Healthcare is very different from most other industries. It is fragmented, conservative, highly regulated, and hierarchical. It doesn’t follow most of the usual business rules around supply and demand or consumerism. An important aspect of my role at Microsoft is helping my colleagues at the company understand the many ways that healthcare is different from other “businesses”.
Having said that, there are a lot of things that healthcare could learn from a company like Microsoft or other technology companies. When someone asks me what it’s like to work at Microsoft, I often say what someone told me when I started at the company 13 years ago. Microsoft is like a global colony of ants, working independently and yet together but always “neurally” connected by enabling technologies. At any given moment, I can be connected to any one of my 100,000 fellow workers or tens of thousands of partners with just a couple of clicks or taps on a screen. I have tools that show me who’s available, what they do, what they know, and where they are. I can engage in synchronous or asynchronous communication and collaboration activities with a single member or multiple members of my team using messaging, email, voice, video or multi-party web conferencing. We can use business analytics tools, exchange information, review documents, co-author presentations, and collaborate with our customers and partners anywhere in the world from anywhere we might be. Our business moves, and changes, at the speed of light. It is the rhythm of the industry.
I sometimes wake up in the morning and think, “If only my clinical colleagues could avail themselves of similar tools and technologies how different could healthcare be?” I’ve been using information communications technologies in my daily work for so long that I almost take for granted that this is the way work is done. But I also know that in the real world of healthcare the journey is still quite different. That hit home again last week when I asked my mother’s family doctor for a copy of a report on an imaging study he had ordered. It took five phone calls to make something happen and my only choice was to receive the report via fax machine. Fax machine, really?
In my heart I know it is not totally as bleak as it seems sometimes. I could cite numerous examples of hospitals, health systems and clinics around the world that are using our latest technologies to improve health and healthcare delivery. I am well aware of the forces in retail health, specialty and concierge medicine, travel health, tele-health, mobile apps, wearable devices, sensors, remote monitoring, population health and health reform that are disrupting, and will continue to disrupt business as usual in the industry. That disruption can’t happen soon enough, although making significant changes to an industry as large and complicated as healthcare doesn’t happen overnight.
While we wait, I just want clinicians, managers, healthcare executives, and others who work in the healthcare industry to know that there are some readily available technologies that, even today, can significantly improve the way clinicians do their work and healthcare is delivered.
Categories: Uncategorized
Thanks everyone for weighing in on this post originally published on my HealthBlog (http://blogs.msdn.com/healthblog) some time ago.I beg to differ with those who think FAX is a secure way to exchange a sensitive document. Get the phone number wrong and your document could land anywhere. Even if the number is correct, who knows who might be looking at the document on the other end of the line. Also, for those who expressed concerns about on-line security especially related to contemporary cloud-based solutions, please read my colleague’s post here http://t.co/hPM4OZTwc0 .
It is amazing. The very society that has hand-crafted THIS particular healthcare system takes no responsibility for it, externalizing it and blaming it on a foreign cabal.
It is the VERY SAME society that has seen the computer revolution. Given our infantile tendency to label the “good guys” and the “bad guys” and fight the “bad guys,” is our current course of “compassionate obliteration” of hte current healthcare system really that sensible?
We should, as a society, take responsibility for WHY the healthcare system is so fragmented – it has not happened in Yemen, nor crafted by wily terrorists, but has grown up as the result of decisions made here in the USA – decisions and opinions that we are unwilling to reconsider.
We have, believe it or not, come to the conclusion that this is the best of all possible healthcare systems – we as a society, not ISIS. If we cannot change OUR assumptions and preferences, all changes are fleeting, and the system will restore itself to the same balance.
I agree that Healthcare is a very different industry from the most of other industries and if healthcare could learn from technology company for it will be beneficial for good health.
Nowadays, it is seen that many health industries are using such technologies for making better health, and there are certain examples you can find out for this.
@Peter1: “No, I dislike people who want government out of health care but like the tax advantages that make their HSAs work. It’s called hypocrisy.”
