Right on trend: an interview with Bill Crounse, MD
Dr Bill Crounse flies around the world as Microsoft’s senior director, worldwide health, and frequently writes his well-known blog on the plane.
Lyn Whitfield caught up with him on a rare afternoon in his office in Seattle, and asked what he will be saying to NHS IT managers when he visits Britain in the New Year.
Dr Bill Crounse MD practised medicine in Seattle for 20 years, founded a company to improve communication between doctors and patients and held senior managerial positions at a Washington DC hospital group before joining Microsoft.
He is now senior director, worldwide health, for Microsoft Corporation, and, as such, is responsible for providing “thought leadership, vision and strategy” for its solutions for the healthcare provider industry.
He is also a frequent speaker at events and writes an entertaining blog about trends in healthcare and Microsoft’s activities.
Among other subjects, this has speculated on what healthcare might be like if Disney decided to run hospitals (conclusion: “they would still charge of ton of money, but their customers would seldom if ever complain, because the total experience would always exceed their expectations”) and what it might be like if Wal Mart decided to go into the business.
Five trends worldwide
The Wal Mart blog jumps off from something the company is actually doing, since it has already opened more than 40 clinics in its stores – dubbed McDocs by less kind critics – and has plans for as many as 200.
This kind of commercialisation of services is also being mooted in Britain, where supermarkets are reported to be interested in hosting GP services as part of the Government’s push to make services more “personalised” while reaching under-doctored areas.
This does not surprise Dr Crounse in the slightest, as he sees such commercialisation as one of five trends that can be detected in healthcare systems worldwide. “There is a tendency to think that healthcare systems are very different, but both government and private healthcare systems are stretched,” he says. “[That means] there is a lot of dissatisfaction with them. “When patients have 24/7 access to information about their disease and the options open to them, it completely changes the dynamic.”
“Sometimes that is focused on cost, as here in the US, sometimes it is focused on access, sometimes it is focused on quality. But either because people find the cost of services too high, or because they are not happy with what they receive, you [are seeing developments such as] the health booths we have in the US, and medical tourism.
Medical tourism is also starting to affect the UK, since more and more patients are travelling abroad for operations or drugs their primary care trusts will not fund, and the EU is attempting to formalise the process with its borders.
This “globalisation” of healthcare is another of Dr Crounse’s trends. “Healthcare will always be local and regional, but it is also becoming more global,” he says. “Indeed, we are seeing some countries, particularly in Asia and the Far East, that are very interested in attracting this business.
“Governments might actually be very happy about that. So might insurance companies and employers here [in the US] because it will drive down the cost of healthcare that people need.”
The Internet and the end of medical paternalism
While such developments may push down the cost of healthcare, they are also likely to push more of the cost onto individuals – the third of Dr Crounse’s trends. And they depend, critically, on individuals having more and better information about what is available.
Unsurprisingly, this makes the development of “information everywhere” services the fourth of Dr Crounse’s trends. Indeed, his blog predicted some years ago that the Internet would mean the end of healthcare as a physician-driven business.
“I practiced medicine here in the US for many years and I predicted very early on that the Internet would mean the not so quiet end of paternalism in medicine,” he says. “When patients have 24/7 access to information about their disease and the options open to them, it completely changes the dynamic.”
He notes that it is now common to hear grumbles from doctors that their patients are coming into their surgeries “with a handful of pages off the Internet.” However, in his blog and speeches Dr Crounse argues that the revolution will go much further than that. “Office workers would rebel if they had to learn anything like 50 word processing systems. We need a much more common look and feel to the systems that are going into healthcare.”
Some patients can already access scans and genetic tests that will give them at least as much information about their health status as their doctors. And the development of new Internet services is giving them far more information about the services available to deal with them.
Microsoft has itself moved into this area with the launch of HealthVault in the US; a free, secure platform that allows people to store personal health information, input their own data from medical devices, and decide who to share this information with.
User friendly and commodified IT
The last of Dr Crounse’s five trends is the commercialisation of providers – or, in the UK context, the attempt to shift services into less expensive settings for delivery by less expensive professionals. This means specialist GPs taking on work previously done by consultants, or High Street dispensers taking on work previously done by GPs.
Such shifts also depend, critically, on information and on getting information to clinicians – about patients, pathways and protocols – in a way that is safe and easy to use. Dr Crounse feels the healthcare IT market has yet to really deliver on this.
“Vendors have not been as responsive to the needs of clinicians as they have needed to be. They have often taken paper systems and turned them into electronic processes. We need to start changing that,” he says.
