This year marks my 10th anniversary at Microsoft. I have much to be thankful for. I have a wonderful family. I am gainfully employed. Through my work, I’ve had an opportunity to travel the world and learn more about health, healthcare, information technology, and people than I might ever have possibly imagined. Although I sing the praises of technology on this blog and in the keynotes I give around the globe, I am also very pragmatic about where we are and how far we yet need to go in this journey to transform what is without question one of the most complex and important “industries” of the modern era.
Having just spent the last few weeks helping a family member navigate the complexities of what we ironically call a “healthcare system”, I am once again reminded that the “system” is dysfunctional. On one level we have healthcare that is totally amazing in its technical advances and capabilities. But it is equally frustrating and downright frightful in so many other ways like its processes, procedures, inefficiencies, and cost. Tracking down the source of my family member’s abdominal pain led to a clinical cascade of examinations and procedures costing more than a mid-size luxury sedan. It was also agonizing at times, even in this community renowned for high tech, to move from specialist to specialist and facility to facility having to deal with the same paper forms and repetitive questions at each stop along the way. There is still far too much inefficiency and waste in healthcare for clinicians and patients alike.
In that regard, let me share three observations gained over the course of my career that were recently once again so well reinforced about technology, processes, and incentives in healthcare.
1. Technology can’t transform healthcare if people won’t use it.
The information technology industry has come a long way since I started my career clinical medicicine and technology. With ubiquitous broadband, mobile devices, more options for data input, advanced analytics, and applications in the cloud, information technology has reached a point of maturation so that well designed software can actually improve rather than impede clinical workflow. However, things are far from perfect. Information is still too often held in silos. EMR and HIS systems too often still don’t communicate with each other well, if at all. The remnants of IT legacy are holding back innovation. And people, behaviors, and culture are still the most important determinants of success or failure in healthcare IT. Only people can truly transform healthcare.
2. Technology alone won’t fix what’s wrong with a medical practice or hospital.
If you think that a shiny, new EMR or HIS system is going to fix everything in your clinic or hospital, think again. Most experts will tell you that an EMR or HIS solution will only exaggerate many of the workflow inefficiencies in your clinic or hospital. And, it certainly won’t do anything to fix a rude receptionist or grumpy surgeon. Technology can and does make things better. It provides instantaneous access to information when, and where, it is needed. It can help facilitate communication and collaboration. It can sort through vast amounts of data and help you make sense of it. It can free up space in your office that was previously dedicated to paper records. Properly applied, and with appropriate training in its use, information technology will help transform clinical workflow and practices for the better, but it won’t do everything. Only people can truly transform healthcare.
3. Technology will fail if business processes and incentives don’t support it.
Around the world, I’ve seen some astonishing uses of technology to bring health information and medical services into the home; to provide real-time monitoring about the status of a patient's health; to warn about a pivotal threat to public health; to markedly improve response times to emergencies, and so much more. I’ve seen technology pilots that demonstrate over and over again significant improvements in care quality, cost and satisfaction and yet, they never seem to break out of pilot mode and into full mainstream implementation. More often than not, the barrier isn’t the technology. What’s missing is the regulatory relief, aligned business processes and appropriate incentives that are needed to support widespread adoption of technology. Telemedicine is is but one example of a technology that could be doing so much more, yet is persistently held back by arcane regulations and payment systems that don’t support it. Only people can truly transform healthcare.
So although I’ve been at this longer than I care to remember (long before I came to Microsoft) there is still so much work to be done. I suspect a good portion of that work will get passed along to succeeding generations of technologists and clinicians who share my passion. None-the-less, it is an honor to work in this industry, and for that I am very thankful. Happy Thanksgiving. Please take some time to reflect on everything you have to be thankful for too. And remember, only people can truly transform healthcare.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft