Harnessing the Power of

Technology to Improve

Chronic Care Management

A Whitepaper

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Contents

Executive Summary .............................................................................................................................................................................................. 3

The Cost of Care .................................................................................................................................................................................................... 4

Self-Management Scenario .............................................................................................................................................................................. 6

Care Coordination Scenario.............................................................................................................................................................................. 8

Caregiver/Patient Collaboration Scenario ................................................................................................................................................. 11

Improved Decision Support Scenario ......................................................................................................................................................... 13

Future of Healthcare .......................................................................................................................................................................................... 15

Start Building a Better Future Today ........................................................................................................................................................... 17

Appendix: Microsoft Technologies Supporting Chronic Care Management .............................................................................. 18

Why Microsoft? .................................................................................................................................................................................................... 19

Appendix: Microsoft Solutions at Work Today ....................................................................................................................................... 20

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Executive Summary

The prevalence of chronic conditions is increasing in Canada, and the financial impact on

health system is mounting. In the current environment, technology can be harnessed to

support new approaches of coordinating and managing chronic conditions benefiting

providers, patients and all Canadians.

The Canadian healthcare system is perceived to be a successful model by international comparison. However,

governments and providers of healthcare services will need to develop new approaches in order to address key

trends and challenges such as long wait times, growing consumer demand for access to higher quality healthcare,

rising costs, rise in chronic illnesses, and an aging population. Overcoming these challenges will require a

combination of initiatives such as coordinated disease management, patient self-care programs, and timely

interventions to identify early warning signs of potential problems that could result in costly acute situations.

In particular, Canadian healthcare can benefit from both existing information technologies, as well as adaptation

of newer information technologies and services that facilitate:

Improved on-line patient interaction: Web based technologies that enable patients to self-manage

conditions, access and share critical information about their health, and connect to biometric devices such

as blood pressure monitors, glucometers and more.

Improved coordination of care: Empowering health professionals to have access to critical patient

information as patients move across the continuum of care.

Remote monitoring and virtual communication: Tools that enable telehealth scenarios where

consultations and collaboration take place via low cost and pervasive web conferencing tools and

commodity devices, rather than face-to-face.

Population health intelligence: Making data readily available to provide a clear view of patient

populations, helping drive better treatment for both the individual and the broader population health

initiatives.

This thought paper illustrates the financial impact of chronic disease in Canada, and how a move towards the use

of technology has the potential for improving the delivery of services, while helping to keep costs down. Many

healthcare organizations in Canada as well as across the globe are realizing the benefits of taking advantage of

existing infrastructure and information technologies.

Advances in web and mobile technologies, and telehealth services are helping improve efficiencies in care team

collaboration, patient-doctor consultation, and patient education. Gaming technologies are gaining recognition

for their potential in supporting health and wellness, physical activity and even rehabilitation scenarios. Cloud

technology gives healthcare providers an opportunity to rapidly build and deploy scalable and interoperable

systems without a large capital investment in infrastructure.

Microsoft has made significant investments to develop technologies that connect the health community, enable

healthcare providers to unlock the power of data to help improve care, and to provide consumers the tools they

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need to better manage their own health and specific conditions. In this paper, you will learn how technology can

help improve chronic care management in the areas of:

Patient Self-management

Care coordination across the health continuum

Caregiver/patient collaboration

Improved decision support and analytics

The Cost of Care

The Canadian healthcare system is perceived to be a successful model by international comparison. Spending on

healthcare was expected to reach 11.6 percent of gross domestic product (GDP) in 2011,1 which compares

favorably to the United States’ expenditure of around 17 percent of GDP.2 The future of Canadian healthcare,

however, is facing serious risks. The current system is grappling with long wait times, growing consumer demand

for access to high quality care, rising costs, and an aging population. Canada needs to find affordable ways to

meet the increasing demands on their healthcare system.

The cost of healthcare is perhaps the most pressing issue. It’s rising rapidly in Canada – from $39.7 billion in 1975

to $200.5 billion in 20111 – an increase that more than doubled per-capita spending. Costs are being driven by a

number of factors – data show that hospitals make up the largest component of healthcare spending, accounting

for 29.1% of total health expenditures in 2009. Drugs represent the second-largest share at 16.2%, while

physicians make up the third-largest share at 13.6%. While hospitals, drugs and physicians account for almost 60%

of the total healthcare spending, many experts believe that one important way to reduce healthcare spending is to

shift care delivery from costly acute settings to more cost effective community and home based settings. There are

a number of critical factors required to make this shift, including policy enablers (such as payment models),

information and communication technologies, and consumer empowerment – to help individuals take a more

active role in managing health.

The largest single driver of healthcare costs in Canada is chronic disease. In 2010, the direct cost of care for

chronic disease in Canada reached $68 billion, more than half of all health care spending3. Take diabetes, for

example. The number of people diagnosed with diabetes in Canada [was] expected to double between 2000 and

2010, from 1.3 million to about 2.5 million. By 2020, another 1.2 million people are expected to be diagnosed with

diabetes, bringing the total to about 3.7 million. As that number grows, diabetes will consume a growing share of

healthcare budgets. By 2020, diabetes is expected to cost Canada more than $16 billion. It now accounts for about

3.5 percent of public healthcare spending in Canada, a share that is expected to rise significantly. Other chronic

disease costs driven by obesity, cardiovascular conditions, and other illnesses, are expected to increase in a similar

1 Canadian Institute for Health Information, CIHI, (2011), National Health Expenditure Trends, 1975 to 2011,

http://secure.cihi.ca/cihiweb/products/nhex_trends_report_2011_en.pdf 2 Centers for Medicare & Medicaid Services, National Health Expenditures 2009 Highlights, National Health Expenditure Data, Historical,

https://www.cms.gov/NationalHealthExpendData/downloads/highlights.pdf 3 Public Health Agency of Canada, Chronic Diseases – Most Significant Cause of Death Globally (2011), http://www.phac-aspc.gc.ca/media/nr-

rp/2011/2011_0919-bg-di-eng.php

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fashion.4

The Canadian healthcare sector can make strides toward managing these costs and improving chronic disease

management through the use of existing information technologies, and leveraging new innovative technologies

and services. Many healthcare organizations in Canada and worldwide are already realizing the benefits of the

technologies. These technologies enable greater patient self-management, improve care coordination through

better access to patient information, provide ways to support caregiver/patient collaboration using remote

monitoring and virtual communication, and allow healthcare providers better access to population health

intelligence data and improved decision support.

