Steve Ballmer: Healthcare Information and Management Systems Society (HIMSS) Conference 2007

Remarks by Steve Ballmer, CEO, Microsoft
Corporation Healthcare Information and Management Systems Society (HIMSS) Conference 2007
New Orleans Convention Center
New Orleans, Louisiana
February 26, 2007

As reported by Microsoft

STEVE BALLMER: Well, thanks. It is an honor and a privilege for me to have a chance to be here with you today. I've got to admit I was very, very excited when given this opportunity. The opportunity, what we see going on in healthcare, the role that we think information technology and software can play for providers, for consumers, for payers, I mean, it really is stunning.

And in a sense we take a look at the whole area of health and we say this is the largest segment of the world's economy, it's one of the fastest growing, it's one in which information plays and will play an increasingly large role, and really the opportunities for information technology to make an incredible difference is the way and the quality of health that people have a right to pursue is stunning.

And in some senses it is an industry that has yet to be fully scratched by IT technologies in the way that many, many other industries have. When you think about banking, you think about travel, you think about many of these things where consumers or patients in this case have a chance to meet businesses, and the automation that's gone in that simplified that process, and we see all of that having the opportunity to come to the healthcare industry really quite rapidly.

There's going to be an explosion in the amount of data. You heard that in the video. There's just going to be an explosion in the amount of data for healthcare providers. There's going to be an explosion of interest and opportunity for the patient to participate in their own wellness, their own healthcare, their own fitness. And really the opportunity for all of us in this industry to use information technology to advance the important agendas in healthcare I think is absolutely stunning.

The rest of you I guess had a chance to actually see Captain Kirk here on stage. I was backstage preparing for my speech when this guy walked in, and I said, man, that guy looks familiar. (Laughter.) And I guess in a sense I'll borrow liberally from that "Star Trek" theme, and say in some senses what I really want to talk about today isn't the problems in healthcare and blah, blah, blah, blah, blah, but I really think what we want to talk about is the opportunity [to] boldly go where no man has gone before. We really want to talk about what technology can do to positively revolutionize healthcare over the next several years.

Our company has by and large focused on all, shall we say, vertical industries evenly. We have people who get in and understand the retail industry or the banking industry or the healthcare industry. This industry though we've decided is simply too big and too important to not have more of a dedicated focus and feel. And so we're really building capability. You heard from a number of the docs who work at Microsoft, we're trying to build distinct capability, distinct products, distinct technologies because we think there's just so much opportunity in healthcare to really change the way people work and live.
I want to start with those two big basic premises though, one premise being the explosion in consumer access and consumer data, and the other big theme being the explosion in clinical data that's going to be important as we move forward.

You know, if you stop and think about it, and let's put healthcare aside for a minute, just think about what's happened over the last several years, the explosion in what end users, consumers, people around the world expect to have available to them technologically. With the Internet, with the PC, with intelligent mobile devices we've just seen the world explode in terms of what people can do researching things for themselves in any walk of life, sharing with others, collaborating, participating in community with people with similar issues and consumers.

And in a sense really continuing to focus in on the consumer, on the patient as the center of all of what we do technologically, in addition to patient care-wise I think is very important, because consumers expect it. And in a sense we've been talking about Microsoft for years about people leading what we call a digital lifestyle, turning to the computer as a fundamental access point for information. And when we started talking about this six, seven, eight years ago, people said, well, we're not sure. Nowadays people do point out that there certainly are people who do not participate yet for a variety of reasons in the information revolution. And yet if you just give these things time, it's certainly clear. You take a look at any 20-year-old, any 22-year old; the first place people will turn for information, the first place people will expect to transact business, the first place people will expect to register, sign up, fill out a form will be online. The people that we all serve expect to be able to have a rich electronic interaction with the people that they collaborate with, do business with quite broadly.

And the technologies are only going to continue to feed this: natural language processing that makes it easier for people to really get done what they want to get done with computers; the continued explosion in technologies like interactive television, which will bring information technology to us more hours a day, if you will; the continued explosion in what's going on with wikis and blogs and portals to allow people to author and share and communicate with one another quite broadly.

And this fundamental consumerization of information technology will also apply in the world of healthcare. And as certainly people in this business well understand, part of what will be required in the future is to involve patients more in their own wellness and in their own healthcare, so will information technology permit that interaction to happen in a very I think interesting and compelling way.

As people get online, as people not only want to research and understand better their particular health situation, but people want to talk to others who've gone through the same experiences, as people want to share perspectives on best treatment options, this kind of stuff will proceed, and I think having it be front and center on the agenda of the healthcare industry is extremely, extremely important.

