REDMOND, Wash., Aug. 30, 2007 — For years, hospitals and healthcare systems have suffered from ‘siloed’ information residing in separate and isolated systems. And for years Microsoft’s Health Solutions Group (HSG) has been active in promoting standards in this area to help bring those silos together, while carefully studying the market for innovative technologies that could help healthcare providers address this issue at the business solutions level.
Just over a year ago, HSG acquired a technology developed at Washington Hospital Center called “Azyxxi” to do just that. Over the past year, HSG has integrated the Azyxxi team, including developers, designers and clinicians, and infused into its ongoing development the valuable assets and insights they had developed from years of using their technology to solve real-world challenges in the clinical setting.
Today, as Microsoft’s new unified enterprise platform for healthcare, Azyxxi is fundamentally changing the way healthcare is managed in the organization, and delivered at the bedside.
Based on Microsoft .NET Framework, Windows Server 2003 and SQL Server 2005 software, Azyxxi addresses a core challenge of most healthcare providers — integrating vast amounts of clinical, administrative and financial information that flow in and out of various, disparate information systems, and delivering it through role-based, optimized user interfaces to analysts, laboratory technicians, nurses, administrators and physicians.
“Azyxxi unlocks the value of a health system’s vast stores of critical data, aggregates it from across all the organization’s existing technologies, and provides unique access to transactions, details and images,” says Steve Shihadeh, general manager of sales, marketing and solutions for HSG. “From the inside out, Azyxxi was designed on .NET and SQL Server for simplified deployment and support, high availability, scalability and secure data storage.”
A Complex Enterprise
The healthcare IT ecosystem, says Shihadeh, is affected by a litany of factors — most hospitals are not the only place patients receive care. Separate records are typically kept at hospitals and physicians’ offices for the same patients. Lab work and other specialized services may be outsourced to third parties. The hospital may accept hundreds of different health plans for patient coverage, and they are obligated to comply with an increasingly stringent regulatory and standards-driven environment.
Each of the processes in that web of interactions is likely to be supported by information systems from different vendors — making it difficult if not impossible to coordinate data from across departments, let alone stakeholders scattered across the industry.
“Healthcare is complicated, often times disjointed,” Shihadeh says. “Hospitals, health systems and insurance plans, physicians, specialists and consumers all interact in a very complex ecosystem.”
Yet, collecting all that information is critical to increasing the quality of patient care, as well as the efficiency of the organization in containing costs that are ultimately passed on to consumers.
“There have been several valuable investments and improvements in health information technology,” Shihadeh says. “But rarely, if ever, have health systems been able to tie together all the different digital information sources they have, and that is the unique value proposition of Azyxxi.”
According to HSG, Azyxxi is able to accomplish this industry-leading level of integration because the technology that underpins the offering is “data agnostic,” meaning Azyxxi will accept data from any system, a key factor given today’s IT environment in healthcare. Azyxxi can accept multiple forms of data including computer generated data, text, images, video or scanned data.
“Azyxxi is extremely flexible in taking all that data, storing it in a meta data format, and allowing rapid views of individual patients built out with everything the system knows about them — really enabling a physician to make informed decisions about patient care,” Shihadeh says.
At the same time, the flexibility of the solution also allows cross-patient, cross-organization views that give administrators clear insight into business and operational impact, which is critical to hospitals working off narrow profit margins.
But more important than profit margins, according to Shihadeh, is the fact that a health system with that kind of information integrity will be a safer place to be a patient, with better and more rapid measurements about how the organization is performing.
“In effect they’ll have a command and control system over their clinical operations, patient interactions, and the financial business of the hospital or health system which allows them to be a more efficient business, and deliver better care,” he says.
Early Adopters Exploring the Possibilities
Over the past several months, the Microsoft Health Solutions Group has carefully gone to market and secured early adopter customers to engage in collaborative development, to refine the product and help commercialize it. During this process, the real potential of Azyxxi has begun to emerge.
Early adopters include 21 different hospitals at academic medical centers such as Johns Hopkins Health System and New York Presbyterian Hospital; large health systems such as MedStar Health System and, just announced today, Novant Health; and even the Wisconsin Health Information Exchange, which will eventually tie together 25 different hospitals in Southeastern Wisconsin.
“We have been very fortunate to have some real market leaders who have seen the value in Azyxxi, and who are very excited to be working with Microsoft to help us create a groundbreaking unified enterprise platform for healthcare,” Shihadeh says.
