid feature and call up pictures of both — side by side — for comparison.
“The closer you can bring all this rich information to the physician’s workflow, the more you can maximize value for the institution and improve patient care,”
says Brunelle.
Children’s Hospital
Earlier this month, Children’s Hospital in Seattle became the first to implement a pilot program of the new Microsoft Office System in a healthcare environment. The initial phase of the pilot is a four-week program in the pediatric intensive care unit and infant intensive care unit. The second phase of the pilot will be a four-week program in two of the hospital’s medical units, according to Thomas McGee, Infrastructure Program Manager at Children’s Hospital.
Assisting in the rollout was the Seattle office of Quilogy, a Microsoft Gold Certified Partner headquartered in St. Charles, Missouri.
“Children’s Hospital is building an infrastructure for the future to improve patient care by fully utilizing wireless and portal technologies,”
says Matt Warmack, Microsoft Alliance Director at Quilogy.
“The solution delivers complete, real-time data wherever the patient is being treated: at bedside, in the operating room or any of the special-care units. They’ve implemented an enterprise portal server with Microsoft Office System and SharePoint. They’re going wireless throughout most of the hospital’s in-patient units and deploying wireless Windows-based computers on wheels, Tablet PCs, and wired PCs at the nurses’ stations.”
According to Warmack, the combination of mobile technology and the SharePoint Portal Server solution is perfect for critical care.
“If a child comes in with a life or death situation, clinicians can bring the Tablet PCs to wherever they need them,”
says Warmack.
“Even in the intensive care units, where the medical emergency and diagnostic equipment is very bulky, the doctors and nurses have real-time access to the patient records system, the medical research documents and the Internet. They don’t have to leave the patient’s bedside to enter an order for medication, look up records or research information. Everything they need is right there.”
As the regional pediatric referral center for Washington, Alaska, Montana and Idaho, Children’s Hospital was also seeking a solution that would support both its patient care and research missions, according to McGee.
“We knew that 78 percent of our data sat on individual hard drives and that when a doctor wanted to begin a research study on any topic, he usually had to start at square one,”
says McGee.
“There was no way of leveraging the information and research that’s already been done unless it resides in a known public place. Collaboration is a huge issue here at the hospital, and we’re looking for the combination of Office and SharePoint to resolve that issue. Initial reactions have been very positive.”
Healthcare without Boundaries
In designing technology tools for the healthcare industry using the Microsoft Office System, Hashem says the goals were to connect people, information and business processes through enhanced tools for collaboration, business information management and productivity.
“In the current healthcare system, with all its inefficiencies, redundancies and paperwork, the patients are paying the price,”
says Hashem.
“They’re not getting the treatment they need fast enough and they’re not getting the high-quality care they want or that healthcare professionals want to deliver.”
The Microsoft Office System can help the healthcare industry to function more efficiently and cost-effectively, according to Hashem, because the ever-increasing volume of healthcare information will be available anytime, anyplace and will be easier to manage and act on.
”
Our vision at Microsoft is healthcare without boundaries,” says Hashem. “That means a healthcare industry and delivery system where vital information flows efficiently and securely to and from all the parties who need it, at the exact moment they need it, to improve patient-care outcomes and free medical professionals, researchers, administrators and patients from the tangle of red tape.
“If a clinician spends less time pushing paper and is free to treat more patients; if tired doctors at the end of a long shift in a busy trauma center can access the information they need to make the right diagnosis instead of the wrong medical decision; if drug researchers can speed the clinical trial process and get new breakthrough compounds to the market faster, that is healthcare without boundaries. Lives will be saved, symptoms relieved, and diseases cured. That is our vision, and soon it will be a reality.”
