If Healthcare Managed Restaurants

For the last couple of years, I've been using this metaphor to highlight the ridiculous nature of healthcare and particularly, healthcare billing-- the point being, we tolerate ridiculous behaviors and processes in healthcare that we would never tolerate in the rest of our lives, yet we keep building healthcare software that supports the insanity.  Why should we tolerate these crazy processes in what is one of-- if not the most-- important area of our lives?  Let’s at least build software that allows us to move away from these broken processes, even if we don’t have the cultural willpower to do so right away… at least give us the software option to be better, someday.

I used the metaphor again today in a lecture at HIMSS and several people asked me to blog it….so here you go….

If healthcare managed restaurants:

·      You wait 45 minutes for a table, even though you had a reservation.

·      You tell the waiter that you’re hungry– but there’s no menu.

·      The waiter returns with a meal that he thinks is appropriate for you…but he doesn’t know how much it costs.

·      You have no idea what the food is or what it costs, but you agree to eat it.

·      You leave without knowing your bill.

·      The restaurant sends the bill to your bank, not you.

·      Your bank tells the restaurant, “Your waiter ordered the wrong thing for you. We’re not paying for it.”

·      90 days later, the restaurant calls to tell you that your account is being turned over to collections.

:-)

Career Planning: Three Parts Chance, One Part Planning

This blog is mostly intended for the younger professionals whose careers are just beginning, but older geezers (like me) might also find it interesting, as they face the challenge of honoring their aging parents while maintaining their career. The key messages are: (1) Career paths and opportunities are three parts chance, one part planning and preparation; (2) The professionals that reverse that ratio— place great emphasis on planning and preparation, leaving very little room for chance—are often times the least happy and fulfilled. Wandering is sometimes the most direct path to a perfect destination; and (3) If you sacrifice your career in the interests of others, your career won’t sacrifice you.

There are too many first person pronouns in this story and for that, you have my first person apologies. This is an ode to a different person — a person who doesn’t look for what life owes her, but what she owes life — and the manner in which her attitude towards life has affected the way I look at my career. I share this story, though fearful that in doing so I disrespect the sanctity and solemnity of the entire event — the opportunity granted me. Hopefully, that fear is unfounded, the purity is intact, and the story somehow serves others who face similar quandaries. If nothing else, it serves as a long and public letter of thanks to very special people.

About a year ago, I had a fairly deep spiritual and introspective experience — the kind that happens to people who live alone on a tropical island, ala Tom Hanks in Castaway. It was the type of experience that forces you to rethink your priorities… I mean really rethink them, deeply.

During this experience, it struck me that the overwhelming priority in my life at this time should be to honor the irreplaceable time that remained in my mother’s life. At 87-years old, Ruby Sanders is still in amazing physical and mental condition. She still lives in the same house in Durango, Colorado where she raised six children; where winters are still winters. She’s a product of the Dust Bowl, escaping the plains of eastern Colorado and western Kansas with our grandparents, where they lived for a short time in a cabin with a dirt floor, escaping west to the mountains of Colorado just in time for the Great Depression.

 

During this hardest of times, the highlight of Christmas was often the gift of an orange or, even more special, a banana. Mom raised her first baby while our father was half-the-world away, in World War II, surviving The Battle of the Bulge.

A few short years after his return from WWII, they would suffer a parent’s worst nightmare, as our sister (their 18-month old daughter) would die painfully from aspirin poisoning. A few years would pass, the wounds of heart would become tolerable, and Mom and Dad would suffer yet another nightmare of parenting as our brother (their oldest son) at barely 18 years of age would be killed in an aircraft explosion. I can remember the scene at our kitchen table, early in the morning, when we found out — you don’t soon forget the inconsolable sobs and tears of your parents.

A few more years would pass — her wounds of heart now so deep they could never heal completely — and she would lose the love of her life (our father) at much too young an age, a victim of genetic cardiovascular disease. Some of us wonder if his heart failure was the result of a broken heart, never fully recovering from the tragic deaths of his children so young in life.

