As a practicing doctor, I loved having the opportunity to make a difference in people’s lives, one patient at a time. What I love about my current career is that with health IT, we can make a difference in people’s lives at a system-wide level.

I’m proud to be part of a team that’s helping health providers around the world digitally transform to achieve the quadruple aim of enhancing both the patient and provider experience, improving the health of populations, and lowering the overall cost of care.

Now that technology like hyper-scale cloud computing and AI are more accessible than ever, health organizations can infuse the systems and tools their staff and patients use with intelligence. Together with our vast ecosystem of partners, we help our customers do so in a way that they can continually innovate and scale, while also meeting their security and compliance needs. They can engage patients, empower care teams, and optimize clinical and operational effectiveness to transform health using our trusted platforms and services.

It’s all about trust

As I’ve written before, as a health provider, you can take advantage of intelligent solutions to facilitate the shift from a “sick care” system to a more sustainable, proactive health and wellness system.

But you can only do that if you can trust the technology—and your technology partner.

Trust is essential as you move data sets containing protected health information (PHI), including patient demographics and treatment information, to the cloud. It’s critical as you share data and insights across the health ecosystem, and expand how and where health professionals and patients communicate and access confidential information.

To help protect and manage confidential information, and meet regulatory and compliance obligations, you need a technology platform you can trust.

And perhaps most important, you need to trust that your technology partner will help you to do what you do best, rather than causing disruption.

At Microsoft, earning the privilege to work as our customers’ trusted technology partner is part of our DNA.

We’re involved with health industry standards groups and consortiums of customers and partners around the world. And we are proud to lead the way in offering interoperable platforms and services that can help health organizations maintain compliance with key domestic and international standards and regulations such as HIPAA and GDPR.

Whether it’s through our wide array of compliance certifications and end-to-end security and data protection capabilities, our digital crimes unit, or the more than $1 billion we invest in security research and development each year, we constantly work to help health organizations take a holistic approach to protection, detection, and response to security threats and cybercrime.

And our customers have peace of mind when innovating with us thanks to our Shared Innovation Principles that provide clarity around co-creating technology.

Our mission to empower every person and every organization on the planet to achieve more. So our customers’ mission is our mission. Our business model and flexible solutions enable them to digitally transform their way.

By taking advantage of our trusted platforms and services, health organizations can:

• Help providers and patients make effective decisions about health issues and scale specialists to rural areas—or wherever they’re needed—using
• Strengthen cybersecurity across operations to mitigate risks and help keep vital systems that staff rely on up and running.
• Harness trusted data from disparate sources to create actionable insights. For example, bring together clinical data with genomics and other data to personalize care.
• Empower care teams to coordinate care with a more comprehensive view of patients through security-enhanced collaboration and business process tools.
• Help streamline care delivery with automated workflows and business processes that have the right security features. For example, with remote monitoring for patients with chronic conditions, you can identify patients who need interventions before they land in the hospital or emergency room.

Those are just a few examples of how health organizations can digitally transform their way. Learn more about how you can harness trusted technology to achieve the quadruple aim in the Becker’s Hospital Review whitepaper: “Let’s make healthcare personal.”

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Sometimes you get to be a part of something that can change the world. The past year spent working with the Global Commission has been one of those opportunities. It’s inspiring and humbling at the same time. I’ve relished the steep learning curve, as I worked with some of the most brilliant minds in this field, and now I have every confidence that we’ve created a roadmap and momentum that will lead to meaningful change in this very human domain. Let me share some of my key learnings.

Rare disease is by definition rare. If I had continued working in emergency medicine or primary care, it’s likely that I would never have seen many of these conditions in my entire career. If I was the first (or even the second, third, or fourth) practitioner an undiagnosed family approached, would I have the acumen to think rare disease, or would I instead default to diagnosing and treating the most likely conditions? It happens every day. It takes on average seven consultations and five years before children with a rare disease are finally diagnosed.

However, rare diseases collectively are NOT rare. With approximately 6000 rare diseases identified, the total of people with rare disease worldwide is estimated at a staggering 350 million. There are almost 30 million in the US alone. Each child with a rare disease has a support network of family, friends and carers, that means the true human impact of rare disease in our society is frighteningly high.

