Healthcare Without Boundaries:Enhancing Productivity, Safety, and Quality

An Executive Summary

February 2003

AbstractThe healthcare industry needs better integration among the information technologies that support it. The five key constituents of the healthcare industry — provider organizations and physicians, pharmaceutical and medical device companies, government and private-sector employers, health insurers, and consumers — need to share information. But communication can be difficult because of disparate IT environments, many of which are based on legacy mainframe systems. Microsoft technology can be used to integrate these disparate systems, without requiring alterations to existing legacy programs. Microsoft technology, including the Microsoft Windows 2000 operating system, Microsoft SQL Server 2000, Microsoft BizTalk® Server 2000 with the HIPAA Accelerator, Microsoft Visual Studio® .NET and the Microsoft .NET Framework, provides the ideal platform for developing and deploying XML-based and Web services-based healthcare solutions.

For more information, press only:David LubinskiMicrosoft Corp.(425) 705-6553davidlu@microsoft.com

Sherold BarrSS+K(541) 343-9623sbarr@ssk.com

© 2003 Microsoft Corp. All rights reserved.The information contained in this document represents the current view of Microsoft on the issues discussed as of the date of publication. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information presented after the date of publication.This white paper is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS DOCUMENT.Microsoft, Windows, BizTalk, Visual Studio, Active Directory, SharePoint, Visio, MapPoint, Windows Media, MSN and bCentral are either registered trademarks or trademarks of Microsoft Corp. in the United States and/or other countries.The names of actual companies and products mentioned herein may be the trademarks of their respective owners.Microsoft Corp. • One Microsoft Way • Redmond, WA 98052-6399 • USA

Contents

Introduction..............................................................................................................................................1

Creating Solutions With Microsoft Technology.................................................................................2

Providers..............................................................................................................................................2Abington Memorial Hospital.............................................................................................................2

University of Minnesota Physicians..................................................................................................3

Mississippi Valley Surgery Center....................................................................................................3

Gentiva Health Services...................................................................................................................4

Pharmaceutical and Biotechnology Companies..................................................................................5MedPointe........................................................................................................................................5

Aventis.............................................................................................................................................6

The PHOENIX..................................................................................................................................6

Rosetta Genomics............................................................................................................................7

Health Insurers....................................................................................................................................7BlueCross BlueShield of South Carolina..........................................................................................8

Clalit Health Services.......................................................................................................................8

Government and Private Employers....................................................................................................9Massachusetts Health and Human Services....................................................................................9

Microsoft.........................................................................................................................................10

A Brief Look at Microsoft Technology...............................................................................................10

Web Services.....................................................................................................................................11Tools..................................................................................................................................................11Clients................................................................................................................................................11Servers..............................................................................................................................................11Experiences and Applications............................................................................................................12

Summary..............................................................................................................................................12

For More Information.............................................................................................................................14

IntroductionThe Microsoft Healthcare Industry Solutions Group believes the time is right for technology to have a dramatic and fundamental impact in improving healthcare across the spectrum – including healthcare delivery, pharmaceutical development, health payment and personal health management. Microsoft believes it is time for healthcare without boundaries.

We call it Healthcare Without Boundaries. It’s a vision for a time when physicians and nurses can securely access patient information anytime, anywhere, and on any device; when referrals, authorizations, and insurance claims are transmitted and processed electronically; when prescriptions are written and renewed on-line; when new drugs and treatments come to market in months instead of years; when consumers control their medical information and grant permission to those who need it, whenever and wherever it’s needed. It’s a vision that acknowledges the true value of information in what is perhaps the most information-intensive environment of all—healthcare.

There’s no doubt that healthcare relies heavily on information workers. Patient care is defined by the work of skilled professionals who acquire, analyze, document, and share information. Yet healthcare has been slow to adopt information technologies that have helped workers in other industries be more productive and improve the quality of the goods and services they provide. Healthcare workers are also highly mobile. Clinicians are always on the move. They travel between rooms, corridors, floors, offices and institutions. They have unique requirements for the devices that move with them and provide rapid access to information at the point of care, wherever that may be.

These mobile professionals also require applications that are intuitive and easy to use; that share a common look and feel so users know what to do and how to do it no matter where the applications are encountered. And when it comes to data that is as personal and confidential as that contained in medical records, it needs to be secure. There simply is no room for compromise.

Breaking Down BoundariesBreaking down boundaries to enable information integration solutions has long been one of the big challenges in healthcare, simply because there are so many disparate systems — many of them legacy mainframes — that can’t easily share data. The healthcare industry is like an ecosystem, with its key constituents — providers, health insurers, pharmaceutical and biotechnology companies, and employers — centered on the healthcare consumer. All the constituents are dependent upon the timely, accurate, complete and secure flow of information.

But disparate systems block the flow. Each constituent stands as an isolated silo of information that can’t be easily shared with the other constituents. Adding to the complexity is that within each silo of data are additional silos of information that can’t be easily shared. For example, one insurer may have a mainframe system for handling Medicaid claims that can’t easily exchange information with another mainframe system used for provider claims. On the provider side, a single hospital may have several computing systems that can’t easily share data — one system for radiology, another for lab tests and another for accounts receivables and so on — none of which can interact with the systems running a physician’s office. Across the healthcare landscape are hundreds of noncompatible systems, many of them well-entrenched legacy mainframes, that isolate information.

The need to unify disparate systems led to the Health Insurance Portability and Accountability Act (HIPAA), Health Level Seven (HL7) and other initiatives that seek to standardize the storage and exchange of data.