At the same time, as we heard a little bit in the video at the beginning, there will continue to be an explosion in the amount of clinical data. Whether that will come from ongoing enhancements in imaging technologies, the mapping of the human genome, the incredible advances that we see in scanning and other technologies that will literally over time lead to a situation in which people will get much more information, analysis of their bodies early on in their lives, before perhaps they ever have a condition that causes them to seek out medical care, all of this will continue to explode.

As you heard, the amount of data therefore that providers will want to deal with, need to deal with will continue to increase. And there's only one path to deal with that, and that's automation.

You see this in other industries. There are very good people in a variety of industries, and yet as the amount of information they deal with grows, they look for ways to use information technology to model and to use the data but not have to confront every bit of detail.

I spent last week or the week before last in New York, and we were talking to people who are traders on Wall Street. The amount of information that gets generated and needs to be analyzed and looked at in that industry is enormous. And yet what they're doing is hiring the best and the brightest quantitative people out of universities to build models so that the people who are trading, who are buying and selling these complicated financial instruments can still do their jobs and do them in a professional way.

I think this need is going to be even greater, even more compelling, even more important to healthcare providers. Having the tools that take this enormous amount of information that is and will increasing be available, and be able to take a glance, whether it's at a disease class, whether it's at all the information that maps to a particular human being, and give them exactly the right diagnosis, et cetera, will require an incredible amount of technology to filter through that data and make some sense of it.

And we think this theme, explosion of information, explosion of tools for the consumer and the provider create a framework of opportunity for all of us going forward to really make healthcare to allow people to deliver better healthcare outcomes, and to be able to do that in a way that is increasingly cost-effective, which is, of course, the other big pressure point in the industry today.

The technology from the information side, from the IT side, it's really there. And the question is, how do we harness this technology, these technologies up in a way that really make them make sense?

I've asked our people for years one question, which still in a way from my perspective is mind-blowing. I'll use that word; it's kind of right out there, but it's kind of mind-blowing. Healthcare is the single largest industry in the world. And yet we don't see quite the same level of standardization of software tools in the healthcare industry that we do, say, in the manufacturing industry. And I think it's because the depth and level of understanding that people are seeking, the needs of the providers simply haven't been met. And we need to continue to push the state of the art in information technology to allow robust but general purpose tools to allow healthcare providers to deal with this explosion of information.

Increasingly the notion that every provider, every hospital, every health plan will be able to fund its own R&D in these tools and systems, that will be increasingly I think a thing of the past. There is simply too much that's going to happen, too many new things that are exploding onto the scene to allow that trend to continue. And I think it's up to the information technology industry to really step up to its role to build the tools that will allow healthcare to advance to the next level.

It should come as no surprise to you, given that I come from Microsoft, that we think of software as really the strategic asset that is necessary here to bridge the gap. All of the hardware that is required to collect data is really there on the horizon. Whether it's equipment that will be available in hospitals, whether it's increasingly low-cost monitors and other tools, hardware that people are going to be able to have in their homes so that they can provide real time information to their healthcare provider, all of the information is going to be collected. The question is, how can the software bring it all together; how can we have software that helps connect these systems and brings the information together; allows providers and their patients to collaborate together on an outcome; how do we let people drive informed decisions, informed decisions not just for the providers themselves but for consumers who increasingly need to make choices, not only choices of which is the best path but which is the best path at the right cost for individual consumers?

And as I said, we've seen these gaps bridged in other industries. Think about airlines just for a second, or think about banking and payment. Most people have multiple banks that they do business with. People want to be engaged but don't really understand what's going on as they make all of these complicated financial transactions, and how does all of that get pulled together in a way that makes sense.

That opportunity is available. It will require standards, it will require policies, it will require innovation, it will require new technology. But at Microsoft we're so enthused about that opportunity, I can't tell you.

We talk about our mission as a company is enabling people and businesses throughout the world to realize their full potential. Our mission depends on a healthy populace, and frankly the opportunity to pursue our mission by helping improve the quality of information technology that supports all of the fantastic work that the people in this audience do is an amazing, amazing opportunity for us.

Before I talk a little bit about those three trends, technology trends in some detail, I'd like to show you a little bit of a video that we've put together to kind of try to envision what healthcare technology and what healthcare delivery might look like in the future. Most of what's in this video is possible or real today at least in research laboratories, but I think it will give you a little bit of a sense on how we see software helping to harness the incredible capability in the market today and deliver the next generation of healthcare. Roll the video, please.

