Needed: A Few More Instigators for the Healthcare Internet Revolution

Yesterday in Las Vegas, I had the pleasure of delivering a keynote luncheon address at the 11th Annual Healthcare Internet Conference.  I say pleasure because the audience consisted of the very folks needed to drive and innovate new web services and care delivery models in healthcare.  These were marketing VPs, senior healthcare strategists, physician executives, CEO's, IT executives and web developers.

Sadly, I must say that we still have a long way to go in realizing the kind of Internet revolution in healthcare that Bill Gates evangelized in his October 5th, 2007, Wall Street Journal editorial.  I've been following how healthcare is using the Net for perhaps a dozen years or more.  During my keynotes I frequently show a slide of consumer expectations for on-line healthcare services based on their experience with other industries like banking, retail, travel, and even  plumbers.  In fact, I also show a photo that was sent to me not long ago by a colleague who needed his  toilet fixed.  He said the plumber arrived at his home in a GPS enabled van and carried a Tablet PC into his home.  He used the PC to order parts, document his work and present an electronic invoice.  My colleague who sent me the picture asked, "Why isn't healthcare more like this?"  My flippant answer was, "Probably because these days that plumber is making more money than your family physician!"

In any event, consumers today do have high expectations of service industries and healthcare is no exception.  Consumers want;

  • On-line appointment scheduling
  • Web messaging with physician and support staff
  • Access to lab and radiology reports
  • On-line prescription refills
  • Reminders and "information therapy"
  • Access to personal medical records
  • Outcomes and disease management tools

For the past ten years I've been asking audiences "how many of you can say that your hospital or clinic is providing everything on that list?".  A decade ago, virtually no one would raise their hand.  Today in any audience of 500 to 1000 a few hands will go in the air, although during my talk in Las Vegas not a single hand was raised.  Maybe they were just shy, or maybe none of the organizations represented truly have hit this level of on-line services.  I was a bit surprised since this was after all, a healthcare Internet conference.  I pointed out that there are many organizations in America large and small that can check off everything on that list, and even more in other countries where e-health services are being driven by progressive governments and industry executives.

My despair at the lack of progress was lifted as the day went on.  I met lots of energetic people with great ideas and enthusiasm who pledged they would go home and make it happen for their hospital or clinic.  We shall see.  In the meantime as previously stated, I am seeing a lot of progress and  many promising initiatives from our customers and partners around the globe.  I've said it before and I'll say it again; it is a great time to be in healthcare IT.

Bill Crounse, MD   Worldwide Health Director    Microsoft Corporation

Comments (14)
  1. I post quite a bit about tablets on the Medical Quack whenever it has some health care relevance and recently added a couple articles about Homeland Security and the CSI television show making use of slate tablets, and at the same time wonder why we don’t see television shows such as Grey’s Anatomy using more tablets and mobility, and even Scrubs could do a little better with their humor and perhaps have Dr. Cox carrying one around as well.  CSI even does an outstanding job in using the touch screen with mapping locations, the actors and actresses are well trained!  The media can also be a huge asset in promoting health care technology and mobility.  If we could raise the bar and have health care with the same thought processes in the area of mobility as "the plumber", we would be miles ahead!  

  2. David Collie says:

    Appointments Online is a UK based service that provides online appointment booking, secure messaging with the physician and support staff and online prescription refills. You can find out more about it at

  3. hlthblog says:


    Thanks for weighing in.  You are right.  I think some of the well-known vendors (Motion, Fujitsu, HP, Toshiba) should "seed" devices to these dramas and television series to gain more visibility.  Of course what really counts is visibility and traction in the real world.  I’m pleased with the progress I see, especially overseas, but we have a long way to go.  Thankfully, the technology and the devices have now matured enough to reach a needed tipping point in their ability to meet the work-flow needs of highly mobile knowledge worker professionals like doctors and nurses.

    Bill Crounse, MD

  4. hlthblog says:


    Thanks for your comment.  Yes, I’m very well aware of the e-booking solution and other e-health initiatives in the UK.  Microsoft is deeply involved with the NHS.  That’s why I frequently point out the disparity between the US market and healthcare information technology initiatives overseas.

    Bill Crounse, MD

  5. Bill,

    With and ever increasing number of care options, consumers with new symptoms or injuries need guidance as to if, when, and where they should access care.  

    FreeMD triage does not diagnose, but determines:

    * Does the patient need a work-up?

    * If so, how soon should it be done?  (e.g. now, within 8 hours, within 1 day, within 3 days, within 2 weeks)

    * If so, where should it be done? (e.g. 911, ER, Urgent Care, Your Office, or a Nurse retail clinic)

    Check it out the beta at:



  6. hlthblog says:

    Thanks Steve. I applaud any service that helps people better understand their health; especially when it is free.

    Bill Crounse, MD

  7. Michael M. Moore, MD says:

    "Why isn’t healthcare more like this?"  My flippant answer was, "Probably because these days that plumber is making more money than your family physician!"


    Your answer is probably more true than we would like, but perhaps only indirectly.

    Some "from the hip" thoughts and opinions.

    In the predominately third party payer system we have in the US, physicians generally get paid according to what insurance companies will pay them.  Until payers decide some of these tools are helpful and effective it will be on the shoulders of the individual physician or practice to calculate if they can give overall better care more efficiently and take on the burden themselves.  The rise of "concierge" medicine may help the rise of such tools and services for those who can afford it.

    "Fourth parties" are now getting involved, as companies may contract for various on-line services for their employees, calculating that the costs will be more than made up in preventing lost productivity.  There are services now where one can ask about a sore throat and cough on-line and get a reply which is essentially a triage and recommendation.  This is done faster than waiting on the office nurse to call you back, and certainly more efficient if the harried nurse and doctor say, "just come on in" because they can’t/won’t take the time on the phone for a non-reimbursable service.

