Message to Washington — It’s all about Outcomes

Yesterday, I testified before the Senate Health, Education, Labor, and Pensions Committee, otherwise known as HELP.  You can see a video of my testimony here.   Before getting to the substance, I need to highlight how I continue to be awe-inspired about how our government works -- in a positive way.   Any body can walk into the halls of Congress and sit in and listen to a hearing.   Folks from all walks of life have input via a variety of means -- and while I get it's not perfect and can be better -- I remain proud of our democratic system and feel honored to be able to contribute/participate in it.

My main message to the Senate was:  We should really focus on the health outcomes we want to achieve, not just on the technology itself.  What the health system needs is to adopt technology in ways to deliver better outcomes, better chronic care management, better hospital effectiveness.   We really want to make sure that we have the leadership focused on encouraging the usage of technology to achieve certain goals, like better chronic care management.  

We were the only technology company testifying, and I think people were surprised to hear us saying that technology isn’t the silver bullet.   It's not that Microsoft doesn't want to see spending on health care technology. Far from it.  We just want to see smart spending, on technology that will really have impact.  When we decided to go to the moon, we didn't say let's build a great rocket...we said let's go to the moon...I feel a little bit of the conversation has been about let’s build a great rocket and hope we get to the moon.

The other witnesses included Health Leadership Council President Mary Grealy, National Quality Forum President Janet Corrigan, Permanente Federation Executive Director Jack Cochran and Valerie Melvin, Director of information technology for the Government Accounting Office.  Their comments were unexpectedly aligned with mine -- namely take a holistic view; incenting the adoption of technology is not a silver bullet; and, we must have reform of the payment system too.   So at a high level -- folks understand the challenges of creating the right kind of change in the complex health ecosystem.   Where the differences lie -- is how to get started.   Unfortunately as is often the case -- the stimulus bill (big incremental spend investing in health IT) is separate from the activities around health reform.    Getting the spend without the right payment system reform -- could lead to the unintended consequences the panel was cautioning against.

The legislation is being drafted now -- that is why the hearing was held on a day when there was a lot of other activity going on in the Senate.   There is a clear sense that something big will pass in 2-3 weeks - which is like moving at the speed of light.   I am sympathetic to the challenges of the staffers trying to find the right language -- it is not easy to figure out how to guide the spend of $20billion over two years!     The scale of spend is still hard to put into perspective for me -- in my last post I tried a per physician number, so this time let's try per day -- it is $27M/day!    I am very confident there is lots of low hanging fruit to generate a return on investment in the health system (waste, overuse, misuse, error reduction) that technology can enable -- but still $27M/day!  

Since I spend the bulk of my time building software -- decisions about features, hiring great people, how and where to sell -- the hardest question from the staffers to answer is - how do you recommend we spend the money?

My answer is in my closing remarks with the five key things that I think the government needs to focus on:

1. Encourage innovation in health IT by setting out objective goals and criteria, not by mandating specific technologies or development models. 

2. Reward innovative doctors who make the Internet the foundation of the patient-physician connection. 

3. Provide incentives for sharing data. 

4. Focus on making data interoperable today, not waiting for standards tomorrow, and insist that vendors separate data from applications. 

5. Enable the private sector to develop an information infrastructure that connects data, systems, and people.

These are really critical, so we don’t end up in the wrong place.  They’re based on our learnings as we’ve delved into this complex world of health. 

One final thought -- surely it is an exciting time to be in the health information technology business!   I personally got passionate about trying to really contribute and make a difference in HIT from my time on the President's Information Technology Advisory Council (PITAC) in 2003-2005.   As co-chair of the Health Subcommittee -- we published a report titled Revolutionizing Health Care Through Information Technology with key recommendations for the government to consider.   While my depth of understanding has gone up dramatically, what I find is both fascinating and perhaps cautionary -- is the discussion is largely on the same key issues/recommendations.     This time there is a lot of money at stake -- but it goes to show that change is hard and probably slow.   

I had a great exchange with Fox News --- video embedded below. 

You can also read more about Microsoft's general views on a number of topics here

Comments (6)
  1. Anonymous says:

    Have you thought of how it is now possible to predict with reasonable accuracy who will and will not respond to approved drugs using expression profiling -especially in Oncology where they often cost $50K-$100K per patient /y and many only work in less than a quarter of the patients. We are working with several groups in Europe and Asia where the payor is the one who also delivers. I really wish we could get traction on this problem in the US and have begun to find those who may be interested in doing this here in the US.


    Sage Bionetworks

  2. Anonymous says:

    Peter Neupert, Corporate Vice President of the Microsoft Health Solutions Group and my grand-grand-boss,

  3. Anonymous says:

    The current hot, behind-the-scenes, debate in HIT is around how “meaningful use” of HIT will be defined

  4. Sanjay Gidwani says:

    I think your testimony to congress was on point.  It is not so much that we throw "technology" at the problem and hope for the best.  It is that we use technology in the correct way to affect change.  

    Maybe Microsoft can help by creating an incubation program (or somehow extend BizSpark) for health care technology companies that use Microsoft Technologies/Tools (.NET/Visual Studio/HealthVault/etc…) in order to show the government how innovation can come from the private sector.  


  5. Aditya Pathak says:

    While I agree with your point about the need for improving outcomes to be the larger objective, I do not think the comparison with the moon mission is apples-to-apples. Moon was a specific object in space, the distance to it was known and what lay between Earth to Moon was also pretty much known. "Improving Health Outcome" is like saying "Let us go further in space". It means so many different things to so many different people. Hence there have been so many different solutions that have been tried – each an evolutionary attempt to "go further".

    Given the lack of specificity of the objective, if we have to have a chance at "going further into space", we need to keep on equiping our "astronauts" with better rockets (of course, built collaboratively by the rocket scientists & astronauts). Generic Tools and their usage & outcomes are not necessarily always deterministic (and are more often exponential in their impact on productivity).

    For example, the PC was not designed for you and I to interchange our ideas on your blog – but that is exactly what we are doing – as the PC has made the process of knowledge sharing efficient in unimaginable ways. And this example is just a tiny example of PC led productivity improvement.

    In Healthcare, our focus needs to be on building the generic tools right now, rather than getting bogged down in the specifics of hard to define lofty objectives. We need to build the base tools to start with, faciliatate their adaption, and Doctors (being one of the most educated, high IQ section of our population) will come up with ideas that can help us further improve the tools and incrementally improve the outcomes.

    Back in the 70s & 80s, we did not start building the PC with a color LCD screen, 4GB RAM, 300GB hard disk and quad core processors (these specs where almost unimaginable for a PC). We built what we could, we built what was at the cutting edge of technology back then, and then we evolved as smart users found new uses and new needs.

    The bottom line is that let us start putting the building blocks in place now with EHRs and HIEs. With the arrival of a medical workforce born in the internet era, adaption is bound to increase in ways we might not be able to think now.

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