Improving the healthcare system and keeping costs down is important to the Canadian public as well. According

to a press release published by the Canadian Medical Association entitled, Canadians see "Moral Imperative" to Fix

Health Care System Ottawa, August 10, 2011; the Canadian public is ready for a change in the healthcare system.

In reference to the Voices into Action: Report on the National Dialogue on Health Care Transformation, the

Canadian Medical Association states, “The report shows clearly that, while the public recognizes that our system

does not work as well as it should, there remains a strong national commitment to transform our system so that it

can deliver timely, compassionate and efficient care in the appropriate setting.” 5

4 Canadian Diabetes Association (December 2009), New Canadian Diabetes Cost Model Paints a Sobering View of Diabetes in Canada

http://www.diabetes.ca/get-involved/news/new-canadian-diabetes-cost-model-paints-a-sobering-view-of-diabetes-in-cana/ 5 Canadian Medical Association, CMA, (August 2011), Canadians See "Moral Imperative" to Fix Health Care System,

http://www.cma.ca/advocacy/canadians-see-moral-imperative

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Self-Management Scenario

While online personal health record solutions are offering a way for people to manage their health information,

their functionality can be extended to meet the specific needs of a healthcare providers and patients, creating an

inter-connected hub to allow provider, patients and care teams work together and share critical information more

efficiently.

By harnessing the power of technology, providers can access useful and comprehensive data in order to gain

continuous insight into the patients’ status. Timely interventions can help prevent the need for spur-of-the-

moment appointments and preventable acute episodes. For patients, being able to track health-related

information into one easily accessible view and share that information with doctors and specialists enables them

to be more informed and proactive in partnering with their care teams. The more patients are engaged, the more

likely they will become active participants in managing their health and wellness. Recent studies demonstrate that

Canadians are ready.

For the Vancouver-based family of Sara, helping her husband, Bob, manage his diabetes is an everyday

task. He sometimes struggles to keep his blood-sugar in balance which puts him at risk for further

complications.

Sara lacked an easy way to keep track of Bob’s diabetes treatment. Records from visits to specialists,

prescriptions, lab results, plus personal records of diet and glucose levels were kept in various locations,

and not readily available. Having a centralized location to store and access all this information could help

them a great deal to successfully manage his condition. Sara also needed to keep track of her own health

records as well as those of her two teenage sons. One place for everything was the ideal solution.

Recently, Sara read an article about a new, web-based tool to manage personal health information, and

she gave it a try. Using her computer and her mobile device, Sara was able to collect, store and manage

health records for her entire family – even for her parents, who live in Toronto. She could also store

copies of records from doctors’ appointments and prescriptions, and share that information with other

healthcare providers, saving time and ensuring that relevant records are available and usable.

Bob, meanwhile, could now send data from his blood glucose meter directly to his online health record

and diabetes management application. That way, both he and his doctor see blood sugar patterns over

weeks or even months, and better understand how to help Bob keep control of his health. Similarly, Sara

can add personal information about family conditions, upload data from a variety of medical devices and

tools such as blood-pressure monitors, and share all of this important information with doctors and

health professionals.

Scenarios described here are for illustration purposes only, and people described in the scenarios are fictional.

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A project that paired

the patients of the

Cleveland Clinic with

Microsoft HealthVault

offers a promising

model of how

technology can help

improve patient self-

management.

Over 65 per cent of Canadians said they would favor having a government-provided

electronic health record that could be used by themselves and their health providers;

a similar number support medical devices that enable them to check their health

condition and send information electronically to their doctor.6

In December 2008, Cleveland Clinic and Microsoft collaborated on a pilot project

that pairs the hospital’s electronic medical records system with the software

company’s online HealthVault service to monitor patients’ health conditions. The

participants of the program used a set of information technology tools and portable,

digital medical devices to upload health data to HealthVault – a security-enhanced,

web-based data storage platform for patients – which then connected the data to

their electronic medical record system used by the patient’s healthcare providers at

Cleveland Clinic.

The project found a significant change in the average number of days between

physician office visits for patients. Diabetic and hypertensive patients were able to

make doctor’s office visits less often, increasing the number of days between

appointments by 71 percent and 26 percent respectively, indicating that patients had

better control of their conditions.7

The project demonstrated how technology can help link patients with caregivers,

and it offers a promising model for improving patient self-management and

physician oversight of patients with chronic diseases.

Technology innovation, however, is not only prevalent in US-based examples – these

technologies and tools are quickly gaining momentum in Canada. In May 2010,

TELUS®

Health Solutions announced the launch of TELUS health space, powered by

Microsoft HealthVault – Canada’s first Canada Health Infoway certified online

platform for personal health. This cloud-based solution will give Canadians greater

control on the organizing and managing of their personal and family health

information in one place, and with a powerful ecosystem of health tools and

applications on the platform.8 TELUS health space will allow patients to play a more

active role in their health and manage their chronic conditions in a number of ways

including tracking medications, lab results, and readings from devices (such as blood

pressure cuffs and blood glucose meters), and sharing that information with their

physicians and other allied health professionals.

6 Marketwire (August 2011), A Majority of Canadians Report They Are in Good Physical and Emotional

Health, but Challenges With Wellness, Healthy Living and Chronic Disease Are on the Rise: Deloitte 7 Cleveland Clinic (2010, March 1). Cleveland Clinic/Microsoft Pilot Promising; Home Health Services May

Benefit Chronic Disease Management. Retrieved from myclevelandclinic.org March 2012. 8 TELUS Personal Health Record introduced at eHealth 2011 Conference (May 2011). Retrieved August,

2011. http://telushealth.com/en/newsroom/news/2011/may30-a.aspx

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Care Coordination Scenario

Patients’ health data is frequently confined to individual providers’ information systems (whether electronic or

paper-based); consequently, physicians must often make treatment and prescription decisions without all

available clinical data, or else spend valuable time and resources attempting to aggregate data.