[Video segment]

STEVE BALLMER: The innovations will be amazing over the next few years, and the technology is ready.

You talk about connecting systems: The move of our industry to embrace XML as the set of standard protocols is very, very important. This will allow us to bring together information for consumers and providers in new ways. You can see a unified view of what are my allergies, what are my immunizations, what do I do if I have the following chronic condition.

As healthcare increasingly gets "retailized", if you will, and we see these small clinics growing up in all kinds of places, there will need to be a very quick way to get a single point of truth and to get it very, very quickly.

Improving collaboration, we need to drive collaboration for the patients themselves. How do I get a diagnosis if I live in a rural area? What does it look like to me? We already see kiosks going in, in India, for remote diagnosis. How do I get access to information and expertise wherever I happen to live? I want to know about a treatment that somebody has received at a hospital or other provider in a place that's remote; how did it work, what was it like, tell me about that experience. That's important to patients as they go through this process, very, very significant.

And more informed decisions: I know we've all seen the research, we all have the anecdotes, we all understand that from the consumer perspective people feel very – lack confidence, aren't sure what to do. They see very smart and very informed doctors, nurses giving them different direction sometimes when you get a second opinion, and the ability to do your best job as a patient, as a consumer, to get access to information, to make an informed choice and move on is very important.

You know, we think about the world of the PC as being a world of empowerment. Starting with VisiCalc and Excel, we gave people the tools for analysis. We need to take a step to give people the tools for analysis and understanding in the world of healthcare.

We think about a home, and you got a sense of this in the video, a home that evolves electronically to support healthcare needs. Sure, you'll go online, you'll fill out all pre-visit forms online. You'll be able to network with people who have the same issues you do. You'll be able to get secure access to your own personal health record online. You'll be able to go online and search and get access to a broad set of information.

Your TV, your Smart Watch, your exercise equipment, your videogaming machine: Those will all be places where smart electronic alerts can be delivered to you to remind you to do something, to take an action that is important in your personal healthcare.

We had a group of about 100 business CEOs last May in Seattle, and we showed them some prototypes on a wide variety of consumer devices that we think can make a difference in healthcare in the home in the future, and I'd love to have a chance to replicate that some time for this audience, because it's really compelling to see how far the hardware and software has come to allow the home to be an important place for healthcare, wellness, information capture, et cetera.

On the provider side, same three big themes, connect the systems, improve the collaboration, and do a better job of informing systems. How do we give you an aggregated view of patients, so that you can not only look at an individual patient, but what the experience has been with groups of patients? How do we really get these unified records pulled together? How do we move data seamlessly from provider to provider, or department to department, from ambulatory to ER to the operating room? How is all that information really going to be woven together?

We are at a different point in time. There is now an architected approach, as I said earlier, through these XML Web services for letting these systems work together. So-called service-oriented architecture is a new technology, and one that I think will be more important in this industry than in any other.

How do we let people communicate securely in a clinical context? How do we do real time clinical consult? How does a doctor collaborate with one of his or her patients who is at home? What are the collaboration technologies to facilitate that? Voice over IP, videoconferencing, real time information capture are just some of the ones that I think are going to be very important.

And last but certainly not least, how do we allow for providers to drive more informed decisions? How do we centralize records, and allow the data that's in them to be mined? How do you really get a unified view of patient information? How does the hospital pull things together and do appropriate analytics and really understand how they're doing, where things stand? And again the scenario where there's new technologies, business intelligence technologies, database, data warehousing technologies that are all going to be fundamentally important as the amount of data available to providers just continues to explode.

I'd like to show you some work that we've been involved with at the LSU Healthcare Network. I think you'll find it very, very interesting. Certainly we've been incredibly impressed, and obviously there have been incredible special needs here in the state of Louisiana over the last several years. So, we'd like to show you just a little bit of commentary on what one leading healthcare institution is doing to automate itself in new and modern ways. Roll the video, please.

[Video segment]

STEVE BALLMER: Particularly being here in New Orleans, I thought it was valuable to share, because there's some unique perspective there that I think is incredibly, incredibly important.

We see a lot of great innovation happening today in terms of systems for providers. One of the areas where, in conjunction with a number of partners we work with in the health IT space, that we see a lot of great stuff going on, is in the operating room itself: bringing together secure, role-based access to patients, medicine, operating room information; remote management of systems; automatic updates to patient's families in the right way; use of modern technologies – Wi-Fi, Bluetooth, et cetera; unified view of information across surgeons and anesthesiologists; pulling information together from multiple systems.