Herein lies the problem. We have a mismatch between supply and demand. An estimated 80% of rare diseases have either a single or multi-variant genetic cause. We simply do not have enough geneticists in the world to effectively scale the current medical referral model, even if genetic testing was cheap and accessible to all. Even in developed countries we have bottlenecks, and the issue is compounded in developing nations. We need solutions that address these constraints. Solutions that fundamentally deliver diagnostic services in entirely new ways, if we are to make inroads in shortening the time to diagnosis and treatment.

This is where the Global Commission has focused efforts. Recognizing that the holistic answers are bigger than any one company, this collaboration has brought together rare disease specialists, life sciences experts, and technologists to work through these challenging issues. I am excited about the role of technology. Technology that helps empower patients and families with access to their own records, technology that uses artificial intelligence to provide diagnostic guidance from patient symptoms, social networks that crowdsource answers more effectively, and virtual care that assists with connecting patients with specialists faster. We were deliberate in electing to focus on real world pilot projects where these technologies are in productive use, so that the recommendations are practical and actionable. I encourage you to download and read the report, then join the movement as we change the lives of millions with rare disease. It will take all of us contributing our unique talents to make a better system.

Find out more about Microsoft in Healthcare.

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When hospitals rose to prominence in the 1700s, they were relied upon to treat infectious disease and battlefield trauma. At the time, it made sense to have a central place where providers with the right skills could tend to patients. Yet, as the world changed, hospitals remained largely the same.

As humans live longer, chronic disease has emerged as not only a leading cause of death, but an expensive one. One in three adults worldwide suffer from two or more chronic conditions, and the United States alone spends the equivalent of almost 18% of GDP on healthcare. Mental illness also compounds chronic disease, making it much more expensive.

Rising healthcare costs make it clear that the current reactive care model is unsustainable. We need a new approach that shifts away from “sick care” to a model of empowering overall health and wellness, providing patients with access to proactive care that identifies risk and manages chronic disease early to prevent escalation and deterioration.

Let’s look at three ways we can leverage technology to support this new health and wellness system with AI-assisted personalized care, mixed reality devices, and virtual care.

AI assistance: Uncovering patterns to predict risk and reduce costs

Today’s care teams often suffer from information overload. They have large amounts of patient data but lack the tools to improve outcomes. AI and machine learning can provide these tools, empowering care teams to leverage their data and become more efficient, as well as explore new approaches to critical challenges.

Artificial intelligence (AI) is a compelling solution to improve the safety of acute hospitalizations. Recently, Ochsner Health fed the information they were already collecting into a machine learning model to predict cardiac arrest. It transformed care at the bedside, alerting doctors about patients who needed their attention, and enabling them to transfer patients to the ICU four hours faster, if required. The healthcare data analytics solution was so effective, they are now rolling it out facility-wide.

Organizations can also use AI to make care safer and more cost effective, ultimately keeping people out of hospitals. The University of Washington uses machine learning to calculate the optimal discharge time for cardiac patients and has dramatically reduced their rates of readmission. By applying an algorithm to medical records, AI can predict a patient’s risk factors so care teams can make changes to the care plan to mitigate those risks.

By managing and analyzing big data, AI assistance enables providers to convert vast stores of rich data into intelligence, unlocking new capabilities in preventative, personalized care that enhance team collaboration and deliver better outcomes.

Mixed reality devices: Revealing the unique structure of each body

Healthcare faces the unique challenge of treating three-dimensional biological structures that are often visualized in two-dimensional images. This makes it difficult to learn and communicate anatomy or plan complex procedures for the variations in individual patients’ bodies.

Mixed reality offers an innovative solution to this challenge and has found a ready home in health. In medical education, Case Western Reserve University is one of many medical schools teaching human anatomy in three dimensions with Microsoft’s HoloLens device. Traditionally, training skills and procedures were often learned on mannequins, but mixed reality enhances this learning by depicting anatomy in three-dimensional images that can be manipulated with gestures so trainees can gain skills more effectively.

Mixed reality is also being utilized for procedures and surgery, enabling more proactive approaches to care planning. The University of Maryland is using HoloLens to provide a more seamless experience for clinical ultrasonography, and University Hospital of Oslo in Norway is using HoloLens to plan surgeries where complex organ structures vary from person to person, including pediatric cardiac, colorectal, and liver surgical approaches.

As new uses for mixed reality continue to be explored, the technology is already changing the status quo by improving how providers interact with patients, plan treatments and deliver results.

Virtual care: Bringing the specialists to the patients

Modern healthcare providers have evolved from community generalists to specialists located in urban centers of excellence across the globe. As a result, connecting patients with the right specialist often becomes a complex exercise in care team coordination, timing, travel and overhead costs.