Improving care coordination would enable better chronic condition management, as described by the Chronic

Care Model, a framework developed in the 1990s by E.H. Wagner and his team. At the core of the Chronic Care

Model is a fundamental premise that the best quality chronic care is accomplished by having collaborative,

productive interactions between patients and their clinical care teams. The model focuses on strengthening these

through self-management support, improved therapeutic decision-making, care team collaboration and managed

follow-up. The Chronic Care Model is specifically designed to address the increasing problem of chronic disease,

and the disparity of approaches for the management and care of chronic illnesses.9

While in some sectors, today’s consumers are accustomed to dealing with organizations that understand and even

anticipate their needs – in the healthcare sector – patients go from the hospital, to their doctor and other

specialists without a sense that their care providers understand their complete history or needs – which can

negatively impact consumer confidence. Tools that have long been a staple of the business world, such as

customer relationship management (CRM) systems, can help bring a similar ‘customer orientation’ to healthcare

by leveraging case management, care coordination and patient outreach programs.

Through the use of CRM technology, providers can streamline administrative tasks, automate communications

and manage patient outreach – often referred to as patient relationship management. CRM technology provides a

central hub to process and integrate the patients' data collected by clinicians, care teams and staff, and manage

9 E.H. Wagner, “Chronic Disease Management: What Will It Take to Improve Care for Chronic Illness?” Effective Clinical Practice 1, no. 1 (1998),

Retrieved May 2012 .

Dr. Jones – Sara and Bob’s family physician – has her own challenges. When treating Bob, she

needs to know what medications Bob is taking and what other kinds of treatment he may be

receiving. Dr. Jones has an electronic medical record for Bob and her roster of patients, but other

health professionals and clinicians with whom she works (such as dietitians, endocrinologists, or

ophthalmologists) have their own systems, which don’t “talk” to one another. This makes it

difficult for Dr. Jones and her peers to get consolidated access to Bob’s data, monitor his care

plans, make patient medical performance visible to other clinicians, and see complete records of

specialist referrals, hospitalization history, and more.

A connected system that enables information sharing between providers could allow Dr. Jones to

practice more “team-based” medicine, and take a coordinated-care approach toward Bob’s needs.

Scenarios described here are for illustration purposes only, and people described in the scenarios are fictional.

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complex workflows. CRM technology also supports shared access to patient information to monitor critical

procedures and track patient symptoms. As a result, physicians can spend time more efficiently with patients,

spend less time accessing hard-to-find or paper-based information, and effectively change the care paradigm,

from treating episodes of illness to enabling proactive care by establishing productive, ’shared decision making’

relationships with patients.

Maccabi Healthcare Services,10

a healthcare provider serving one of every four people in Israel with full range of

facilities - hospitals, clinics, dental offices, and pharmacies - needed a means for bringing the data from these

disparate systems together. Implementation of CRM technology helped Maccabi improve service levels and open

up information from multiple systems to their care teams

In order to garner a 360-degree view of member data, information from multiple systems would be integrated

into a single service application. The team integrated Microsoft Dynamics CRM solution with Maccabi’s core

system. Every transaction that is performed in the older legacy system is populated into the CRM platform using

automated processes to move tasks and work-flows from person to person through to completion.

As a result, customer service representatives have a full, real-time view of member data. Each interaction picks up

where the previous one ends, boosting productivity and efficiently routing issues and tasks appropriately.

Members no longer have to repeat their history because representatives have access to comprehensive member

data at their fingertips.

Implementing portal platforms to both present and capture data in real time can improve operational efficiencies

and patient services. In Australia,11

the Improvement Foundation produced a portal platform to connect more than

1,000 general practices to their patients. Using Microsoft SQL Server to house a wide range of data and Microsoft

SharePoint portal to present the data, general practice physicians and staff were better able to collect and report

data themselves, and share information across systems. Quick access to this data led to improvements in chronic

care.

10

Microsoft Case Study Portal (July 2009.) Maccabi Healthcare Services, Healthcare Provider Improves Customer Service with Real-Time Patient

Data Visibility. Retrieved August 2011. (see Appendix) 11

Microsoft Case Study Portal (June 2010) Improvement Foundation Australia, How Sharepoint helped IFA connect with healthcare professionals.

Retrieved August 2011 (see Appendix)

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“The new integration

solution enables us to

provide our patients

with a better level of

care and support.”

- Marc Devaud, Head

of Projects and

Development,

freiburger spital.

Often, disconnected data systems that don’t talk to each other provide a huge

challenge for coordinated care. The freiburger spital,12

a consortium of six public

hospitals in Fribourg, Switzerland, joined together to integrate their various

applications into one IT system using Microsoft BizTalk Server. As a result, a large

number of point-to-point connections were replaced by a central hub, through

which data from a wide variety of systems is consolidated, synchronized, and

forwarded. “Thanks to this integration solution, we have increased our flexibility,

reduced costs, and connected all hospital locations to a common IT infrastructure.

This, in turn, enables us to provide our patients with a better level of care and

support,” said Marc Devaud, Head of Projects and Development of the freiburger

spital.

Healthcare providers managing chronic diseases could also benefit from technology

that simplifies research, identifies drugs and side effects, and provides evidence

based recommendations for how to manage patients with multiple chronic diseases.

In the United Kingdom, for instance, business tools such as Microsoft SharePoint

Server and FAST Search technology in combination with Microsoft ASP.NET were

used to build a web-based search portal called NHS Evidence.13

Developed by the

National Institute for Health and Clinical Excellence (NICE), part of the United

Kingdom’s National Health Service (NHS), NHS Evidence is a single-source location

where healthcare providers can find the latest and most authoritative clinical and

nonclinical evidence, and use that information to better treat their patients.

NHS Evidence had 12,000 visits on its first day (in April 2009), and, as of November

2010, traffic averaged about 1 million visits a month. NHS Evidence users love the

new service. The doctors can now find information in a fraction of the time it used to

take. Also, because NHS Evidence is built with Microsoft products, it integrates well

with other Microsoft products already in use by the NHS.

