Take it from the top: an interview with Neil Jordan
Neil Jordan joined Microsoft seven years ago. For three years, he was the company’s head of healthcare in the UK, leading the team that signed the 2004 enterprise agreement with the NHS that also committed Microsoft to the £40 million Common User Interface programme.
He then moved to Microsoft Corporation in Redmond to become senior executive, chief strategist and spokesperson for healthcare provider initiatives worldwide.
When he stopped off in the UK en route for China recently, the NHS Resource Centre took the opportunity to ask him some questions about his role, the issues facing healthcare and the role that technology can play in solving them.
Q: Perhaps we could start by finding out a bit more about your role. You’re Microsoft’s head of provider initiatives worldwide, but what does that entail?
A: Microsoft got into healthcare about seven years ago because we realised there was an enormous opportunity for us to tackle some big issues in an area that has not, traditionally, made the same use of IT as some others.
About three years ago, we really started building some internal expertise in health and I was asked to head that up. Since then, I have been doing three things. One is listening to a lot of people in a lot of different countries – not all of them developed ones - to understand what the common issues are. "The NHS is quite amazing in terms of what it delivers for what it costs, while one of the interesting things about being a patient in the US is seeing how much less efficient its system is."
The second has been taking some of that understanding into Microsoft as a corporation. And the third has been creating a coherent structure to help both our internal customers – like the healthcare team here - and our external customers to understand where we fit in.
Q: From the UK, it’s easy to think that the NHS is alone in the problems it has to solve and that it must come up with unique solutions. Are there really common issues that all healthcare systems face?
A: The good and the bad news is that there is a remarkable commonality of issues. It is easy to think there must be some divide between the healthcare systems in developed and undeveloped countries, but that is not true.
In the US, for example, there are lots of places without good access to healthcare and a lot of inefficient use of IT. Whereas in Thailand, which is undeveloped on many measures, there is pretty good basic coverage and some of the best IT anywhere.
However, everybody has some issues and those tend to fall into three categories. The first is quality of care, the second is cost - and the escalation of costs – and the third is access. In each of those categories, the task of getting data and turning it into information that people can use to tackle the issues they face is the same everywhere.
Q: And that, presumably, is where technology comes in?
A: Absolutely. It is very clear that the computer – in the widest sense of the word – has to be part of the healthcare delivery model; whether that is something in a UK doctor’s hand that is helping them to understand a care pathway, or a terminal in an Indian village that is being used for health advice during the day and for showing Bollywood films at night. "Healthcare workers are the exemplar of information workers, so there are many technologies that can make them more efficient about managing themselves and what they do."
Q: In what areas is technology ready to make a difference?
A: Healthcare workers are the exemplar of information workers, so there are many technologies that can make them more efficient about managing themselves and what they do. We are in Bristol [where United Bristol Healthcare trust is about to deploy a Microsoft Office SharePoint environment]. This is a great example of a trust using simple and commoditised technology to help people contact each other and share information.
Another area where technology can help is analytics. Increasingly, people are comfortable with using business language in healthcare when it comes to business decisions: where to spend money and how to get the most out of it. We can provide tools that generate business intelligence that help managers get to grips with these issues.
And then there is a new area for Microsoft worldwide, which is personal healthcare. We recently launched a portal called HealthVault, which is all about people managing their own health.
So, it is about search, because it lets people look for health information that is personalised to them. It is also about storing information in a way that is secure and about sharing that information in a way that is controlled by the person who owns it. And it is about devices. At the moment, medical devices all speak a different language and HealthVault provides a platform they can all plug into.
Q: HealthVault has only been launched in the US. The NHS has something that looks similar, called HealthSpace. Are there any plans to launch HealthVault here, or to offer its model to the NHS?
A: HealthSpace is personal health record, which is not the positioning of HealthVault. HealthVault is a platform that other people can use. We have something like 50 partners in the US who want to work with it, from hospitals to health management organisations to device manufacturers. So HealthSpace and HealthVault are different. But could HealthVault be a useful platform in the UK? Absolutely. "CUI feeds into that common interest that all healthcare systems have in quality. But it also feeds into commoditisation."