This is where Microsoft can help. With its consumer-centric strategy and end-to-end platform solutions, Microsoft is uniquely positioned to bridge information islands in an efficient and cost-effective way for healthcare organizations, integrating systems and information workers across the enterprise and beyond, from handheld devices to the most powerful datacenters. Microsoft technology can integrate systems and empower healthcare workers, giving them the information they need when they need it, including at the point of care, where physicians can see the latest lab reports, access electronic medical records, and

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enter prescriptions electronically from a handheld device such as a Pocket PC or Tablet PC.

The Benefits of Integrating Data from Disparate SystemsThe benefits of unifying disparate systems would be enormous. Approximately 70 percent of healthcare transactions today are paper-based, resulting in administrative costs of up to 20 cents of each dollar spent. In the U.S. marketplace alone, the yearly cost of processing and administering claims is about $90 billion. The current practice of moving paper around and making telephone calls to track and confirm information compares unfavorably with the seamless efficiency of the banking industry’s automated teller machine (ATM) system. Some healthcare industry analysts believe administrative costs could be slashed to $5 billion or less by moving from a paper-based system to a coordinated and integrated digital system.

Saving $85 billion a year would be just one of the benefits to emerge if industry standards were used to unify healthcare’s disparate systems. The benefits span the field:

A parent traveling in another state or country could take their child to a physician and provide immediate access to the child’s medical records by logging onto their personal health Web site. Physicians would benefit from having instant access to vital patient information, including lab reports and electronic medical records, available at the point of care on a mobile device such as a Pocket PC or Tablet PC. Pharmaceutical companies could reduce the time required for clinical trials, streamline manufacturing and enhance distribution. Providers and health insurers could proactively address the requirements of HIPAA and turn them into competitive advantages. Employers could enhance employee well-being and reduce healthcare costs by providing access to preventive healthcare information. Removing the boundaries to information flow would help provide the life-saving solutions being called for by The Leapfrog Group for patient safety.

Microsoft and its industry solution partners are working to create a new generation of applications and devices that address the needs of both the people who work in healthcare and their patients. That’s why we call it Healthcare Without Boundaries, because it’s ultimately about much more than information. It’s about maintaining good health and saving lives.

Creating Solutions With Microsoft TechnologyProgressive healthcare organizations are already breaking down information barriers, using both Microsoft and solutions from its industry partners that benefit from the breadth and integration of the Microsoft platform and its $5 billion in annual research and development. Here’s a sampling of how Microsoft technology is being put to work across the healthcare spectrum.

Providers To improve the quality of care while reducing costs, hospitals, clinicians and other providers require technology that enables them to share mission-critical information across the healthcare continuum, including at the point of care.

Healthcare executives know the importance of having information technology that can help them improve market competitiveness, enhance efficiencies, improve clinical and service quality, and support overall outcomes management. This section provides a brief look at how progressive healthcare organizations and Microsoft partners are creating real-world solutions.

Abington Memorial Hospital Abington Memorial Hospital (AMH) is a not-for-profit, 508-bed community teaching hospital in Abington, Pa. AMH is using Microsoft technology, including the Tablet PC and Eclipsys’ SunriseXA advanced

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clinical information system, to stay on the leading edge in implementing recommendations from the National Academy of Sciences’ Institute of Medicine and The Leapfrog Group to improve patient safety.

The Tablet PC offers the full power of the Microsoft Windows XP Professional operating system, with additional features that allow a user to control the computer by using a digital pen to make notes and convert them into typed text for use in other applications. With digital pen and speech recognition capabilities, the Tablet is easily carried and offers maximum mobility.

Abington is using TabletXA, Eclipsys’ mobile clinical solution for the Tablet PC, which works in conjunction with SunriseXA. The Eclipsys solution includes computerized physician order entry (CPOE), which eliminates illegible handwriting, reduces medical errors and improves patient care. CPOE accomplishes this by ensuring order legibility and minimizing transcription errors, increasing timeliness and coordination of care, and enhancing preventive care and cost control. For example, the system lowers the chance of medication errors because it eliminates written prescriptions that can be difficult to read. In addition, the system’s knowledge base instantly checks prescriptions for dosages, allergies and other complicating factors, so potential problems are avoided before the order is made. Lab values and test results are automatically sent to the patient’s electronic medical record.

“Implementing CPOE was the first phase of our mission to improve patient safety,” said Alison Ferren, Abington’s chief information officer. “Moving to TabletXA is the second phase and will play a key role in further improving patient safety and workflow. Not only will it provide real-time access to the computerized patient record, reducing time spent on documentation and eliminating dependency on paper, TabletXA will also enhance communication among our clinicians to help them care for patients more efficiently.”

The SunriseXA solution is hosted on a Microsoft platform that includes Microsoft Windows 2000 and Windows XP, Microsoft Internet Explorer, Visual Studio, Application Center 2000, SQL Server 2000, and Windows 2000 Advanced and Datacenter Server.

University of Minnesota PhysiciansUniversity of Minnesota Physicians (UMPhysicians) prides itself on “specializing in breakthroughs,” a progressive attitude that carries over into choosing the tools used to support electronic medical records (EMR). The organization is a group medical practice comprising physicians who also are faculty members at the University of Minnesota Medical School, in Minneapolis.

