Microsoft’s General Manager of Worldwide Health, Neil Jordan, discusses the broad picture of the sector with Owen McQuade and how information technology can help improve patient outcomes in Northern Ireland.
Neil Jordan has had an “incredibly exciting” journey while developing Microsoft’s health ICT work, and has seen first hand its real potential to transform services once the the technology is comprehensively rolled out.
Jordan is Microsoft’s General Manager of Worldwide Health and is speaking to agendaNi from Seattle as a radical phase of health reform gathers pace in Northern Ireland. Jordan will be in the North in a few weeks’ time to talk directly on the subject to people in the sector. He firstly differentiates between technology in general and information technology.
“Healthcare has benefitted enormously from advances in technology, whether that’s vaccination technology 30 years ago, the use of non-invasive diagnosis technology, and more recently genetic and proteomic technology,” he comments.
“Given how information-centric the quest of delivering quality healthcare at acceptable or at least contained cost is, it’s interesting how information technology has not only lagged some of the other forms of technology in health but also lagged the use of information technology in other industries.”
His particular interest is in ICT: the convergence of information technology and voice technology is “essential” in health. The last 10 years have seen the increasing use of electronic medical records, and more communication and collaboration using new technology. That said, ICT is not yet in widespread, standardised use in health and is certainly not available for everyone. Providers with larger budgets are more likely to take it up.
Jordan notes that “there’s still a lot of art as well as a lot of science” in health as an industry. Sectors which allow for “real transformational change at scale” are sometimes hard to find. He sees a lot of pilots being embraced across the system but bringing that to scale is the hard part. Implementation has proved “very difficult” in the NHS in England.
Asked why this is the case in health, he points to three parts of the system: healthcare staff, the finance departments and the political decision-makers.
“If you don’t deliver value right in the moment of usage, specifically for clinical workers, they won’t use the systems,” he states firstly.
“The clinical users are already pretty efficient in the way that they work,” he remarks, “and unless information technology provides them with the benefit at the time that they’re going to use it, we’re not really going to get the systemic benefits that we can get from using information technology.”
In practice, that value may mean a community nurse inputting information at the point of care rather than going back to an office to key it in. Alternatively, a specialist doctor may need access to National Institute for Health and Clinical Excellence (NICE) resources on heterotypic bone growth.
Financially, ICT is often not seen as a strategic imperative compared to other parts of the health ‘ecosystem’. Jordan suggests: “How many hospitals have a Chief Medical Information Officer rather than just an IT Director who reports into the Head of Finance?”
Most health organisations, in his estimate, spend less than 3 per cent of their operating budget on ICT. This compares a general proportion of 4-5 per cent across government, a 6-7 per cent norm in the private sector, and 10-12 per cent for intensive e-commerce.
At a higher level, people are nervous about the returns they will get, especially in the current economic conditions. It is politically risky for a Minister to say: “I am going to close that ER and I’m going to use that money instead to put in a telehealth system which will allow me to scale to many, many more people.”
A fundamental discussion about the nature of health needs to take place: “Do we believe that we will solve some of the problems of quality and access to health just by maintaining the current system, or by making some real transformational changes which are highly reliant on a better transport of information and a use of information technology?”
Looking forward, he senses that health is “on the cusp of bigger changes and opportunities”.
Firstly, staff will realise that putting in an electronic records system is not going to solve all problems. More communication and collaboration is needed, and there is already a substantial uptake in Microsoft Lync, an enterprise-class voice and videoconferencing and instant messaging system. A radiologist and physician, for example, can see and discuss the same image in an instant, rather than filling out forms to arrange a review meeting.
Cloud is the second area of change. Jordan appreciates that many smaller health organisations “simply don’t have the time, expertise or in some cases budget to invent some of these systems and cloud allows us to do that a lot more easily and cost effectively.”
He points to how Office 365 encourages collaboration in a network of Dutch orthopaedic centres, spread across small offices. In Rio de Janeiro, 160 public health clinics keep 500,000 records on Microsoft’s Azure system, with minimal infrastructure and investment.
The third opportunity is in maximum user interfaces. People, whether staff or patients at home, will not use systems unless they are “easy and intuitive to use”. Voice- or motion-based interactions are the most natural and the Kinect software already being used in hospitals will make use of these.
Across the board, health ICT needs to shift from a hospital-centric mainframe model to the personal and community- centric PC model. Achieving the benefits, though, takes longer than the typical electoral cycle.
European healthcare systems, Jordan notes, are more centralised and also proportionately less expensive than their equivalents across the Atlantic.
OECD figures show that the share of Dutch GDP spent on health stabilised at 9.7-10 per cent over 2003-2008 (although it rose to 12 per cent in 2009). The Dutch Ministry of Health, Welfare and Sport has two main sub-divisions (public health and health care), recognising that prevention controls the costs of dealing with illness.
The USA is one of the very few countries where the payment system is geared entirely towards paying for procedures once people get sick rather than managing and preventing illness. The changes needed are starting to happen but are hard and, today are not moving fast enough for the economy or the citizens.
Customer relationship management (CRM) or, in this case patient relationship management, has a key role in reducing those costs. It links community care with hospital care, and can help to stop re- admissions.
Amalga, an enterprise health intelligence platform from Microsoft, can aggregate and amalgamate large amounts of data. “We can start to understand, using high performance computing, what the trends are for re-admissions,” he explains, “and decide much more early whether a patient is likely to be re-admitted in 30, 40 or 50 days and the processes to stop that from happening.”
This not only increases the patient’s quality of life but also reduces the cost burden. In England, patients at home can use HealthVault to monitor their own health and the systems can be tailored to specific conditions e.g. diabetes or chronic obstructive pulmonary disease (COPD), or groups such as parents who have had their first baby.
