Microsoft and Azyxxi: What does it mean to our industry?

So what does the announcement of Microsoft’s acquisition of Azyxxi mean to the healthcare industry?  In my opinion, it is an important first step in a journey that will produce huge benefits for clinicians and patients.  First and foremost, it signals an important change in strategy for our company.  I’ll let you read the article in the New York Times for more on that. 

More importantly, I believe it takes healthcare information technology and those who build solutions for the industry in a whole new direction.  If you’ve followed my Blog and some of the articles I have written, you’ve seen my rants on the clinical systems commonly in use today.  You’ve read why I believe we must evolve to a more common user interface that is so intuitive; clinicians need little or no training to use it.  Community doctors move from hospital to hospital.  Nurses move around as well.  We are becoming increasingly mobile and we need solutions that work no matter where we are or what device we are using.  We cannot expect healthcare professionals to change the way they work depending on the particular hospital they are visiting, or for that matter, the state, region or country they are practicing in.  It is difficult enough to do patient care without having to learn a dozen different ways to do the work-flow depending on what clinical information system or systems are in use.  Think of the analogy of driving a car.  You may need a little time to familiarize yourself with the controls for a given make and model and then adjust for regional variations by country (traffic signs or what side of the road to drive on) but once you know how to drive a car, you can generally jump in and start driving it no matter where in the world you are.

The Azyxxi solution came about, as most good things do, out of sheer frustration.  One of the physician developers told me his hospital had spent hundreds of millions of dollars on clinical systems the doctors working there couldn’t or wouldn’t use.  Using commodity software and the latest technologies from Microsoft, they built a solution that aggregates clinical information from all the disparate systems in use.  With sub-second response time it securely delivers patient information in a standardized and intuitive format to enable clinical decision making, business and clinical analytics, bio-surveillance, and more.  Furthermore, the solution opens up ways to take advantage of the information worker tools, and communication and collaboration technologies our company is famous for.  Frankly, I sometimes think better solutions to facilitate communication and collaboration in healthcare are perhaps more important to the industry and to patient safety than tools that simply help us assimilate and document patient information.

I’ll have more to say on this in future entries.  You’ll find a bunch more information about Azyxxi and MedStar on-line including videos, articles and case studies.  Just search the keywords “Azyxxi” or “Microsoft and Azyxxi”.  Now, if I could just learn to spell Azyxxi without having to look at the word each time I type it 🙂

Bill Crounse, MD    Healthcare Industry Director    
Microsoft Healthcare and Life Sciences


Comments (34)

  1. PatriotB says:

    I can’t see how this is good news for anyone.

    Microsoft’s roots are platforms and development tools, and the farther they stray from that into specific industries, the more it hurts the third parties that have built their products on top of Microsoft’s platform.

    I should know, I used to work on health care software (specifically, at one of the companies mentioned in the NY TImes article).  Large parts of our software were built upon Microsoft platforms and tools.  However, many of the "top" people at the company did not particularly care for Microsoft; I think they would see your latest move as a big threat and would increase their distrust of MS and increase their investigation into alternative platforms and tools (e.g. Java).

    You might counter this with, "It will help improve patient care!"  The best way that you, Microsoft, can help with that is to continue to provide the best platform for third parties (whom you often refer to as "partners") without making those third parties feel like you are trying to take over their business.  *Enable* third parties to make the best products they can (via platform/tools, MS-HUG, even participation in HL7 and other industry standards), but *don’t* insist that you have to have a piece of every niche market.

    Yes I know Microsoft is running out of growth areas.  But what is next?  CAD/CAM software?  Bank or stock market software?  Stick to what you do best and provide the platform for third parties without alienating them.

  2. PatriotB says:

    P.S.  I’ll be interested to watch the videos that you mention in your last paragraph.  I remember watching the "Longhorn in Healthcare" video and having a good laugh.  The concept from at video might help out a 5-physician practice, but could never scale to even an individual hospital, or to an organization with dozens of hospitals/clinics and hundreds of doctors.