Peter1, don’t get angry and say things you will later regret. You know I don’t like the healthcare tax deduction and would be rid of it if possible even for HSA’s. I am forced to deal with second best solutions. A person who pays a higher premium for a low deductible gets the tax advantage for that extra premium. Why shouldn’t the HSA holder get the same tax advantage either with the savings on the premium or on the money spent for healthcare?
In any event the HSA is an idea that promotes savings and if applicable to the entire nation, would ultimately reduce prices. The studies have demonstrated that they reduce total costs and when an individual on an HSA wishes to save even more money they have the opportunity to bargain with a provider and get a lower price. Moreover, they have the cash to cover non covered items such as over the counter medications. The additional risk HSA holders have is relatively small since after the high deductible is reached the insurance covers the bill. That means most HSA holders can have a cushion should it be needed and they have control over the dollars.
Ultimately the decision we are making is who should control the dollars? The insurance company in conjunction with the government or the patient in conjunction with the insurance company? I choose the patient.
This takes us to another mistaken impression, insurance company micromanagement. Insurers transfer risk from the individual to the company. They are indifferent about how that is done as long as they earn their profit. Thus it is ultimately the patient that determines what is covered unless government enters the picture and forces the insurers to do things they wouldn’t normally consider doing.
“Cronyism exists in all politics, state and local”
There you are correct, but when the dollars are broken into smaller pieces the lobbyists become less and less willing to spend a lot of money to get government to do their bidding. That is why governments of all sizes should be restricted from having too much money to spend.
” I find most people talk freedom but want the money anyway.”
That is true and that is another reason we should restrict the amounts of money governments have to spend. That does not mean government has no place in these types of things. It only means government’s place should be limited.
“you seem to dislike HSA’s ”
No, I dislike people who want government out of health care but like the tax advantages that make their HSAs work. It’s called hypocrisy.
“They have also cut costs without overall negatively affecting care.”
No, they have not cut prices for health care, they have transferred costs and risk to patients. The lower your income the higher the risk, the higher your income the larger the tax incentive and the lower the risk.
“Insurance companies by nature don’t micromanage.”
They micromanage the payment system. Narrow networks and refusal to pay for certain procedures are two examples of micromanaging delivery of care. They also routinely frustrate premium payers by slow pay/no pay tactics.
“It seems that you like crony capitalism where the feds have huge amounts of cash to give to their friends.”
Cronyism exists in all politics, state and local. I doubt you oppose the politicians you vote for of practicing it, and I imagine you have hobnobbed with a few political cronies in your day. If states want more freedom from the feds they’d better start paying for more local stuff themselves. I find most people talk freedom but want the money anyway.
“The best solution is to end the tax exemption for healthcare.”
Good luck. Would that include HSAs?
“Targeted subsidies can be used in any of the circumstances to provide the truly needy”
I guess you thought your HSA tax subsidy was for the truly needy.
“You think that is sound political and financial policy? No wonder we have so many problems and so much pork.”
You have a consistent knack of misinterpreting my posts.
Peter1, you seem to dislike HSA’s though as a program they have worked for the middle class as well as the rich. They have also cut costs without overall negatively affecting care. What other program has done that?
It is true that the lower income group gets less of a tax deduction, but the same thing is true when their healthcare premium is paid in lieu of income. In other words it is a wash except the HSA has saved a lot of money and therefore can lead to lower premiums for everyone concerned.
“I guess you’d prefer insurance companies micromanaging.”
Insurance companies by nature don’t micromanage. They transfer risk in the manner determined by the purchaser. It is only when the government becomes too involved that they are forced to use micromanagement techniques. Why are you so afraid of permitting the patient to own his own insurance?
Federalism: It seems that you like crony capitalism where the feds have huge amounts of cash to give to their friends. Let the states and more local authorities manage most of the money that has to do with domestic affairs. That will end a lot of the crony capitalism that we see today.
Subsidies: The best solution is to end the tax exemption for healthcare. Second best is ether to give the exemption to everyone or to provide everyone with a fixed amount of money to help purchase healthcare
Targeted subsidies can be used in any of the circumstances to provide the truly needy with additional funds with the idea of having the least negative effect on the healthcare market place.