    In addition, any service related to medicine in the US is a prime target for litigation, and where there is a litigation risk there is an insurance need, and where the insurance need is poorly defined the rate will be high, and where the rate will be high the demand will be low, and so on…

    The plumber does not have to deal with these issues.

    It is hard to "blame" any one institution for the situation.  For all of the good our system encourages, once the decisions are out of the hands of the doctor and patient, each entity involved in the provision or financing of healthcare wants to maximize the profits and minimize the overhead of their part of the puzzle (unfortunately at times at the expense of other parts).  Innovation is driven by this, the difficulty is how to drive innovation in a way that makes sense (and cents) for the system as a whole, the components of the system, and ultimately the physician and the patient, which should be the central concern of any healthcare system.

    By no means am I advocating a national health system run by the government to take the place of our current system.  That would be concerned with the cost of the system as a whole, but at the expense of innovation and the ultimate concern about patients and their doctors.  Perhaps moving toward an insurance system that is more for "catastrophic coverage" with the savings in medical accounts that individuals have more freedom and responsibility for is an answer.  I know there are problems with that, too.  Unfortunately it is usually easier to spot problems than devise truly wise solutions.  –  Mike

  8. hlthblog says:


    Thanks so much for contributing to the discussion.  Clearly you understand the issues.  I deeply appreciate your insightful comments.  It is extremely important for clinical leaders to take a stand.  America is falling behind the rest of the industrialized world in the deployment and use of contemporary information technology in healthcare.  IT isn’t the answer to all of our problems in healthcare, but there is so much more that could be done to provision health information and medical services to our patients more efficiently and cost-effectively if providers of care and payors of care (be that insurance, government, or patients themselves) could align their interests and embrace the use of Unified Communications and other technologies in healthcare.

    Bill Crounse, MD  

  9. I had the pleasure of catching Dr. Crounse’s presentation and especially the portion that dealt with the ‘flat world’ and the globalization of elective health care.  As I asked in a question posed to Dr. Crounse:  How do we ensure that the U.S. health care system for elective medicine/surgery does not go the way of US semiconductor manufacturers, US LCD manufacturers, US DVD manufacturers, etc.  In other words, will a significant portion of our health care system, and a profitable segment of that system, become largely extinct as US residnets seek elective health care through ‘cheaper’ intermediaries?  These may take the form  of tele-medicine providers, or health care providers and institutions abroad.

    I agree with Dr. Crounse that we have far to go in this country with our e-health initiatives and applaud his efforts as an evangelist for techonological advances in the healthcare field.

  10. hlthblog says:

    Thanks for the kind words, Ron.  Yes, it will be difficult for providers and healthcare systems to maintain the status quo in the years ahead.  The industry does indeed face the same kind of disruptive innovation that has reshaped other industries; improving quality and making goods and services more affordable.   Progressive organizations and providers who keep their eye on the ball and know "not where it is but where it is going next" will survive and may even thrive.  I suspect you will be one of those.

    Best always,

    Bill Crounse, MD

  11. MD in Philly says:

    I think we probably all agree on a simple basic concept.  People want in a doctor/(NP, PA) (as well as a carpenter, or auto mechanic) someone they feel they can trust.  Preferably that would be a local physician who is reasonably accessible, has time to answer appropriate questions, is medically knowledgeable, and has an office staff that also treats patients with respect and patience.  The best use of technology will be tools to help facilitate this.  

    Independent telemedicine and other "innovations"* will thrive only when the preferred arrangement is unavailable.  I am sure most people would be willing to pay "a little more" for the accessible, trustworthy and knowledgeable "local MD".  The questions are:

    1.  Will LMDs have administrators that implement tools to serve the ideal with a view to the long term, rather than the use of "innovations" that will aid the financial picture next quarter?  

    2.  Will insurance companies and large health systems have a vision that serves the interest of the physician-patient team, or merely make decisions for the benefit of the profit margin in the short run in the interest of improving the ethereal "health care system".

    3.  Will enough LMDs be able to make good use of available tools in order to not be overwhelmed by their own success?**

    Yes, we need as many prominent voices as possible

    advocating wise adaptation of technology in health care.

    *The late Dr. Robert Austrian made the wonderful statement, "People make the mistake of confusing change with progress.  Just because something changes doesn’t mean it’s better."

    **My mother’s own LMD in rural Ohio, appearing increasingly harried over the years, stated, "I can’t take all of the patients of retiring doctors" when asked if he could assume care for my father.  He is only one doctor in a regional group medical practice, but apparently has the qualities that patients want. – Mike

  12. Jerry Watson says:

    As a PhD candidate I am focusing on the application of techniques of human reliability analysis and multivariate analysis to develop a framework that can be used to reduce medical errors made by nurses. One of many facts I have discovered is that the rate at which humans make errors is not related to the rate at which technology is introduced into the workplace- if anything that rate seems to be increasing despite all the technology that has been introduced. This is because the designers of technology assume erroneously that just because they can design and build a better mousetrap, the better mousetrap is needed, all the functionality built into the device will be embraced and understood by the intended user and that its use will be universal. All this without consulting potential users to determine if it is needed, what functionality is needed and how can it easliy be used? Also a basic tenet of human reliability analysis is that humans will make errors- it is the job of the designer to design so that humans cannot make mistakes. Instructions must be written so that anyone, not designers, can easily follow. Choose any Army techical manual as a guide. One fact cannot be overlooked which is that 25% of Americans read at or below the fifth grade level. We do not all have a PhD from MIT,Cal Tech, or even Ga Tech ( my alma mater).


  13. When I read this story I couldn't help but think back to the post from Dr. Crounse at Microsoft about

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