  3. hlthblog says:

    PatriotB wrote:

    The best way that you, Microsoft, can help with that is to continue to provide the best platform for third parties (whom you often refer to as "partners") without making those third parties feel like you are trying to take over their business.  *Enable* third parties to make the best products they can (via platform/tools, MS-HUG, even participation in HL7 and other industry standards), but *don’t* insist that you have to have a piece of every niche market.

    PatriatB, that’s exactly what we are doing.  Azyxxi is a health information integration engine.  It was developed for doctors by doctors.  We believe in the vision and path of its developers – to improve healthcare delivery using unique and powerful information technology.  

    This acquisition deepens Microsoft’s commitment and investment in the healthcare industry and to improving personal and population health using information technology, while making a proven solution more widely available to its customers.  It does not displace or replace healthcare IT systems developed by our partners.  It just makes it easier for clinicians to get the information they need, when and where they need it.  Azyxxi was created with Microsoft developments tools.  The system has a proven track record and we plan to replicate that success.

    Bill Crounse, MD     Healthcare Industry Director    Microsoft Healthcare and Life Sciences

  4. Mark D says:

    There is no doubt in my mind that getting big companies, such as Microsoft and Google into healthcare will be good for healthcare professionals and patients. As a doctor I am fed up with limited solutions, difficult interfaces and diiferent systems. MS has the breadth of expertise, to make an excellent system. I hope they commit. Some small companies will falter. Some will continue to provide valued add-ins. Some will be bought and do well. The only disappointment is that they are leaving things so long.

  5. How do you reach this Microsoft group that is moving into medicine? We have a prime project for their consideration.

  6. Dr. Bob says:

    I am gone to wait and see on this one.  Microsoft has had a health care vertical for years.  But I have seen no evidence that they have made any impact on the industry- positive or negative.  They, Microsoft, like any company has an interest in selling its core product.  Much like Intel, CISCO, IBM, HP, and other high tech giants.  The product developed by Washington Hospital may be very good…but so was the product developed at Duke or at Brigham-Women’s over 15years ago…..making a scalable and sellable product to a very diverse and almost cottage-like industry is another matter. So I will take a wait and see approach to this

  7. Bill Crounse, MD says:

    Thanks for writing, Bob.  I agree that there is some element of "wait and see" here.  However, the Azyxxi solution was developed "by doctors for doctors" and it has a proven track record.

    I must, however, object to your statement that "I’ve seen no evidence that they (Microsoft) have made any impact on the industry- positive or negative".  We work with more than 600 partners who deliver very robust solutions built on our technologies to the healthcare and life sciences industries around the world.  Some of the most innovative solutions on the market wouldn’t be possible without what we do; communication, collaboration, business and clinical analytics, health information exchange and interoperability, web services, distance learning, and more.  It would be a very different world without Microsoft technologies in healthcare.  And the future, looks even brighter.

    Thanks again for your comments.

    Bill Crounse, MD    Healthcare Industry Director    Microsoft Healthcare and Life Sciences

  8. Bill Crounse, MD says:

    Responding to the comment left by Dr Ralph Grams:

    At the appropriate time, the team from Azyxxi will reach out to evaluate market opportunities beyond MedStar for their health information integration solution.  At that time, Microsoft will provide guidance on how to engage with the team.

    Bill Crounse, MD    Healthcare Industry Director    Microsoft Healthcare and Life Sciences