“You forget that the first job of a federal politician (after corporate donations) is to see how much federal money they can bring to their state.”
You think that is sound political and financial policy? No wonder we have so many problems and so much pork. I didn’t think you felt that way, but now I have a much better understanding of why we have so much disagreement.
“Peter1, I have been the one that wants to provide subsidies to those in need.”
allan, seems everyone in America needs a subsidy. From employer provided tax free, to HSA tax deductible, to Medicare, Medicaid and now ACA. Just who would your “in need” be?
“You want the government to own the plan.”
Who owns the plan now? Insurance, employer, patients, Medicare recipients?
“So far HSA’s are the only program that seems to be voluntary, growing and successful in keeping costs down so don’t knock them.”
Sure, with a tax subsidy and for those with incomes large enough to afford the savings/deductible amounts.
” However, as far as tax subsidies go I would end them if I could or I would give a fixed amount to everyone and end the need for government to micromanage healthcare.”
Fixed amount, from government? There’s that subsidy again. And who would determine how large the voucher for what income level?
I guess you’d prefer insurance companies micromanaging.
“Yes, it appears you want to grow government removing power from the states and the individual.”
The first step to getting the Feds out of your state would be to refuse all that free money poring in, especially in those “live free or die” red states. How about we start with FEMA subsidies for states that refuse to enact their own storm abatement programs. FEMA Is used as the federal redevelopment plan.
You speak as if you don’t get to vote for your federal reps. You forget that the first job of a federal politician (after corporate donations) is to see how much federal money they can bring to their state.
Fax machine?! It certainly sounds from what you say that the healthcare industry could do with a little “modernizing” in order to not only work more efficiently (cost savings) but also offer a better service to patients. After all, if waiting times could be slashed through the use of technology – without patient standards dropping – wouldn’t that be great for everyone?
“Ya, giving people subsidies to buy health coverage – how despotic.”
Peter1, I have been the one that wants to provide subsidies to those in need. You want the government to own the plan.
“Seems you didn’t mind the tax subsidies for your HSA”
So far HSA’s are the only program that seems to be voluntary, growing and successful in keeping costs down so don’t knock them. However, as far as tax subsidies go I would end them if I could or I would give a fixed amount to everyone and end the need for government to micromanage healthcare.
Yes, it appears you want to grow government removing power from the states and the individual. I want that reduced. By wishing for such a high degree of centralization of government you are paving the way for more dictatorial and fascistic power.
“they exert more dictatorial and fascistic power”
Ya, giving people subsidies to buy health coverage – how despotic.
Seems you didn’t mind the tax subsidies for your HSA and HD coverage – from the feds. Have you looked how many federal dollars flow into the states – especially red states? Don’t forget FEMA dollars for states that won’t enact storm measures.
There’s this really relevant article about how technology boosts healthcare services; it has just been published this week. You may want to read it as well: http://www.infinithealthcare.com/resource-center/10-ways-technology-boosts-healthcare-services/
@Bobby: “YOU were the one who called regulation “coercion” on this blog.”
You ought to start reading more carefully. I don’t know how many times you have misread something or taken something out of context. Where did I say all regulation is coercion? I accused some regulation of being coercive. It may well be that all regulation has some coercive qualities otherwise how would one regulate which side of the road to ride on? I never proposed anarchy or a lack of any government or any regulation. Once again I challenge you to find and quote my statements in context that would agree with what you say rather than relying upon your poor interpretation of what is written by others.
I also suggest that you start reading about the free market per Adam Smith and other economists that followed. Milton Friedman would be a good choice and the best book for a quick, but pretty comprehensive review of the most important things, would be Free To Choose that could be read by a sixth grader while at the same time is not well understood by many adults that dabble in this type of subject.
“Dyad. No mention of the requisite 3rd party.”
I didn’t mention the third element in the statement you referenced because most educated people recognize that the market relying upon contract needs the third for disputes, but it doesn’t require the third party except in rare instances.