12

Microsoft Case Study Portal (June 2010) freiburger spital Hospital Network Reduces Costs and Improves

Care by Consolidating Disparate IT Systems. Retrieved August 2011 (see Appendix) 13

Microsoft Case Study Portal (January 2011), National Institute for Health and Clinical Excellence Health

Agency Simplifies Information Access for Health Professionals with Web Portal, Retrieved August 2011

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Caregiver/Patient Collaboration Scenario

Patients with chronic diseases – and the physicians who treat them – can benefit from harnessing technology

solutions that allow more efficient collaboration, patient-doctor consultations, and patient education.

In January 2009, the Hawaii Medical Service Association (HMSA)14

became the first health plan in the U.S. to offer

every Hawaiian resident and HMSA member medical care online, providing patients with the opportunity to speak

to a physician or specialist via web-based video conferencing, telephone, or secure on-line chat. Patients can

immediately speak to a local physician anytime and virtually anywhere and get answers to medical questions

without waiting weeks for a scheduled appointment.

14

HMSA (January 2009) First in the nation, HMSA’s Online Care goes live,

http://www.hmsa.com/mediacenter/press/2009/090115_onlinecare_launch.aspx

Dr. Jones is responsible for scores of patients. Some live nearby, some in remote areas. Indeed,

geography is a constant problem for Canadian healthcare providers, many of whom are

responsible for patients in thinly populated areas where it’s not feasible to locate permanent

healthcare facilities. She found that many of her patients were going too long between

appointments making it difficult to catch changes in symptoms which put them at risk for medical

complications, emergency care or hospitalization.

One patient in particular who lived over two hours away, relied on virtual on-line visits from a

nurse to report changes in symptoms rather than having to travel to Dr. Jones’s office. During a

recent on-line visit, the nurse suspected the patient may have been experiencing negative side-

effects from a medication. The nurse was able to arrange a virtual consultation with Dr. Jones

about this patient’s symptoms and seek guidance on the appropriate protocols. It turned out the

nurse’s evaluation was very timely and a short video conference with Dr. Jones prevented

complications and a costly trip to the nearest emergency room.

Dr. Jones found that her patients who kept themselves educated about their conditions and

overall health, and those able to keep up with regular consultations did much better overall,

requiring fewer interventions. This was true for both her long-distance patients, as well as those

living nearby. Oftentimes a quick consultation (on-line or face-to-face) with another member of a

patient’s care team was all she needed in order to make effective intervention decisions.

Scenarios described here are for illustration purposes only, and people described in the scenarios are fictional.

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Built in a partnership with American Well™, the HMSA system solves several problems relevant to Canada’s needs:

Time — Illnesses and accidents rarely happen at the best times. And some patients must be seen

immediately, unable to wait for weeks for a scheduled appointment. Online Care is an on-demand

service that provides almost immediate access to doctors.

Distance — Hawaii is a rural state with a scattered population and a limited number of doctors.

Online Care connects patients with doctors statewide.

Mobility/disability — Patients with impaired ability to get around may find it difficult to leave their

homes for doctor visits. Online Care allows patients to speak with doctors without having to leave

their own home.

Canada also is realizing some of the benefits of telehealth. The Ontario Telemedicine Network, for instance, uses

video capabilities to deliver healthcare in remote locations. It employs some 1,200 video conferencing endpoints

in locations across Ontario, and currently is rolling out capabilities that will allow doctors and nurses to access the

network from personal computers. More than 3,000 healthcare providers in Ontario use the network, and manage

remotely about 135,000 patient visits each year.15

According to a recent study commissioned by Canada Health Infoway,16

Telehealth Benefits and Adoption –

Connecting People and Providers across Canada, telehealth services grew more than 35 percent in the past five

years. This is resulting in improvements in care such as better chronic disease management and improved care

coordination. Expanding telehealth offerings in Canada could help drive more efficient use of provider resources,

delivering healthcare to remote areas, and give patients everywhere better access to health information and

advice.

Unified communication technologies, such as Microsoft Lync and Skype, offer solutions that bring the many ways

healthcare professionals communicate into one familiar user interface. With the click of a mouse or a simple voice

command, a caregiver can initiate an email, an instant message, a phone call, a web conference or book a

meeting. By using an audio or video conference, caregivers can quickly find colleagues by department or role and

connect with them using the presence information integrated within clinical and administrative portals. Distributed

care teams can share test results, X-rays, and other clinical information with each other on a variety of systems and

devices.

Such an approach can help resolve issues faster. Microsoft Lync also makes it easy to schedule patient

appointments, plan follow-ups and set up alerts. Patients and caregivers can communicate more efficiently before,

after and between office visits. That may include remote delivery of patient education, post-treatment counseling

and virtual group sessions.

15

Ontario Telemedicine Network, Copyright © 2008 OTN. All rights reserved. http://otn.ca/en/otn/about-otn,

http://otn.ca/index.php?uri=/en/services/video-conferencing 16

Canada Health Infoway, Telehealth Benefits and Adoption – Connecting People and Providers across Canada Source: https://www.infoway-

inforoute.ca/about-infoway/news/news-releases/740

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Cancer Care Ontario (CCO) replaced their private branch exchange (PBX) systems17

with Microsoft Office

Communications Server to make their conferencing and communications systems more robust and agile, thus

reducing the infrastructure costs required for a new employee. By implementing the Microsoft Unified

Communications system, CCO was able to reduce or avoid additional equipment costs, improve employee

efficiency and communication as well as provide employee’s location information that was so critical for 911

services.

Improved Decision Support Scenario

Commercial enterprises and advanced medical systems worldwide use advanced business intelligence tools to

better understand their customers and optimize their business performance. Yet today, many healthcare

organizations and governments lack the ability to effectively collect and use valuable information to gain insights,

improve patient care, manage patient populations, improve operational performance, and speed up research

cycles.