There are more stories of suffering for Ruby — too many to mention here — but throughout these periods of anguish, Mom would remain loving, caring, thoughtful, and resilient, never stumbling for more than a few steps, always hiding her broken heart to support the rest of her children, family, friends and community. Always, her first priority was instilling life and confidence in everyone around her.

About a year ago, during my Castaway reflective moments, I called Mom to check-in. Her voice was cracking with emotion, holding back tears. I prodded, “What’s wrong Mom?” to which she hesitantly replied, “Oh, I’m just so frustrated. I’ve been trying all morning to open this damn jar of peanut butter, but I can’t get it open and I feel so helpless!”

And with that, her little old lady tears came pouring out. It wasn’t long, maybe 30 seconds, and she stopped crying, apologized, and started counting her blessings — giving thanks for even having a jar of peanut butter when so many people have nothing.

With that conversation, I asked myself, “What kind of son am I if I fail to honor such a mother?  What if I fail to help her lead a worry-free life, the remainder of her life — a life that has had so many worries already?” I realized I would be no son at all.

I said a prayer at that moment, planting a seed of hope in the Universe, asking for an opportunity to return to our home town of Durango (population 12,000) so that I might help her lead that worry free life, the rest of her life. The likelihood of finding work in an isolated mountain town that would suit my career path was low, but I didn’t pray to that level of detail. All I asked for was the opportunity to return to Durango, in hope and faith that the details of my career and livelihood would work out.

Three months later, after more prayers and contemplation, I announced to our CEO of the Cayman Islands Health Services Authority that I would be leaving — two years sooner than planned. I didn’t have another job lined-up, nor any clear idea of what I might do to make ends meet in Durango, but my conscience  told me to commit first and plan later….the plan would come together.

Thankfully, it did, with the help of my dear friend Daphne Lawrence and the gracious willingness of Dave Garets at The Advisory Board (where I’ll be taking on a new position), and Lizzette Yearwood, my current CEO, who supported my transformation to a telecommuting role. Now, I have the privilege of returning home with nary a skip in my career to spend irreplaceable time with Mom, sisters, family, and friends.

I share this story in hopes that it might help those who are younger in their career and believe that you can and should plan every step of your career. I say rubbish. Keep your hearts opens to non-career priorities and the opportunities of random chance, for therein is the adventure of life. Jump when there is no safety net and see what happens. You’d be surprised how often you can fly.

Data Warehouse Data Modeling For CIOs

Data modeling is the single greatest cause of long term failure and under-performance in data warehousing and business intelligence systems, across all industries.  It is compounded as a problem in healthcare due to the complexity of the data and the analytic environment.

Errors in data modeling strategy gestate slowly, usually emerging in 2-3 years after go-live when the demands for more flexible, complex and real time analytics increase in the maturation of a data driven culture.  The most debilitating and common mistake in data modeling is the assumption that a star schema (sometimes referred to as a dimensional model) can meet all of the analytic needs of the healthcare enterprise.   Consider a traditional library of books as a metaphor.  An encyclopedia can serve as a general reference for simple research in elementary and middle school, but its content is soon not sufficient for satisfying the more in-depth and complex research of a college or graduate student.  Initially, to organizations who are early on the path of data driven decisions and research, star schemas often appear useful and valuable, but over longer periods of time, typically 2-3 years, as the data driven culture matures and the analytic needs become more complex, star schemas suffer from a number shortcomings including the loss of source system data fidelity and query performance problems.  

Star schemas have the unusual effect of requiring increasingly complex SQL statements that would be less complex under more appropriate data modeling environments.  These complex SQL statements take longer to develop, require higher skills on the part of the data analysts, and lead to programming errors.  Often times, these programming errors go undetected, resulting in the most risky analytic errors—false positives and false negatives-- in reports that are intended to inform significant business and clinical quality decisions. In summary, star schemas are useful in supporting relatively simple analytic needs such as counts and summations of events and financial transactions, but they should not be used as the single-- or even the dominant-- strategy for data modeling in healthcare BI systems.

