HIStalk Quotes
What's Microsoft got up its healthcare sleeve?
posted 07/27/2006
Nothing gets a niche industry more atwitter than having the Big Boys come calling. When it comes to technology, you just aren't playing in the Bigs these days until IBM, HP, Microsoft, or Google sees an opportunity in your "space," as the brash young hotshots say. Orifices moisten at the thought of companies being bought and sold, predatory competitors dislodging hopelessly mired dinosaurs, and mind-boggling brainpower being focused on an unexplored territory of new problems - ours.
Microsoft's presumably tiny purchase of Azyxxi is generating huge headlines. Bill's in the house! Like the old bumper sticker said, "Jesus is coming -- and boy, is he pissed!" Is there a new sheriff in town, or are we getting ahead of ourselves?
First, what did Mr. Softy buy, exactly, in its purchase of bizarrely-named Azyxxi? A big data repository, basically, whipped up by a couple of ED docs. Slick by all accounts, lightning fast, sporting all-Microsoft internals, and working well at the hospital for which it was developed. A nice accomplishment, but can it really form the centerpiece of a much-ballyhooed Microsoft healthcare IT strategy?
The doctors did a good job getting themselves written up in business and technical magazines, no doubt to add some dollar signs to the company they formed to sell it independently (without success, it would appear.) Just because their product is a nearly invisible player in the healthcare industry didn't keep them out of the non-healthcare headlines, nor did it hurt their publicly chummy relationship with Microsoft, for whom they pitched hardware and development tools. Give them credit for delivering sizzle just like a big vendor.
What I like about their product (if it really is a product and not just a cool program) is that it was developed by experts in the business who had a crystal-clear vision of what they needed in order to be successful in a struggling hospital emergency department. It sounds like they did an outstanding job of designing it with a clean user interface and strong technical underpinnings that deliver superb performance (maybe with some Microsoft help, often available when you commit to an all-Redmond platform.) Best of all, technology quibblings aside, it solved their business problem, which is what everybody except geeks wants to know about software.
On the other hand, it's a one-trick pony. You can't enter any data into it. As one of the docs who designed it said, "Putting data in is not important in medicine." His theory: 75% of what doctors and nurses want involves looking at data, not creating it. It's true in the ED, where you're trying to piece together information from many sources quickly to make treatment decisions, but I would question that breezy summary of the 90% less-emergent side of medicine. Treat 'em and street 'em is easy compared to designing the systems that makes someone willing to enter all that data for the ED docs to play around with, where the technology and complexity get a lot harder. If everyone had only Azyxxi, they'd be staring at a blank screen.
Like most repositories, lots of the work and money must have been spent on interfaces and the interface engine they require. That takes a lot of expertise and vendor cooperation, not to mention smart contracting on the customer's part if you're going to get your other vendors happily formatting data for a competitor to use. Microsoft can't just sell a shrink-wrapped package that's ready to go. Customers already dread buying a portal because they know the vendor arm-twisting required to feed it.
The product saved the hospital lots of money. Lots of software can do that, right down to carefully designed and deployed applications written in Access or old copies of dBase. While the hospital says they gave Cerner's PowerChart and FirstNet the boot as a result of what Azyxxi did for them, that seems unlikely. How can a read-only database replace a robust ED application? Probably only if it wasn't being fully used. My guess is they wanted to can Cerner anyway and decided to double-dip with a nice marketing story for their new creation.
Other hospitals that have sold homegrown slick (and not-so-slick) applications later purchased by vendors had problems making the leap to off-the-shelf software. The effort to remove hard-coded business rules, to support a variety of hardware platforms, to offer customization switches, and to package up documentation and implementation tools is not inconsequential. Sometimes about all the vendor buys is the design, rebuilding just about everything else around it to make it usable. Can a package that was designed for the ED of an 800-bed hospital work in one much smaller, at an attractive price point? Because if it can't, you've only got a few dozen prospects to sell it to.
So, my summary is that Microsoft bought a technically cool software package with unknown applicability anywhere other than where it was developed. If that's where they stop, or even if it really is the centerpiece of some yet-undefined software porftolio as they're suggesting, then it really is much ado about nothing. So what else could be up their sleeve?