University of Washington Medicine’s Institute of Translational Health Sciences (ITHS)18

utilized Microsoft Amalga –

a health intelligence platform that integrates vast amounts of data from disparate information systems and turns

that information into critical knowledge – in an effort to accelerate and improve translational research. This type of

research involves applying knowledge gained from basic sciences and research to real-world clinical and

17

Microsoft Case Study Portal (July 2010) Cancer Care Ontario - Government Healthcare Agency Implements Unified Communications Solution

to Reduce Costs. Retrieved August 2011 (see Appendix) 18

University of Washington to Use Microsoft Amalga to Support Clinical and Translational Research, September 2008

http://www.microsoft.com/presspass/press/2008/sep08/09-30UWAmalgaPR.mspx

Over time, Dr. Carey noticed that a number of her patients were showing increased risks of

developing diabetes, heart disease and other chronic conditions. While some patients were

exhibiting negative trends in the progression of their conditions, she didn’t have access to

comprehensive data that would support her observations or offer insights as to cause. She felt

that having this insight could help her better identify “at risk” patients and improve care

coordination across her extended care team. Access to comparative outcomes and analysis of

different treatments and procedures could help her better manage patient care, and create

efficiencies in clinic services.

Dr. Carey knows from reading peer review journals and attending conferences that healthcare

providers and health systems around the world are putting new business intelligence

technologies to work in healthcare environments. The data from these technologies is helping

doctors understand which patients are at greater risk for hospital readmissions and how

changes in treatment options can help with transitional care.

Scenarios described here are for illustration purposes only, and people described in the scenarios are fictional.

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community settings. University of Washington Medicine (UW Medicine) now is expanding its use of Amalga to

support a range of clinical and research projects across the health organization.

In one study, UW Medicine is using the Amalga platform to launch a study of children and adolescents who have

diabetes. Over the course of five years, a massive database of diabetic patients will be compiled and analyzed to

better understand the potential number of new diabetes cases apt to appear among U.S. children, as well as

describe the complications and quality-of-life issues of those with the disease. The system makes it possible to

collect and analyze the large amounts of data that will be collected during the study.

Business intelligence tools can make it possible for organizations to better understand clinical and operational

performance - for example - identifying which patients are at risk for being re-admitted to a hospital after

discharge and the overall impact of preventable readmissions on cost and outcomes. Those tools help clinicians

gain valuable insights into an acute care population by helping proactively manage at-risk patients throughout

their stay and at discharge, effectively monitor patient cohorts across the organization, and reduce data collection

time. As well, root causes of readmissions can be analyzed, with patient readmit probability reports based on

predictive models.

At Providence Alaska Medical Center, professionals are using the Modified Early Warning System (MEWS) –

powered by Microsoft Amalga – to help proactively monitor early clinical signals among all inpatients to help

prevent infections, escalations to intensive care and fatalities.19

Manual tracking processes weren’t sufficient and

missed early warning signs unnecessarily. With this platform, Providence has been able to immediately engage the

appropriate clinician as soon as an early warning signal was flagged. In the first two months of use, the technology

has increased the desired interventions by 40 percent, and Providence estimates that it could save as much as

$450,000 annually from unreimbursed expenses that are associated with preventable intensive care admissions.

Computing power in support of laboratory and clinical research is an increasingly important factor in delivering

appropriate care – systems that can handle quick analysis of genetic samples, for example, can help researchers

deliver actionable results to clinicians. The Melbourne-Parkville branch of the Ludwig Institute for Cancer Research

Ltd., which conducts clinical-related laboratory research, found that by converting to an all-Windows-based

platform, deploying Microsoft HPC (high Performance Computing) Server, they gained needed computing power,

reduced costs and improved their analysis.20

Cloud computing environments – such as Microsoft Azure - can also

provide clinicians and the research community with efficient and scalable HPC compute and storage services –

helping to speed up research cycles and unlocking computing resources and storage in cost effective ways.

Leveraging cloud computing models allow organizations to utilize or ‘rent’ processing power and storage using

on-demand models. On-demand service is more cost effective as it avoids costly up-front capital costs and

permits organizations to pay for what they use.

19

Microsoft Users Group 2011 Innovation Awards Honors Forward-thinking Health Companies Powering Patient-Centered Medical Homes,

Chronic Condition Management and Mobile Consumer Health, April 2008

http://blogs.msdn.com/b/microsoft_in_health/archive/2011/04/27/microsoft-users-group-2011-innovation-awards-honors-forward-thinking-

health-companies-powering-patient-centered-medical-homes-chronic-condition-management-and-mobile-consumer-health.aspx 20

Microsoft Case Study Portal (January 2011) Ludwig Institute of Cancer Research Windows Supercomputer Speeds Quest to Identify Cancer

Proteins. Retrieved August 2011

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Another aspect of managing chronic disease includes making sure patients get regular checkups, appropriate

referrals or tests – and that the information is accurately recorded. Without accurate patient records and data,

healthcare providers will find managing patients more labor intensive and a strain on their valuable time.

Djerriwarrh Health Services (DjHS) of Australia was struggling with a patient management system consisting of

inaccurate patient records and poor data quality, while also combating patient absenteeism.21

Because DjHS must

provide accurate information to government about patient volumes, the health service was being underfunded

according to the levels of care it was providing. Implementation of Microsoft SharePoint technologies led to a 20

percent increase in funding, early warning of data entry issues, less patient absenteeism, better resource

management, and better visibility into activities.

Future of Healthcare

There’s no argument – technology holds the promise of transforming healthcare for health providers and patients.

A major emerging innovation comes from the cloud. Cloud technology gives healthcare organizations the

opportunity to build and deploy leading-edge technology quickly and relatively inexpensively. The cloud offers

opportunities to help reduce costs, move information outside the four walls of a healthcare institution, and

engage with patients in new ways. From a cost savings perspective, a study conducted by Microsoft for the

European Union concluded that Cloud computing brings the benefit of unprecedented economies of scale to IT

operations, and the combined impact of economies of scale can result in long-term savings of up to 80%. Cloud

services will enable IT groups to focus more on innovation while leaving non-differentiating activities to reliable

and cost-effective providers.22

Using technology such as Microsoft Windows Azure, for example, a healthcare organization can deploy a large-

scale chronic disease study within weeks, and without a large investment in infrastructure. This is achievable

because applications can be built, hosted, and scaled on Microsoft datacenters with limited IT local resources

required. Developers can use familiar tools such as Microsoft Visual Studio, so applications can be built quickly,

and then deployed to the cloud.