Retaining the fidelity and detail of the source system data as you pull that data into the data warehouse is critically important.   Often times, inexperienced data architects will overemphasize the “Transform” in the ETL process and in so doing, will lose the ability to transform and evolve data structures within the data warehouse to meet new analytic needs that they didn’t anticipate in the original design.   If uncertain about the organization’s analytic requirements, don’t over analyze and become lost in requirements gathering.  Start simple, with the known analytic needs in today’s US-based healthcare enterprise, for example:

•             JCAHO

•             HEDIS

•             NCQA

•             PQRS

•             MU

•             Professional accreditation, such as STS, ACS and Trauma

•             State-specific reporting such as Cancer, HIV and Behavioral Health

•             Organizational goals regarding Clinical Service Lines or Quality Improvement  Programs

•             Disease registries for both large and small n diseases and conditions

It is critically important to configure transaction systems in a manner that will support the analytic needs of the organization; otherwise, the best data modeling strategy is of little or no value in the BI system.  Many times, electronic health records are rushed into deployment with physician adoption being the most important criteria.  While this is an important goal, pausing in the planning phase to configure the EHR transaction system so that it supports the analytic needs of the physicians and organization will actually improve physician adoption, not detract from it.  The same analytic needs described above should be addressed in the configuration of the transaction system EHR-- work backwards from these known requirements into the data collection strategy when configuring the EHR and your analytic capabilities in the data warehouse will benefit enormously.

The best data modeling strategy for a BI system is one which is tailored to meet the specific analytic environment or need, and thus adapts to the data analyst rather forcing the data analyst to adapt to the data model.  In the most successful data warehouses and BI systems, a review of the data modeling strategy would reveal a combination of 1st, 2nd, and 3rd normal form, star, and snowflake models, arranged in database schemas according to specific analytic subject areas, analogous to the books that are organized by sections and subject areas in a library. For example, the analytic needs associated with hospital case mix data can usually be satisfied with a 1st normal form data model augmented by a star schema.  The analytic needs for a chronic disease management environment can generally be satisfied with the combination of a 1st and 2nd normal form data model.  The same data modeling strategy can be used to support HEDIS, NCQA, and JCAHO reporting needs.  The analytic needs associated with managing a physicians’ group, where productivity, claims processing, and accounts receivable reports are important, can usually be satisfied with a 2nd normal form data model augmented by a star schema.

When in doubt about the best data modeling strategy to use for a particular analytic need, the best option is usually a 1st normal form.  These “flat” data models can often times be millions of records deep and over 100 columns wide.  Quite often, this simple approach is sometimes counterintuitive to many data architects who lack analytic experience, but these unassuming data models meet a very broad number of analytic scenarios.  It is also worth noting that the growing use of and familiarity with spreadsheet-based analysis (e.g., Excel) among data driven cultures is particularly well-suited to simple, flat tables of rows and columns in the data warehouse where relational joins to other tables are less important than filters, sorts, and pivot tables to the data analysts’ needs.

 In conclusion, the most valuable and extensible data warehouse and BI systems in all industries, especially healthcare, use a data modeling strategy which leverages numerous data modeling techniques applied and arranged in adaptive fashion to meet the needs of data analysts in specific subject areas of reporting and analytics.

Top Ten Essential Vendor Behaviors in Today’s Market

A few weeks ago, a noteworthy healthcare consulting firm asked for input that they could pass-on to vendors that would help those vendors understand the relationship imperatives that are critical to a healthcare CIO, right now, in today’s market.  After giving this topic a few days of background thought, I concluded two things:  (1)  At least 60% of the imperative relationship advice that I give today, applies at any time in history; and (2)  My current Cerner account representative, Lisbeth Fabiny, was a great source of reference.  I found myself asking, “Why do I value Liz’s support so much?  What does she do that makes her feel so valuable?” 