  9. Ric A. says:

    Seeing is believing.  I’ve seen and used Azyxxi and it’ll change the way medicine is practiced.  No more will we have to have a dozen accounts and passwords on old and new systems to get the information needed to make decisions about patient care.  You want old records, you’ve got them in fractions of a second, if they’ve been scanned and you can read my chart. No more waiting hours while some overworked clerk pulls the charts or going without and flying blind.  Lab results? As soon as the lab machine has the results, Azyxxi has them.  Not only can one access the current labs but any old results that are stored in an electronic format and feed to Azyxxi.  You can graph results, see what their trends are.  Is that an abnormal result for this individual patient or is it their norm?  Azyxxi will show you and let you decide for yourself in seconds.  You want x-rays?  How about seeing them before the patient is back from x-ray.  And talk about research potential?  Azyxxi lets me, as a user, ask questions that I haven’t even thought of while I’m sitting in front of my PC.  Real time!  My biggest concern was that I’d become too dependant on the system and if it wasn’t there I’d be handicapped.  Those guys at Azyxxi have thought of that too.  Azyxxi has more redundancy than a 50 pound sack of peppermint lifesavers.  How about ease of use?  If you can point and click you can use the system, no classes, no learning curve.  You can walk up and use the system the very first time with ease.  Best of all is we don’t have to change our business process.  We can use all the systems we have in place and Azyxxi will suck up the info and present it in a single easy to use interface. The integration with other systems will be the bottle neck from my POV.   This is Windows at its finest.  The only question is how fast can MS get it to all of us?  Will those other IT systems cooperate with the Azyxxi Team or will they play turf wars.  I hope not, this is good for patients good for business.  I’ve heard that Azyxxi is ancient Phoenician for “Far sighted wisdom”.    I don’t know about that but what I do know is that Microsoft shows far sighted wisdom with it’s acquisition of Azyxxi.  Be excited, be very excited, the job of saving lives just got a whole lot easier!

  10. hlthblog says:

    Thanks for sharing your insight, Ric.  I couldn’t have said it better.  It is obvious, you "get it".

    Best always,

    Bill Crounse, MD     Healthcare Industry Director    Microsoft Healthcare and Life Sciences

  11. PatriotB says:

    Thanks for the explanations, Bill and Ric.  That helps to clarify the role of Azyxxi, and clear up the misconceptions I may have had about it.

    But yet, while Azyxxi may be helpful to certain organizations, its existance really exposes how much more improvement is needed in the underlying systems that Azyxxi is aggregating.  Access to scanned records, up-to-the-minute lab results, x-rays, and research trending should all be available through your primary EHR system.  It shouldn’t take a separate product–at least in the ideal world.  Since an organization will probably not buy all its systems from the same vendor, there is a use today for a product such as Azyxxi.

  12. I agree that this is a very interesting play into HealthcareIT for Microsoft.

    Neil Versel reported:

    ""Microsoft sees it as applicable to clincians and integrated delivery networks, not just a hospital system," Washington Hospital Center ED chair Mark Smith, M.D., said at a press teleconference this morning."

    One thing I don’t understand is how this is going to affect anyone but hospitals and large group practices.  If it can’t apply to small practices then it won’t have nearly the effect on healthcare that people are describing.

    Maybe you could help me understand how this will apply to the small doctors offices.

  13. hlthblog says:


    Thanks for writing.  It means a great deal to me that someone who covers the healthcare IT landscape so thoroughly immediately appreciates the value our proven health information integration engine brings to the enterprise.  First and foremost, the system was built by doctors, for doctors.  While it does not replace existing HIS/CIS systems, it does make them more useful by freeing the data locked up in disparate systems.  It provides clinicians with an intuitive, extremely responsive way to view patient data.  It is truly a world-class iteration for the era of knowledge-driven healthcare.

    To the extent that data can be normalized, assembled, and securely distributed via web services, clinicians in all kinds of settings large and small, will have access to information that has previously been unavailable or locked up in silos.  Patients could benefit as such systems populate their personal health record.  The scenario I envision isn’t all that different than the way my financial services institutions populate information in my brokerage or retirement accounts.

    Granted, this must play out in stages and we have a lot of work to do.  But I am hopeful that we are on the right course, for clinicians and the patients we care for.

    Bill Crounse, MD     Healthcare Industry Director    Microsoft Healthcare and Life Sciences

  14. I think this is inspired.  MS has a chance to help theraputic healthcare outcomes.  The VISTA project is good, but it is way to expensive for small offices to implement and run.  the new functionality that SQL 2005 offers will bring this technology to every office in the country and the world.

