Last week I met with two company CEO's here in Redmond who wanted to show me their latest solutions for telemedicine, bedside monitors, and home health remote monitoring.  It should come as no surprise that neither company is based in the United States.  If you've been a follower of this Blog you know that I tend to see much greater use of telepresence technologies in healthcare beyond US boarders and especially overseas.  It's not that we don't have the technology in the United States, it's just that the business model for using it isn't as compelling as it is in countries that have more centrally managed, publicly financed health systems.

The first company I met with was TeleMedCare of Rosebery, Australia.  Professor Branko Celler, TeleMedCare CEO, is a bioengineer by training.  You might assume he was a physician when hearing him speak about the telehealth solutions his company has pioneered.  Throughout the demonstration of TeleMedCare's latest solutions and devices, their clinical rigor shined through.  Professor Branko (he still maintains a professorship at New South Whales University) is passionate about using technology to extend health information and medical services to people with chronic diseases.  He totally understands why such an approach not only saves money, but improves personal health and well being.  He cited numerous examples of this from the many pilots his company has conducted with patients in Australia and the UK.

I was particularly impressed by seeing the company's latest telehealth monitoring station in action.  The station is about the size of a small, flat screen television.  It can measure temperature, pulse, blood pressure, weight, peak flow, pulse oximetry, and glucose using a variety of attached and Bluetooth compatible devices.  The unit can also handle fall monitoring and social alarms, do health screenings and patient education, and provide medication management and monitoring functions.  With a built in camera and voice over IP setup, it can serve as a real-time telemedicine link to the patient's own healthcare providers.   The monitoring station was remarkably unobtrusive and simple to use.  According to Professor Branko, even elderly patients adapt to the technology with ease.

My second meeting was with a company I've been following for some time.  That company is QualiLife, one that I've written about previously on this Blog.  QualiLife is based in beautiful Lugano, Switzerland.  I've met with QualiLife CEO, Claudio Giugliemma, on several prior occasions here in Redmond and also in Zurich.  In our meeting last week, Mr. Giugliemma updated me on his company's latest technologies including their new patient bedside counsels.  These flatscreen devices provide hospitalized patients with music, television, movies and patient education on demand, Internet access, e-mail, messaging, and voice and video communications.  In a federated network, doctors can do virtual rounding on their patients from anywhere.

QualiLife got its start by developing computer software for people with disabilities.  By applying this discipline to their bedside counsel solutions, the company offers a user interface to its applications that makes them accessible to anyone regardless of age or disability making this the ideal solution for hospitalized patients.

Unified communications technology is now being combined with smart software, affordable base stations, and a full array of connected physiological monitoring devices for use in the home, hospital, and everywhere in between.  This signals the beginning of a revolution in telehealth; an independence day or sorts for telepresence in healthcare.  It's time to celebrate.  And for my US readers, Happy 4th of July!

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

"In a controlled nonclinical trial setting, RFID technology is capable of inducing potentially hazardous incidents in medical devices. Implementation of RFID in the ICU and other similar health care environments should require on-site EMI tests in addition to updated international standards".

So concludes a study published in the June 25th edition of the Journal of the American Medical Association.  In the study, incidents of electromagnetic interference with medical equipment were far more common with passive 868-MHz chips than active 125 kHz RFID systems.  The median distance at which all RFID incidents occurred was 30 cm with a considerable range up to 600 cm.  41 medical devices (IV pumps, anesthesia machines, monitors, defibrillators, etc.) were tested using both chips.  The results included a total of 34 incidents of reproducible electromagnetic interference, 22 classified as hazardous and 2 as significant and 10 as light.

The results of this study are cause for concern and may prompt some hospitals to seek alternatives to RFID for real-time tracking of equipment or staff especially in critical care areas of the hospital.  One such alternative was brought to my attention during a recent visit to hospitals in Norway.  At the grand opening of the European Center for Health Innovation in Oslo, I met briefly with Ragnor Bo, CEO of Sonitor.