Microsoft teamed up with experts from Emory University to create the H1N1 Response Center,23

a Web site where

people can receive information about flu and guidance based on a self-assessment. Visitors fill out a self-

assessment form and Emory's algorithms determine the severity of the situation and offer guidance that

individuals can use as input to make decisions about next steps.

The web site needed to be able to handle big spikes in traffic. When the media broke a story about the virus, it

caused dramatic increases in site visits.

21

Microsoft Case Study Portal (February 2011) Djerriwarrh Health Services Reporting and analysis technology improves resource management,

reduces patient absenteeism and secures additional funding. Retrieved August 2011 (see Appendix) 22

Microsoft (November 2010), The Economics of Cloud Computing for the EU Public Sector,

http://www.microsoft.eu/Portals/0/Document/EU_Public_Sector_Cloud_Economics_A4.pdf; summary-

http://www.microsoft.eu/Cloudeconomics.aspx 23

https://h1n1.cloudapp.net/

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The H1N1 Response

Center is a great

example of how

organizations can use

Microsoft Windows

Azure to guide people

help people facing a

scary and potentially

dangerous situation,

like H1N1, thereby

helping to reduce the

burden on the public

health system.

The solution was Windows Azure. The site saw peak traffic on November 9, 2009

with 123,746 page views-an unexpected 365% increase over the previous day. In

addition, by using Windows Azure we were able to go from idea to deployment in

just three weeks.

The H1N1 Response Center is a great showcase of how organizations can use

Windows Azure to help people who are facing potentially dangerous situations, like

H1N1. And by The H1N1 solution built on Windows Azure helps people have the

information they need to make good decisions, we can help reduce the burden on

the public health system and help keep healthy individuals from being exposed to

serious risks unnecessarily.

Using the cloud, Canadian healthcare providers also can engage patients more

effectively. TELUS health space, powered by Microsoft HealthVault is a Canadian-

based private cloud platform that is designed to empower patients. TELUS health

space helps people be more actively involved in their health and wellness by

enabling them to collect, store and share health information with family members

and participating healthcare providers, and access to a variety user-friendly third-

party applications and devices to help them manage their fitness, diet, and health.

The increasing power of mobile devices also will play a big role. Smartphones such

as Windows Phone 7 open rich new possibilities for improved productivity because

they work seamlessly across a myriad of technologies. With familiar Microsoft

productivity tools, like Microsoft Office and Microsoft Exchange, Windows Phone 7

enables professionals to wirelessly connect to information and resources from

virtually any environment. For physicians – it’s an opportunity to get real-time,

relevant information when and where they need it – viewing and interacting with

personal healthcare records “on the go”, viewing schedules and lab results, receiving

notifications, connecting with peers, and more.

Interactive gaming technologies will play an ever-increasing role in a variety of

health scenarios. Microsoft knows the power gaming technology can play when it

comes to supporting health, wellness and physical activity. Imagine Kinect in

pediatric centers where children can connect virtually with family and friends to play

games, or in elderly homes with supervised exercise programs, or capturing a

person’s biometric health data and connecting that data to Microsoft HealthVault so

family members and their care providers can monitor and manage their health in

new, collaborative ways.

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Start Building a Better Future Today

Today’s technology offers healthcare organizations affordability, ease of use, and power on a scale that could not

have been imagined 10 years ago. That means there is no reason to wait for the “next big thing” in technology – it

is around us now, and ready to go to work.

Microsoft has the technology, the partnerships, and the know-how to help Canadian healthcare organizations

reach their goals of improving care. As chronic diseases become more prevalent and consume a larger portion of

each healthcare dollar, it is important for healthcare providers to find new, innovative ways to manage those

conditions proactively and collaboratively within a connected network of care providers and patients. Whether

through powerful data management tools such as Microsoft SQL Server, Windows Azure and Microsoft Amalga;

Caregiver Collaboration tools such as Lync; personal health platforms such as Microsoft HealthVault; or consumer

technology such as Kinect and Windows Phone 7, Microsoft can help Canadian healthcare providers build a better

future for themselves and their patients. Start now.

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Appendix: Microsoft Technologies Supporting Chronic Care Management

Self-Management Coordinated Care Caregiver/Patient

Collaboration

Decision Support

Technology that provides

access to health information

and resources for supported

self-management with chronic

conditions.

• Microsoft® HealthVault™ is a

privacy- and security-enhanced

online service that puts patients

in control of their health

information with self-

management health tools and

devices and supports

connectivity between clinical

systems.

• Microsoft® SharePoint®

Server‑based patient portals

provide a way to deliver

personalized information and

resources to patients.

• Windows Phone provides

opportunities to create anytime

and virtually anywhere access to

critical health information for

providers and patients alike.

Technology that enables

multidisciplinary care teams to

integrate information sources

and coordinate care around

the needs of patients.

• Office 365™ provides virtually

anywhere access to email, web

conferencing, documents, and

calendars.

• Microsoft® BizTalk® Server

connects clinical information

systems.

• Microsoft SharePoint Server

enables effective information

sharing amongst providers and a

mechanism to expose data from

existing systems.

• Microsoft Dynamics® CRM

provides an out-of-the-box

solution for case management

and care coordination.

• Microsoft SQL Server®

aggregates data from diverse

healthcare systems to provide

health analytics. These can be

linked to patient data, financial

and operational data, decision

support tools and geographic

information to be displayed in

relevant, role-based dashboards.

• Microsoft Amalga provides a

platform to coordinate care and

engage patients by identifying,

tracking & managing chronic

populations and promoting self-

care.

•Forefront helps deliver end-to-

end security and access to

information via an integrated line

of protection, access, and

identity management products.

•Windows Server/System

Center enables IT professionals

to increase the reliability and

flexibility of their server

infrastructures to support

applications, clinicians and

Care-teams.

Technology that makes it easy

for care teams to collaborate

and communicate effectively.

• Office 365™ provides virtually

anywhere access to email, web

conferencing, documents, and

calendars.

• Microsoft Unified

Communications powered by

Microsoft® Lync bring together

voice, video, email, text

messaging and fax.