    Dr. Crounse, will you please take a look at

    I am so glad that Microsoft is attacking this problem rather than wait for someone else to build it.

  15. Ajay Joshi says:

    I think one of the things that I would like Microsoft to do is to send a clear message to their own employees as well as to their customers.

    Are they a company that wants to create solutions for various markets or would like to continue to be the company which creates tools to assist in the solutions being created by their partners. To me, some of the messages I am getting from Microsost are confusing.

    I have no doubt that Microsoft will add value to healthcare market in a positive sense but the real question is whether the value add will be incremental or "game changer". No marks for guessing which one I would like for it to be. 🙂

  16. Mike C says:

    I work for one of the large clinical systems software companies and have for the last four years, and admit that I have been awaiting an entry into this market by the (what I consider) 800 lb gorillas that have or can obtian the resources needed to successfully enter the healthcare IT vertical, Microsoft being on the top of that list =).  I watched Amicore relatively closely(backed by Microsoft, Phizer, and IBM, a powerful combination), but haven’t heard much about broad acceptance, they aren’t mentioned much in the press at all, perhaps because the scope of the software is physician practice vs. hospitals.  I had always assumed that there would be a progression to the enterprise setting for Amicore, but that never happened either, I am assuming because the solution wouldn’t scale.  Given how ripe the market is and has been, I cannot fathom any other reason!  My point is that Microsoft has already been involved in this market to a degree, but against my intuition I didn’t see the success that I see with darn near anything else Microsoft attempts, it honestly doesn’t look like they really tried either.  What are the plans for Amicore?  Is this aquisition another attempt to enter healthcare for MS after a previous failed one?  This is not a negative stab by any means… I very much admire Microsofts success and the capabilities of this company are extraordinary… just curious what happened :).

    With this aquisition, Microsoft takes another step into the healthcare vertical, but from what I see, Azyxxi doesn’t really do anything but integrate other clinical systems that must already be implemented, adopted, and used 100% of the time.  There is great value in this, don’t get me wrong, but how does this eliminate the need for the clinical systems themselves like charting solutions, billing solutions, pharmacy solutions, lab analysis solutions, patient tracking solutions, automated drug interaction solutions, workflow management, and on and on… the implementation of which that Medstar apparently "threw in the towel" on?  If I don’t already have an EMR/EHR solution, a digital imaging solution, etc. to integrate then what can Azyxxi do for me?  Many hospital still rely on pen and paper today… and I do not see how Azyxxi replaces those tools, it just eases the access to the data that those other clinical solutions have facilitated digitizing… those solutions that really DO replace the paper chart.  Heck, replacing the paper chart is just the start of the value most clinical systems provide.  To me, Azyxxi looks like a robust version of X1 Search, with interfaces to clinical systems instead of Outlook and Eudora =-).  Am I missing something?

    1/8th of a second access time to data housed within a 13TB database though… that is quite impressive =)!

  17. Bill Crounse, MD says:


    Thanks for your insightful comments.  To answer your question about Amicore; the company was recently purchased by Misys Healthcare.  I had the privilege of delivering the opening keynote at the Misys Users Conference at the Reno Hilton last week where Microsoft was also awarded the Misys "partner of the year" award.

    Regarding your other questions specific to Azyxxi, and all of the other questions posted on this Blog, I have decided to devote my next House Calls audio-cast on to this topic.  Joining me on the program will be representatives from Azyxxi and the Vice President of our Health Solutions Group, Mr. Peter Neupert.  We hope to post the program sometime around the end of August.  I’m sure it will be popular with HealthBlog readers and listeners.

    Best always,

    Bill Crounse, MD    Healthcare Industry Director     Microsoft Healthcare and Life Sciences

  18. Graham says:


    I am not sure I understand the Azyxxi offering all that well – Who are the users of this tool? Is that something MSFT will take to the RHIO market or is it intended for the IDN market? Or is it intended for developers maybe?