Sonitor is a physician-founded company that has pioneered the use of ultrasound in an indoor positioning system that can automatically track precisely, by room, the real-time location of moveable equipment and people in complex indoor environments.  Mr. Bo handed me one of the company's patient wrist bands (pictured).  The bar-coded band has a light-weight ultrasound tag.  The tag is housed in a disposable outer case that also contains a small battery that powers the device.  Similar tags and receivers can be used to precisely pinpoint the location of equipment or personnel within a room or even focused sub-zones of  room.   USID, as the technology is sometimes called, is much better than RFID for room-level location because ultrasound waves, unlike radio frequency energy, don't go through walls or floors.  The tags are also being applied in scenarios that enable proximity log-on to computers or other equipment.

A detailed review of USID is out of scope for this Blog.  However, you can learn much more by visiting Sonitor's web site.  They also have a very nice animation that illustrates why USID is better than RFID for precise room location tracking.  I suspect the article in JAMA will only accelerate Sonitor's success in the marketplace; success that has already placed the technology in 27 hospitals,  23 of these in the United States.

Bill Crounse, MD   Senior Director, Worldwide Health    Microsoft Corporation

I'm back from my travels in Norway.  While I was gone, we published a compelling case study that illustrates how software can be used to improve patient care in busy clinical settings. 

At Microsoft, we published dozens of health industry case studies every year.  But it's not every day that we get quotes like this one.  "In three days’ time, Microsoft and Orlando Software Group were able to provide us with more business intelligence and insight than we were able to achieve in two years of study."  Those are the words of Dr. Christopher DeFlitch, Director and Vice Chair of the Department of Emergency Medicine at Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania.  Dr. DeFlitch is a strong advocate for process modeling and analytics tools in managing core process redesign initiatives in healthcare delivery systems.  Recently, DeFlitch and his associates learned about ProcessView, a design and analysis tool and add-in to Office Visio Professional 2007, from Microsoft Certified Partner Orlando Software Group.  They used the software to simulate and analyze complex and time-critical processes involved in properly diagnosing and caring for acute coronary syndrome patients arriving at the ED.“In about three hours, we were able to create a top-level process flow diagram for the overall process,” says Frank Kapper, Vice President and principal partner of Orlando Software Group. “We found there were 88 unique workflow paths, and within that, 15 workflows occurred 90 percent of the time.” With this information, the department was able to focus on the highest-occurrence workflows and make sure it had the proper staffing, equipment, supplies, and other resources.

There is a whole lot more to this story than I am able to cover on my Blog.  You can read the full case study here.  Any physician, nurse, or administrator charged with improving clinical workflow and quality of care outcomes will benefit from reading the report.  It's just one more example of how software can be applied to solve some of healthcare's most pressing issues in caring for our patients.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation 

My Norwegian healthcare tour comes to a close today.  On Wednesday we visited with physicians and executives at Asker and Baerum Hospital. We also participated in the grand opening of the European Health Center of Excellence.  On Thursday, we met with officials representing the 15 hospital trusts in the South East Norway Regional Health Authority and toured the new $1.6 Billion Akershus University Hospital.

Asker and Baerum is a more typical Norwegian community hospital and certainly less glitzy and grand than the newer facilities we visited.  However, the physicians at Asker and Baerum were absolutely delightful and extraordinarily engaged in our discussions about clinical information systems and the opportunity to use IT to improve care quality and safety.  I especially enjoyed meeting a young doctor, Arne Soraas, who was responsible for the intensive care unit.  Dr. Soraas and his peers have developed on-line tools and workarounds that help solve workflow issues not addressed by their core clinical systems.  All patients at the hospital have an electronic chart, but we agreed there were many opportunities to improve staff productivity and access to information at the point of care.  It was refreshing to see physicians so engaged and interested in using computers in the care of their patients.  Could it be that this new, young generation of doctors, physicians who literally grew up with the PC, will take this industry where it needs to go? The hospital lacked a wireless network, and we all agreed the physicians would be better served when mobility is added to their solution mix.  In the meantime, they are quite happy using their clinical work stations.  A recently added speech recognition system helps speed data input.