As of 2017, 71% of healthcare providers in the United States use telehealth and telemedicine tools as an alternative to in-person care, but these resources are smaller pieces of the larger care picture. A complicated case may have an entire network of clinicians supporting the patient behind the scenes, each constrained by their own siloes and systems.

Virtual care uses technologies such as video, apps, messaging, wearables and other digital technologies to transform this siloed, disconnected approach to a more streamlined patient experience. It virtually connects the eyes and ears of clinicians directly to the patient, avoiding travel and further disruption. By engaging virtually, providers can coordinate across care teams, collaborating and sharing crucial data to aid in diagnoses and treatment. It also saves costly clinician time, which translates to an estimated $10 billion economic value annually in the US alone.

Virtual care engages patients at their homes or on the go, providing valuable wellness information and enabling care teams to remotely monitor and provide health recommendations to patients.

Accelerate the shift to a health and wellness system

By embracing new technologies that enable greater insight and facilitate significant steps forward in personalized care, we can transform health from reactive “sick care”—treating patients long after chronic disease has become complicated—to a new model promoting proactive health and wellness. Microsoft is committed to supporting this new approach to create a more sustainable, effective healthcare system. For more information, read our eBook on engaging patients in the digital age.

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For healthcare providers, interoperability seems like a never-ending discussion. Many organizations have attempted to navigate this thorny challenge, only to be frustrated by its complexities. The proliferation of hundreds of on-premise databases has fragmented information, further compounding the issue. A recent study found that only 30% of healthcare providers in the United States were pursuing advances in the four key domains of interoperability: data integration, reception, distribution, and finding. Poor interoperability has also impacted broader data sharing, resulting in information siloes that inhibit progress.

As the healthcare economy reaches a crisis point and the current model becomes unsustainable, it’s time for a new approach to interoperability—one that goes beyond technical strategies like common standards. Let’s take a look at how Microsoft and its partners are tackling interoperability to enable future healthcare innovation for health organizations.

Focusing on trust and adoption to make compliant data sharing a reality

In today’s cloud era, the conversation has shifted from digitizing paperwork and provider workflows to generating data that can be converted to insight. Data is a critical asset, and lower barriers for technologies like artificial intelligence (AI) and high-performance computing (HPC) have removed longstanding cost concerns.

With these new technologies readily available, healthcare has an opportunity to do things differently. The cloud offers a technical platform to modernize legacy systems and aggregate data, but to be trusted, it needs to be secure and compliant. Interoperability is nuanced, and while common standards like Fast Healthcare Interoperability Resources (FHIR) are an excellent step forward, making interoperability work at a practical level requires widespread adoption by the software engineering community, continued support for customers with legacy infrastructure, and ongoing advocacy with regulators. Electronic Health Record (EHR) providers will also have an active role to play as healthcare pursues new cloud partners that provide secure, compliant, interoperative platforms.

Fostering the next generation of interoperable healthcare solutions

As a leading provider of cloud technology, Microsoft is deeply committed to interoperability in healthcare. We invest over $1 billion USD annually in security and were one of the first technology providers to offer HIPAA business associate agreements (BAAs). We continue to build regulatory trust globally with our robust support for General Data Protection Regulation (GDPR) compliance. Recently, we’ve made it simpler than ever before to create a health industry compliant cloud environment with the Azure Security and Compliance Blueprint—a set of automated scripts that enable healthcare organizations to quickly spin up an Azure workspace and work in a HIPAA-compliant manner.

To develop strong relationships within the developer community, Microsoft regularly contributes to open source and open standards efforts in many industries. We collaborate on new open tools such as cloud-hosted APIs and services for AI and machine learning. Last month, we issued a joint statement with other industry leaders, advocating for the adoption of FHIR as a healthcare common standard. But our commitment to FHIR doesn’t stop there. We actively encourage our vast partner network to embrace these standards and design a new wave of FHIR-enabled, compliant healthcare applications and solutions. We also work side-by-side with our health customers to develop and implement new strategies that deliver greater interoperability and help get your data flowing despite legacy infrastructure.

Join the conversation at Health 2.0

While the discussion may be far from over, Microsoft is hard at work on technical, policy, partner, and customer efforts to make interoperability real for healthcare providers—no matter where you may be on your digital transformation journey. In support of this critical topic, Microsoft’s Chief Medical Officer, Simon Kos, will be speaking at Health 2.0’s annual fall conference next week along with other healthcare leaders. We look forward to seeing you next week in Santa Clara.