He also argues that Microsoft can help in at least two ways. Firstly, by applying some its knowledge about how to make software user-friendly to healthcare systems. Secondly, by making it easier for healthcare organisations to buy IT “out of the box” that works with, instead of replacing, their existing investments.
“This really plays into some of our initiatives,” he says. “The Common User Interface programme, for example, started in the UK but it is looking at something that is common and global.
“Why should clinical workers have to deal with 50 different systems? Office workers would rebel if they had to learn anything like 50 word processing systems. We need a much more common look and feel to the systems that are going into healthcare. “Healthcare and education are two verticals that are really getting a lot of attention within Microsoft Corporation because they have business needs that require the kind of solutions that we have.”
“The other thing I talk about a lot is the importance of commodification. The cost of a hospital putting in good systems needs to be much less than it is now. We really need to get away from the $50 million big ticket system and find ways for people to get IT at a more reasonable price.”
In his blog, Dr Crounse talks enthusiastically about hospitals in Spain and Portugal that have created whole hospital information systems and paperless environments using off the shelf servers and software that comes in at a fraction of the traditional cost.
Microsoft goes shopping
Microsoft has also made some acquisitions in this space. Last year, it bought a technology and company called Azyxxi from MedStar Health in Washington DC. This is a platform that captures, stores and re-presents information stored in clinical and administrative systems, and makes it easier for healthcare staff to find and use it.
Earlier this year, it bought a Thai company, Global Care Solutions, that provides clinical and back office solutions for hospitals (and which, interestingly, developed in a “destination” hospital dealing with patients from some 200 countries around the world in “five star hotel” conditions).
This activity has raised eyebrows among some business commentators; who have noted that Microsoft has not taken the same route in some of the other “verticals” it trades in, such as financial services.
However, Dr Crounse argues that healthcare is different. “Of course we look at healthcare from a strategic, business perspective,” he says. “But there is also a higher calling. A lot of that comes from [Microsoft founder] Bill Gates – the Bill and Melinda Gates Foundation has a vision of improving healthcare around the world.
“Also, we are a software business. Healthcare and education are two verticals that are really getting a lot of attention [within Microsoft Corporation] because they have business needs that require the kind of solutions that we have.
“As for acquisition; sometimes acquiring assets is better than building them from scratch. You see many large companies doing this in areas where they can be sure that [acquisitions] will plug and play well with what they have already.
“GCS was very Microsoft already. I have been following it for some years and have blogged about how it is an excellent example of what can be done with SQL database. Azyxxi is a bit different, but it occupies a very important niche within healthcare, in that it is a revolutionary product that brings systems together in a way that is invisible to the end user.”
Talking about a revolution
Another thing that Dr Crounse is convinced will revolutionise the provision of healthcare is the set of solutions that sit under the banner of “unified communication” and allow people to communicate, instantly, while controlling who can reach them and when.
“No longer am I restricted to the telephone for communicating with colleagues or patients,” he wrote in a recent blog. “As communication technology converges to the computer and is increasingly facilitated by the Net, my office telephone, Smartphone, Pocket-PC, laptop, Tablet-PC or desktop PC will all be able to do the job for me, whether it’s an instant message, e-mail, voice, or video communication that is required.
“The use of multi-media web conferencing and interactive e-learning technologies will absolutely explode in healthcare [as] advances in speech recognition will open up new vistas for securely accessing patient information and relaying clinical orders.”
However, unified communications will also feedback into Dr Crounse’s five worldwide trends. “Any healthcare provider with a laptop and webcam can now provide a lot of services,” he points out. “I think governments are starting to understand that, and use it as a driver for change.”
At the same time, though, any consumer with an Internet connection can find such services and start driving change themselves. “I think that the healthcare organisations that do well in the future will be very attuned to these trends and able to make adjustments to the delivery of healthcare as we have known it,” Dr Crounse says. “I truly believe we have now reached a tipping point for change.”
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Dr Bill Crounse's CV: Dr Bill Crounse MD is senior director, worldwide health for Microsoft corporation. He provides vision and strategy for Microsoft solutions for the healthcare provider industry, and works with industry partners and healthcare organisations to help them benefit from the company’s technologies.
Before joining Microsoft, Dr Crounse was senior vice president and chief medical information officer for Overlake Hospital Medical Center and Overlake Venture Center in Bellevue, Washington. He was also founder of a company that worked in partnership with Microsoft to improve connectivity between physicians and patients.
Prior to this, he practiced medicine in Seattle for 20 years. Dr Crounse is well known for his work in communications, and his blog can be found at http://blogs.msdn.com/healthblog
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