But just as we saw in the consumer case, in a sense there's a remake, there will be a remake of what happens in the home for the patient, there will be a remake in every context, if you will, inside the hospital, inside the doctor's office, there will be a remake of how we think about the hardware, the software, technologies coming together to let the provider, let the consumers deal with the explosion of information and the kind of tools that they'll want to use to really access that.

I want to share one example for you of where we see huge breakthroughs coming in healthcare that's outside the context of the provider or the consumer, and that's the view from the life sciences perspective. Certainly one of the things that will cause the explosion of data available to us is the amount of information that we will eventually have through genomics and other new life sciences techniques. And so it's really important that information technology does a good job supporting the research scientists as well in their activities and in their endeavors.

And so I'd like to welcome on stage with me one of our customers, Peter Kuhn, who comes from the Scripps Research Institute, and one of our partners, Tim Huckaby from InterKnowlogy. They have built a system that supports cancer research at the Scripps Research Institute, and Peter as a user, and Tim as a software developer want to show you a little bit of that and have a chance to talk about it. Please welcome Tim Huckaby and Peter Kuhn. (Applause.)

PETER KUHN: So, thanks for having us. The Scripps Research Institute down in La Jolla is one of the largest biomedical, not-for-profit biomedical research foundations in the United States, and my lab at Scripps Research is working very closely with the clinicians over at the Scripps clinic. And what we are trying to do is we are trying to identify proteins on the surface of cancer cells, trying to characterize them, and then trying to interfere with them, with the goal, of course, to develop effective diagnostics and therapeutics; and again with that as a long range goal is to really make cancer a managed disease.

Now, we've heard a lot this morning already about interoperability and complex data, and certainly this is the kind of challenge that no individual researcher can really attempt to address on his or her own, so we really need to collaborate with other scientists and clinicians across the halls but also halfway around the world.

So, with this complexity, the challenge really was that it is not just about individual text files, but the type of research data that we needed to share is all kinds of research reports, large amounts of research data, and we needed to be able to actually attach this data in three dimensions to protein molecules.

So, with that challenge in mind, we then approached Tim Huckaby at InterKnowlogy about less than a year ago, and the solution that he will be showing off today is really something that shows you how we now are in a position to actually attach this research data to proteins in three dimensions. The example that he's going to show off is a real example out of the lab that we are currently working on, so this is all real life research data.

TIM HUCKABY: Peter's group is using some amazing technologies to find cancer cells within blood, and to develop new drugs. They have many high-tech toys that allow them and their researchers to stare at molecules in 3-D and such. What they didn't have is a way to tie the research itself to the 3-D view, in molecular terms, of cancer.

What you're seeing here is the next generation user interface application that solves Peter's 3-D and collaboration requirements.

So, let's pretend I'm a researcher – even though I'm a software guy – and I'm going to do a desktop search, and grab a document, pretend I was working on this document on a train, disconnected or something like that. I had to find it on my desktop. I simply dragged and dropped the research onto the cancer molecule, that very spot on the cancer molecule itself. Now, what's important about this is this research is now persisted to that very spot on the 3-D view of cancer.

PETER KUHN: And this is important now for us because I might have a collaborator who is – and actually again this is a real case that you're seeing here – and he's actually sitting at the university in Austria, and he came up with this concept of thinking about a result that we had and how this applies to the kind of chemistry that he does.

So, what Tim has now just done is he has potentially attached my ideas, my thoughts to the protein in 3-D. And, of course, because this is attached to the collaboration background, that means that the scientists in Austria can now get to it in real time.

Now, if he or she does not have the application installed, what you see Tim doing now is he's actually browsing to that research data on the Web. And so if he or she does not have the application installed, they can still get to this data and look at this data; again, speaking to the whole issue of interoperability on complex data.

TIM HUCKABY: This is why using portal technology is so important to the solution. It allows Peter's group to share information across geographic and organizational boundaries. It also allows them to search and find the shared research quickly and effectively.

PETER KUHN: However, if, of course, you have no application installed, and again you see this is a much richer environment, of course, to do this kind of work, you can actually get to the shared data on the application itself, you can then understand this much better, and add your own thoughts and notes to this research, and then with that, of course, again in real time it's available to us halfway around the world. And again whether it's halfway around the world, across the hallway, it doesn't really matter anymore, so we have this entire transparency of data there.

So for us again this is a real breakthrough as we are now using this not just on our cancer related research, but this is now already being used on the infectious disease program in our lab and other labs as well.

TIM HUCKABY: The greatest thing about this application is we built the initial prototype for this in two weeks with two developers and a half of a project manager. That type of developer productivity was unheard of before these technologies.