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In today’s post-EHR health environment, the amount of data generated by digitization is staggering. Dozens of systems feed data across healthcare organizations daily, and IDC predicts that health data volumes will continue to grow at a rate of 48% annually.[1] Yet, despite advances toward becoming a data-rich and data-driven industry, medical errors are still the third-leading cause of death in the US alone.[2]

Though artificial intelligence (AI) is still in early stages of adoption in healthcare, its exceptional ability to manage big data makes it a powerful weapon in the fight against medical errors.  But don’t worry—robots aren’t about to replace clinicians anytime soon. Humans and machines are complementary, as humans have ingenuity and emotional intelligence, for example, while machines are better at tackling repetitive, high volume tasks where accuracy is vital. Where artificial intelligence can add the most value is through amplified intelligence—the idea of AI shouldering the big data burden and working in concert with human intellect, empathy and creativity to solve medical problems and find better ways to do things.

This human and machine companion model has the potential to significantly benefit healthcare providers, enabling them to reimagine processes and refocus clinicians’ efforts where they can deliver the most value. While there are numerous ways amplified intelligence can be applied across health organizations, here are three distinct looks at AI in action—from adding intelligence to everyday tasks like medical transcription to enabling new capabilities in medical imaging.

Delivering an intelligent transcription experience that surfaces insight at the point of care

The clinical workflow is complex, often requiring physicians to multitask while interacting with patients. Taking notes during consultations hinders them from focusing solely on the patient and is time-consuming to edit and approve later. Furthermore, their notes need to be annotated to provide clinical value for the patient’s extended care coordination team. In this scenario, AI has quickly emerged as an ideal intelligent assistant. Using cognitive services such as voice, speech, language understanding and more, AI can capture, transcribe, annotate, and learn from conversations to deliver powerful insights at the point of care.

An exciting example of this is the EmpowerMD project from Microsoft Research, an initiative focused on transforming medical conversations to medical intelligence. Built with custom speech and language understanding and tailored for the medical domain, EmpowerMD’s Intelligent Scribe captures and synthesizes patient-physician conversations[3], noting clinically relevant phrases that naturally occur in dialogue. The phrases are mapped to common areas of an encounter note, and the physician can edit the content before approving it. The system also learns from encounters and physician input to adjust over time.

Another example is intelligent agents—patient-facing chatbots (like the Microsoft Health Bot) that can have a conversation with patients online. The bots ask questions designed to guide patients to the right kind of care; based on the answers, the bot can assist them with next steps, such as making an appointment, talking to a care worker, or even calling an ambulance on the patient’s behalf. It also adds the conversation to the patient’s history, enabling clinicians to pick up right where the chatbot left off.

By using AI to build on and learn from clinician expertise, physicians can focus on patients and minimize high-volume busywork, as well as optimize encounters and gain valuable intelligence for diagnosis and treatment planning.

Detecting risks and preventing deterioration with AI-enhanced video observation

In a typical inpatient setting, clinicians make incremental observations of patients at regular intervals, then use this data to guide treatment decisions. However, incremental observations only generate limited data points, increasing the risk a patient might deteriorate because something was missed.

In contrast, the combination of AI and video can provide a complete picture of the patient in real time. By applying AI to streaming video, second-by-second statistics can be analyzed. When synthesized with physical movement and periodic observations, AI can alert clinicians to check on patients and detect problems before they become critical.

For example, a large US-based children’s hospital is leveraging AI to analyze years of video of infants and using the insights to detect warning signs of deterioration in current patients. The AI solution analyzes everything from the color of the baby’s skin to their breathing and behavior, and alerts care workers when an intervention may be required.

Video AI supports the clinician workflow by enabling more thorough observation, freeing up clinician time and mitigating risks to improve the quality of care.

Driving speed, accuracy and outcomes with advanced medical imaging analysis

Given the proliferation and sophistication of images coming from modern medical imaging systems, clinicians must sift through large volumes of information to determine what’s clinically relevant. In addition, imaging data is often disconnected from other patient data, limiting the clinician’s ability to build a comprehensive picture.

AI has the capability to transform this time-intensive approach. By infusing AI into the imaging workflow, clinicians can surface relevant data from disparate image sources and conduct analysis in a clear, concise and easy-to-digest format.[4] AI can also connect imaging data with other data such as the patient’s medical history, pharmacy information, prior imaging, recent lab results or pathology reports.