As a major research institution, the University of Minnesota has a long-standing tradition for breakthroughs, priding itself on the world’s first successful open-heart surgery performed in 1952. And researchers at the group’s Stem Cell Institute published groundbreaking findings in 2002 that showed stem cells taken from bone marrow in mice and rats can form tissue for most of the organs in the body.

When the group researched the best way to implement EMR and bring lifesaving information to physicians at the point of care, they chose the Microsoft-based technology of Allscripts Healthcare Solutions (AHS). AHS’ TouchWorks software is a modular electronic medical record and clinical information solution that enhances productivity for a physician using a wireless handheld device, Tablet PC or desktop workstation. TouchWorks automates physicians’ most-common activities, including prescribing, capturing charges, dictating, ordering lab results and viewing those results, providing patient education, and taking clinical notes. AHS, headquartered just outside of Chicago, IL, provides software and services to more than 20,000 physicians across the United States.

“We are pleased to be able to implement an electronic record that is physician-owned, archived for our practice, and linked to our hospital partner for data access,” said Dr. Roby C. Thompson Jr., Chairman of the Board and CEO for University of Minnesota Physicians. "We specialize in breakthroughs and we think this will be another one for our faculty. We deployed the TouchWorks set of solutions as part of our ongoing efforts to provide our physicians with the support they need to access patient information whenever and wherever they need it.”

Mississippi Valley Surgery CenterMicrosoft technology can be used to gather and analyze data to provide a better picture of cost structures.

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For example, the physician-owned outpatient clinic Mississippi Valley Surgery Center needed a powerful yet flexible database that supported exacting cost analysis to help it reduce its fees while retaining profitability. Using Microsoft Windows 2000 Advanced Server, SQL Server 2000 and the Windows-based AdvantX surgical center management tool from Birmingham, Ala.-based HealthIS, Mississippi Valley Surgery Center created a win-win solution for patients, insurers and itself.

“To keep our costs under control, we do what I call micro case-costing on every case that goes through our surgery center,” said David Dooley, information manager for the Davenport, IA-based Mississippi Valley Surgery Center. “This case-costing is vital to successfully contracting with health insurance companies and health maintenance organizations that increasingly want to establish a set fee for a procedure.

“Our center performs a lot of orthopedic implant surgeries, and depending on the case and the surgeon, different implants will be used,” Dooley said. “The implant choice can create a pricing difference of perhaps $5,000. Typically, a hospital will set the price according to the most expensive case option, and then some. We use case-costing to provide a more exact, and competitive, fee.”

But the center’s database didn’t provide the openness and flexibility required for sophisticated case-costing. In addition, patient information had to be re-entered each time a new billing unit was used.

“Our old system wouldn’t support the transfer of patient and insurance data from one billing unit to another,” Dooley said. “This meant that patient information that had been entered during their first visit with a surgeon would have to be typed in again if they saw an anesthesiologist, typed in again if they had a lab test, and entered again if they visited a physical therapist. The patient information had to be typed into every individual billing system.”

Dooley found that the HealthIS AdvantX system provided an exceptionally well-integrated suite of modules to simplify management of a surgical center. And he found that the Windows 2000 platform with SQL Server 2000 provided the powerful and robust platform he needed. Patient data is now entered just once and is accessible across the system. And with SQL Server 2000 as the database, the AdvantX system can be used to perform extensive case-costing analysis. Dooley has seen other gains.

“The stability of Windows 2000 has been unbelievable,” Dooley said. “And SQL Server has given us speed increases of 50 to 60 percent over our previous database.” 

Gentiva Health ServicesGentiva Health Services, the nation’s leading provider of home healthcare services, is piloting point of care applications on Microsoft Windows-based Tablet PCs to simplify life for its employees. Gentiva, based in Melville, NY, considers its 30,000 remote workers, nurses, therapists and other trained specialists to be its most valuable resource. The Tablet PCs are replacing a paper-based system, slashing the time required to update client records and increasing employee job satisfaction.

Home healthcare, and healthcare in general, involves significant amounts of paperwork and recordkeeping, including clinical records, claims, and benefits-related forms and documentation. A significant portion of a healthcare professional’s time involves this paperwork.

The company has created a prototype for a Tablet PC-based solution using Microsoft Visual Studio .NET with C# and XML programming languages, along with the ink controls included with the Tablet PC platform software development kit (SDK). Ink-enabled Microsoft Office applications ease documentation and communications tasks by allowing the user to use a digital pen to work with forms on the screen.

Because Windows XP Tablet PC Edition is a superset of the Windows XP Professional operating system, it addresses issues that were previously difficult and expensive for Gentiva to solve with traditional mobile devices. For example, Windows XP can help protect patient information security and privacy by offering robust, industry-standard security and encryption features such as the Encrypted File System (EFS), and public key infrastructure (PKI) and virtual private network (VPN) features and protocols.

Also, because the Tablet PC is a powerful personal computer and, as such, includes support for USB devices, additional peripherals, such as digital cameras for patient identification and wound-care

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documentation photos, data backup devices for field-based, automated backups, and color printers for producing patient education materials, can be added easily.

“The Tablet PC technology has the potential to make a dramatic difference to our nurses,” said Bob Creamer, chief information officer and senior vice president for financial operations at Gentiva Health Services. “This type of technology could give our company a competitive edge for recruiting and retaining nursing staff, which is crucial to delivering good service to our patients.”

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Pharmaceutical and Biotechnology Companies Pharmaceutical and biotechnology companies face the challenges of a rapidly changing marketplace and a demanding regulatory environment.