Q: What about the NHS? How do you see it when you come back from the States?
A: The first thing to say is that the NHS needs to stop beating itself up about what it does and its use of technology. The NHS is quite amazing in terms of what it delivers for what it costs, while one of the interesting things about being a patient in the US is seeing how much less efficient its system is.
I broke my arm recently and had to spend time in a Seattle hospital, which charged $6,000 a night. At the end of my stay, my health insurer had to go and argue that down to $2,300 a night. What an inefficient use of time! Some hospitals have great IT, but a lot of it is used for this kind of pricing. And outside hospitals, IT is not well developed at all.
Q: Has the NHS’ relationship with Microsoft changed since you were UK head of healthcare in the early days of the National Programme for IT in the NHS?
A: The NHS is it has been a customer of Microsoft’s for a long time. We first did a deal with the NHS six years ago, and we have been working together ever since. Things have changed over that time.
There used to be pockets of good things going on, but now there seems to be a more standardised approach, both because of the programme and because of the work we have been doing with it to help the NHS get the most out of our technology.
I think that’s really positive. I often compare it with ploughing a field in one direction. In the past, lots of different applications were deployed that grew in different directions and wouldn’t work with each other. Now, there’s lots of ploughing going on and applications can be deployed on top of it. Like here in Bristol. They have good infrastructure so they can start doing interesting things with it. "...at some point we need systems that people can pick up and use at lower cost."
Q: The Common User Interface programme, which was part of the 2004 enterprise agreement between Microsoft and the NHS, was also intended to help with standardisation, wasn’t it?
A: Absolutely. Richard Granger [the director general of NHS IT] wanted us to bring to the NHS some of the commonality of systems and ease of use that we have been able to bring to other areas. We all saw that as important for making systems easier to use and safer for patients.
Two years in, the CUI programme has delivered its first set of IP to the NHS [in the form of guidance on infrastructure deployment and on how key pieces of healthcare data should be displayed, and in the form of tools that NHS system providers can use in their own applications].
It has also delivered it to the rest of the world, where it has attracted a lot of interest. CUI feeds into that common interest that all healthcare systems have in quality. But it also feeds into commoditisation. We have not seen much commoditisation when it comes to IT in the healthcare sector, but it needs to come.
We cannot keep going out and building bespoke systems that solve problems hospital by hospital. I’m not saying that all healthcare IT system suppliers are bad, but at some point we need systems that people can pick up and use at lower cost. That’s why we applaud hospitals – like one that I visited recently in Portugal – that are starting to go out and create their own solutions, using commoditised IT.
Q: Finally, do you see Microsoft’s relationship with the NHS continuing to develop?
A: Of course. If there is one thing Microsoft should be famous for it is sticking with things. It took something like a decade for Windows to outsell MS DOS. We are only seven years into our relationship with the NHS, and we have just signed an enterprise agreement that will run until 2010. We are definitely in the healthcare space for the long term.
Neil Jordan’s vision for healthcare, IT and Microsoft: seven key points:
1. This is about people not systems – or, perhaps, it is about what people can do with good systems.
2. Systems have to be available to all and not just to some – that is why commoditisation is important.
3. Healthcare is not just hospitals –other areas of healthcare also need good IT.
4. Systems are not just clinical systems – non-clinical workers need good applications, too.
5. This is not about digitising the processes we have today, otherwise we will just drive our present systems faster – we need to use IT to get real change.
6. We [Microsoft] cannot do this on our own – that is why we are building platforms for others to work on.
7. We cannot do this fast – which is why we are in the healthcare space for the long term.
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Tags: Bristol, clinical, commoditisation, CUI, enterprise agreement, HealthSpace, HealthVault, information worker, interview, Neil Jordan, NHS EA, UBHT