An excellent example of this is Project Inner Eye, a Microsoft Research initiative. Inner Eye utilizes computer vision and machine learning to build tools for automatically analyzing 3D radiology images. For example, in a common computed tomography (CT) scan, Inner Eye enables clinicians to automatically detect organ locations, then select specific organs and zoom in for a more detailed analysis. The clinician remains in full control of the results, while their efforts are augmented by the machine learning, enabling AI to become a true consultant to physicians.

By enhancing medical imaging analysis with AI, clinicians can harness the vast landscape of imaging data to accelerate diagnoses, improve accuracy and efficiency, and positively impact patient outcomes.

Partner with artificial intelligence to reimagine care delivery

Amplified intelligence, powered by AI, offers a compelling opportunity for healthcare organizations to achieve their long-term goals. Providers could reduce medical errors and improve quality across the care continuum by enhancing medical imaging, mitigating risks, detecting patient deterioration faster, and putting actionable intelligence in the hands of clinicians. Read our eBook to learn more about Microsoft’s investments in AI.

[1] https://www.cio.com/article/2860072/healthcare/how-cios-can-prepare-for-healthcare-data-tsunami.html

[2] https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html

[3] https://blogs.microsoft.com/blog/2018/02/28/microsofts-focus-transforming-healthcare-intelligent-health-ai-cloud/

[4] https://www.itnonline.com/article/how-artificial-intelligence-will-change-medical-imaging

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In the nearly 30 years that followed, technology has advanced considerably, enabling fully immersive “virtual-reality” experiences, as well as “mixed reality”—the result of blending the physical world with the digital world.

While mixed reality is still a relatively new technology in health, it has the potential to make a significant impact on patient care. Its unique ability to project visualizations into physical space and its low barrier of entry is spurring health organizations to experiment in ways that are incredibly promising. Here are three examples of providers that are pioneering mixed reality in medical education, the perioperative pathway, and virtual care.

Enhancing medical education by helping students see the human body in three dimensions

While medical students have traditionally learned through textbooks and hands-on training, this approach has its disadvantages, such as a lack of real-world exposure to multiple anatomical variations. For practicing physicians, on-the-job training is often conducted via mannequins and simulators, which are an improvement over textbooks, but even these sophisticated tools have limitations. Each patient is different, and while mannequins are helpful, nothing beats actual patient care for learning.

Mixed reality enhances physician education by combining the anatomical and procedural to create a more robust education platform. Case Western Reserve University in Cleveland is utilizing mixed-reality devices to accelerate their medical students’ grasp of anatomy. With mixed reality, students can visualize the muscles on top of a skeleton and understand the body’s different layers. They can project any piece of anatomy digitally and examine it in three dimensions, move it around, or make it translucent to see through to what lies underneath.

As a result, students have more freedom to experiment and explore the ways anatomical systems work together, helping them build confidence and empowering them with stronger working knowledge of anatomy.

Expanding the opportunity to learn in a new dimension changes the way medical students and physicians see their patients and the world, opening new avenues to approach medicine from a “hands-on” perspective, not just a theoretical one.

Delivering new intelligence to the perioperative pathway by simulating the physical world

When approaching complicated surgeries, each scenario is unique. Some procedures are more complex than others due to the unique characteristics of the patient’s anatomy and the type of surrounding tissue and organs. A growing number of surgeons have already adopted innovative methods like three-dimensional (3D) printing to prepare for the intricacies of each surgery, but this approach is challenging to scale and hinders collaboration among surgical teams.

Mixed reality takes this innovation further, enabling surgeons to interact with an accurate digital representation of a patient’s unique organ structure, as well as collaborate with their teams to orchestrate and rehearse procedures. The University of Oslo is leveraging mixed reality to plan complex procedures, such as liver surgery. By creating a digital 3D model of the patient’s liver from a computed tomography (CT) scan, surgeons can move, scale, rotate and isolate different parts of the organ, as well as switch layers of the model off and on with simple hand gestures. Multiple surgeons can also share the same experience through separate devices.

The new technique enables doctors to navigate around the patient’s other organs and leave more of their healthy liver tissue undisturbed, improving their ability to withstand surgery during treatment. Researchers are looking for ways to apply this technology to patients undergoing other complicated procedures such as cardiac surgery.

Applying mixed reality to perioperative planning enables a customized approach for each patient, offering surgeons enhanced visibility into the patient’s unique anatomy. This approach can improve each individual surgery, helping surgical teams prepare more effectively to create the best possible outcome for each patient.