For their organizations to thrive, pharmaceutical executives know it is important to break down informational barriers, to enhance the ability of their scientists and information workers to communicate, collaborate and accelerate the building of innovative pharmaceutical insights.

The challenges include optimizing the capacity and asset value of legacy systems, and unifying disparate systems, applications and platforms, to improve the overall effectiveness of information management. In addition, pharmaceutical information systems need to seamlessly link with contract research organizations, regulatory agencies, clinical study sites and other business partners. The rewards for integrated systems can include enhanced drug discovery efforts, shortened clinical trials, accelerated approval of new drugs, increased enterprise operational efficiency, and improved sales and marketing.

MedPointeIt is harder than ever for professional sales representatives from pharmaceutical companies to get face time with physicians. Today, 87 percent of the calls they make on physicians are drop-ins and are mostly spent providing samples and registering the physician for educational events. On an average call, a representative gets just 1.6 minutes (96 seconds) per primary product with a physician. During this time, a representative must educate the physician about a product, acquire the physician’s signature for the samples, and register the physician for events.

Somerset, N.J.-based MedPointe Pharmaceuticals has the added burden of specializing in short-term therapies, such as respiratory (including ASTELIN nasal spray and cough/cold products), pediatric and central nervous system (including muscular relaxants and anti-epilepsy) therapies. When a firm with more long-term patient usage programs persuades a physician to prescribe its treatment for a patient, it locks in a recurring revenue stream. But MedPointe sales representatives must consistently and effectively position the benefits of ASTELIN and MedPointe’s other therapies at each call, effectively making the sales representative earn each prescription.

To help its sales representatives maximize the value of their time with physicians, MedPointe deployed a selling system for its entire national sales force using a Proscape Technologies solution, developed with Microsoft Visual Studio .NET. Running on a Tablet PC platform, the integrated solution combines the Proscape pharmaceutical solution with sales force automation (SFA) software for territory management and precall planning.

The solution uses the Microsoft Windows Active Directory® directory service, which provides the representative with secure Single Sign-On capabilities with automatic authentication. With the solution’s Electronic Visual Aid (EVA) feature, the Tablet PC replaces all paper-based presentation and clinical materials previously used by the sales force. Sales representatives typically begin with a preformatted presentation tailored to individual physician or patient types, but with EVA they can link to authorized information on the fly. This capability provides a “bottomless bag” of visual aids, clinical studies, opinion-leader video, and real-time marketing and training materials that can be drawn on to answer a physician’s questions or objections.

The MedPointe marketing team makes extensive use of the Fort Washington, PA-based Proscape’s pharmaceutical solution’s ability to provide two-way communication in the field by surveying physicians on a variety of topics to gain quick, direct insight into doctors’ concerns, needs and interests. The information is used to continually refine presentation material. The solution leverages the Microsoft .NET Framework to move Extensible Markup Language (XML) packets up to the Microsoft SQL Server 2000 database and back out to the Microsoft Excel reporting tool on the Tablet PC.

The SFA software provides the sales staff with the ability to record and catalog physician data, determine whom to call on, and schedule sales calls. When the MedPointe representative leaves samples, the SFA software manages the sampling activity and helps pharmaceutical companies comply with the

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Prescription Drug Marketing Act of 1987 (PDMA) and Title 21 Code of Federal Regulations (CFR) Part 11 guidelines. The system also allows MedPointe to get an electronic signature from the physician. This sample/signature capture capability is fully integrated with the EVA feature so that the representative can maximize time spent with the physician during the sampling process.

MedPointe reports that the solution is enabling sales representatives to double the time they spend with physicians teaching them about ASTELIN nasal spray. Gary Lee Evans, vice president of field sales for MedPointe Pharmaceuticals, said, “Thanks to the Proscape pharmaceutical solution based on the Microsoft .NET Framework and the advent of pen-based computing, we have found a technology that provides value for physicians by enabling our representatives to deliver detailed information specifically targeted to the physician’s practice and to immediately access the clinical reference information required to answer questions and facilitate discussion.”

AventisAnything that can enhance the efficiency of clinical trials can have significant value for pharmaceutical firms. Aventis, a global pharmaceutical company employing nearly 70,000 people with a network that spans 127 countries, found potentially significant benefits when it evaluated the Tablet PC running Microsoft Windows XP Tablet PC Edition as a new productivity tool for the lab and the field.

Aventis, a leader in prescription drugs, human vaccines and therapeutic proteins, has numerous areas in the company that require a mobile work force. Aventis, with corporate headquarters in Strasbourg, France, employs hundreds of clinical trial associates (CTAs) and study managers who work in the field with physicians who are conducting clinical trials. These associates monitor the progress of each clinical study site, which requires travel from their home base every four to eight weeks.

Because pharmaceutical research is governed by strict federal regulations, it is essential to properly document clinical trials. As a result, when in the field, CTAs often choose pen and paper over a notebook PC while interviewing physicians and gathering data. Laboratory chemists also are required to maintain extensive documentation. They usually tabulate, record and paste instrumentation results into large, signed notebooks that are sealed and stored offsite.

When Aventis learned about the Tablet PC, the company began to envision ways that this latest evolution of the personal computer could provide business value by advancing its goals for technology: to improve collaboration, speed data capture and help bring drugs to market more quickly. Aventis piloted the Fujitsu Tablet PC to three user groups: clinical trial monitors, research chemists and several Aventis managers, who replaced their notebook computers with a Tablet PC loaded with the Microsoft Office XP productivity suite.

