Doctors write their own prescription for healthcare IT

This past week I've come across two examples of why I believe we are finally at a tipping point in healthcare IT solutions; solutions that are meeting the expectations and work-flow requirements of clinicians.  Both solutions were designed by clinicians for clinicians rather than by computer science engineers.  That likely explains their success in delighting the clinicians who use them. 

One of these solutions I've written about before on this Blog.  It's the solution known as Azyxxi; a technology acquired by Microsoft about 9 months ago from MedStar Health in Washington, D.C. and currently in use across MedStar's seven-hospital system.  We are now in talks with a number of customers who want to be early adopters of this technology.  Earlier in the week, I accompanied our Azyxxi team for executive discussions with a few of those customers in Arizona and California.  All I can say is that most everyone we talk with totally "gets" the clinical and business value proposition of Azyxxi and why this system delights clinicians and provides insight to information as never before.  Stay tuned for more announcements about Azyxxi in coming months.

The other solution that warrants mention, just like Azyxxi, was born to address clinical work-flow requirements in a large academic teaching facility that weren't being met by the facility's existing vendor solutions.  Doctors and residents at UCLA Medical Center were frustrated by not having adequate tools to access needed information and document their findings during patient rounding and for patient hand-offs at shift change.  Once again, it was the doctors themselves using readily available commodity software that came up with the solution to address their own work-flow pains.  Dr. Neil Martin, chief of neurosurgery at UCLA who I had the opportunity to chat with at HIMSS in New Orleans a few weeks ago, tells the story best in some recent correspondence with me.  He writes; 

Rounding and progress note generation is a time-consuming everyday requirement for any physician managing inpatients.  It involves "hunting and gathering" the clinical data required for daily patient assessment (lab results, vital signs, test results, etc), making a rounding list with key information, finding all the patients, examining each patient and analyzing all the data, generating a daily plan, and writing a daily progress note.  Much of the work for rounding involves low-cognitive-value clerical-level data retrieval, and transcription onto the rounding list and into the progress note.  This is particularly time-consuming and onerous at tertiary academic medical centers (AMCs) with a large high-acuity patient population.  Traditionally the clerical aspects of rounding and note generation have been done at AMCs by interns and residents - but with new mandatory resident work-hour limitations, the time available for this sort of clerical work has disappeared. 

At UCLA Medical Center, we have designed and deployed a software application that automates rounding list generation, and provides a templated daily progress note partially auto-completed with data (labs, vitals, etc).  The automated list/note application saves interns and residents 45-90 minutes per day for each clinical team.  When the time-savings associated with this application became apparent to the interns and residents, its use expanded from 100 users to more than 1200 in less than a year, with very little in the way of formal announcement or training - the spread was by word-of-mouth and was virtually "viral". More than 25 clinical service teams now use this application for rounding daily.  Interns, residents, and many attending staff physicians now use and depend on this application. A modified rounding application has also been developed for ward charge nurses - and this is currently in a pilot phase.   A conservative estimate is that this application at UCLA saves more than 7300 hours of clinician time annually, with a value of approximately $ 365,000/year.  In this presentation we will describe the application, discuss its development, and examine its current real-world clinical utilization at an academic medical center.

Dr. Martin will be a featured speaker at the HIMSS Summit in San Diego in June.  If you want to learn more about the good work of Dr. Martin and his colleagues at UCLA, be sure to attend his session.

It is thrilling to be involved in an industry with so much potential to improve the quality and safety of patient care, and the satisfaction of those receiving and giving that care. It is also thrilling to see so many of my clinician colleagues using their deep clinical experience and healthcare industry knowledge to drive innovative new solutions to market.

Bill Crounse, MD           Worldwide Health Director                 Microsoft Corporation


Comments (2)
  1. Thanks, Bill, for posting out Rounding List story.  The application we developed for use at UCLA has been licensed to, and is being offered commercially through Global Care Quest’s Integrated Clinical Information System Soution Suite (ICIS Workflow) – see (Disclosure: I am a founder and equity holder of GCQ, Inc.)

    As you write – this sort of development is best done by clinicians for clinicians.  It is the highly clinically-informed and clinically-oriented applications which will help us realize the efficiencies, productivity enhancement, and improved quality and safety that information technology has the potential to bring to healthcare.  Once one has some understanding of what is possible with contemporary digital technologies and software, one can see opportunity everywhere in healthcare – it is a very target-rich environment.

    Today, it doesn’t take a huge team to get things done.  We basically started with the medical equivalent of three guys in a garage, and put together our applications over a period of several years.  And yes, Microsofft’s tools enable a small group to compete to a degree with the big healthcare IT companies of the world – very much a flattening factor as Thomas Friedman would point out.

    Neil Martin, MD

  2. Manish Gupta says:

    Thanks Bill…I think this is an apt article to share with our doctors and in general, the entire medico community in India. Work & revenue pressure on doctors is so high that IT is last on their minds. Let alone development, even adoption of IT by doctors for patient discharge or clinical flows has to be handled by an incentive. We are thinking of such ideas and would appreciate your suggestions. I am impressed by examples including Azyxxi in this regard.

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