• Microsoft SharePoint Server

clinical portals provide fast easy

ways to share patient

information, clinical documents,

test results medication reviews,

images and care plans.

• Clinical documents such as

referrals, discharge summaries

and care plans can be created

and exchanged using

Microsoft® Office and the

Microsoft Clinical Document

Solution Accelerator.

•Windows Phone - creates new

opportunities for health

professionals to share

information and to consult with

colleagues in real time.

•Windows Server/System

Center enables IT professionals

to increase the reliability and

flexibility of their server

infrastructures to support

applications, clinicians and

care teams.

•Forefront - helps deliver end-

to-end security and access to

information through an

integrated line of protection,

access, and identity management

products.

Computer-based decision

support tools that enable

patients, clinicians and policy-

makers to make informed

evidence-based decisions.

• Windows Azure and SQL

Azure enable you to build, host

and scale applications in

Microsoft datacenters, requiring

no up-front expenses, no long

term commitment, and enabling

payment only for the resources

used.

• Microsoft Amalga aggregates

disparate data together and

makes it easy to identify and act

on insights into clinical, financial,

or operational performance.

• Microsoft SQL Server®

aggregates data from diverse

healthcare systems to provide

health analytics. These can be

linked to patient data, financial

and operational data, decision

support tools and geographic

information to be displayed in

relevant, role-based dashboards.

•Microsoft SharePoint Server ‑

based patient portals provide a

way to deliver personalized

information and resources

• Windows Server /System

Center enables IT professionals

to increase the reliability and

flexibility of their server

infrastructures to support

applications, clinicians and

Policy-makers.

•Forefront - helps deliver end-

to-end security and access to

information through an

integrated line of protection,

access, and identity management

products.

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Why Microsoft?

Microsoft has been committed to healthcare for the long term. Together with technology partners, Microsoft is

creating powerful solutions that will help providers collaborate with people to connect processes and information

and make insightful decisions.

Microsoft has a strong track record in developing user-friendly interoperable technology to be able to deliver

cost-efficient technology solutions that work. Microsoft also provides unique comprehensive solutions for

organizations and individuals that give direct integrated access to information using safety, security, and privacy

technology/features. Microsoft also understands that clinics and hospitals are increasingly being asked to do more

with less. That is why Microsoft is dedicated to offering easy-to-implement, off-the-shelf commodity technology

to healthcare providers, so that they quickly and directly help benefit patients.

And because Microsoft makes some of the world’s most widely used and supported software, most people in an

organization are familiar with Microsoft products - and healthcare enterprises can build on existing investments

and leverage current infrastructure to do more. And because Microsoft technologies are interoperable, they can

be combined with existing systems and prepared to integrate them with future technologies, and remain flexible

and scalable.

Lastly, Microsoft knows that people make decisions based on knowledge, not just data, and they often don’t need

more information, they need better information. That is why Microsoft solutions don’t just bring data together,

they turn it into information that people can use to take knowledge-driven action. People can use Microsoft-

based technologies to accomplish more throughout their day because they are familiar, intuitive, and user-

friendly.

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Appendix: Microsoft Solutions at Work Today

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United States

Wellness: Mayo Clinic24

The Mayo Clinic Health Manager helps people track

progress towards recommended and personal goals,

assess risk, monitor vital health stats like blood

pressure, weight, and cholesterol, and offers

personalized condition and wellness guidance

developed by the experts at Mayo Clinic.

Technologies:

Microsoft HealthVault

Chronic Condition Management - American Cancer

Society

Circle of Sharing allows people to share personalized

cancer information with loved ones and caretakers,

and access a vast array of personalized cancer

resources. Connected to the health ecosystem, it

enables data sharing between other applications on

the platform. Technologies:

Microsoft HealthVault

Personal & Family Health Management: New York

Presbyterian Hospital25

MyNYP.org wanted to reduce delays in getting patient

health information to the appropriate healthcare

provider, in order to avoid redundant tests and

procedures. NYP was able to consolidate their clinical

data and make it accessible to both providers and

patients. Technologies:

Microsoft Amalga

Microsoft HealthVault

24

Microsoft Case Study Portal (January 2010): Cleveland Clinic

Prestigious online wellness resource launches with help of

Commerce Server 2009. Retrieved October 2011. 25

Microsoft Case Study Portal (March 2011): New York-Presbyterian

Hospital Pioneers New Personal Health Record—myNYP.org.

Retrieved August 2011

Chronic Condition Management – American Heart

Association (AHA) Heart36026

This online wellness center from the AHA helps people

track and manage risk factors for heart attack, heart

disease and stroke. People can receive information

from HealthVault-enabled devices and applications,

and share that data with the caregiver. According to

research by Kaiser Permanente, patients who used

home monitoring and web-based reporting tools

were 50 percent more likely to have their blood

pressure in control than those who were monitored in

the doctor’s office. Technologies:

Microsoft HealthVault

Home-based digital BP monitor

Caregiver/Patient Collaboration - Mason General

Hospital & Family of Clinics (MGH&FC)27

MGH&FC wanted to give patients easier access to

their visit summaries and medical histories and to

engage patients, families, and referring physicians in

more-coordinated ongoing care. MGH&FC built a web

portal through which patients can view their

information and, soon, share it with other caregivers.

The result was improved patient experience and

coordination of care, increased organizational

efficiency and support of future enhancements.