Aventis also is considering installing the chemists’ instrumentation applications on the Tablet PC. Combining the note-taking capabilities with instrumentation data and archiving everything into a read-only medium could reduce the paper-based process used today.

“In our global environment, Aventis knowledge workers are often managing diverse activities in different parts of the world,” said Peter Loupos, vice president of Aventis Information Solutions at Aventis. “We are in the knowledge creation business, and it is the speed and quality with which we generate and deliver knowledge that will provide a competitive edge. Tablet PCs and their wireless capabilities have the potential to make this knowledge available to the worker wherever he or she is.”

The PHOENIXMicrosoft technology helps organizations seamlessly integrate data across applications and platforms. The PHOENIX, a contract research organization with a list of clients including Abbott and Bayer, has always been able to perform clinical trial work quickly and cost-effectively. But it has made a leap forward through the use of an integrated, Microsoft technology-based clinical trial management solution called DataLabs CTMS.

Developers at the Irvine, CA-based DataLabs created XML-based Web services through the Microsoft .NET Framework and Visual Studio to form the core of the company’s flagship product,

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DataLabs CTMS. The first fully integrated trial-management product in the biopharmaceutical industry, DataLabs CTMS is designed to lower drug-development costs, reduce time to market, increase efficiencies and enhance the quality of research. The DataLabs system allows pharmaceutical companies to consolidate, analyze, integrate and process data from clinical trials being conducted worldwide.

By integrating all document, data and project management functions in a single Web-based solution, The PHOENIX has increased the number of trials it manages by 70 percent while reducing its internal costs. And it has completed assignments several weeks faster than it could before.

“There’s great joy in this business if you beat the timeline,” said Mike Gleeson, executive vice president of The PHOENIX. “The average drug generates $200 million per year in sales. If a manufacturer can get that drug to market even one day earlier, it is looking at millions of dollars in sales. It is also looking at a longer patent life and increased ability to generate a good return on investment.”

Rosetta GenomicsPharmaceutical and biotechnology companies must often work with huge data sets as they search for potential therapeutic agents. The high performance and scalability of the Microsoft platform delivers superior business value for deploying large database solutions.

Rosetta Genomics, an Israeli-based genomic-data analysis company, used Microsoft SQL Server 2000 Enterprise Edition to create the tools required to analyze the massive amounts of data being produced by the human-genome-sequencing project. These tools have produced amazing performance statistics. The cost of the SQL Server 2000 solution is just one-fifth the cost of comparable supercomputing solutions and provides an easy and affordable means to scale up as the genomic database grows.

Genomics is a vital area of research, but powerful search tools are required to assemble raw data into the keys to creating new therapeutic agents. “After all the initial excitement over the huge achievement in mapping the human genome, it became evident that all this information would be meaningless and useless if tools could not be found to process, analyze and understand it,” said Dr. Zahon Bentwich, chairman and chief executive officer of Rosetta Genomics.

The genomic database amounts to 20 billion records totaling 2.7 terabytes. Rosetta Genomics recognized the need to make genomic-sequence data analysis and data mining tools available to the greatest number of partners. The company set out to provide a solution as well as a service. It would offer analysis services running on Rosetta’s own system, but eventually would offer a solution that would allow customers to affordably build their own systems as well.

“In effect, the challenge was to develop a solution that would enable the analysis of complex genomic information at one-fifth to one-tenth the cost required in a supercomputer environment,” Bentwich said. “The Microsoft platform has allowed us to do this.”

Health Insurers No one knows more than health insurance executives about the need for healthcare without boundaries, because they are at the crossroads of dataflow between employers, providers and consumers. In addition, they must handle both administrative and clinical information from many disparate systems across large geographic regions.

The success of health insurers depends on how well they can manage and act on data flows to and from multiple sources to feed multiple processes: claims payment, rate setting, pricing, marketing, care management, prescription benefits, eligibility verification, clearinghouse transactions and referral management.

In their position, health insurers need to know the information they send and receive across boundaries is trusted and trustworthy. And they need standards-based solutions that support HIPAA-mandated electronic data interchange (EDI) transactions.

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BlueCross BlueShield of South CarolinaBlueCross BlueShield of South Carolina, based in Columbia, S.C., has an award-winning Web site (http://www.southcarolinablues.com/) that provides a variety of features and tools designed to assist the company’s physician partners, broker agents and customers.

Doctors and other healthcare professionals can check the status of claims and/or eligibility, submit referrals and confirm the status of those referrals. The site also offers an Ask Provider Services feature, through which providers can ask questions and receive responses in an environment with enhanced security technology. By March 2002, more than 9,500 physicians had registered to use the site’s My Insurance Manager through DirectorySmart. Broker agents can access a variety of business management tools to improve sales and promote BlueCross products and services. Benefits coordinators can access online forms and enrollment procedures. Members can check their claim status, view their explanation of benefits (EOBs), order identification cards, and more.

But the popularity of the site soon overwhelmed its original infrastructure, which was based on the Sun/iPlanet Web platform using two directory servers, with one operating as the “supplier,” or master, meaning it held the authority to write to and replicate with the other, “consumer,” directories. According to Bry Curry, .NET systems director for BlueCross, this supplier-consumer server configuration required constant replication, which significantly slowed down authentication. As the number of registered users grew, Curry said, the company couldn’t tolerate recurring downtimes and slow replication and authentication, making a multimaster directory configuration a must. BlueCross needed the assurance that if a directory server was unavailable, for whatever reason, updates and replication would continue without affecting end users. In addition, the original deployment carried a $2 per directory user charge. BlueCross needed an identity management solution that offered low-cost or no-cost directory licensing.