Wednesday afternoon I provided a keynote for the grand opening of the European Health Center of Excellence.  The Center is a joint project of HP, Cisco, Imatis, Telenor and Microsoft.  It features a two-bed hospital room mockup with some of the very latest solutions for patient monitoring, bedside patient entertainment and communication systems, and caregiver collaboration solutions.  Visitors to the center will have an opportunity to "test drive" and learn more about these technologies as they plan implementations for their own facilities.

On Thursday afternoon, we visited the new Akershus University Hospital.  Like St. Olavs Hospital in Trondheim, this is a full replacement program for the university's old facility.  The new hospital is designed totally around the patient experience and offers amazing architecture, soothing environments connected to nature, and of course, a lot of high-tech, digital technologies.  The cost of the new facility will be offset in part by expected increases in staff productivity and streamlined operations from the hospital's advanced IT solutions and improved clinical workflow.  The entire project has been guided by the hospital's own employees and division leaders with a lot of input from patients.  Everyone is looking forward to the grand opening of the university hospital's new facilities.

I would like to give special thanks to my Norwegian hosts.  In particular I would like to thank Dr. Jan Stomer in Tromso for his generous hospitality during my visit.  I would also like to give special recognition to my Microsoft colleagues Jan Rylund and Helge Blindheim for their tireless efforts in planning the agenda, meetings, tours, and entertainment for my visit to Norway.  You guys rock!

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

The past few days of travel in Norway have been truly eye opening.  After leaving Tromso on Monday, we headed to Trondheim where I had an opportunity to hold meetings with clinical and administrative leaders and take a tour of St. Olavs Hospital.  The hospital is nearing the tail end of a rebuilding project that started in 1999 and will finish in 2012.  They started with the notion that the patient would be at the very center of everything in the design of their new facilities.  Some 5500 employees now work at St. Olavs.  The campus includes, or will include, a heart-lung and emergency center, a women's and children's center, and centers for neurology, gastroenterology, mobility, and psychiatry.  There is also a knowledge center, patient hotel, lab and supply center.

The various buildings on the sprawling campus are connected by an underground tunnel system.  Supplies zip around on laser controlled robotic  pallets that greet you and kindly ask you to step to the side if you happen to be in their way. Lab samples and small supplies are routed by an extensive pneumatic tube system.  Patient rooms are private and arranged in small clusters.  The rooms feel very home-like and have all the modern conveniences including flat-screen bedside monitors that provide access to television, e-mail, movies, Internet, and a variety of other services.   All data, telephony, voice and video are IP.  The hospital also has a reasonably contemporary clinical IT system.  All patient records are electronic, although paper still exists in places.  The day I visited, they were in the process of turning off all hospital printers as one more step in the transition to a fully digital campus.

I had a nice visit with one of the staff physicians, a geriatric specialist, Dr. Sletvold Seksjonsoveriege.  He took me on a tour of a typical patient floor.  He admitted that the transition to digital hadn't been easy, especially for some of the older members of the medical staff.  None-the-less, he applauded the progress that had been made and the improvements in patient safety and care quality.  He said that younger members of the staff were eager for even more technology.

If you happen to find yourself in Trondheim and want to experience a truly contemporary and increasingly digital healthcare delivery system, take at look at St. Olavs.  You will leave feeling quite optimistic about the future of healthcare.

Next time, I'll tell you about some of the other healthcare facilities I visited on my trip to Norway and the grand opening of the European Health Innovation Center in Oslo.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

High quality healthcare today can only be delivered by multidisciplinary teams consisting of doctors, nurses, pharmacists, therapists, social workers and others.  This often includes caregivers who work out in the community and in patients' homes.  But such "teamwork" can lead to fragmented information and work processes that put quality at risk with duplication of patient records, unnecessary tests, and prolonged hospital stays.  Effective caregiver collaboration requires an integrated information environment. Clinicians need access to patient information from a variety of locations. The information must always be up to date, and the exchange of information from one caregiver to another must be done securely. In addition, the tools that enable such exchanges and collaboration must be familiar, affordable, and easy to use.