@allan: “the willing buyer (patient) and the willing seller (physician) were permitted we would have a marketplace”
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Dyad. No mention of the requisite 3rd party.
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“Don’t conflate the free market as understood by most people with free market anarchism.”
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YOU were the one who called regulation “coercion” on this blog.
For contracts one needs judicial and enforcement bodies.
In todays world there is more requirements of government, however, government’s involvement should have the least interference with the marketplace as possible.
We also have to consider the concept of federalism. As central governments grow bigger and more powerful they exert more dictatorial and fascistic power.
Hopefully we can use technology to help the world with its health
With health care and technology we should be implementing factors on how we can use this to educate the public. With medical advancements being made all the time it is worth it for us to technology to our creation of good health.
“The marketplace will sort out the need for both security and ease.”
Does the marketplace include government?
So getting the report of your mother’s imaging study by fax was bad for her health because . . .
Peter1, I’m not sure what direction you are taking in your comment, but I will accept it as a positive one. The marketplace will sort out the need for both security and ease. In fact it would permit all methods to survive as long as there were enough individuals desirous enough for a method that would support it.
Bobby: The free market depends upon laws of the state and the enforcement of contracts. Don’t conflate the free market as understood by most people with free market anarchism.
Also take a look at section 8 of the Constitution.
“If there were only one man in the world, he would have a lot of problems, but none of them would be legal ones. Add a second inhabitant, and we have the possibility of conflict. Both of us try to pick the same apple from the same branch. I track the deer I wounded only to find that you have killed it, butchered it, and are in the process of cooking and eating it. The obvious solution is violence. It is not a very good solution; if we employ it, our little world may shrink back down to one person, or perhaps none. A better solution, one that all known human societies have found, is a system of legal rules explicit or implicit, some reasonably peaceful way of determining, when desires conflict, who gets to do what and what happens if he doesn’t.”
Friedman, David D. (2001-07-02). Law’s Order
“Law is the means by which society seeks to achieve some stability in the face of disagreement over just about everything.”
Linder, Douglas O.; Levit, Nancy (2014-04-06). The Good Lawyer
“Americans often think of the Constitution as a defensive document, designed to shield “the people” against the reach of government and “the states” against federal authority. But where is either in the list of purposes? In fact, the purposes are active—“ form, establish, insure, provide, promote, secure”; strong verbs that signify governmental power, not restraint. “We the people” are to be bound— into a stronger union. We will be protected against internal disorder— that is, against ourselves— and against foreign enemies. The “defence” to be provided is “common,” general, spread across the country. The Constitution will establish justice; surely this means not merely the Aristotelian ideal of giving each her own, but a system of justice, courts, judges, and jails. The new Constitution will promote the “general” welfare, not welfare varying by condition or by place of residence. It will secure our liberties— against whom?
There’s an ambiguity here; liberty could be secured against foreign enemies and domestic subversives, or against the new government itself. The latter interpretation is soothing to American ears; but in this context, it seems far-fetched. The clause appears in a list of things government is to do, not things it is not to do; a list of powers, not of prohibitions. The new government, it would appear, is not the enemy of liberty but its chief agent and protector.
The purpose then, in its most plausible reading, is to create a strong, active, national government, one whose benefits will flow directly to the people who create it. “Limited government” as an idea receives at best an incidental nod; the states are nowhere to be found. It would seem legitimate to interpret the rest of the Constitution purposively, as a remedial statute is interpreted in terms of the evil it seeks to remedy.”
Epps, Garrett (2013-07-12). American Epic: Reading the U.S. Constitution
“If men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary”
– Federalist 51
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The notion of an n-dimensionally dyadic “free market” devoid of independent, authoritative 3rd party regulation could not be more absurdly simplistic. Excluding perhaps the tribal regions of Afghanistan and the budding Islamic Caliphate of ISIL.
Yeah, morally and economically autonomous “willing sellers / willing buyers,” the “sanctity of contracts,” yadayadayada. All really swell. Until you need to turn somewhere for peaceful, effective remedy in the wake of a breach of contract.