BlueCross worked with OpenNetwork Technologies, headquartered in Tampa Bay, FL, and asked the company to prepare a technical profile on a variety of directory services on the market. This led BlueCross to choose a solution built with Windows 2000 Advanced Server and Active Directory directory service. BlueCross made an initial investment of $310,000 and now offers its Web users a faster, more reliable portal to the company’s products and services. The Microsoft-based identity management solution helped BlueCross avoid cost-prohibitive licensing fees totaling $1.34 million over the next five years. The Microsoft solution also helped BlueCross address its security concerns.

“As we expand and improve our e-business solutions, Active Directory and DirectorySmart give us a unified and manageable security infrastructure,” said Steve Wiggins, chief information officer with BlueCross BlueShield of South Carolina. “Combined, they enable us to reduce our security risks and help protect the privacy of our members by simplifying the complexities of managing identities, privileges and security operations both within and beyond the enterprise.”

Clalit Health ServicesProviding real-time business intelligence to information workers helps them improve service while optimizing expenses.

Clalit Health Services, the largest health service provider, or HMO, in Israel and the second-largest worldwide, used the Microsoft platform and Boise, ID-based ProClarity data analysis as the front end to provide real-time business intelligence. The solution gives every clinic manager and doctor timely access to multidimensional analysis of the vast database containing hundreds of millions of records on patient hospitalization and pharmacological history, medical resource utilization and other operational information.

After evaluating alternative solutions, Clalit decided to adopt Microsoft’s SQL Server 2000 Enterprise Edition Analysis Services in a centralized configuration. An eight-processor Unisys ES7000 server with an EMC Symetrix storage area network was selected for the hardware platform. Because of the robust platform and the superior performance of SQL Server 2000, the response to most analysis queries is

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almost instantaneous; within a few seconds the user can get a freshly calculated view of the data, updated to the minute.

Initially, the solution covered 15 “worlds,” or subject areas such as hospitalization, lab tests, medicine use history, prescription statistics and demographics. Every world includes multiple world views, the various aspects of the data cubes that are generated by SQL Server 2000 Analysis Services on the fly. The deployment has been so successful that additional “worlds” come online at a rate of two per month — a testimony to the ease with which the solution is scalable and users’ eager anticipation for more information.

“Dealing in medical and financial information required top-notch security and manageability, which dictated a centralized solution,” said Gadi Gilon, chief information officer for Clalit Health Services. “This in turn demanded a very high performance level, which our legacy systems couldn’t deliver. To be useful to non-IT users, a graphical, easy-to-use front end was mandatory. And to attract the user base, it had to provide updated, relevant information in near-real time, which leads back to performance and the ability to achieve high levels of it with a reasonable outlay.”

Government and Private Employers Government and private-sector employers face the problem of dealing with the continuing increase in the cost of providing medical care. To date, a maze of disparate systems have made it difficult to analyze expenditures.

Massachusetts Health and Human ServicesGovernments especially face a problem of multiple legacy information systems that don’t easily share information. A study of Massachusetts Health and Human Services found that 15 agencies each had their own mainframes and proprietary databases, with no way to talk to each other.

This problem can be found throughout local, state and federal governments. Until the separate silos of data can be united, it will be difficult to develop the kind of consolidated data required to make better decisions on healthcare spending.

BizTalk Server provides great orchestration in uniting data from disparate systems. BizTalk Server understands legacy data in a variety of formats and can translate data to XML format for export to other processes or Web services.

In the case of Massachusetts Health and Human Services, data from the 15 agencies was brought into a centralized secure repository residing on Microsoft SQL Server 2000 databases to create what was called the MassCARES system. An analytical layer, powered by online analytical processing (OLAP), enables analysis of anonymous client data by authorized staff, and a public layer gives access to preformatted reports on client population, services, performance and such. Microsoft technology allowed this unification of data to occur without altering legacy systems.

“We couldn’t rip and replace,” said Alan Day, president of Systems Engineering Inc. (SEI), a Massachusetts development house and Microsoft Gold Certified eCommerce Solution Provider with expertise in state government. “We couldn’t modify every legacy system to accommodate the data of every other legacy system. We couldn’t demand that everyone change their applications. The only way to do it was to link to the legacy databases by providing a Web additive. We had to find a technology that everybody had on their desktop and that everybody was familiar with, that allowed us to add value and give universal fully understood access to fairly complicated capabilities. For this, Microsoft tool sets were really the only choice.”

The MassCARES unification of 15 disparate legacy systems provides a model of what can be done throughout the healthcare field.

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MicrosoftMicrosoft has found from its own experience that good things happen when consumers are empowered to improve the quality of their healthcare. In recent years, Microsoft, like most other businesses operating in the United States, has seen its annual employee healthcare costs rising, often by more than 10 percent a year. While some companies have shifted the increased costs of healthcare to employees, Microsoft wants to continue to attract and retain the very best minds, which means providing an attractive and competitive healthcare package.