Microsoft's success with enterprise applications is limited -- Great Plains accounting software comes to mind. Healthcare software requires a lot of industry knowledge, consulting abilities, and clinical knowledge. Maybe they can buy their way into competitiveness with long-timers like GE Healthcare, Cerner, Meditech, and Epic. Maybe not. Would we trust them to understand our business and not just size up our pockets for picking? Do they really want to revolutionize healthcare, or just goose a sagging bottom line in an industry that doesn't look all that tough with all of our MUMPS and Cache' stuff running everywhere? And don't forget their healthcare partners, who might not appreciate seeing their bestest buddy becoming their most-feared competitor.
Maybe they're limbering up for a big purchase. Eclipsys comes to mind immediately since they're not doing so well, they're a fervent Microsoft shop with super-technie John Gomez running development, and they have a good interfacing group that could help get Azyxxi going. Or maybe they'd shoot for the stars with Cerner or Allscripts. Conceivably they could pull an IBM and buy a struggling but talented consulting firm like First Consulting Group to get immediate credibility. Or, maybe they'll just grab all the unhappy vendor and hospital IT staff and pay them big bucks to sit in private offices and play Foosball on the Microsoft campus.
Even more importantly, the possibility of Microsoft's doing something big has to be on the radar of arch-rivals Google and Oracle. Might they buy pre-emptively, or bid up prices on mid-range healthcare IT vendors with good technology and decent prospects? Or, could Microsoft be looking for expertise on pulling clinical information into a beefed-up search engine to compete with Google Health with personal health records vendors like Intuit? Could Emdeon or Misys be in play, with their widely installed but technically low-rent platforms begging for a new owner? Microsoft does love that tollgate revenue and I can see them salivating at transaction processing.
Enough free-form speculation from me without a sanity check. What do you think? If you're a vendor, what areas would you fear Microsoft's entry the most? If you're a customer, would you buy from them, and what do you hope they'll deliver that's not already available? Has Microsoft made the first chess move in a big-scale game with Google and others, and if so, what will happen next? No wallflowers, please -- I really want to hear what you have to say (and you know the other rags aren't saying anything insightful.) Take a few minutes and e-mail me your thoughts, OK? I'll summarize your ideas for the world to see.
comments (6)
1. p_anon left...
07/28/2006 12:36 am
Is this going to turn into a "MUMPS is great/awful" flamewar again? If so,
let me start it off. I'll do this purely by example, and I'll pick on
MEDITECH because I know them uncomfortably well:
2. Anonymous left...
07/28/2006 9:05 am
OH MY GOD. That article AND the MUMPS response were both PAINFULLY too
long. I could not get through either entry!
3. no one left...
07/28/2006 6:05 pm
Meditech does not equal Mumps. Look at Epic's architecture, or any other
players. You're picking on Meditech's product, not their technology.
4. Anony-mouse left...
07/28/2006 8:11 pm
It's called A-D-D - attention deficit disorder. Oops... this is too long
for you!
5. anonymous left...
07/29/2006 12:39 pm
On the Microsoft/MUMPS thing...here's why I don't trust Microsoft to build
my healthcare software. Their own Service Pack 2 for Windows XP crashed a
good enough percentage of computers running XP Home until they realised
that and released an updated update. I was working tech support at the time
and had to try to fix it. That's just one example; there are countless
others. Let's just say I wouldn't want to be an early adopter of MS
HealthCare; I'd want to wait until most of the bugs were worked out. Though
at least most healthcare organizations are used to having their vendors'
applications sunset on them, so when MS says, "we're no longer supporting
this, you have to buy the new one" that won't be a surprise.
6. p_anon left...
07/31/2006 7:58 pm
I use MEDITECH, so I know its (many) faults. It's MUMPS I'm after; more
specifically, YOUR undeserved love of it. MUMPS sucks. MUMPS is voodoo
hoodoo sorcery. Show me that it's possible to do transactions in MUMPS;
show me some readable code. MUMPS is prone to entire CATEGORIES of errors
that modern languages simply DO NOT ALLOW.
