Microsoft, Other Companies Investing in Healthcare

Known for its software innovations and major influence on making computers ubiquitous in homes and businesses, Microsoft Corp is increasingly pouring resources into a field that has been slow to embrace technology: healthcare. For instance, Kinect is a popular device for Microsoft’s Xbox 360 gaming system and computers that tracks someone’s body through a motion sensor. It can detect a person’s face and voice. Now, Kinect is being used or tested in therapy sessions with stroke patients and autistic children as well as in operating rooms to examine magnetic resonance imaging exams and computed axial tomography scans. In all, Microsoft has 850 scientists at 9 centers across the world working on ways to utilize technology to help patients and keep costs down. It also recently announced a healthcare partnership with General Electric. Other companies are looking at merging information technology (IT) and health, too, eager to be on the forefront of the transformation. The rewards are potentially lucrative. The Patient Protection and Affordable Care Act (ACA) includes numerous provisions dealing with healthcare IT. And even if all or parts of the ACA are not enacted, most industry observers are certain that the coming months, years, and decades will see a shift from a paper-based system to a digital future. “We’ve never had an industry that needs breakthroughs like healthcare,” Dennis Schmuland, MD, chief health strategy officer at Microsoft, said at the Life Sciences Innovation Forum in Princeton, New Jersey. “There’s a tremendous amount of opportunity in improving efficiencies.” The federal government is taking the initiative seriously and has vowed to spend $27 billion to promote the use of electronic health systems. As of February, the Centers for Medicare & Medicaid Services (CMS) had made $3.12 billion in incentive payments to physicians, hospitals, and other healthcare providers to use electronic health records (EHRs). Incentives can reach $44,000 for Medicare and $63,750 for Medicaid. According to an American Hospital Association survey, 35% of hospitals in the United States adopted EHRs in 2011, up from 16% in 2009. By 2015, 85% of hospitals will have EHRs and receive incentive payments. Still, there is some uncertainty if healthcare IT will save as much money as projected. The March issue of Health Affairs featured a study that found physicians who had access to computerized imaging results were 40% to 70% more likely to order a test. Physicians with access to electronic imaging results ordered imaging in 18.0% of visits compared with 12.9% for physicians who did not have access (P<.001). The authors examined the 2008 National Ambulatory Medical Care Survey of 28,741 visits to 1187 physicians. They acknowledged the results differed from other widely publicized studies that indicated adopting computerization would reduce the orders and lead to cost savings. For instance, a study projected annual savings of up to $77.8 billion, while another predicted $81 billion in annual savings. Farzard Mostashari, MD, the national coordinator for Health Information Technology, criticized the study in a blog posted on the US Department of Health and Human Services Web site. He noted the article examined data from imaging results and not EHRs. The data was also compiled in 2008 before the enaction of the Health Information Technology for Economic and Clinical Health Act. Among his other objections was that it was an observational study that could not determine the cost or association between quality and EHRs. “Seemingly surprising headlines can be tempting, but it’s important to get the facts,” Dr. Mostashari wrote. “The evidence shows we are on the right track to establishing the health IT foundations for a true 21st-century US health system where patients get better care, while we reduce healthcare costs.” At Microsoft, Dr. Schmuland and his colleagues have ambitious plans. Dr. Schmuland said the United States faces 2 main healthcare challenges. The country pays twice as much per capita compared with most other developed countries and 20 times as much as China. And medical costs keep rising, particularly pertaining to chronic diseases and obesity. Dr. Schmuland cited several reasons for the medical spending: low health literacy, unaccountable consumers, unhealthy behaviors, unhealthy environments, primary care shortage, nursing shortage, administrative complexity, defensive medicine, and government cost-shifting. Medicaid is already the second largest budget item in most states (behind education), according to Dr. Schmuland. If the ACA remains intact, millions more will enroll in Medicaid and an additional 30 million people in total are expected to have insurance by 2014, which will likely drive the costs even higher. “Our situation is serious, and it’s getting worse,” Dr. Schmuland said. “The trend is not good.” To that end, Dr. Schmuland emphasizes the “Triple Aim” initiative from the Institute for Healthcare Improvement (IHI), a nonprofit organization based in Cambridge, Massachusetts. Donald Berwick, MD, was a cofounder of IHI and the CMS administrator from July 2010 through December 2011. In a 2008 Health Affairs article, Dr. Berwick described the Triple Aim as improving the health of the population; enhancing the quality, access, and reliability of care; and reducing or controlling the per capita cost of care. Microsoft announced in February it had partnered with General Electric on a joint venture focused on developing a technology platform and clinical applications. The company, called Caradigm, is expected to launch this year. Nate McLemore, general manager of Microsoft Health Solutions Group, wrote in a blog post on Microsoft’s Web site that the venture “will combine Microsoft’s deep expertise in building platforms and ecosystems with GE Healthcare’s experience in clinical and administrative workflow solutions.” He noted the companies will continue selling their own products and services. Microsoft has >160,000 healthcare customers and >20,000 partners selling its products, according to Mr. McLemore. Caradigm will leverage numerous existing technologies, including Microsoft Amalga (enterprise health intelligence platform), Vergence (context management solution), and expreSSO (enterprise single sign-on solution), as well as GE Healthcare’s eHealth (information exchange) and Qualibria (clinical knowledge application environment). “We have an exciting opportunity to transform healthcare globally with an established open platform and a new generation of applications focused on population health,” Michael Simpson, Caradigm’s CEO, said in a news release. “Around the world, delivery system reforms and payment model changes are requiring healthcare providers to integrate data across silos of care delivery to enable better care coordination and performance improvement. We’re founding Caradigm to meet the changing needs of health and healthcare across the globe.” Microsoft is already involved in ambitious initiatives. The company, in collaboration with the University of Washington, is working on developing a functional contact lens that measures glucose levels via sensors and light-emitting diode displays. The lens is intended for patients with type 1 diabetes. Instead of patients drawing blood several times per day to monitor their glucose levels, the contact lens would monitor the glucose levels through a person’s tears. A radio transmitter embedded in the lens would transfer information from the eye fluid to a machine that records the glucose level data that a doctor can access anytime. People wearing the lens may be able to see the information and then know when to stop eating or when to have a snack to stabilize their glucose levels. Kristin Tolle, director of the natural user interface in Microsoft’s Research Connections group, wrote in a blog post that the company hopes the lens will eventually replace screening or diagnostics that involve drawing blood and that the lens will deliver medicine into the bloodstream through the cornea. Microsoft is also partnering on a project with academic institutions and researchers to develop an HIV vaccine. Steve Clayton, editor of Microsoft’s “Next” blog, explained in a posting that Microsoft’s researchers are utilizing the same approaches to finding an HIV vaccine that they did in building an e-mail spam filter. He noted that spammers avoid filters in similar ways to how the HIV virus constantly mutates to avoid attacks by the immune system. Microsoft’s software can recognize complex patterns that allow researchers to analyze how immune systems respond to the mutations, according to Mr. Clayton. “It seems like the more we spend, the less healthy we are,” Dr. Schmuland said. “There’s something seriously wrong. The real question is, How can we become a healthier nation that requires less care?”