International Travelogue

  • Article

After my visit to Washington D.C. and the U.S. Senate, I thought it might be instructive to visit other parts of the world to gain additional perspective on the challenges the global economic crisis is posing to health systems.  For the last five days, I have been in Western Europe visiting four different countries and interacting with health system CEOs and CIOs, ministers of health, leading social service bureaucrats and members of the Microsoft health ecosystem.

Here are some observations worth sharing:

  • Everywhere there is a deep interest in personally controlled health records - more than I anticipated, and despite the fact that some early projects in the category have performed poorly and have low adoption.  Stakeholders recognize that citizens/consumers need to be actively engaged in their health in order to improve the results and economics of the health system.  They view personally controlled health records as an important tool to motivate and engage them.  They don't see other options that can accomplish this goal.
  • Privacy is a major issue surrounding the sharing of health data -- either in the professional arena (insurance, provider to provider, provider to pharma) or in the case of professional to consumer.  Many have concluded (as we have in the design of HealthVault) that personally controlled health records are the best solution (but not the only one).
  • Health systems and their funders are looking for ways to connect the health delivery system across institutional boundaries -- from GP systems to hospitals and specialists.  No one is doing it well yet.  They see it as critical to delivering better outcomes and containing costs, and they acknowledge that seamless data sharing is critical to enable new work flows.  Unfortunately there remain many barriers to this seamless data sharing -- some technical, but mostly economic fear of existing stakeholders around loss of revenue or the implications of transparency on business practice/quality of delivery.
  • The payment systems inhibit innovation in many cases or drive it in others.  In some markets, governments are pinning their hopes on private insurance as a vehicle for innovation and focus on wellness/prevention while in other markets the government is directly trying to tinker with the payment schemes to encourage new behaviors by the provider organizations.  From an economics perspective -- what strikes me as the real problem and challenge with these approaches is that the feedback loops are long and indirect, and consequently the cycle time of improvement will be incredibly slow.  This is why price mechanisms in the capitalist system are so important - real time feedback mechanisms with the ability to self adjust.
  • The people with whom I met had an informed interest in what was going on in the U.S., particularly around the stimulus bill for health IT and about the prospects for health reform.   They are watching to see the impact.  What surprised me was the low esteem in which most regarded the U.S. health system...based on the statistics around health spend as a % of total GDP spend and reported health outcomes.  I acknowledge that the U.S. system has many flaws, is broken in many ways, and has lots of waste that should be eliminated.  But I have always been a bit of a skeptic that the statistics on outcomes really tell the full and complete story around quality of care delivered across different societies.  I am not sure that the perception of others really matters in this case in terms of the U.S. needing to fix the problems regardless -- but it bothered me enough to flag it and put in my "think about it later" list.

Some I visited are surprised to learn that Microsoft is investing in health specific software and services solutions.  Others are challenging us to do even more to bring ease of use, effective application integration and user interface innovation to the health worker desktop today!  Most are hopeful that the next round of technology and software investments really help improve the working environment on the front lines of health delivery and health outcomes.

Next stop -- Asia Pacific.  Given our ambitious goals, I often tell my team that time is our enemy when it comes to success.  Ironically, I have turned the motivational saying into a concrete reality as my itinerary has three of the next six nights aboard planes.  whoops