Harnessing the Power of
Technology to Improve
Chronic Care Management
A Whitepaper
Harnessing the Power of Technology to Improve Chronic Care Management
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 spending 3. 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
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.
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-themoment 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.
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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
A project that paired
the patients of the
Cleveland Clinic with
Microsoft HealthVault
offers a promising
model of how
technology can help
improve patient selfmanagement.
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
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.
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 .
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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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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.
“The new integration
Healthcare providers managing chronic diseases could also benefit from technology
solution enables us to
that simplifies research, identifies drugs and side effects, and provides evidence
provide our patients
based recommendations for how to manage patients with multiple chronic diseases.
with a better level of
In the United Kingdom, for instance, business tools such as Microsoft SharePoint
care and support.”
Server and FAST Search technology in combination with Microsoft ASP.NET were
- Marc Devaud, Head
of Projects and
Development,
freiburger spital.
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
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 sideeffects 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.
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
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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
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.
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
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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-thinkinghealth-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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Harnessing the Power of Technology to Improve Chronic Care Management
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 largescale 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 selfassessment 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; summaryhttp://www.microsoft.eu/Cloudeconomics.aspx
23
https://h1n1.cloudapp.net/
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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.
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.
Using the cloud, Canadian healthcare providers also can engage patients more
effectively. TELUS health space, powered by Microsoft HealthVault is a Canadianbased 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 thirdparty 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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Harnessing the Power of Technology to Improve Chronic Care Management
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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Harnessing the Power of Technology to Improve Chronic Care Management
Appendix: Microsoft Technologies Supporting Chronic Care Management
Self-Management
Coordinated Care
Technology that provides
access to health information
and resources for supported
self-management with chronic
conditions.
Technology that enables
multidisciplinary care teams to
integrate information sources
and coordinate care around
the needs of patients.
• Microsoft® HealthVault™ is a
privacy- and security-enhanced
online service that puts patients
in control of their health
information with selfmanagement 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.
• 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 selfcare.
•Forefront helps deliver end-toend 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.
Caregiver/Patient
Collaboration
Technology that makes it easy
for care teams to collaborate
and communicate effectively.
Decision Support
• 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 endto-end security and access to
information through an
integrated line of protection,
access, and identity management
products.
• 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 endto-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 policymakers to make informed
evidence-based decisions.
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Harnessing the Power of Technology to Improve Chronic Care Management
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 Microsoftbased technologies to accomplish more throughout their day because they are familiar, intuitive, and userfriendly.
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Harnessing the Power of Technology to Improve Chronic Care Management
Appendix: Microsoft Solutions at Work Today
Note: Each dot indicating the location on the map is linked to its respect details in the table below. To know more
about the location indicated on the map, press Ctrl and click the dot.
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Harnessing the Power of Technology to Improve Chronic Care Management
United States
Chronic Condition Management – American Heart
Wellness: Mayo Clinic
24
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:

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
Microsoft HealthVault
pressure in control than those who were monitored in
the doctor’s office. Technologies:
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
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
Personal & Family Health Management: New York
information and, soon, share it with other caregivers.
Presbyterian Hospital
The result was improved patient experience and
25
MyNYP.org wanted to reduce delays in getting patient
health information to the appropriate healthcare
provider, in order to avoid redundant tests and
coordination of care, increased organizational
efficiency and support of future enhancements.
Technologies:
procedures. NYP was able to consolidate their clinical



data and make it accessible to both providers and
patients. Technologies:


Microsoft Amalga
Microsoft HealthVault
Microsoft SharePoint Server
Microsoft Amalga
Microsoft HealthVault
Home Health Monitoring May Significantly Improve Blood
Pressure Control, Kaiser Permanente Study Finds
http://www.prnewswire.com/news-releases/home-healthmonitoring-may-significantly-improve-blood-pressure-controlkaiser-permanente-study-finds-94576164.html
27
Microsoft Case Study Portal (June 2011) Mason General Hospital
26
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
& Family of Clinics Hospital Offers Advanced Online Patient Services
Through Healthcare Portal. Retrieved August 2011
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Harnessing the Power of Technology to Improve Chronic Care Management
Business Intelligence - First Choice Home Health
The National Institute for Health and Clinical
and Hospice
Excellence (NICE) provides clinical guidance and helps
28
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
establish healthcare quality standards in the United
Kingdom. To help professionals to easily access up-todate information, NICE launched an Internet portal.
There is now a single access point to more than 250
core information sources.
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
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
Dallas Neurosurgical & Spine (DNS) needed a
conferencing, scalable VoIP telephony, and integrated
telemedicine solution that would enable remote
messaging and desktop-sharing capabilities.
patients to conduct follow-up visits at their local
Technologies:
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
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
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
28
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
31
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Harnessing the Power of Technology to Improve Chronic Care Management
based on Microsoft BizTalk Server 2009. Now the
poor data quality, while also combating patient
hospital network has access to consolidated,
absenteeism. Because DjHS must provide accurate
synchronized, and automated systems, enabling better
information to government about patient volumes,
patient care and reduced support costs. Technologies
the health service was being underfunded according
used:
to the levels of care it was providing. Implementation




Microsoft BizTalk Server
Microsoft SQL Server
Windows Server
Microsoft BizTalk Accelerator for HL7
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:


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 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

Microsoft Dynamics CRM

Microsoft Office SharePoint Portal Server

Microsoft Windows XP Service Pack

Microsoft Exchange Server

Microsoft Office Standard
Business Intelligence & Research – Ludwig

Microsoft SQL Server
Institute36

Microsoft Windows Server
Australia
Business Intelligence - Djerriwarrh Health Services
(DjHS)34
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:
DjHS was struggling with a patient management


system consisting of inaccurate patient records and
Windows HPC Server
Windows Server
33
Microsoft Case Study Portal (July 2009.) Maccabi Healthcare
Services, Healthcare Provider Improves Customer Service with RealTime Patient Data Visibility. Retrieved August 2011
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
34
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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Harnessing the Power of Technology to Improve Chronic Care Management



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.
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