The technology is out there to solve healthcare's stubborn information management problems but the industry must organize for the challenge, says Microsoft Corp. Chairman Bill Gates.
Gates last month summoned his star power to speak to 2,000 information professionals at a gathering of the Microsoft Healthcare Users Group in San Diego to publicize a plan for integrating computer information.
Bedecked in a white golf shirt, his hair tousled, Gates articulated a campaign to maximize existing investments in information systems and put advanced Internet technology to work.
The initiative, dubbed Windows DNA for Healthcare, draws providers a picture of how to weave innovative cybertools into and among diverse, scattered information systems. The aim is to standardize the way computer data are identified, aggregated and presented to clinicians and managers, despite the fact that the data originate from otherwise incompatible systems.
"One of the things that people have been asking us to do is to take all of the work we do around healthcare applications and come up with an explicit architecture that shows how those pieces fit together," Gates says. "Overall, it says that these medical applications will use the Internet."
Healthcare executives are beginning to understand the connection between good information and cost reduction, says Stephen O'Dell, managing director of e-health at First Consulting Group, a Long Beach, Calif.-based healthcare information technology consulting firm.
The Microsoft initiative is "a very significant effort to try to reduce that fragmentation," O'Dell says. But, he adds, "it is only a blueprint concept at this point."
Microsoft has a tough sales job ahead to explain the benefits of its blueprint and gain its acceptance, observers say.
If Microsoft can coalesce healthcare around standard solutions, it would be "a great benefit to the industry," says Dan Vogel, program director of healthcare at Meta Group, a Stamford, Conn.-based information technology research firm. "At this point it's just a bunch of talk."
That talk is being converted into action at Dallas-based Baylor Health Care System, which is incorporating elements of the Windows DNA idea. Baylor uses a data management scheme developed by Sequoia Software Corp. of Columbia, Md. Gates' presentation included the innovations at Baylor.
The core technology is an advanced Internet protocol that can be used in existing information systems to extract and standardize specific data.
Using that protocol, called Extensible Markup Language, or XML, Baylor can preserve and exploit the tremendous investment it has made in new versions of healthcare computer applications and replacement workstations required to avoid Y2K problems, says Mike Miller, Baylor's chief technical architect. XML allows Baylor to aggregate information extracted from its many disparate hospital systems and physician practice data sources, he says.
Unlike the prevailing Internet protocol known as HTML, which converts data into a standard format for presentation on a World Wide Web browser, XML can "read" the content and decide how to route and index data, says Jeff Mason, Sequoia vice president of corporate communications.
That enables Baylor to assemble patient information from admissions, transcription and laboratory systems on one screen for a clinician. The information is displayed in an easy-to-use way but retains an interactive connection to the sources.
As a result, clinicians with predetermined rights can revise a transcription or order a new lab test by interacting with the information on the screen-without training in the application from which the data originates, Mason says.
Because the computing scheme is based on an Internet standard, it can manage data and applications from internal and external sources consistently, erasing the line between the Internet and hospital systems.
That sets up the industry for a new generation of computer system development that leverages the Internet and standardizes healthcare applications based on the same XML format, says Robert Pickton, Baylor's senior vice president and chief information officer.
Meanwhile, the new systems continue to communicate with the older information systems that are fitted for XML-based data management. Ultimately the diverse information sources can be channeled to Web browsers anywhere in the Baylor service area to create a singular and universally accessible "portal view" for the healthcare system, Pickton says.
But the long-term potential of the Microsoft blueprint depends on its acceptance among suppliers of healthcare computerization, Vogel says. "It's going to require a lot of participation on the part of vendors."
Microsoft says it has support from several vendors and customers, including Partners HealthCare System in Boston, Sequoia Software, Shared Medical Systems in Malvern, Pa., and Superior Consultant Holdings Corp. in Southfield, Mich. The Microsoft Web site also is replete with details to jump-start development.
Though most of the development work in healthcare would be left to vendors using Microsoft building blocks, the Redmond, Wash.-based software giant is developing its own onscreen presentation called a "digital dashboard," which can search out specific data from the Web and from a hospital's information systems and organize it all for a particular user.
"Part of the idea here is that someone can set this up according to their individual interests-mixing in what kinds of data actually drive their daily activities," Gates says. "And so you could have stock quotes, weather information, your voice mail notification-along with all that patient data and analysis-brought together exactly the way that you want it."
Underlying Microsoft's activity is a desire to "accelerate the pace of business change" in healthcare, which has been moving too slowly despite the need for breakthroughs in cost reduction, says Joel French, vice president of strategic development at Superior Consultant. "Microsoft is intensely impatient" with the inertia of decisionmakers, but healthcare executives also are rightly skeptical of spending more on information technology without assurance of return on investment, he says.
"The CEO is not looking for master plans. He's not looking for committees to vote on features and functions. I think those days are gone," French says.
Reorienting information technology around Internet innovations can better align software and business solutions, capitalizing on information that is available but difficult to use, says Deb Davis, division president of Superior Consultant.
"We have got to revolutionize IT, because the capital is not there," Davis says. Future information strategy "will be driven by the CEO's office and driven by business value and not technical minutiae," she says.
Internet-oriented architecture may sound like technical minutiae, but, French says, it's a framework for big-picture business strategy, enabling healthcare systems to change more quickly with less risk and less threat of technological obsolescence.
Microsoft's selected solutions won't succeed, however, unless they show results in practice. "If value is proved, (Microsoft's solutions) will be standards," French says. "If value is not proved, (they) will be just a lot of noise."