Dr Bill Crounse, MD, Microsoft’s senior worldwide director of health
Dr Bill Crounse, MD, Microsoft’s senior worldwide director of health.

Part of Dr Crounse’s brief is to act as a roving international ambassador for Microsoft’s burgeoning healthcare team, evangelising and keeping his finger on the pulse of developments. Dr Crounse’s highly readable blog is testament to his enthusiasm for harnessing health IT.

Speaking to E-Health Insider in London at the end of January, where he was over to speak at Microsoft’s NHS CIO summit, Dr Crounse, says “healthcare is all about information at the point of care and making it available”.

It is a market in which Microsoft is investing heavily. The healthcare group of Microsoft is growing fast, says Dr Crounse: “The healthcare vertical now has 700 people around the world, making it the newest and fastest growing group in the company.”

Microsoft’s footprint in health is currently about 80% aimed at the consumer and 20% at enterprises. Two further indications of Microsoft’s ambitions in consumer search and health came after the interview with the announcement of a tie-up with the US Mayo Clinic Group of health information tools for consumers, and the blockbuster news of Microsoft’s hostile bid for Yahoo!.

Exemplars in healthcare information

Asked by E-Health Insider to point to who he considers the exemplars in using technology to deliver healthcare services in new ways, Dr Crounse says: “Typically it is organisations arranged as both payers and providers of care such as Kaiser Permanente in the US, who are now providing services like physician-patient email and telemonitoring.”

“They are in the business of taking care of a given population, so it makes sense to provision care in the most effective way they can and that supports the bottom line. As soon as you go into hospitals or clinics it’s expensive, the trick is to keep patients from needing to go into hospital.”

He says it is organisations like Kaiser Permanente or Group Health that are also best placed to provide patients with personalised information and personal health records. The NHS he says is ideally placed to capitalise on these advantages, but to deliver benefits to an entire country.

Why the NHS can harness information for care

Dr Crounse says that at the higher level the NHS shares some of the traits of a Health Management Organisation (HMO) like Kaiser Permanente. “At Microsoft’s recent CIO summit I pointed out that the NHS has these types of organisations within it, it is both a payer and provider of healthcare.”

He points out that through its Enterprise Agreement with Microsoft, the NHS has already standardised on the latest information worker solutions, such as Office, and unified communications stack, Exchange.

The Common User Interface (CUI) programme is also a critical development in Microsoft’s view, though a long-term project. “As you might imagine, having a common user interface to clinical systems across the entire NHS landscape, in every facility, will dramatically improve patient safety, staff productivity, and caregiver satisfaction.”

When combined with the national infrastructure available to it, the NHS has an extremely powerful set of tools, says Dr Crounse: “The NHS now has access to all the tools and technologies to provision information, care and services using exactly the most appropriate modality; whether in a hospital, in a clinic, GP’s office, a patient’s home or virtually on the internet.”

He added: “NHS organisations are in an ideal position to make information available to patients.”

Microsoft’s acquisitions in health

Microsoft’s rapid expansion in health over the past few years has been backed by a series of recent acquisitions and launches. Three firms, each in very different segments of the healthcare industry, have been bought by Microsoft.

In the sphere of consumer health information it bought health vertical search specialist MedStory, since renamed Health Search, in Febuary last year, which provided an essential foundation for, last October’s launch of HealthVault personal health platform.

Health Vault, currently only available in Beta in the US, is about having a place where people “can put information, store that information and share it with whoever they want.” Dr Crounse readily admits that HealthVault remains a work in progress, but is a platform with huge potential, particularly as new partners join it.

Just as interesting was Microsoft’s purchase in July 2006 of ‘health intelligence’ specialist Azyxxi (rhymes with pixie), addressing the needs of complex healthcare organisations who may already be running dozens of systems containing vast amounts of historic data they want to be able to interrogate.

To serve the medium-sized hospital sector, Microsoft in October 2007 announced the purchase of Thailand-based healthcare software company Global Care Solutions, which at Bumrungrad Hospital, Bangkok , has blazed a trail in the development of low-cost, fully fledged hospital system built cheaply using Microsoft’s SQL Server.

Built in 50 languages for a hospital that serves over 400,000 foreign patients a year, the system covers scheduling and medical functions. Dr Crounse says of the system: “Developed for a small amount of money it compares favourably to major systems developed at far greater cost.” The system has multiple modules covering clinical and administrative tasks.

Dr Crounse enthuses: “The system is used by every single person in that hospital organisation from the orderlies to the doctors who do the heroic surgery.”

Commoditisation of health IT

One of the central messages that Dr Crounse is keen to push is the notion of the healthcare industry reaching the same tipping point already achieved in other sectors, where having been very bespoke and expensive, software is becoming commoditised and much more affordable.

He points to Microsoft’s work with Portugese hospital, Hospital de Sao Sebatiao, where a relatively small in-house team of 11 at the 330-bed hospital, have “built an end-to-end solution for all administrative and clinical functions”, at what he says is a remarkably low cost. “The hospital’s CIO believes they have done it for approximately less than 1% of what an equivalent US implementation would cost.”

Dr Crounse adds: “It was built end-to-end on Microsoft technologies, and uses some of the best bits of systems in other countries.” He says such a move to commodity pricing is coming in part from use of standards and recycling of components such as Microsoft’s very own Common User Interface (CUI) for health.

Referring to the current costs of big hospital IT systems in the US, Dr Crounse added that as a clinician he’d most likely be appalled by the cost. “For a clinician to see $100s millions spent on just one hospital in an IT system; that is money not being spent on clinical care.”


Jon Hoeksma