The two physician developers of Azyxxi -- a unifying
health-intelligence software program that enables hundreds of
administrative and clinical systems to communicate with each other --
listened to many offers to sell before Microsoft Corp. came a
"We agonized for some time before deciding to do any deal," says Craig
Feied, M.D., former director of the Institute for Medical Informatics
at MedStar Health, a six-hospital system based in Columbia, Md. "We had
many suitors over the years asking to do a deal, and we always said
'no.' Hundreds of hospital CEOs have asked us to sell this system, but
we needed to wait for the right commercial partner."
Azyxxi (pronounced "Azixie" like "Trixie") initially was developed in
1995 using Microsoft's SQL Server database software. Feied and
co-developer Mark Smith, M.D., have worked together on medical
informatics since 1983.
"This health-intelligence engine I believe will solve a lot of unsolved
problems in medicine today," says Smith, chairman of emergency medicine
at MedStar's 786-bed Washington (D.C.) Hospital Center. "The big
problem is data is localized in separate information silos. You get
multiplicative power by bringing all that data together."
Azyxxi works by managing hundreds of terabytes of live data from
patient records that include electrocardiograms, scanned documents,
X-rays, CT scans, magnetic resonance imaging scans, positron emission
tomography scans, angiograms and ultrasound images. The program also
integrates business, financial, administrative and vendor information,
and stores historic data for quick retrieval.
"It will make any hospital program 10 times more effective," Feied
says. Smith adds: "It has the ability to transform healthcare in this
country. The tools and the power of informatics have finally caught up
with the vision and the need."
Feied and Smith -- two emergency physicians with decades of information
technology experience -- say Microsoft has the resources and the desire
to successfully mass market Azyxxi.
"We went as far as we could go on our own," says Feied, adding that
MedStar did not have the financial resources and vendor support staff
to sell and support Azyxxi. "Microsoft stands to be that vendor."
Feied says when Microsoft inquired about purchasing Azyxxi for an
undisclosed amount, "We were thrilled. This is the best technology
around in healthcare, and being picked up by the largest software
company in the world will help us get this to every hospital."
In September 2005, Microsoft entered the healthcare field when it
formed its Health Solutions Group to tap into the federal government's
recent interest in helping providers implement electronic systems to
reduce medical errors and costs, and improve quality and patient
In July, the Institute of Medicine issued a report recommending that
doctors and hospitals adopt e-prescribing by 2010 to reduce the
estimated 1.5 million annual preventable drug errors.
Feied says while it may take some time for Microsoft to start selling
Azyxxi commercially, "It will get done. You can't scare Microsoft out
of the market."
Before the sale, Azyxxi was co-owned by two companies founded by Feied
and Smith -- Datomics Licensing and General Datomics -- and MedStar
Health. In an alliance, Washington Hospital Center will serve
as Microsoft's development laboratory.
As part of the deal, 40 MedStar employees have become Microsoft
employees, including Feied and Fidrik Iskandar, Azyxxi's lead
programmer who has been involved in the project since 1995.
Feied, who recently spent a day in orientation training at Microsoft,
will become the general manager of Azyxxi development.
"It is quite different to be one day embedded in the health culture
surrounded by patients and the next day around Microsoft people," he
Smith, who remains at MedStar, will serve as chief liaison to
Microsoft. "We developed Azyxxi because we wanted a system designed by
clinicians, for clinicians," he says. "It helps patient care, helps
hospitals run better, and it helps the bottom line. ... Microsoft is
the right fit. I wanted to see Azyxxi acquired by a company that shared
our vision of its potential."
Before they went to medical school, Smith and Feied were trained in
Feied, a California native who graduated in 1978 with a degree in
biophysics from the University of California at Berkeley, paid his way
through medical school by forming his own information services
mail-order company that developed software programs.
"I had formal training in engineering and computer science, but it was
mostly in mainframes," he says. In 1982, he received a medical degree
from the University of California at San Diego.
"I will miss patient care," says the 52-year-old Feied, who also is a
professor of emergency medicine in the Georgetown University School of
"As an ER doctor I cared for more than 50,000 patients, but I will be
working on something that could affect millions of patients by reducing
errors and improving decisionmaking," he says. In 2005, Feied won
Microsoft's Physician of the Year Award. Smith, who also is professor
and chairman of emergency medicine at Georgetown, received a master's
degree in computer science from Stanford University in 1971.
"I studied computer science in graduate school, but I wanted to connect
more directly with people," says Smith, 59, a native of New York. In
1977, he earned a medical degree from Yale University School of
"My observation back then, and it still holds true today, is that
healthcare lags other industries by more than 20 years in the
application of information technology to the service of its mission,"
Smith says. "Most gratifying to me is that Azyxxi has enormous
potential to transform healthcare and provide doctors with tools to
First installed in 1996 in the emergency department at Washington
Hospital Center, Azyxxi is now used in all of MedStar's teaching,
community and rehabilitation hospitals. "In each hospital, the
underlying information technology structure is different," Feied
Regardless of the type of information system, Azyxxi allows users -- in an
eighth of a second -- to "view all the data about a patient, which had
been sequestered in different electronic silos," Smith says. "What the
Azyxxi system does is takes copies of each data atom from the different
electronic silos (as the data atom is generated) and puts them into a
uniform Azyxxi store."
Iskandar says Azyxxi interfaces with "hundreds of sources" at
Washington Hospital Center. "It works seamlessly, with nearly
instantaneous response time, and it is simple to use," he says. "It
takes five or 10 minutes ... to learn the system."
It also is used by the District of Columbia Department of Health for
management of such mass-casualty incidents as a bioterrorism attack and
in a variety of other settings in Arizona, Maryland and Virginia. The
Cleveland Clinic recently installed the system in a pilot project as an
imaging and data integration system.
"It has helped us double the amount of patients seen in the emergency
department over the years," Smith says, "and it has helped us improve
processes of care and identify opportunities to save money, improve
coding accuracy and billing." But Azyxxi's core contribution is to
"help clinicians provide safer, better and faster care," Smith says.
Feied says he plans to help further develop Azyxxi, but he also hopes
to delve into other projects. "We want to develop the personal health
record," he says. "There will be a fair number of initiatives to tie
hospitals back into the community through regional health information
networks, where labs, hospitals, doctors, pharmacies and clinics share
information to make it more accessible."
Jay Greene is a former Modern Healthcare reporter and now a
freelance healthcare writer based in St. Paul, Minn. This article
initially appeared in the e-magazine Modern Physician. Contact Greene at href="mailto:[email protected]">[email protected]
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