It is worth noting, I have nothing to gain by offering meaningless compliments to Liz or by association, Cerner.  Cerner and Liz will both tell you that I can be very demanding and uncompromising in my expectations and criticisms of products, services, and expenses.  But, it’s also important and proper for me to praise the positive, not just complain about the negative, and in that vein, Liz Fabiny is a role model for vendor support and customer relations.  The best I've ever had in my 30 year career.

Here are the Top Ten:

1.       Help Me Compete:  Help me build my "Annual Report for Information Technology" as if my IT organization were a separate, stand alone business that could be outsourced.

2.       Help Me Hire:  The market for healthcare IT employees has never been more competitive.  If you know I'm having a hard time recruiting for a critical position that is important to the success of your product in my organization, help me find a great match. 

3.       Help Me Measure:  The Age of Analytics in healthcare is just beginning.  Our industry is way behind in the proper use of data to drive costs down and quality up.  Help me address my short term analytic needs, but do so within the scope of a longer term strategy. 

4.       Help Me Save: Simplify your licensing, billing and contract administration.  Make it as easy as possible for me to manage my expenses with you, and especially make it easy to predict and budget for increases in prices due to inflation, increased number of users, transactions, etc.  When you give me new contract to sign, put a face sheet on it that summarizes the key issues and terms.  Don't make me read 15 pages of legal jargon.  Likewise, if you know of a creative way for me to reduce licensing fees, try to be motivated by our long term relationship instead of your immediate potential loss of commission.   You will win more of my business, easily.

5.       Help Me Listen: Be proactive in extracting the ROI and value from your products.  Help me look good and thus make your product look good, too.  If you know that I'm under-utilizing your products or have them configured improperly in some way, pester me until I fix it.  I'm busy and juggle lots of priorities.  Be the squeaky wheel until I listen.

6.       Help Me Expand: Annual conferences and blogs are not enough for me to keep up with everything going on in healthcare right now.  Help me build close relationships with a limited number (3-4) of peers or mentors who have a similar organization, product mix, and profile so we can learn from one another.  Force us to meet and hold a conference call every once in awhile.  Facilitate the meetings.  Help us reuse strategies, policies, and technology as much as possible.

7.       Help Me Plan: Help me build my strategic roadmap by overlaying the needs and culture of my organization with your products and the future outlook of the industry.  Look ahead for me and pester me until I build that roadmap with you.  I am particularly concerned about the growing sophistication of cyber attacks.  And I'm also concerned that I'm not leveraging mobile computing as well as I could.  Push me on these two issues, please.

8.       Help Me Migrate: Help me build the cheapest, safest, quickest path to ICD-10 adoption for my company and critical partners in the insurance industry.

9.       Help Me Prove:  Help me build the cheapest, safest, quickest path to Meaningful Use qualification for my company--  And don’t charge me anything extra because this is something that you should have done for every customer, a long time ago.  The Meaningful Use legislation forced it, but like HIPAA, we should have been doing this all along.

10.   Help Me Evolve:  ACOs are coming; one way or another.  Even if they are nebulous right now, we know that there are certain characteristics that will survive, regardless.  In particular, you better have a product strategy for engaging patients in greater accountability for their own care, and the changes in the revenue cycle required for managing the risk of bundled payments.

The ROI of Evidence Based Protocols

A new study from Johns Hopkins reveals the value of standard protocols (aka, clinical practice guidelines) on reduction of central line infections in the ICU--  $1.1M per year. If I were CEO of an insurance company or major employer paying for healthcare, my contracts would require my healthcare providers to show proof that they’ve implemented evidence based protocols to achieve the best patient care and at the lowest cost possible.