Microsoft’s strategy for its healthcare business is based on three main areas:
• building a secure and connected underlying infrastructure for delivering health information;
• advancing collaboration; and • health information modernisation.
According to the Gartner consultancy, around 64 per cent of healthcare ICT budgets in the USA and Europe are spent “just keeping the lights on” e.g. data centres and desktop management. Reducing those costs “enables people to optimise the way they use their infrastructure” and helps to make ICT a strategic asset.
The Asklepios group of hospitals, in Germany, reduced its infrastructure management costs by 36 per cent in one year. This was achieved by implementing practices and tools that Microsoft freely open-sourced through the Connected Health Framework. The savings were reinvested in a telehealth platform using Office Communicator (now Office Lync).
Microsoft’s advancing collaboration work focuses on SharePoint and Lync, to help people access and share knowledge. For example, in England, NICE put together a knowledge management system for all of its users, bringing together 250 sources of information. Clinicians can look for the latest clinical information, either from the British Medical Journal or internal syndicated sources.
Health information modernisation means getting better at digitising the information that’s already available in electronic medical systems, PACs and case management systems. Microsoft works with providers (such as SystemC in the UK) and, in Jordan’s view, these companies are “taking very modern, open architectures to what has typically been a closed shop.”
On top of this work, Microsoft wants to help people take that data and turn it into knowledge with business intelligence tools. Adding dashboards and analysis allows anyone inside the health enterprise to “ask the questions and get the answers that they need out of the data.”
Jordan says that one of the problems has been where people digitised “the processes that they’re already doing today rather than using [ICT] either to re- engineer the processes or to let them get much better business information and intelligence out of those systems.”
As ICT in health develops, he expects cloud computing to become “incredibly important for the public sector”. Cloud is sub-divided into:
• a purely public cloud (e.g. Google, Amazon, Microsoft);
• a purely private cloud (virtualisation happening inside data centres); and
• a community cloud (creating effectively a publicly-used but privately-held cloud).
All three sectors have a lot to offer in health. HealthVault and Office 365 can be offered, with stringent security standards, in the public cloud. Private cloud involves simple virtualisation to help people to automate and manage and reduce cost.
In the “middle space” of community cloud, DHSSPS is already considering a service that is secure for all its users. This would follow on from the community cloud email system deployed in the NHS in England.
Collaboration and office support systems are the best entry points for cloud. He comments: “I am predicting that by the end of this year, as much as 30 per cent of the revenues that come from that space will be in cloud-hosted solutions.” Electronic medical records and imaging will be “slower to move over to cloud” but he expects that they eventually will do so.
Jordan notes that cloud is opening up interesting and new services in health. Three areas stand out:
• coding and information;
• image storage; and
• voice dictation and subsequent transcription.
SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms) is used for most coding and information in Northern Ireland. Microsoft has worked with the US firm Health Language to build cloud-based versions of its services so that clinical coding can be done anywhere.
Image storage means not only storing large medical images but also doing large computing cluster analysis of them “without having a super-computer in every office”.
nVoq already offers very high fidelity voice dictation and transcription for health by using cloud.
“As the medical terminology and lexicon changes, they do not need to keep reinstalling new bits of software and so they can interface with the software that’s already there,” he remarks. “Even pretty simple low-powered devices, like smart phones, can take a stream of voice, fire it up to the cloud and then send back some very well translated and transcribed text.”
Ensuring patient confidentiality, of course, will be essential. Microsoft, he says, is “being incredibly diligent and planning for ensuring that data held in the cloud is secure” and also that it complies with national and EU privacy requirements.
Summing up Microsoft’s future vision for health, he picks out two phrases: connected health, and real impact through connected health.
Connected health incorporates all the different aspects of health ICT, from the consumer space (e.g. Kinect on Xbox) to fitness management, community care, enterprise and government-specific solutions.
Microsoft can “uniquely” work across these areas. He explains: “We need to connect to the ecosystem together and help everyone to learn from each other and to learn about the stories where success has happened and also, frankly, the stories where we’ve not had so much success.”
Impact means taking the broad set of technologies on offer, which are already “relatively commoditised”, and “really focusing on having fast impact so we can prove the value of software in health.” In practice, this involves encapsulating information in free and open source tools and commentaries.
The coming together of telecoms and health care also promises to be “very interesting” with Vodafone already working in that space. That said, technology must be viewed as a means to the end of improving patients’ lives.
“If there’s one thing I’ve learnt in all of this time, it’s about people not about systems,” he reflects. “If you don’t deliver positive experiences and understand the needs of the users that you’re dealing with, you really won’t get any of the systemic benefits that you want to get out of the investments.”
Profile: Neil Jordan
Neil Jordan is the General Manager of the Worldwide Health Group at Microsoft Corp. He was born and educated in the UK, obtaining a bachelor of arts honours degree and then a masters in biological anthropology from the University of Cambridge. He joined Microsoft seven years ago, and for three years he was the head of Healthcare for Microsoft UK, leading the local team working with the NHS in England during the unprecedented National Programme for IT, before joining Microsoft in Redmond, Washington state, to take up his current role.
Jordan is passionate about the positive transformation that technology can provide to the delivery of healthcare in emerging and developed economies. He is equally passionate about the need to measure and prove that value in not-for-profit healthcare economies, where it is all the more vital to ensure that the benefit realized from a budget spent on technology solutions must balance and should significantly outweigh that derived by spending the same budget on procedures, staff and medication.
Before joining Microsoft, Jordan worked for IBM and also spent time building healthcare applications in the UK for the NHS, and also spent a number of years as a professional classical singer, a passion that he attempts to keep alive to this day through performances and teaching.