In the latest edition of my House Calls for Healthcare Professionals audio-cast series we examine how contemporary information technology is being used to solve this problem at Eastern and Coastal Kent Primary Care Trust in England. We reveal how healthcare workers in the field can communicate and collaborate with each other and with their hospital or clinic based colleagues more efficiently, no matter where they might be? We make the case that this kind of facilitated collaboration contributes to improved patient safety and caregiver satisfaction. 

This special program examines how one division of what is perhaps the world’s largest healthcare delivery system, has solved their need to improve collaboration across multidisciplinary care teams.  My guest is Julie Ansell, a clinical specialist in intermediate care at the UK National Health Service’s Eastern & Coastal Kent Primary Care Trust.  Also joining me on the program is Ray Jordan, solutions director with Microsoft partner D2i Solutions Ltd.

To listen to the audio-cast click HERE.

Also available for MP3 download

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

I am writing this from Tromso, Norway, where later today I will deliver a keynote address at the Tromso Telemedicine and eHealth Conference.  Preceding me on stage is Dr. Clayton Christensen of Innovator's Dilemma fame.  I believe my message on healthcare delivery innovation and the power of commodity IT will reverberate well with what Dr. Christensen has to say.

Tromso is a town of about 60,000 residents in Norway's north.  It is so far north, on the same latitude as Barrow, Alaska, that the sun never sets during the summer months and likewise never rises during the winter.  Tromso is also home to the University of North Norway, the northernmost university in the world.  The university was founded in the early 1970s with a medical school to help secure Norway's northern regions with a sustainable population of physicians. The university has since expanded to offer degrees in fishing management and oil and gas engineering; degrees perfectly aligned to the region's natural resources.  This might be the last place you would expect to find an internationally renowned research center for telemedicine and e-health but that is exactly what is here.  Tromso is home to the internationally recognized Norwegian Center for Telemedicine, chaired by Dr. Steinar Pedersen.

I had an opportunity to tour the telemedicine center with Dr. Pedersen and university hospital with Dr. Jan Stormer.  I have long known that Europe's Nordic countries lead the rest of the world in the use of electronic medical records.  That is not to say that I didn't find any traces of paper in the university hospital. There is certainly room for even greater automation and improvement in clinical workflow, but I must also say that the hospital is a modern marvel of clinical IT.  I had a nice conversation with a young orthopedic physician, Dr. Petter Gjessing (pictured), who lauded the hospital's clinical systems but as a young man who has grown up with computers, clearly yearns for even better solutions that are more contemporary, powerful and user-friendly.

  The research, services and programs offered in by the Norwegian Center for elemedicine are no less remarkable.   While many countries are only now exploring home health monitoring, ehealth applications for the management of chronic disease, virtual clinical visits on the web, and cell phones and cellular networks as a platform for tele-health services, the telemedicine center in Tromso has been breaking new ground for more than a dozen years.  I was especially impressed by a tele-dialysis program developed by the center that is moving dialysis from hospital and clinic into the home.

This evening we head to Trondheim and later to Oslo where on Wednesday we will hlep open the European Center for Health Innovation.  Stay tuned for more.

Bill Crounse, MD    Senior Director, Worldwide Health   Microsoft Corporation

On a recent post titled "Improving Preventive Care Compliance" I nudged my clinical colleagues to be more proactive in reminding patients about needed preventive services.  I made comparisons to service notifications that are typical in other industries and the relative paucity of this practice in clinical medicine.  I also provided an example of how technology is being applied to help doctors do a better job.

One of the great things about blogging is its worldwide reach, and the great feedback that I receive on what I write.  A young physician named Jessica read my post and provided what I think is an important perspective on the topic of IT and barriers to wider adoption by physicians.  If you are an IT professional or a developer of health IT solutions, this is definitely worth a read.  I'm sure Jessica speaks for all clinicians on why IT adoption is a two-way street. 

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Dr. Crounse:

As a doctor myself, I am pleased to see this comparison. It is all logical and certainly a great solution for automating routine documentation. There are certainly challenges, however, and the statement you made below, Bill, urged me to comment (although a bit off topic of the article.)

You commented "so doctor, no more excuses!"