“Fax machine, really?”
Bill, given the insecurity of the internet lately, for which Microsoft is the most insecure, why are you surprised? How upset would you be if your mother’s medical records were hacked – from a Microsoft platform?
allan, maybe that’s the free market you’re always illusion-ing to?
“If only my clinical colleagues could avail themselves of similar tools and technologies…” … “That hit home again last week when… I asked my mother’s family doctor for a copy of a report on an imaging study he had ordered.”
If the nitty gritty exchange between the willing buyer (patient) and the willing seller (physician) were permitted we would have a marketplace. I’ll bet that you would have gotten the report any which way you wanted and if not a good reason why. But medicine is not in the free market, rather under tremendous government control, so we have to expect inefficiency, high cost, a degeneration of quality and lines.
In addition:
At a forum sponsored by Khosla Ventures, Google co-founders Sergey Brin and Larry Page discussed the burden of health care regulations in the United States. When asked, “Can you imagine Google becoming a health company?”, Brin responded:
Health is just so heavily regulated, it’s just a painful business to be in. It’s just not necessarily how I want to spend my time. Even though we do have some health projects, and we’ll be doing that to a certain extent. But I think the regulatory burden in the U.S. is so high that I think it would dissuade a lot of entrepreneurs.
Page agreed:
I am really excited about the possibility of data also to improve health. But I think that’s what Sergey’s saying. It’s so heavily regulated, it’s a difficult area…I do worry, you know, we kind of regulate ourselves out of some really great possibilities.
Yes it would be easy to email, but see the attached about email and HIPAA. Then you will understand, since faxing is considered secure, and one would really need to employ an encrypted email service to be free of the concerns about a costly HIPAA fine.
Does the HIPAA Privacy Rule permit health care providers to use e-mail to discuss health issues and treatment with their patients?
Answer:
Yes. The Privacy Rule allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply reasonable safeguards when doing so. See 45 C.F.R. § 164.530(c). For example, certain precautions may need to be taken when using e-mail to avoid unintentional disclosures, such as checking the e-mail address for accuracy before sending, or sending an e-mail alert to the patient for address confirmation prior to sending the message. Further, while the Privacy Rule does not prohibit the use of unencrypted e-mail for treatment-related communications between health care providers and patients, other safeguards should be applied to reasonably protect privacy, such as limiting the amount or type of information disclosed through the unencrypted e-mail. In addition, covered entities will want to ensure that any transmission of electronic protected health information is in compliance with the HIPAA Security Rule requirements at 45 C.F.R. Part 164, Subpart C.
Note that an individual has the right under the Privacy Rule to request and have a covered health care provider communicate with him or her by alternative means or at alternative locations, if reasonable. See 45 C.F.R. § 164.522(b). For example, a health care provider should accommodate an individual’s request to receive appointment reminders via e-mail, rather than on a postcard, if e-mail is a reasonable, alternative means for that provider to communicate with the patient. By the same token, however, if the use of unencrypted e-mail is unacceptable to a patient who requests confidential communications, other means of communicating with the patient, such as by more secure electronic methods, or by mail or telephone, should be offered and accommodated.
Patients may initiate communications with a provider using e-mail. If this situation occurs, the health care provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual. If the provider feels the patient may not be aware of the possible risks of using unencrypted e-mail, or has concerns about potential liability, the provider can alert the patient of those risks, and let the patient decide whether to continue e-mail communications.
Health care IS like Microsoft.
Products difficult to understand and impossible to navigate but for the most proficient user, dominate control of market (not from innovation) and hugely frustrating to work with.
Please Microsoft, stay out of health care, it’s already complicated enough.
Healthcare care learn to embrace innovation without decades of studies (for some things)
And put the patient (read: user) at the center of the action: https://www.google.com/intl/en/about/company/philosophy/
You left out:
Move to more democratic power structure and less fragmented organization (sure, depends on the tech company, but in many cases)
Embrace a culture of creativity / innovation
Encourage failure
Build legal firewalls that encourage risk taking