HELP! We need some IT (but not just any IT): an interview with Peter Neupert

Health IT executives don’t get much more experienced than Peter Neupert, Microsoft’s vice president for health strategy. Recently, he gave evidence to the US Senate about President Barack Obama’s plan to include health IT spending within his multi-billion stimulus for the American economy. On a trip to Europe, he spoke to Jon Hoeksma about the experience and his vision for patient-centred care.

Peter Neupert’s CV is impressive. In his first stint at Microsoft, he was director in charge of operating systems before becoming responsible for MSNBC as vice president of news and publishing.

During the dotcom boom, he led Drugstore.com to a highly successful flotation, returning to Microsoft in 2005 head up the health group. He is also a man with connections. He was a member of former US president George W Bush’s Information Technology Advisory Council, and is said to be good friends with Microsoft CEO Steve Ballmer.

In January, Neupert was the sole technologist to testify to the US Senate Health, Education, Labor, and Pensions (HELP) Committee on President Barack Obama’s economic stimulus plan, which includes a $20 billion provision for electronic medical records. On his blog, he describes this experience of democracy in action as “awe-inspiring.”

Surprisingly then, his key message to the Senate committee was that technology does not provide a magic bullet to solve the problems of the US healthcare system. In the first place, he says, “IT is not going to fix healthcare without wider reform.” And in the second place, spending alone will not do the job. “We want to see smart spending – on technology that will really have an impact,” he says.

Great rocket: going where?

President Obama’s Economic Stimulus Bill, which became law this week (17 February 2009), has been described as the most ambitious legislation of its kind since the Roosevelt New Deal, which helped to pull America out of the Great Depression of the 1930s.

The $787 billion package includes tax breaks for individuals and hand-outs for non-tax payers, alongside government spending proposals. These include $200 billion of investment in US infrastructure: and that $20 billion to help bring electronic medical records (EMRs) to all Americans within five years.

Neupert compares the big idea of EMR’s for all to building a rocket – instead of setting the objective of landing on the moon and then working out what technology would be needed to achieve it.

He says the US government should think about what it wants to achieve in healthcare, and that the objectives should be cast in terms of keeping people out of hospital or improving the management of chronic conditions, such as diabetes or coronary heart disease.

“The right objective is to say that a significant part of acute care is around treatment of chronic conditions – 60%-65% - and people on the whole do a bad job of self management. That’s what we need to change.”

He also says that when it comes to EMRs, incentives must be thought through. The Obama project may make little sense unless the rules are changed that pay US physicians on the basis of how many patients they see. Consultations using an EMR may be better informed and safer, but they often take longer.

Seeing a return on investment

Neupert also argues it should be possible to put a figure on the benefits of investment on technology. “There is a clear Return on Investment on keeping someone out of hospital, rather than having to admit them,” he says.

But he also says the wider aim must be to put the patient at the centre of their healthcare. “The only person on the planet who can completely take responsibility for a condition is the patient.”

Placing patients at the centre of their healthcare means freeing and mobilising data from the various places, systems and organisations in which it presently resides, and giving patients the tools to control who has access to it, he adds.

And this is the rationale behind Microsoft’s HealthVault personal health platform, which allows the individual to connect to many stakeholders to gain a networked effect. It is also the rationale behind Microsoft’s call for data to be freed from proprietary systems, so institutions can work with “commoditised” technology.

The best demonstration of HealthVault in action is the Cleveland Clinic, a specialist heart centre in Ohio. Neupert says it is “connecting with HealthVault all the way down to device connectivity, taking data through to clinical workflow.”

Neupert says Microsoft is talking to potential Western European customers about HealthVault. “Five years ago, consumer controlled health records were not on the top of people’s agenda,” he says. “They are now, due the realisation that they must get people to take control of their health, and personal health records offer the only way to engage with the patient.”

Neupert also confirms that Microsoft is taking its Amalga suite of health enterprise software to the market in the UK. “There are many projects that people have to do that don’t fall in the remit of the National Programme for IT in the NHS. There is money being spent outside NPfIT,” he says.