Technologies:

Microsoft Amalga

Microsoft HealthVault

Microsoft SharePoint Server

26

Home Health Monitoring May Significantly Improve Blood

Pressure Control, Kaiser Permanente Study Finds

http://www.prnewswire.com/news-releases/home-health-

monitoring-may-significantly-improve-blood-pressure-control-

kaiser-permanente-study-finds-94576164.html 27

Microsoft Case Study Portal (June 2011) Mason General Hospital

& Family of Clinics Hospital Offers Advanced Online Patient Services

Through Healthcare Portal. Retrieved August 2011

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Business Intelligence - First Choice Home Health

and Hospice28

First Choice, facing the same challenges as healthcare

providers throughout the United States, needed to

increase efficiency to offset rising costs and reduced

Medicare reimbursements. The company gave its

clinical workers Windows Phones running Allscripts

software to file the patient reports used to generate

invoices resulting in savings of U.S.$500,000 annually

in rent, labor, travel and a 4% reduction in

hospitalization rates. Technologies:

Windows Phone

Bing Maps

Coordinated Care - Dallas Neurosurgical & Spine

(DNS)29

Dallas Neurosurgical & Spine (DNS) needed a

telemedicine solution that would enable remote

patients to conduct follow-up visits at their local

physician’s office. US Medical IT, DNS’s project

management and IT service provider implemented a

telemedicine solution that enables DNS to use audio

conferencing, videoconferencing, and desktop sharing

capabilities. The benefits to DNS include: ability to

provide more immediate care, reduction in patient

costs, while providing cutting-edge technology

without the need for technology expertise.

Technologies:

Microsoft Office 365

Microsoft LYNC Online

United Kingdom

Decision Support - National Institute for Health

and Clinical Excellence (NICE)30

28

Microsoft Case Study Portal (July 2011) First Choice Home Health

and Hospice of Utah Home Health Provider Saves $500,000

Annually, Doubles Cash Flow, with Mobile Solution. Retrieved

August 2011 29

Microsoft Case Study Portal (June 2011) US Medical IT, Medical IT

Company Helps Physicians Provide Immediate Care through Online

Solution. Retrieved August 2011

The National Institute for Health and Clinical

Excellence (NICE) provides clinical guidance and helps

establish healthcare quality standards in the United

Kingdom. To help professionals to easily access up-to-

date information, NICE launched an Internet portal.

There is now a single access point to more than 250

core information sources.

Microsoft SharePoint Server

Microsoft FAST Search Server

Microsoft ASP.NET

Canada

Caregiver Collaboration - Cancer Care Ontario

(CCO)31

CCO deployed a Microsoft Unified Communications

solution, which enabled it to provide robust

conferencing, scalable VoIP telephony, and integrated

messaging and desktop-sharing capabilities.

Technologies:

Microsoft Office Communications Server

Microsoft Office Outlook

Microsoft Exchange Server Enterprise Edition

Switzerland

Care Coordination – Public hospital consortium -

freiburger spital32

To control rising healthcare costs, standardize

infrastructure, and streamline IT operations, the

freiburger spital, a consortium of the six public

hospitals in the territorial subdivision of Fribourg,

Switzerland, deployed a systems integration solution

30

Microsoft Case Study Portal (January 2011) National Institute for

Health and Clinical Excellence Health Agency Simplifies Information

Access for Health Professionals with Web Portal 31

Microsoft Case Study Portal (July 2010) Cancer Care Ontario -

Government Healthcare Agency Implements Unified Communications

Solution to Reduce Costs. Retrieved August 2011 32

Microsoft Case Study Portal (June 2010) freiburger spital Hospital

Network Reduces Costs and Improves Care by Consolidating

Disparate IT Systems. Retrieved August 2011

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based on Microsoft BizTalk Server 2009. Now the

hospital network has access to consolidated,

synchronized, and automated systems, enabling better

patient care and reduced support costs. Technologies

used:

Microsoft BizTalk Server

Microsoft SQL Server

Windows Server

Microsoft BizTalk Accelerator for HL7

Israel

Decision Support - Maccabi Health Care Services33

Maccabi Healthcare Services is a leading healthcare

provider in Israel. The company provides lifelong

medical and dental services to members. [They]

created a plan to help improve the level of service to

their members. In order to garner a 360-degree view

of member data, information from multiple systems

would be integrated into a single service application.

Technologies:

Microsoft Dynamics CRM

Microsoft Office SharePoint Portal Server

Microsoft Windows XP Service Pack

Microsoft Exchange Server

Microsoft Office Standard

Microsoft SQL Server

Microsoft Windows Server

Australia

Business Intelligence - Djerriwarrh Health Services

(DjHS)34

DjHS was struggling with a patient management

system consisting of inaccurate patient records and

33

Microsoft Case Study Portal (July 2009.) Maccabi Healthcare

Services, Healthcare Provider Improves Customer Service with Real-

Time Patient Data Visibility. Retrieved August 2011 34

Microsoft Case Study Portal (February 2011) Djerriwarrh

Health Services Reporting and analysis technology improves

resource management, reduces patient absenteeism and

secures additional funding. Retrieved August 2011

poor data quality, while also combating patient

absenteeism. Because DjHS must provide accurate

information to government about patient volumes,

the health service was being underfunded according

to the levels of care it was providing. Implementation

of Microsoft technologies led to a 20% increase in

funding, early warning of data entry issues, less

patient absenteeism, better resource management,

and better visibility into activities. Technologies used:

Microsoft SharePoint Server

Microsoft SharePoint Designer

Care Coordination – Improvement Foundation

Australia35

Through the Australian Primary Care Collaborative

Program, Improvement Foundation Australia and OBS

use Microsoft SharePoint to produce a portal platform

that connect over 1000 General Practices to their

patients to assist in the management of chronic care.

Technologies used:

Microsoft Office

Microsoft SharePoint Administration Toolkit

Microsoft Office SharePoint Server

Technologies

Business Intelligence & Research – Ludwig

Institute36

The branch needs to analyze patient protein samples

very rapidly. However, genetic analysis demands vast

quantities of computing power, and the Institute’s

budget limits expensive IT purchases. Technologies

used:

Windows HPC Server

Windows Server

35

Microsoft Case Study Portal (June 2010) Improvement Foundation

Australia How Sharepoint helped IFA connect with healthcare

professionals. Retrieved August 2011 36

Microsoft Case Study Portal (January 2011) Ludwig Institute of

Cancer Research Windows Supercomputer Speeds Quest to Identify

Cancer Proteins. Retrieved August 2011

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Microsoft High Performance File System

Windows Server 2008 Technologies

Microsoft Windows Server Data Objects

(c) 2012 Microsoft Corporation. All rights reserved. This document is provided "as-is." Information and views

expressed in this document, including URL and other Internet Web site references, may change without notice.

You bear the risk of using it. Some examples are for illustration only and are fictitious. No real association is

intended or inferred.