Interesting to note that development of this singe protocol/CPG at Johns Hopkins was $160K.  Repeat:  $160K to develop a single protocol.   In the Cayman Islands, we are in the midst of implementing an Evidence Based Practice Strategic Initiative, anchored by a collaborative effort with the British Medical Journal and Cerner.  In only a few months time—which could be compressed to a few weeks with the proper focus-- we already have four protocols prepared and those will soon be embedded in Cerner’s PowerChart and reflected in Cerner’s Chronic Condition Management reports.  Our cost-per-protocol will be a fraction of $160K as will the Time to First Value.

I find it more and more amazing that anyone practicing medicine today could possibly argue against the adoption of standardized evidence based protocols, CPGs and order sets, because, as the argument goes, adopting them represents a threat to “independent thinking by the doctor.”  (Yes, that’s a real and recent quote from a physician).  Further, I find it even MORE amazing that anyone would argue that these same protocols should be developed internally, rather than through an orders-of-magnitude less expensive service such as that we enjoy through BMJ and Cerner-- which will also, by the way, produce a better product than could be produced internally because of the robust process and resources available to BMJ that cannot (and should not) be replicated at every hospital in the world.

Accountable Care Organizations: Measurement and Management

This recent JAMA article (link below) on ACOs is a very common sense, succinct summary of healthcare’s future challenges.  As recently described by Francis Crosson, senior fellow at the Kaiser Permanente Institute for Health Policy, and despite the justifiable criticisms of the Affordable Care Act, Accountable Care Organizations cannot fail.  They will, in some form, define the future of healthcare, and underlying their success is the collection, measurement and feedback of data to healthcare organizations and patients; and the management of cultural change driven by that data.  The title of the JAMA article’s last paragraph sums it up nicely--  THE WAY FORWARD: MEASUREMENT AND MANAGEMENT.

As dramatic as the changes feel now, the data ecosystem of healthcare needs to change even more dramatically, but current healthcare IT vendors and systems are saddled with application architectures that simply can’t keep up with the rate of change.   It’s like trying to transform an office building in a manner of days that is built of concrete inner walls--we need modular inner walls to meet the needs and deadlines.  As one vendor CEO recently bragged—ironically-- 60,000 labor hours were required to change their application to meet Meaningful Use requirements.   And Meaningful Use is an easy hurdle to clear in comparison to what lies ahead. 

If ever there were a ripe market opportunity for disruptive innovation to displace entrenched, concrete walls of old-school thinkers and technology, now is the time.

Implementing Accountable Care Organizations

Nurture Dissent

In ancient Mesopotamian judicial systems, it was against the law to convict a suspect of a crime without a dissenting judge or juror.  In other words, the system recognized the imperfection of human judgement and ensured that every suspect and different point of view should have at least one advocate.  A 100% consensus judgement of guilty was not allowed.

Every major business decision should include at least one major dissenting opinion in the debate.  If not, there's something wrong with the decision making culture... and leadership would be better served to find a dissenter.

RFP: Cayman Islands Enterprise Health Information System

The Health Services Authority of the Cayman Islands is engaging in the selection of a core vendor to supply an Enterprise Healthcare Information System. HSA defines a “core vendor” as an extension of its senior leadership who shares the same vision and values to constantly evolve and improve clinical, financial, and administrative operations.  Qualified vendors are encouraged to respond with their proposal no later than noon, 23 September 2011. 

At present, the core enterprise applications are provided by the Cerner Corporation.  The contract for those services expires in June 2013.  The RFP begins a re-compete process for the award of that contract. The intent is to evaluate other vendors and products, and determine if it is in the best interests of the Cayman Islands to remain in partnership with Cerner. Cerner will be invited to participate in this re-compete. 

The RFP can be downloaded from the Central Tenders web site here.

Making Small Healthcare IT Start-Up Easier

Many friends and professional colleagues are taking advantage of the growth in healthcare IT spending to start their own companies, which I think is great.  Quite a number of them call me for a sympathetic ear to lament about their administrative burdens.  In the mid-1990s, I was a founder and partner in a very successful IT consulting and software development company... but the idea of doing it again makes me shudder.  The administrative paperwork, payroll taxes, and corporate taxes were a NIGHTMARE to manage-- one of the most stressful and distasteful uses of my time, ever.  Equally stressful and expensive was providing affordable, high quality healthcare coverage for our 50 employees.

More and more, I am convinced that the most effective way to stimulate the economy and efficiency of small business employment and innovation would come through the elimination of payroll and corporate taxes for companies with less than 100 employees... with an eye on eventually eliminating payroll and income taxes for all companies and employees...and replaced with a national, simple sales tax.  No more IRS, no more tax loopholes.  You buy something, you pay taxes. End of story.  Seven states (Alaska, Florida, Nevada, South Dakota, Texas, Washington, and Wyoming) and virtually all US cities operate on this "no income tax" economic model.  Can you imagine filing a tax return for your city?  Of course not... we've come to expect a sales tax as a means of funding local government and infrastructure.  Likewise, making no-frills, affordable healthcare coverage available through a government-run program-- i.e., making Medicaid/Medicare available for purchase-- would be enormously helpful to small businesses.  I am absolutely convinced that these two concepts would jump-start small business growth like we've never seen before.  And I'm equally convinced that the concepts would find support among enough Republicans and Democrats to make it happen.

Why not, during this time of economic and unemployment crisis, try this "tax free status" for small companies as a federal experiment for five years?  How about a five year experiment for small employer buy-in to Medicare and/or Medicaid?

Below is a great excerpt from a related blog in The Economist.  The full blog can be found here.

"We need to stimulate the prospects for employment, but we also need to make it easier for people to just work in ways that may not show up in the official unemployment stats. You can think of this as tearing down barriers to "self-employment", if you must. Clearly, decoupling health benefits from employment would help a lot. Less obviously, but at least as importantly, we need to eliminate the insane patchwork of regulations that keep folks from legally cutting hair for money in a kitchen, or legally making a few bucks every now and then taxiing people around town in a 1988 Ford Escort. De-formalising and de-bureaucratising labour certainly makes it harder for government to track who has paid what to whom, who owes how much in various taxes, and so forth. But it would be truly pathetic if the legal/economic organisation of our society was optimised for government surveillance and tax collection and not for the exercise of autonomy in pursuit of a meaningful life."

HITECH the Only Bright Star in $1T Darkness?

Arguably, the only investment from the US federal stimulus money that might have a long term return on investment (ROI) is the money being invested in healthcare computerization which should eventually drive down costs and improve quality.  Unfortunately, that money-- the HITECH (Health Information Technology for Economic and Clinical Health) Program-- is being spent on mediocre but very expensive health information systems products, so the ROI will be minimal and require at least 5 years to appear...at least 5 years.

In the US, we continue to elect politicians who make promises to maintain and/or increase federal spending and/or reduce taxes.  We can't have both.  As this chart below clearly indicates, we've been on a steady mismanagement of tax revenue vs. tax spending since the early 1980s-- when the rate of the curve started to take off under the Reagan administration.  In the past three years, the curve has gone straight up under the Obama administration.

Federal spending can only improve the situation described in this graph if that spending is invested to increase business productivity.  Unfortunately, the Obama administration spent--not invested-- $1T in stimulus money on short term job creation--hiring for the sake of hiring-- not long term investment to aid local economies and business productivity (new technology for manufacturing, more efficient transportation; business venues that generate jobs, taxes and local economies; lower cost fuel, less burdensome tax laws, new software engineering techniques, scholarships (not student loans) in critical skill areas, etc.). That $1T in stimulus money is now gone and so are those short term jobs.  In my hometown, the Civilian Conservation Corp, born from the federal stimulus money of the Great Depression, built the county fairgrounds.  That venue hosts innumerable events that continue to contribute to the local economy, 80 years later.

Anyone who campaigns and suggests for one moment that we can change the direction of this curve without cutting Medicare/Medicaid, Defense, and Social Security benefits...AND raising taxes is running for short re-election, not long-term leadership of the United States.