  19. DaveE says:

    As someone who has been involved in Healthcare IT for getting on for 15 years, I agree with PatriotB’s comments regarding this acquisition.  Over these years I have seen a number of big players (Oracle,  IBM, HP) come into the Healthcare vertical applications space and leave again and in some case re-enter and leave again.

    Microsoft is excellent at providing the enabling development tools, enabling technologies and thought leadership to partners both large and small to allow them to develop these for their customers and should continue to do so.

    Due to this announcement, healthcare application vendors will be more guarded in their working with Microsoft.  Considering their are 100’s of healthcare applications vendors that work with Microsoft and now Microsoft owns one small scale integration piece of software – how will this help the industry?

    The getting access to the information is what healthcare application vendors have been providing for years – this is not something new.  People may comment that they have failed; that may be unfair, but it is probably true that they haven’t always delivered the vision.  It would be very naive to say that this is something this acquisition and Microsoft can fix in the short or medium term.

  20. DaveE says:

    P.S> The analogy of driving a car to global healthcare applications is amusing.  Very few healthcare application vendors have been able to globalise their applications – the closest to managing this have been Cerner ( and iSOFT ( and even these have had limited true global success.

    The country of origin bais around all healthcare IT blogs including this one for the US highlights how "local" healthcare people think.

  21. Bill Crounse, MD says:


    Thanks for sharing your thoughts.  One thing we (Microsoft) are not is naive about the complexities of the healthcare IT industry or building solutions for the industry.  As I’ve traveled the world, one thing I’ve noted is that clinical work-flow (the work of doctors and nurses) is much the same the world over.  We interview our patients, we examine them, we order tests if they are available, and we recommend treatment once a diagnosis or probable diagnosis has been reached.  We all struggle to keep up with the explosion of information in the medical and scientific literature.   We do our best to avoid harming our patients.  In one way or another we document what we do, so the patient or others who care for the patient in the future will know what has been done previously.

    Information technology solutions that address the needs of clinicians have been evolving for decades and will continue to do so.  No one technology or solution is going to change the industry overnight.  But with each year that passes, whether it’s innovations around mobility, devices, data input, machine intelligence or other breakthroughs; the story gets better.  I’m very proud to be associated with a company and a rich ecosystem of partners that are leading the way in solving some of the toughest issues confronting the healthcare industry.

    Again, thanks to everyone for weighing in.  For more information about Azyxxi, I will direct you to the audio-cast we have planned in coming weeks.  When it becomes available, I’ll be sure to mention it here.

    Best always,

    Bill Crounse, MD     Healthcare Industry Director     Microsoft Healthcare and Life Sciences  

  22. Epic User says:

    Epic rules!!!

  23. The PACS Designer says:

    I’ve read all the comments which really show that there is a need for someone with a large footprint in the software world to enter the healthcare arena in a big time way.  I’m truly happy that Microsoft has chosen to be that large footprint company with the purchase of Azyxxi from Washington Hospital Center.  Since WHC has a Windows based PACS that was designed by myself and a colleague I know that the Azyxxi software has the  potential to  add great value to the information a user sees from a patient encounter and improve the Windows experience as well as the patient present.  Also with the future release of Windows Vista users will have even more reasons to want to join the Windows Healthcare bandwagon!  

  24. Caducian says:

    We’ve been working at the largest medical center in the world. From a dearth of information to an overload, clinicians in critical care (which remember is the bulk of the costs of hospitals budgets and over a point of US GDP) want treatment protocol indicators to improve the time differential from knowledge to treatment change. When we began data integration was a huge deal, now our time has come. What the heck do you ‘do’ with all that data coming so fast in critical care? Wait for a chart review? Turn off one more crashing alarm? Waste RRT resources constantly? Weird ‘bubbles’, nice but who has the time? It is interesting to see the 800 lb gorilla get serious about healthcare. If they are interested in critical care, let’s talk.