One of those early adopters, New York Presbyterian Hospital and its associated network, is using the system to unify its existing and legacy information systems to create broad accessibility of its vast quantities of information.
“As we’ve automated more and more of the processes within the hospital and created more electronic data sources, our ability to mine and utilize that data is becoming more of a priority,” says Aurelia Boyer, senior vice president and chief information officer for the New York Presbyterian Hospital and Healthcare system. “Making the data from different systems available in a way that makes good management, clinical and quality sense takes a lot of effort, and is a major goal for an institution like ours. Giving people in the hospital ready access to different kinds of data is priceless to us.”
According to Boyer, while each system has its own interface and can be accessed efficiently for specialized queries, it’s often necessary to correlate different types of organizational information, to analyze trends and make decisions.
“Sometimes you want to bring the data together from different systems,” she says. “HR staffing data could be viewed alongside clinical data to balance our productivity, for example. As more electronic data is available, there are more opportunities to cross over those bridges. And you can’t just put the data together — you have to model it in a way that has meaning.”
Boyer says the technology will help her organization target their research projects going forward, as well as give them access to the volumes of information contained in legacy information systems, without needing to keep each system in operation.
“At some point you inevitably move on to a new system,” she says. “When you do that, the historical data has to be kept somewhere so that you don’t have to keep all the old systems running, which of course would become a bigger and bigger issue as time moves on.”
When it comes to research, the system’s ability to unify information and display it side by side will help the organization identify patterns, correlations and populations for more detailed follow up.
“We could use it to identify patients with a particular set of activities, whether it’s a diagnosis or a type of medication,” Boyer says. “It will allow us to see what kind of population we have to do research on, what data we have available, so we can decide what research to do and how to get the data together.”
The flexibility demonstrated in New York Presbyterian’s different uses of the technology is in evidence across the spectrum of early adopters. Whereas New York Presbyterian is looking at Azyxxi as an administrative tool to guide organizational decisions, for example, Novant Health is working to implement Azyxxi in support of its clinical operations.
“I’ve seen estimates that say a physician spends most of his or her time collecting information about the patient before they deliver the care,” says Rich McKnight, Novant’s CIO. “Our goal is to dramatically reduce the amount of time in information gathering, and increase the amount of time in taking care of the patient.”
Currently, Novant’s doctors must navigate several different systems to access the entire scope of information on a patient — lab results are loaded onto PDAs and printed on paper charts. A centralized data collection system presents patient background information on desktop computers.
“Doctors have to look three or four different places to get the complete picture on a patient,” McKnight says. “And the more complicated someone’s medical situation is — the more input they need to make a good decision for that patient — the more places they have to go and look. Azyxxi addresses this problem, and is a creative way to bring all the information together into one screen.”
According to McKnight, doctors like the fact that by bringing all this together through Azyxxi, they have lab results, patient demographic information, radiology results, doctors’ notes, prescriptions and other information in one place. And with repeat patients, Azyxxi can include all of the prior records as well — data in Azyxxi can go back as far as patient records do. Access to radiology images in particular is a unique feature of Azyxxi that brings great value to doctors as they move through their rounds.
“You can see a better, more complete history of the patient in one place in one screen,” McKnight says. “All of that information has been gathered for each doctor to look at and take better care of patients. We certainly have many opportunities down the road subsequent to our phase one implementation, but phase one is entirely focused on doctors and improving clinical care.”
While Novant and New York Presbyterian are still rolling out the technology and exploring what it can do, Shihadeh is finding excitement for Azyxxi growing in health systems across the United States. At MedStar for example, he says, one physician executive uses the product to get the pulse of her organization each morning — patient census, ER workloads, nursing distributions and daily projections — and then uses it in her other job, as a physician, to understand each patient’s condition and history before she enters the room to consult with the patient or another doctor.
“Whether I’ve talked to chief executives, chief medical officers, chief information officers, Azyxxi allows them to leverage current investment, and gives them insights they never had before,” he says. “You see a powerful impact with a tool like this, a system that is able to turn the organization’s existing data into business-critical — and life-critical — information. It has the ability to improve clinical care and patient outcomes, as well as the organization’s bottom line.”
As the product moves into its second year in Microsoft’s portfolio, HSG is focused on increasing its functionality using feedback from the early adopter program, benefiting from around-the-clock development delivered through the establishment of a new development center in China.
With that kind of resource dedication alongside the technology’s already impressive flexibility and power, look for Azyxxi to make deeper inroads across the health ecosystem in its second year at Microsoft and enable even more transformative approaches to business success and patient care.