I recently attended an eHealth conference in Gothenburg, Sweden (www.mie2008.org) which was a great gathering for the scientific eHealth community, as well as a chance to meet with the vendors of Scandinavia that are well represented in this area of development, whether in the hospitals, primary care setting or even in the community. My bottom-line observation was, eHealth is gaining speed!

Anyhow, I was particularly impressed with a lengthy chat I had with one of your IT savvy partners from Microsoft Sweden. He was the "how and why" guy. So basically, he was talking to me about "How can hospitals, healthcare professionals use what they have more effectively?" and "Why are we so inefficient with what we have and what we use today and is there anything hospital IT departments can do to effectively adapt to end users needs without implementing a whole new operating system? Is the change that is needed based on workflow patterns and training to effectively use what we have? Simply synching outlook for appointment challenges between the ward and the out-patient clinic, bed-managing through an interactive network, etc.

And this is where I got interested...and where I need to reiterate that it is not just about "So doctor, no more excuses"...but also about "So IT technician of the hospital, WHERE ARE YOU?

To give everyone an example,

As a junior doctor for the NHS (in the UK) we received an induction, where  apart from standard information about hospital policy is given, the IT specialists of the hospital give a training session, which was superb...but not enough.

I started my first shift as a junior doctor on a night shift. I was fully supported by my senior doctor staff, nursing staff to be effective and prepared for all encounters. But when I needed to sign-in for the first time onto the computer system to check lab results of an ill patient...I reached a dead-end, no IT tech was available to authorize my newly created account...

My battle didn't end there and I was one of the few doctors (who bothered) to approach the IT department of my hospital pertaining to my disruptive work-flow experiences.

First of all, it was a challenge to get a computer engineer/technician on the phone. After so many attempts I began to wonder WHY? So I once brought it up with my colleagues during lunch, who one of which had a mobile number to one of the IT techs that was kind enough to help out the junior staff. It, furthermore, generated a heated debate with all doctors at lunch that day wondering, "What do the IT technicians do day in and day out in a busy hospital?" Surely I would list supporting end-users with the services they are implementing a key task within their work list.

Second of all, it would be of great benefit to see the health care environment working together on this enormous 'change-of-paradigm-within-the-healthcare-system' sort-of project.

Doctors are often considered as the ones not wanting the technology. Being brief, this is not true. However, I can sympathize and even agree with my senior colleagues and non-IT approving ones that without support and incentives, this will never win the approval of key end-users.

I conclude with my statement for hopes of a diplomatic discussion with the IT health techs out there reading Bill's Healthblog..."Where are you guys?"

I can imagine you have lots to do with supportive, technical aspects of the job but I would encourage you to provide better service to end-users...whether through brief workshops during lunch or through a user info-line hospital staff can reach!

Kind Regards,

Jessica Gabin

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Thanks for keeping folks on "both sides of the isle" on their toes, Jessica.  Your comments are very much appreciated.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation

Last week I received a postcard from my auto dealer. It was time to bring my car in for service.  They also send me email reminders and call me should I fail to make an appointment.  I get similar reminders from my dentist.  I even get reminders each year from the city letting me know it is time once again to test my lawn sprinkling system for "back flow".  On the other hand, I cannot remember the last time I got a notice from my doctor that it was time to come in for a checkup.  I guess he's got so many patients that he doesn't need the business, or maybe he doesn't really care that much about keeping me healthy.  One could wonder!

That's why I was particularly pleased to see a new case study from one of our customers.  It concerns a health plan that's been using our unified communications technologies to improve patient outreach and compliance around preventive care services.  The health plan is Care1st in Monterey Park, California.  Working with technology partner 4PatientCare, they implemented an automated interactive patient communication and scheduling system based on Microsoft Office Communications Server 2007.  According to officials at Care1st, the solution has dramatically increased the number of people who are getting appropriate initial health assessments and needed preventive services.