Bringing doctors and patients together virtually when they can’t be in the same place

Within certain patient populations, connecting patients with providers can be time-consuming and costly. For instance, getting to a provider’s office is a major challenge for elderly patients who lack transportation. Those in remote areas often face similar challenges in making the time to travel and finding transportation.

Through mixed-reality devices, doctors can provide high-quality care to patients in their own homes, saving time, money, and hassle while making them feel more comfortable. Silver Chain Group in Australia is doing this already by using Microsoft’s HoloLens to create an “Enhanced Medical Mixed Reality (EMMR) interface. By having a visiting nurse wear a mixed-reality headset at the patient’s bedside, a doctor can see the patient remotely as if they were in the same room. This extends doctors’ reach beyond the walls of the exam room and enables patients to receive care that would otherwise be difficult to obtain. As the world’s population continues to grow older, demand for community-based care will only increase, and innovative telehealth options will be even more critical.

Augmenting reality eliminates logistical challenges to providing care to remote and elderly populations, putting the patient and the problem in front of doctors’ eyes and removing the friction that can get in the way of patients receiving the right care at the right time.

Enable healthcare innovation with mixed reality

For years, technology adoption in medicine has been driven by doctors seeking ways to improve their techniques as well as by patients demanding high-quality care and convenience. Mixed reality is showing great promise in improving medical education, surgical planning, and even office visits, making healthcare delivery easier, faster, and cheaper while driving better results for patients. To learn more about what Microsoft and its partners are achieving with mixed reality, download our eBook on digital transformation in health.

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What a difference a year makes. Once it seemed like healthcare and our digital society were diverging, with healthcare missing out on some of the most promising technologies like artificial intelligence, mixed reality, and the new capabilities afforded by cloud computing. I’m pleased to say, looking back at 2017, I saw firsthand extraordinary progress in each of these fields by leading health innovators around the world. This isn’t an isolated phenomenon, or a charge led by any one country. It’s truly a distributed global movement of innovation, and the breadth and diversity of scenarios illustrate that this is more than a passing fad, we really are in a new era of digital health. What’s most encouraging to me is that these scenarios aren’t just in research, 2017 has shown innovation going mainstream, making a real difference in how we engage patients, empower care providers, and broker new models of care.

That’s why I’m more excited than ever to see the universe of possibilities laid out again at the world’s biggest healthcare IT conference, HIMSS 2018 in Las Vegas in March. With 45,000 attendees, the event barely needs an introduction. For those first timers however, my advice is to turn up with a game plan. The array of concurrent activities can be overwhelming. At the highest altitude, HIMSS is a way to take the pulse of the whole digital health industry. Over the last few years, we’ve seen the emphasis shift from on-premises systems of record (like EHRs) to complementary solutions that unlock value from this digital asset. I think it reflects our increasing digital maturity. Last year I noticed a lot of emphasis on systems of intelligence generally, from data-aggregation and data-warehousing solutions all the way through to predictive analytics and the debut of artificial intelligence. Population health management specifically was prominent as the US health system ramped readiness for value based care.

I think it’s a telling sign of the times that HIMSS has merged this year with Health 2.0. If HIMSS is the event that is grounded firmly in the state of digital health today, Health 2.0 has always pushed the innovation envelope to help us envision what health will look like in the future. I think the merger illustrates that these two horizons are no longer distinct concepts, and that leading health organizations and technology providers alike need to be thinking about both together. In no particular order then, my predictions for HIMSS 2018 this year include:

• Artificial intelligence will move beyond hype, and we will see practical examples of reputable organizations using AI to drive significant health outcomes. Look for not just chatbot scenarios, but also machine vision and video analytics examples.
• Traditional EHR providers will continue to diversity beyond the saturated clinical record space, into health analytics, population health, patient records and even precision medicine offerings.
• The ongoing interoperability discussion will consolidate around FHIR as a standard, and we will see meaningful and scale collaborations across systems using this standard.
• Mixed reality will be prominent, and the scenarios we discuss this year will be clinically rather than technically led.
• We’ll continue to see the lines blur between providers, payors, pharmaceutical and even research organizations as everyone gets closer to and more focused on the patient. A market trend I’m just starting to see emerge of fusion between health organizations and traditional retailers is likely a bit too early to feature prominently this year.