In line with its Healthcare Without Boundaries initiative, Microsoft, based in Redmond, WA, believes that the key to controlling healthcare costs is to provide employees with better access to their own healthcare information. This would be simple to do with the company’s intranet. But studies show that it is often the nonemployee spouse or same-sex domestic partner (who doesn’t have access to the corporate intranet) who acts as the family healthcare manager. “We wanted to be innovative and empower our employees and family members to be better and more effective managers of their own healthcare,” said Tom McPherson, health benefits manager at Microsoft. “And given that we are a technology company, we wanted to leverage technology to accomplish this in the form of a Web portal.”

Microsoft partnered with Portland-based health communication company WellMed Inc. (now a part of WebMD ) to build an employee portal called MicrosoftHealth, where employees and their family members can research health questions, track cholesterol, blood sugar, blood pressure and other key metrics, and enjoy a range of features dedicated to helping them improve their health. Using Microsoft Passport, family members can access the site from home.

“The MicrosoftHealth site is a beginning point for bringing the consumer — in this case, our employees and their family members — into the center and giving them access to the information they need to make better healthcare decisions,” said David Lubinski, general manager of the Healthcare Industry Solutions Group at Microsoft.

Microsoft sees the WellMed solution, which is based on Microsoft technology, reducing “worried well” doctor visits, providing an ROI of 142 percent by the end of its current (2003) fiscal year and a cumulative ROI of 195 percent by the end of fiscal year 2006.

WellMed chose to build its solution using Microsoft technology because it provides a platform with innovative security features to help protect confidentiality.

“We have more than a million people accessing personal health information on our WellMed systems, which we’ve upgraded to Windows 2000 and SQL Server 2000,” said Craig Froude, chairman and CEO of WellMed. “We’ve never considered switching from Microsoft technology because it has scaled as we needed to scale, and it is easy to administer.”

Microsoft Technology OverviewMicrosoft .NET is software that connects information, people, systems and devices. Microsoft .NET connects a broad range of personal and business technologies, enabling the user to access and use important information, whenever and wherever it is needed. Built on Web services standards, .NET services enable both new and existing applications to connect with software and services across platforms, applications and programming languages. Working with Microsoft .NET-connected software means using industry-standard protocols that unify existing code, systems and applications, and unlock their value. Microsoft technology helps bridge islands of information to create Healthcare Without Boundaries.

And Microsoft provides trustworthy computing. Microsoft delivers systems that are secure by design, secure by default and secure by deployment, and provides ongoing communications to customers to help them easily and quickly update systems to help protect health information and reduce their risk of security compromise.

Microsoft also provides excellent business value. Microsoft offers the most cost-effective, flexible and integrated enterprise platform with powerful security features for developing and deploying healthcare solutions. Microsoft Windows 2000 and the forthcoming Microsoft Windows Server™ 2003 support the

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latest technology advances and standards, and provide a standards-based integration point for legacy systems.

Powered by XML and Web services, Microsoft technology harnesses a constellation of applications, services and devices to create a whole new generation of software that works as an integrated service to help healthcare organizations thrive in the digital age.

Web Services With the power of Web services, Microsoft helps increase business agility. It empowers organizations to quickly build, expand and integrate applications that help all healthcare constituents collaborate across the enterprise and close the gaps in the continuum of care.

Web services offer programmable and reusable technologies that leverage the flexibility of the Internet. Now constellations of connected applications can run on multiple platforms delivering information to all the constituencies in the healthcare continuum. Web services are based on a set of common open standards including XML, SOAP, WSDL and UDDI, as defined by the World Wide Web Consortium (W3C) and other standards bodies. Web services applications provide access to information regardless of platform and programming languages boundaries. From the schedule for a doctor’s office to the cataloging of medical images to tracking participants in new drug trials, Web services can be used to produce highly personal, intelligent computing experiences.

Tools Microsoft developer tools provide quick and easy means to develop powerful and feature-rich applications, including Web services. Microsoft Visual Studio .NET is a multilanguage suite of programming tools for building .NET-connected applications. The .NET Framework is a component of Microsoft Windows that provides a programming model and runtime for Web services, Web applications and smart client applications.

The .NET Framework was built for integration. Applications built using the .NET Framework can connect with existing systems and packaged applications across a range of platforms via Web services and other .NET services. This gives the user the ability to leverage existing legacy investments while providing a solid foundation for future expansions throughout the organization and onto the Internet.

Clients Microsoft delivers a set of operating systems for computers and other smart devices, including Windows XP for desktop and laptop machines and Windows Powered Tablet PCs and Windows Powered Pocket PCs. This smart client software helps PCs and devices work more effectively, online or offline. The result is empowered information workers. The Microsoft Windows family of client operating systems lets users get the information they need when they need it — whether they are working online, offline, in the field or at the point of care.

Servers Microsoft Windows 2000 and the forthcoming Microsoft Windows 2003 family of operating systems, combined with Microsoft’s enterprise servers, provide the best infrastructure for building, deploying and operating healthcare solutions across the enterprise. Just some of the powerful building blocks of the Microsoft platform include the following:

Microsoft Application Center to deploy and manage highly available and scalable Web applications.