  25. HealthBlog says:

    Few HealthBlog entries have drawn as much interest as the piece I wrote on Microsoft’s acquisition of…

  26. matthias muenzer md says:

    Dear colleague:
    I am very happy and excited that Microsoft has bought Azyxxi, we need the help of a large company that already has a number of software development tools and expertise.
    We physicians and our information issues are nothing unusual, nothing extrordinary. Every other industry has the same needs, information instantly at your fingertips, and from everywhere please. That applies to manufacturing, Logistics, sales, wherever. Microsoft office actually has almost all the tools or the rudiments of the tools that you need to creat an excellent electronic medical record for the physicians office (which is my primary concern, since I am a practicing Ob/Gyn).
    When will someone come up with an “EMR” add-on to Microsoft office, just like Excel or Powerpoint? It could use SQL server as database, some modifications for word for writing, Excel for graphing, a modified Outlook as patient scheduling and communication tool and some Paperport like technology to scan and process and distribute reports, fax prescriptions to pharmacies etc. All parts of Microsoft office easily conncet to the web, and you could have one button connections to databases that check drug interactions for example. A modified journal keeps track of all changes for legal purposes.
    And so on.
    Once you get a third company involved, they need to make good money building this and have the communication issues with Microsoft. Microsoft itself could easily modify Office and sell and “EMR add on” for a much more affordable price, since they would only have to tweak their product slightly.
    I see this as a large advantage. Please, Mr Gates, come out soon with the OFFICE EMR ADD ON!
    And, should you need help in designing it, I would not mind assisting.
    Your Matthias Muenzer, MD

  27. Alex says:

    It all sounds very good and I know of other hospitals that have accomplished similar things with other custom developed software whether based on the Microsoft platform or not.
    The Microsoft platform is great for developers and there is no question about it. The problem is not there. With the wide variety of systems in Hospitals and their differences in implementation and customization, there is virtually no way to build a “plug and play” product.
    Some of the larger vendors have developed APIs for partners to interface with their systems, but depending on the versions etc… there is no real standard out there to exchange data. Protocols are different from vendor to vendor.
    Lots of tools can do reading of data (and this is already a great thing) from various sources (which is why I understand this to be) but how about writing of the data? Will the physicians still need to go out into the indiviudal disparate systems to make edits?
    Finally, Hospitals systems are currently not integrated with the physicians’ practices systems. Aggregating data from Hospitals is great, but most of the patient’s history and overall medical record resides in the small practices EMR systems…those are the ones that need to be integrated back to the hospital systems!
    So having Microsoft invovled is a good thing overall as they have the skills to provide the developers with lots of tools to integrate those various systems, but until there is a standard set to exchange data…it won’t be the solution to all problems I am afraid.

  28. HealthBlog says:

    Technorati tags: Microsoft , Azyxxi , New York Presbyterian Hospital , Johns Hopkins Hospital , Novant

  29. Technorati tags: Microsoft , Azyxxi , New York Presbyterian Hospital , Johns Hopkins Hospital , Novant

  30. D. Lenier Anderson says:

    I am having a remarkably difficult time getting an intelligent answer/POC for Microsoft’s  Azyxxi software. Our college has a medical school and I foolishly thought there might be some synergy in providing some exposure for Microsoft’s product. All I can get from Microsoft support is "they’ve enver heard of it" and "call the PR firm" – which sspeaks volumes.

    D. Lenier Anderson

  31. D. Lenier Anderson says:

    I am having a remarkably difficult time getting an intelligent answer/POC for Microsoft’s  Azyxxi software. Our college has a medical school and I foolishly thought there might be some synergy in providing some exposure for Microsoft’s product. All I can get from Microsoft support is "they’ve enver heard of it" and "call the PR firm" – which speaks volumes.

    D. Lenier Anderson

  32. Cad cam says:

    I am a cad cam engineer, l like your article