The unified communications solution contains an automated decision tree which gives patients different action options when they receive a call from Care1st reminding them of available services.  They can schedule an appointment for a specific time and date, or let their provider know that they would like an initial health assessment but are not yet ready to make an appointment.  In all, there are more than 100 "nodes" on the decision tree to accommodate nearly all of the possibilities that the system might encounter when interacting with a Care1st member.  Patient like the system because it is so easy to use.  According to Care1st, the automated system does a much better job of documenting their patient outreach activity and is also saving money compared to what was previously spent for patient calls and reminder mailings.

So doctor; no more excuses!  You can read the full case study and get more information about unified communications solutions from Microsoft and our partners here.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation

Last week I was invited to provide the luncheon keynote to a group of hospital and health system executives in San Francisco.  They had gathered under the auspices of The Leadership Institute to share best practices and hear from a select group of outside speakers.  Institute meetings are closed to non-members.  This provides an opportunity for individuals attending the meetings to share information with each other in complete candor.  Even as an invited speaker, I wasn't able to attend other sessions on the agenda although I did receive an invitation to join the group for dinner the evening after my presentation.  This not only made way for some great business discussions, but also gave me a chance to get to know some of the members I hadn't met before.  I'd like to share their names and titles with you, but even that would be breaking protocol with Leadership Institute rules.  Let's just say this group represented some of America's finest and best known healthcare organizations.  Many of the names would be familiar.

The next morning, as I sat in my room at the Huntington Hotel on Nob Hill pondering the terrific view and the many conversations I had had with LI members the day before, I was feeling pretty good about leadership in American healthcare.  These are not the men and women who legislate, capitate, and squeeze the system for all it's worth.  These are the people charged with meeting ever increasing demand for care in their communities in the face of labor shortages, budget shortfalls, cranky providers and increased scrutiny at every turn.  They are also grappling with a pressing need to modernize care delivery and the tools they must use to survive in a healthcare world that is increasingly global and competitive.

It was most reassuring to learn that many of these executives are well-traveled.  I speak and write a lot about the growing competitive threat to American healthcare coming from Mexico and overseas.  My concern wasn't lost on this crowd.  Many of them had personally visited the sites I reference in my lectures and have seen firsthand the digital infrastructure and modern IT investments being made by their foreign competitors; investments that are driving cost and quality transparency breakthroughs and enabling global outreach.

As you might expect, there weren't too many Gen Xr's and Y's in the crowd with the exception of my daughter who lives in San Francisco and works for Google/YouTube.  The Leadership Institute was kind enough to include her as my guest at their dinner.  Actually, I think everyone at our table enjoyed the conversation as it turned to what our kids are doing and how they all work and play a bit differently than their parents.

Hospitals and health systems would be well served to harness the energy and wisdom of our youth.  These are, after all, their future customers.  And, I'll bet they see the world a bit differently than the digital immigrants found in most hospital board rooms today.  Tapping into the thoughts of a new generation of physicians and patients might very well help set the course for a new era in American medicine that is more high-touch and certainly more high-tech from an IT perspective.  Who knows, doctors might even learn how to "text" their patients and one another instead of playing phone tag all day.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

On several occasions, I've told you about some excellent work that is being done to help define a common user interface for clinical applications.  This work addresses the important patient safety and user dissatisfaction issues that arise when clinicians are forced to use software applications in clinical practice that all look and behave differently.  Imagine moving from hospital to hospital or clinic to clinic and encountering an entirely different user interface and clinical system each place you work.  It would be like asking accountants to be equally proficient on a wide variety of spreadsheet applications or writers to know how to expediently edit on every kind of document software on the market.   That just wouldn't work.  Clinical work-flow is no different.  We clinicians need standardized applications and a common user interface to help us practice medicine safely and efficiently, no matter where we are.

As far back as 2005, Microsoft started working with developers, clinicians and other experts in the United Kingdom's National Health Service to define a common and more standardized user interface for clinical applications.  In July of 2007, Microsoft made this work available free to developers around the world by launching an initiative and web site known as MSCUI (Microsoft Common User Interface).

MSCUI provides User Interface Design Guidance and Toolkit controls that address a wide range of patient safety concerns for healthcare organizations worldwide, allowing a new generation of safer, more usable and compelling health applications to be quickly and easily created.  The newest release of this work, V1.3, is aimed at user interface designers, application developers and patient safety experts who want to find out more about the benefits of a standardized approach to user interface design.