Microsoft will of course have a significant booth presence, as we showcase our own first-party efforts as well as those of our strategic partners. Do make an effort to stop by and meet the team. I’ll be coordinating the Innovation Theatre again this year and would encourage any Microsoft partner with a great story of digital transformation in health to please submit an abstract for consideration. As a content team, we’ll be reviewing all submissions at the end of January to ensure that once again this popular forum brings you the very best examples of transformation in an engaging and digestible format. See you at HIMSS 2018!

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I attended an internal event recently where Alex Kipman, technical fellow and chief evangelist for HoloLens, outlined his vision for the potential of mixed reality technology. It gave me chills. He opened with “We are standing together on the threshold of the next revolution in computing” and went on to add that “Computing will allow us, for the first time, to renegotiate our very contract with reality”. I found this moving because, for the past two years since the release of Microsoft HoloLens, I have seen incredible innovation flooding in from the health community. This response is distinctly different from past reactions in a few key ways.

• It’s a global phenomenon right out of the gate. I have seen examples from Brazil to the US, Norway to Australia, Japan to Canada. Hardly a week goes by without a new example cropping up somewhere. Interestingly, some of the less regulated health markets are moving faster and really pushing the boundaries of what is possible.
•  It’s led by clinicians. New technology in healthcare tends to be embraced first by technologists, who then translate for clinicians how this could make a difference. By contrast HoloLens seems to be picked up directly by clinicians, and they are right in the driving seat of many of these examples. While Microsoft is working directly with some of these individuals and organizations, the movement has its own momentum and is proceeding independently.
•  Mixed reality is going mainstream. Historically new technologies in health are treated with skepticism or cautious enthusiasm. This is the curve I envisaged for HoloLens too, but I have seen it make the leap from the lab to the clinic much sooner than expected.

With this as a backdrop, I think it’s timely to start sharing this story more broadly. I’m looking forward to the upcoming Asia Pacific MedTech Forum in Singapore where I’ll have the opportunity to share this story with a select audience. Knowing not everyone will be able to attend however, I’m keen to document some of what I’ll talk about so you can see the timeline of how this fascinating mixed reality technology is progressing.

From the very moment we introduced HoloLens to the world in 2015, health was front and center. The scenario that Case Western Reserve University in the US chose to focus on was anatomy training for medical students, and the feature video still remains one of my favorite examples of how mixed reality is a game changer in health. Subsequently other institutions have launched similar initiatives, including St George’s University in Grenada collaborating with SphereGen to create Living Heart, freely available in the HoloLens store. The ability to visualize complex three-dimensional structures in space, to see where the pancreas sits in relation to the liver and stomach, to understand how the cardiac valves move as the heart pumps, it totally changes understanding.

CAE in Canada took this a step further with their VimedixAR application. Instead of abstractly floating holograms in space, they overlay holograms on top of more traditional simulation mannequins. This is a long way from how I learned medical procedures and surgical techniques, the “see one, do one, teach one” philosophy. With this solution, you can visualize where the where the cardiac catheter is heading in relation to the beating heart, or how the structures of the thorax correspond during a trans-esophageal echocardiogram.

The first cross-over to more mainstream patient management I became aware of was the work Sopra Steria were doing with the University Hospital of Oslo in Norway. They were using holograms to plan surgery. Specifically, liver tumour resections and pediatric cardiac surgery. Ironically, the pediatric cardiac surgery modelling replaces 3D printing, which in itself was a recent innovation at the University. Sopra Steria received the Microsoft 2017 Health Innovation Award, and you can see their work here. Subsequently, I’ve seen a raft of examples of HoloLens being used intraoperatively, from reconstructive spinal surgery in Brazil or in the US with Scopis, to HoloEyes in Japan, and even neurosurgery at Duke University featured by CNBC.

I’m aware of many parallel initiatives to make medical image DICOM files and their 3D reconstructions directly visible on the HoloLens, but I thought the University of Maryland’s approach to virtual ultrasound opens up so many practical applications for democratizing and mobilizing this mixed reality technology.

The final example that I want to share has caused waves of attention around the world. It hails from Australia, where Silverchain are working on a holographic doctor service. I got to speak to CEO Chris McGowan over dinner recently at the Envision conference and can report that innovation is alive and well with this kind of leadership.

I return to where I started, with Alex Kipman’s bold claim that we are on the threshold of a computing revolution. From my perspective, the revolution is well underway. I do hope to share this journey with all of you as it progresses, and look forward to more examples that inspire and amaze me!