Credit to the US Federal Reserve, St Louis for this graph, Kevin L. Kliesen and Daniel L. Thornton.

Let People Tell Their Story

People, including the people you work with and especially kids, have an innate need to tell their stories…their yarns.  Don’t try to pick the stories apart.  Sometimes specific facts matter, and sometimes they don’t.   Be keen to the difference.  And definitely don’t just sit there, saying nothing.  Help them tell their story.  Help them weave their yarn.  Better yet, live life with them and help them build the memories and experiences that build their stories. 
Life is more fun that way for everyone.  :-)

There is a long series of events and situations that I've observed over many years that helped me finally understand this--no single event in recent past.  :-)

Amalga: Still Breathing?

With the recent selection of CSC, Microsoft, and HealthUnity by the MetroChicago Health Information Exchange, I’m once again intrigued with the role that Microsoft might play in the HIT market. I suspect the MetroChicago project is more interested in HealthVault, but Amalga is the most interesting product in Microsoft’s struggling healthcare vertical. Amalga is a strange and potentially very valuable product in the HIT market, but Microsoft needs to improve the way it positions the value statement to CIOs/CMIOs; and reduce the product’s Total Cost of Ownership.

Almaga’s origin in the ER as a tool for summarizing existing data in the healthcare enterprise is very evident in its current architecture and functionality. In that regard, Amalga functions very well as a read-only tool for existing transactions in systems such as LIS, RIS, and billing.

Interestingly, Amalga also provides a very solid data-analysis platform, somewhat similar in intent to a data warehouse. As a consequence, Amalga is equal parts transaction processing and analytic processing — which is potentially very powerful, especially to smaller healthcare organizations or “sometime later” adopters of EHRs who want to leverage existing data and transaction systems at the point of care, without necessarily buying into the current crop of semi-adequate EHRs.

If I were CIO for a small rural facility (or collaborative facilities) with limited budget, I would look strongly at Amalga as a first-step towards computerization of patient care. But, the first big drawback to this strategy is Amalga’s split personality for data collection at the point of care — orders, problems, medications, and progress notes are orphaned.

Achieving Meaningful Use with Amalga is going to be very difficult if not impossible, but I think one could argue that such implies a flaw in MU rather than Amalga. The other big drawback, of course, is the cost, which is historically outrageous and significantly driven by the large footprint in the data center. I’m told that in three prominent customer sites, Amalga was essentially a give-away sale, with Microsoft reaping value by way of brand association with noteworthy healthcare organizations.

I worked closely with Microsoft for a number of months while I was at Northwestern University, offering suggestions about product strategy and pricing models, in hopes that Northwestern might adopt the tool locally, but also in hopes that Amalga would succeed globally. I also advised several other organizations, mostly in the background, about their decision regarding Almalga — some of those organizations adopted, but the vast majority did not. In the end, we (Northwestern and Microsoft) couldn’t agree on a value proposition for Northwestern, which already had Cerner, Epic, and a data warehouse. There wasn’t any room or need for a product like Amalga.

In preparation for this blog, I asked Microsoft for an update on Amalga, but they declined, so I contacted several of the CIOs and other executives in organizations that adopted and didn’t adopt for their thoughts. I think Microsoft is a little tweaked because we didn’t choose the product at Northwestern, and also because I’m candid and open about Amalga’s weaknesses and Microsoft’s continued struggles to realize Amalga’s potential.

But, I’m also fair and open about its strengths. As a professional, I see in Amalga the potential for a new and better class of HIT tools which displace the traditional and often painfully complex and costly dyad of EHR and Data Warehouse. In Microsoft, I see an unfortunate inability to position, price and roadmap Amalga to unleash its potential, which could ultimately change the industry. In all sincerity, I’m cheering for the company to adjust its course because I believe it’s holding a game-changing product — at least conceptually. We need something better than the usual HIT products, and Amalga is definitely not the usual.