There are 5 key elements to the newest release:

1. The announcement of a new Technology Strategy moving to Silverlight 2 and Windows Presentation Foundation for all future controls, samples and demonstrators.
2. Publication of an interactive Delivery Roadmap outlining what guidance and controls we will be developing, when and how the community can engage.
3. Publication of new and updated Design Guidelines.
4. Publication of a new Medications Listview control for Silverlight 2 and WPF.
5. Launch of a new Patient Journey Demonstrator which showcases CUI design guidelines, controls and future UI concepts in a Silverlight 2 application

I think clinicians and developers alike will be especially thrilled to see the CUI design work and future concepts featured in the Patient Journey Demonstrator.  To my way of thinking, this is what clinicians have been waiting for all along.  This is truly an advanced look at the next generation of clinical systems, and the kind of software we'll be using to care for our patients in the years ahead.

My congratulations and thanks to colleagues Andrew Kirby, Su Brown, and the CUI Clinical Applications & Patient Safety team in Microsoft Services UK for another great release of the Microsoft Health Common User Interface.  You can learn more about MSCUI by visiting the web site or watching this video I did last summer with Microsoft UK services director, Andrew Kirby.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation

Regular HealthBlog readers know that I'm a huge proponent of eHealth and tele-health as a means to extend healthcare information and services to citizens around the globe.  In my world travels I see plenty of evidence that we are entering a new age in the provision of care; harkened by a need to help control spiraling costs, improve access, and extend a dwindling and aging population of skilled healthcare professionals.

A few weeks ago on HealthBlog, I told you about a tele-health project that Microsoft's Unlimited Potential group has been working on in rural India.  Imagine remote villages, dusty roads, and formidable distances that must be traveled in order to reach any kind of clinic or doctor.  Such is the case in places like the districts of Barielly and Madhubani in India where 70 percent of the population (some 700 million people ) live in rural areas.  People needing medical care must sometimes travel 10 to 12  hours or more to see a doctor, if they can even find one who is willing to care for them.  Villagers complain of being preyed upon by charlatans and witch doctors who take their money but don't solve their health concerns.

Working with local partners and medical facilities, Microsoft has been piloting a tele-health project that helps connect people living in such areas with the information and skilled professionals they need.  With the assistance of a medical facilitator and by means of a computer and dial up Internet connection, villagers are able to discuss their health concerns with a medical professional at an urban center.  Vital signs, photos, medical records and other information can also be shared.  Simple problems can often be addressed then and there.  People needing more care can be referred for an appointment in town, but with greater assurance that when they make the long trip to get there, they will see the most appropriate specialist for their particular condition.

You can learn more about this exciting project by listening to the latest installment in my House Calls for Healthcare Professionals audio-cast series.  Program guests include Karishma Kiri, a director in Microsoft's Unlimited Potential group, and Michael Aldridge, group manager of UP's rural incubations team. The rural incubations team is chartered with the discovery and concept development of new kinds of relevant technology and services for underserved rural communities in the developing world.  I hope you enjoy the program.

Click here to listen

Click here to download (MP3)

Additional resources

•Microsoft Unlimited Potential

•Microsoft Unlimited Potential video, case studies and white papers

•Drishtee

•Neurosynaptic

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

Yesterday, I had the great honor to provide the opening keynote for eHealth Canada in Vancouver, BC.  Although I accepted the invitation to speak at the conference almost a year ago, nobody had to twist my arm.  I always enjoy my visits to Vancouver.  I think it is one of the most beautiful cities in the world.  Even better, this year's conference with a theme "extending the reach" was the largest ever.  More than 1700 people attended.  Contrast the view outside my hotel window there vs. where I find myself today, overlooking the always-expanding, over the top, mind blowing vistas of the Las Vegas strip.  The mission today was participating on two keynote panels at the Consumer Health World conference at the Venetian Hotel.  Although there's never a dull moment in Vegas and I always enjoy my stays; my soul is quite honestly much more at peace in places like Vancouver.

