The 800-pound gorilla a.k.a. Microsoft enters the arena

My good friend Karthik N., a budding clincial informatician, emailed me about Microsoft's new foray into healthcare and its acquisition of a company called Azyxxi.

"Microsoft plans to offer software tailored for the health care industry, a change from its usual strategy of encouraging others to create industry-specific products using its operating system and programming tools," according to this week's NY Times article "Microsoft to Offer Health Care Software."

The company’s first step, announced today is to purchase clinical health care software developed by doctors and researchers at a nonprofit hospital in Washington [called Azyxii]. Microsoft is also hiring two of the three doctors who created the software system and 40 members of the development team at Washington Hospital Center.

What's compelling Microsoft? Endorsements of "moving health care into the digital age and handling patient records and tracking treatments electronically" by "[h]ospitals, doctors and policymakers worldwide [who] have high hopes for saving money and improving the quality of care." This is a policy supported by both political parties and President Bush, and so digitizing clinical information can potentially be a big business.

But Azyxxi isn't just another Electronic Medical Records application. Instead it's an app that solves the problem of incompatability. "Many hospitals and clinics, they say, have many different kinds of patient information in electronic form, but the different computer systems and software programs cannot share the data. That is the principal problem the Azyxxi system addresses, analysts say."

I ran into this problem first-hand. On a rotation two months ago, I split time between two hospitals, Methodist and St Luke's. (Each had its own EMR system.) In a matter of weeks, one particular patient I saw earlier at Methodist turned up with a repeat problem at St Luke's.

When I most needed it, I was not able to review the patient's medical records from Methodist -- unless I left his bedside, closed my account at St Luke's and walked all the way to Methodist to where the patient first checked in and logged on there. Which is precisely what I did.

This is where Azyxxi, a system "designed to retrieve and quickly display patient information from many sources, including scanned documents, E.K.G.’s, X-rays, M.R.I. scans, angiograms and ultrasound images," steps in.

It was first used in Washington Hospital Center’s emergency department in 1996, and has since been adopted at six other hospitals, including the Georgetown University Hospital, in the MedStar Health group, a nonprofit network in the Baltimore-Washington region.

If installed at both hospitals, Azyxii would allow me to access that patient's Methodist records while remaining at his side at St Luke's. Thus it would have saved time, eased the job of working the patient up and starting his treatment plan, and enhanced each EMR system's ability to save costs and improve care.

Multiply this a thousand times for all the medical caretakers experiencing this problem on weekly, and it's easy to see why Azyxii is valuable.

A big plus is that neither Methodist or St Luke's would need to buy into the same EMR application to allow their people to share patient data or tweak their pre-existing systems. And the federal government would not need to create a national patient database, meaning tax dollars aren't spent on something the private market is able to resolve quite well.

The app has already proven itself effective in making doctors and their staff more efficient:

In 1995, before the system was introduced, the emergency ward handled 37,000 patients a year, waits stretched up to nine hours, and there seemed to be an urgent need for more doctors and rooms, Dr. [Craig F.] Feied, [a principal designer of the software] recalled. Today, the emergency department handles nearly 80,000 patients a year and 70 percent of them are diagnosed, treated or admitted in three hours or less. The staff has increased only 5 percent, and few rooms were added.

The problem, Dr. Feied said, was mostly that patients were waiting in rooms because doctors could not quickly find the patient records, treatment history and other information to treat them.

“We weren’t doctor-poor or bed-poor,” he said. “We were information-poor.”

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From the Washington Post, the story of how Azyxii was created.

It is noteworthy that Azyxxi did not come out of the hospital's IT department, after the appointment of a task force, the drawing up of a detailed needs analysis and approval of a long-term capital budget. There was no request for proposals, no campaign to win "buy-in" from staff, nor was a dime allocated for training. The system was designed largely by two extraordinary doctors who were lured from George Washington University a decade ago with a mandate to fix an under-performing emergency room with nine-hour waits, dissatisfied patients and an unhappy staff.

Mark Smith and Craig Feied quickly discovered that the main reason for the frustration and wait times was the delay in getting test results and other information to ER doctors and nurses. For Smith, who came to medicine from a PhD program in computer science at Stanford, and Feied, who started his career as a biophysicist and knows 25 computer languages, the obvious answer was to write a computer program that could eliminate the bottlenecks.

Sixteen months later, they installed the first terminal in the middle of the ER with a handwritten sign taped on it: "Beta Test. Do Not Use." But as they had hoped, people began using it anyway -- and were astounded by what they could do. And before long, doctors were coming from other departments to retrieve information on patients who had come to them through the emergency room.

Over the next eight years, Azyxxi spread through the hospital as more people used and demanded it, and more information was fed into its database. By 2002, the IT department threw in the towel and canceled a contract with an outside vendor to develop a hospital-wide electronics record system, having already spent $8 million. By the end of last year, with the help of a handful of in-house programmers, Azyxxi had been rolled out in all six sister hospitals in the MedStar system, at maybe a third of the cost of what an outside supplier would have charged, according to hospital officials.

Now, Smith and Feied have won a federal grant to help create a regional health information network that will tie together the medical records of all the hospitals, labs and doctors' offices in the region. What they bring is not only an open, flexible system that can be a centerpiece and model. They also bring the knowledge that you don't have to pay outside vendors a lot of money, or have a "grand solution," or create a lot of bureaucracy and regulations to bring health care into the information age. Just build it and they will come.

***

Microsoft's PR names a third co-creator, Fidrik Iskandar, states Azyxii was created using Microsoft tools, and names the company's VP of health strategy, Peter Neupert. After serving 11 years at Microsoft, Neupert ran Drugstore.com as CEO, was a member of the President’s Information Technology Advisory Committee, and served as co-chairman of a health technology subcommittee that published a report called “Revolutionizing Health Care Through Information Technology" (pdf file) before returning to Redmond.