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Microsoft BizTalk Server to build XML-based business processes across applications and organizations. And Microsoft BizTalk Accelerator for HIPAA gives healthcare organizations the ability to quickly implement and continually maintain the new transaction standards set by HIPAA. Microsoft Commerce Server 2002 for quickly building scalable e-commerce solutions. Microsoft Content Management Server to manage content for dynamic e-business Web sites across an organization. Microsoft Exchange Server to enable messaging and collaboration any time, any place. Microsoft Host Integration Server for bridging to data and applications on legacy mainframe systems. Microsoft Internet Security and Acceleration Server for secure, fast Internet connectivity. Microsoft Mobile Information Server to enable application support by mobile devices such as cell phones. Microsoft Operations Manager delivers enterprise-class solutions for operations management of Windows 2000, the Microsoft Active Directory and other Microsoft .NET Enterprise Server applications. Microsoft Project Server to securely develop and successfully deploy best practices for project management across an organization. Microsoft SharePoint™ Portal Server to share information within an organization and with outside key suppliers, partners and clients. Microsoft SQL Server to store, retrieve and analyze structured XML data. Microsoft Systems Management Server to provide cost-effective, scalable change and configuration management for Microsoft Windows–based desktop and server systems.

Experiences and Applications The combination of Microsoft tools, clients, Web services and servers create an information environment that empowers information workers. Microsoft technology puts information at users’ fingertips, providing them with the most powerful, easy-to-use, productivity software. Microsoft Office XP helps users quickly perform common business tasks, including word processing, e-mail, presentations, data management and analysis. Microsoft Visio® provides a powerful tool for creating flow charts and diagrams to create new procedures and systems. Microsoft Project is an excellent planning tool. Microsoft MapPoint® brings precision to navigation. And Microsoft Windows Media® and real-time communication support facilitate collaboration across the enterprise.

In addition, Microsoft consumer and business services such as MSN®, Passport, and bCentral™ can help empower consumers and businesses to exchange medical information and other services in a secure, standardized and user-friendly manner to help improve the quality of care and streamline the healthcare delivery system.

SummaryThe Microsoft platform provides the standards-based technology the healthcare industry needs to break down the information barriers that have blocked the exchange of data between the disparate IT environments of the key constituents of healthcare: provider organizations and physicians, pharmaceutical and medical device companies, government and private-sector employers, health insurers, and consumers.

With its consumer-centric strategy and end-to-end platform solutions, Microsoft is uniquely positioned to bridge information islands in an efficient and cost-effective way for healthcare organizations. Microsoft technology and Microsoft partner solutions can be used to integrate these disparate systems, without requiring alterations to existing legacy programs.

Across the healthcare industry, this means empowering healthcare workers, giving them the information they need, when they need it.

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For providers this can mean bringing data to the point of care where physicians can see the latest lab reports, access electronic medical records, and enter prescriptions electronically on a handheld device such as a Pocket PC or Tablet PC.

For pharmaceutical and biotechnology companies, Microsoft technology can mean optimizing the capacity and asset value of legacy systems, and unifying disparate systems, applications and platforms to improve the overall effectiveness of information management. The rewards for integrated systems can include enhanced drug discovery efforts, shortened clinical trials, accelerated approval, increased enterprise operational efficiency, improved sales and marketing, and the ability to seamlessly link with contract research organizations, regulatory agencies, clinical study sites and other business partners.

For health insurers, Microsoft technology can mean achieving the dataflow they need between employers, providers and consumers, handling administrative and clinical information from many disparate systems distributed across large geographic regions. Insurers can manage and act on data flows to and from multiple sources to feed multiple processes: claims payment, rate setting, pricing, marketing, care management, prescription benefits, eligibility verification, clearinghouse transactions and referral management.

For government and private-sector employers, Microsoft technology can connect what can otherwise be a maze of disparate systems, and provide the data needed to analyze expenditures and find ways to deal with the continual increase in the cost of providing medical care.

Progressive healthcare organizations are already using both Microsoft and industry partners solutions to break down the information barriers and enjoy the benefits of healthcare without boundaries.

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For More InformationTo learn more about Microsoft’s healthcare industry solutions, visit http://www.microsoft.com/healthcare/ or call (800) 426-9400.

To see Microsoft case studies about the companies mentioned in this paper, as well as the stories of other organizations benefiting from Microsoft solutions, please go to: www.microsoft.com/casestudies.

Customers Highlighted in this White PaperTo learn more about Abington Memorial Hospital, visit http://www.amh.org/.

To learn more about Aventis, visit http://www.aventis.com/.

To learn more about BlueCross BlueShield of South Carolina, visit http://www.bcbssc.com/.

To learn more about Clalit Health Services, visit http://www.klalit.co.il/clalitE/default.asp.

To learn more about Gentiva Health Services, visit http://www.gentiva.com/.

To learn more about MassCARES, visit http://www.masscares.org/.

To learn more about MedPointe, visit http://www.medpointeinc.com/.

To learn more about Mississippi Valley Surgery Center, call 563-344-6600.

To learn more about Rosetta Genomics, visit http://www.rosettagenomics.com/.

To learn more about University of Minnesota Physicians, visit http://www.ahc.umn.edu/ahc_content/colleges/um_physicians/.

Microsoft Industry Solution Partners Highlighted in this White PaperTo learn more about Allscripts Healthcare Solutions, visit http://www.allscripts.com/.

To learn more about DataLabs, visit http://www.datalabs.com/.

To learn more about Eclipsys Technologies Corp., visit http://www.eclipsys.com/.

To learn more about HealthIS, visit http://www.healthis.com/.

To learn more about OpenNetwork Technologies, visit http://www.opennetwork.com/.

To learn more about ProClarity Corp., visit http://www.proclarity.com/.

To learn more about Proscape Technologies, visit http://www.proscape.com/.

To learn more about Systems Engineering Inc., visit http://www.sengi.com/.

To learn more about WellMed, visit http://www.wellmed.com/.

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