The topics at both conferences revolve around the growing consumer movement in health, opportunities to harness the power of the Net and technology to deliver healthcare information and services, and the upward trend in medical tourism.  On that last point, while there is no doubt that increasing numbers of people are traveling to other countries for elective surgical procedures and such, there wouldn't be much of a market for medical tourism if people could easily access and afford care closer to home.  The medical tourism industry is taking off precisely because both public and private healthcare systems around the world are challenged to provide accessible care that people can afford.  Therein lies an opportunity to harness technologies and "commoditize" products and services  that will help us provision care more effectively and efficiently than we typically do today.

One of the exhibitors at Consumer Health World is a company called Abaxis.  They've miniaturized the hospital laboratory into a box just 6 inches wide and 12.75 inches high.  The Piccolo xpress chemistry analyzer, as its called, can do an entire panel of blood chemistries using one tenth of a cc of whole blood in under 12 minutes.  While the market today for the Piccolo and similar devices is physician practices, it doesn't take any stretch of the imagination to see where this kind of technology is going.  It could just as well be at your local drug store or even in your home.  As our ability to miniaturize, standardize and simplify medical testing and imaging continues to improve, think of the implications for remote diagnosis, virtual consultations, and self-service medicine.  Add robotics to the mix, and perhaps even some of those elective medical procedures that people are traveling so far to get today could be done closer to home and still at a reasonable price; with robots guided by highly-skilled clinicians and technicians half a world away.  Definitely something to think about.

Bill Crounse, MD   Senior Director, Worldwide Health    Microsoft Corporation

I'm back in the saddle after a whirl-wind tour of duty at Med-e-Tel in Luxembourg (followed by bit of vacation).  Luxembourg may not be the easiest place in the world to get to in Europe, but I would highly recommend the annual Med-e-Tel conference.  Under the auspices of the Luxembourg Ministry of Health and Ministry of Economy, the event brings together hundreds of thought leaders and advocates for tele-medicine, eHealth and Health ICT from around the world.

It was my honor to speak during the opening keynote general session with government and industry luminaries.  It was also a good time to catch up with colleagues like Dr. Joseph Kvedar of the Center for Connected Health at Partners Healthcare System and David Whitlinger of the Continua Health Alliance among others.  Once again, as I perused the exhibit floor, I was struck by the degree of interest in eHealth in Europe and the advances being made,  Perhaps it is because of the greater socialized construct of healthcare in Europe, or maybe because governments there just seem to be more enlightened. Whatever the case, the Europeans are investing heavily in technologies to improve the delivery of health information and certain kinds of medical services electronically.

On another front, while I was away I received an e-mail that a series of interviews I did a few weeks ago for The Doctors Channel were now live on the web.  If you're a clinician, you'll want to check out The Doctors Channel; what some are calling "the YouTube for doctors".

During my interviews, conducted by TDC founders Drs. David Best and Michael Banks, we discuss my career (how I ended up at Microsoft), how the Internet is impacting patient care, and some of the new health industry solutions and initiatives for both clinicians and consumers now underway here at Microsoft such as HealthVault.  Just click on the links below.

    My Career                         The Internet                   Microsoft Health

Bill Crounse, MD     Senior Director, Worldwide Health     Microsoft Corporation

I'm going to be on the road the next few weeks for a business trip and some vacation.  While I'm away, I wanted to share two brand new videos in my House Calls for Healthcare Professionals series of audio and video programs. The topic is Mobile Devices and Solutions for Healthcare Professionals.

In the first program, we review four popular mobile devices running Windows Mobile 6.0.  If you're like me, you can't wait to get your hands on a cool new phone and we've got some really neat ones to show you.

In the second program, the CEO of IQMax, Paul Adkison, joins me for a look at the company's solutions for mobile healthcare professionals.  The dictation feature alone was enough to capture my attention!

And finally, since I'll be out for a few weeks, I just want to say thanks for your continuing support.  I made a quick video to extend my thanks to all of you for making HealthBlog such a popular destination for news, information, and opinion on information technology in health.   Bon voyage!

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation