The giant Microsoft Corp. is trying to use its Windows operating software as the springboard to market dominance in the race to make computers a key element in the success of integrated healthcare systems.
To do that, the Redmond, Wash.-based computer software maker will have to move inland from its secured beachhead in desktop personal computers. Harnessing the networking capabilities of PCs requires a higher level of computerization that operates behind the scenes.
Leading the charge last week was Bill Gates, Microsoft's founder and chairman, in his first public appearance before the healthcare industry's computer decisionmakers.
In a speech to an overflow audience at the Healthcare Information and Management Systems Society convention, and in a personal interview with MODERN HEALTHCARE afterward, Gates contended that Microsoft has the software tools to make Windows a force in healthcare information technology.
"I can't think of another industry that is changing as fast or that has as much opportunity to take these new information tools and use them to improve efficiency and quality of service," Gates told the San Antonio gathering.
Healthcare providers will have to spend big and spend fast to meet a managed-care maxim focusing on illness prevention and early intervention. Demand has exploded for computerization to track and serve defined populations of managed-care beneficiaries, equipping health networks to make data available wherever needed to improve care at lower cost (Feb. 13, p. 65).
Meanwhile, Microsoft has been establishing Windows in healthcare as a standard for easy computer access and as an operating system to exploit increasing PC computing power.
Nearly 60% of the PCs in healthcare organizations of more than 100 employees were running on the Windows operating system in 1994, compared with 12% in 1992, according to International Data Corp., a Framingham, Mass.-based research firm.
The market penetration "lays the foundation" for making Windows technology the basis of sophisticated computer networks with the capacity to operate databases and move information around a large healthcare enterprise, Gates told MODERN HEALTHCARE. "That's a very state-of-the-art effort that some of the pioneers (in healthcare networking) are doing now. But 90% of the people are not. And yet with the hardware they bought, without too much more investment, they should be able to get in and get involved with that," he said.
For Microsoft, getting the healthcare industry involved means establishing the benefits of an accelerated Windows product, called Windows NT, at the level of a computer "server." Linked to a network of PC workstations called "clients," a server's vast increase in computing power extends the computing capacity of individual PCs by running complex computer programs, managing databases and distributing that output to workstations.
Servers also can turn PCs into communication devices by routing e-mail, transferring medical data and tapping into outside databases that run on their own servers.
Healthcare has only recently started moving toward this "client/server" approach to computerization, considered more flexible than traditional mainframe computer processors and better able to adapt to incremental advances in technology, said Louis Nicholson, vice president with the Houston office of First Consulting Group. "Unlike industry in general, healthcare is pretty much virgin territory," Nicholson said.
So although competitors such as Novell's NetWare and IBM's OS/2 operating systems for network servers are established in the business world, Microsoft has an opening to persuade its considerable base of existing PC customers to use the Windows server operating system for network-building in healthcare, Nicholson said.
An operating system directs the work of hardware components such as microprocessors and memory, forming a foundation that's essential for making the most of computer-processing innovation. Software makers then write "applications" that apply the hardware/operations foundation to specific tasks.
Microsoft is counting on alliances with prominent healthcare software vendors such as Shared Medical Systems to raise the visibility of Windows and its NT server and cultivate enough healthcare-specific applications to create a booming demand for Windows. Microsoft promoted vendors' Windows efforts during Gates' keynote presentation, in press conferences and on the HIMSS exhibition floor.
"Once we get a showcase example and can get word about that around, or get a major vendor like SMS or the others to get behind our stuff, then it can have a very large impact," Gates said.
Promoting computer applications that can run on any type of commercial PC, as Windows does, would play to an industry concerned about getting the most out of its investment, Gates added. "Clearly the healthcare industry wants to use their mainstream standard platforms like everybody else. The question is, how can we help accelerate that, working in partnership with these various people-and particularly at the server level, make that happen sooner than it would if we weren't there getting involved?"
Not all vendors, however, are as ready to follow Windows to the server level. In contrast to the software desktop of the PC, "the back end (at the server level) is more mission-critical," said Richard Corley, marketing manager for the healthcare information management division of Hewlett-Packard's Medical Products Group. "That's more difficult to bet your business on."
Microsoft's efforts also might complicate attempts to find a common language among a variety of information systems.
Up to now, the most popular "standard" has been UNIX, which has been around for 20 years and has stood the test of reliability. On the other hand, Windows NT "might just have a little ways to go" before it can make the same claim, Corley said. "Reliability today for mission-critical applications is incredibly important, so you want to be safe," he said.
If Gates succeeds in his Windows vision for healthcare, Hewlett-Packard will move to the Microsoft product, "but only when we feel that it's a safe mission-critical environment, and that won't happen for some period of time," Corley said.
As for settling on an industrywide operating system, software vendors are beginning to comply with a core set of common technical standards that will reduce the importance of standardization at the operating-system level, said Michael Kappel, vice president for research and development with HBO & Co.
The Atlanta-based information systems vendor has built a market strategy on open architecture and on "the concept of multiple vendors being able to compete and collaborate at the same time," Kappel said.