And we have big plans for this application, too, not the least of which are the complex workflow scenarios and solutions that Peter needs, and his group needs in the application.

PETER KUHN: So, again, and with this timeline that you have just heard from Tim about, we are really excited about this, because we have now finally got software tools that grow alongside our research. We can go back and forth very, very quickly, and we can really evolve together. And that really means that our progress in curing disease in the future, it clearly depends – and again we have heard this today, we all know this – really depends very critically on our ability to collaborate effectively, share our results, and find the data in its relevant context, and this is really what we have seen today.

So, we are excited about how software is growing with us along with the research. We're making breakthroughs every day, and I think we're getting closer and closer to really making diseases like cancer a managed disease.

With that, thank you very much.

STEVE BALLMER: Thanks, Peter. Thanks, Tim. Thanks, guys.

Certainly the work that's going on at Scripps and many other research institutions around the world are essential to the future of healthcare. But in some senses if you think about the technology issues, they also are very similar. How do we let a group of scientists who live in a variety of different places around the world bring their work together, share their best thoughts and ideas, collect and pool information, and now increasingly work together through workflow in more structured ways?

And so not only do I think the work that's going on here will benefit healthcare, in some senses it's also a model for the kind of improved collaboration and informed decisions that we want to drive more universally through healthcare IT.

We're not naοve about this. Nobody in this room I'm sure is. While we have a lot of faith and excitement and see possibilities, as I said at the beginning, in terms of healthcare IT, we know this goes beyond technology. There's a need for policy, there's a need for partnership, which is very, very important.

We need to see policy that really talks about cooperation, group access to information, privacy, ownership of information. That needs to continue to evolve. Standardization of healthcare records, CCR, the NHIN initiative is very important, HL7, and, of course, the work that has gone on with XML Web services needs to be continued and extended.

Public and private partnerships, there needs to be incentives for lifestyle change. How are we going to drive the patient record into the home, the involvement of the patient? How is the consumer, the patient themselves going to get involved in their own healthcare? Why will that happen? That's going to require a different kind of working relationship between public and private people, between providers, insurance, and government to really develop and deploy the kind of interoperable systems that will let this vision happen.

We will announce today here at the HIMSS show something we call our Connected Health Framework. It's a set of tools and technologies that are designed to facilitate, in conjunction with our healthcare ISV partners, to facilitate interoperable systems, and the movement of information across this spectrum. We've done this kind of technology framework for interoperability in a number of other industries to great benefit. We want to bring the power of that thinking now also here into the healthcare arena. And I think what that will allow us to do is to create a reference architecture that serves to document best practices for integrating healthcare systems.

This explosion in data is an amazing thing, and I feel like I've only really today been able to scratch the surface of what we are thinking about and what we see that's really going to be possible.

We've been 10 years or so with a dedicated focus on healthcare at Microsoft. We've got about 600 percent focused in on healthcare and healthcare alone.

Last year, we acquired a company called Azyxxi that I guess for lack of better words we call a unified health enterprise platform. Suffice it to say that the most exciting piece of software, I'll tell you the most exciting piece of software that I've had a chance to see in all of Microsoft this year is this Azyxxi product. And I'm not a doctor and I'm not a provider, and I can't tell you whether you should buy it – of course you should, that would always be our view – but I'll tell you if you just want to see something that can convince you that information technology is an amazing thing, it's an amazing product, it's an amazing technology, bringing information together, showcasing it, highlighting it.

We bought this technology for the healthcare arena, and we take a look at it, and we say because the healthcare industry understands and the folks we have in this industry understand this notion of integrating vast quantities of information, we want to take these same technologies now and bring them to other industries, because this industry will be at the leading edge of learning how to pull together vast amounts of information for a variety of different kinds of constituencies.

We're going to announce here at the show that we're acquiring a company called Medstory, which is a company that has dedicated consumer Internet search technologies that focus in on health and medicine.

We're very committed at our place to healthcare in new and exciting ways. We believe very much not only in the mission of this industry, we believe critically that now is a unique time to innovate, to make a difference, that what we have in front of us in terms of healthcare information technology is one of the greatest opportunities our company has seen in basically our 30-plus years of existence. Innovation will make a difference, hardware, software creativity.

We certainly are going to apply ourselves. We know everybody in this audience, you will all be involved applying your own creativity and energy. Let's go forward, let's go forward together, let's make a huge difference, and let's really, as I guess Spock or Kirk or one of those guys once said, let's really go forward and boldly go where no man has gone before.

Thank you all very, very much. (Applause.)