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It’s a topic that has parallels in our healthcare systems around the world. We’ve been operating within them so long, and conditioned to accept mediocrity together with miracles, that it can be hard to take a step back and conceive of health delivered differently. Especially for those of us within or close to the system. Healthcare is so very personal. We all have a health story that has been deeply impactful, either ourselves or our loved ones. It’s an industry where we try to overlook the stories of heartbreak and loss, where the system hasn’t worked, because we don’t want to direct criticism at the health workers who dedicate their lives to helping others. For the change agents in health however, asking the hard questions and being brutally honest is part of the process. Why, when hospital and hospitality share a common root, do we have such a service and experience gap? What if my hospital experience was as good as my hotel stay – from check in to timely departure?

Which is why Envision is such a special gathering. This is a cross-industry event with a common organizing theme – digital transformation. It’s an opportunity for business leaders to witness firsthand how change is unfolding in other industries, and consider the implications for their own. As a lagging adopter of information technology, healthcare is ideally positioned to learn from these digital pioneers. There are overarching themes that seem to surface repeatedly, regardless of industry. Customer (patient) engagement, staff (clinician) productivity, data driven decisions (care), cost efficiencies. Yes, health is unique in many regards. It doesn’t mean we can ignore the lessons from the rest of our digital society, as it moves inexorably forwards.

I’m thrilled to be sharing the stage with Jane Sarasohn-Kahn, health economist and author of the blog Healthpopuli. Running now for over ten years, Healthpopuli has been asking the hard questions about the validity of our healthcare systems. Taking a data driven approach to quality, access, equity, and the impact of all this complexity on the patient. I welcome everyone at Envision with an interest in health to join Jane and I for the Monday afternoon session at 2pm ‘Saving lives with digital transformation in health’. This will be the first of a packed series of six dedicated health track sessions over three days, which demonstrates the emphasis health has at Microsoft today. Of course, we realize not everyone will be able to travel for this fabulous event. if you are going to miss Envision, be sure to tune into the Webinar, register here!

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Enter precision medicine. Precision medicine is a subset of this personalized movement, and generally refers to individualizing the therapy (often pharmaceutical) based on the genomic profile of the patient and our understanding of how that will modulate the response of the patient. We’ve of course been aware of the importance of genomics in treatment for decades, the classic case being how people of different race respond to antihypertensive treatment. The difference now however is the relative affordability of genomic sequencing, and the skyrocketing cost of certain drug therapies.

We see a lot of the early applications of precision medicine surfacing in modern oncology, but the potential for wholesale system level change is clear. It was only relatively recently that we first sequenced the genome for hundreds of millions of dollars in 2000. Now genomic sequencing is readily available for about a thousand dollars, with projections suggesting that will further drop to a hundred dollars in fifteen years. When the cost of chemotherapy regularly totals tens of thousands of dollars for any given patient, doesn’t it make sense to find out ahead of time whether the drug will be effective?

So, it was with excitement that I accepted the invitation to come speak on artificial intelligence at the Precision Medicine Leaders Summit in San Diego recently. I was most excited about the learning opportunity, to understand more about this rapidly progressing field, and perhaps meet some of the luminaries. San Diego is a pretty fabulous place to visit in summer as well. As I sat though sessions leading up to the panel I was increasingly humbled by just how much I didn’t know about this burgeoning industry, and just how smart the people attending the conference were. I’m familiar with events that dumb down the subject matter and therefore never explore the thorny issues, and also with other events that entertain without much substance. This conference was a standout for me. Issues were debated robustly in panels of highly qualified individuals that blended commercial, technical, clinical and academic perspectives. It’s clear that precision medicine is here to stay, growing fast, and there are plenty of issues to sort through – regulatory, business model, ethical and technical.

I’m relieved to report that the panel not only addressed some of the aspects of AI for this field that really need further public debate, but that it was actually fun. Kudos to my fellow panelists Dr. Atul Butte, Andy Bartley and Dr. Nick van Terheyden for a lively discussion, our excellent moderator Dr. Thomas Wilckens. A special thanks to Adrijana Kekic from the Mayo Clinic for the photo!

I leave with a new appreciation for the importance of the work we do within the Genomics group at Microsoft. Their focus on secondary and tertiary analysis of genomics is but a small part of the larger personalized health movement that some of our Microsoft partners are increasingly making a focus of their product strategy.

If you’d like to learn more about the work that Microsoft is doing in the genomics space, visit this link and download the free eBook.

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