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Healthcare Without Boundaries:

Enhancing Productivity, Safety
,

and Quality




An Executive Summary




Febr
u
ary

2003






Abstract

The healthcare industry needs better integration among the information technologies that support it.

The
five key constituents of the healthcare industry


provider organizations and physicians, pharmaceutical
and medical device companies, government and private
-
sector employers, health
insurers
, and
consumers


need to share information. But communicati
on can be difficult because of disparate IT
environments, many of which are based on legacy mainframe systems. Microsoft

technology can be used
to integrate these disparate systems, without requiring alterations to existing legacy programs. Microsoft
techn
ology, including the Microsoft


Windows


2000 operating system, Microsoft SQL Server


2000,
Microsoft BizTalk
®

Server 2000 with the HIPAA Accelerator, Microsoft Visual Studio
®

.NET and the
Microsoft .NET Framework, provides the ideal platform for developin
g and deploying XML
-
based

and
Web services
-
based healthcare solutions.








For more information, press only:

David Lubinski

Microsoft Corp.

(425) 705
-
6553

davidlu@microsoft.com


Sherold Barr

SS+K

(541) 343
-
9623

sbarr@ssk.com














































© 2003 Microsoft Corp. All rights reserved.

The information contained in this document represents the current view of Microsoft on the issues discussed as of the
date of publication. Because Microsoft must respond to changing market condi
tions, it should not be interpreted to be a
commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information presented after the
date of publication.

This white paper is for informational purposes only. MICROSOFT MAKES NO

WARRANTIES, EXPRESS OR IMPLIED,
IN THIS DOCUMENT.

Microsoft, Windows, BizTalk, Visual Studio, Active Directory, SharePoint, Visio, MapPoint, Windows Media, MSN and
bCentral are either registered trademarks or trademarks of Microsoft Corp. in the United St
ates and/or other countries.

The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

Microsoft Corp. • One Microsoft Way • Redmond, WA 98052
-
6399 • USA



Contents

Introduction

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1

Creating Solutions
W
ith Microsoft Technology

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.................

2

Providers

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2

Abington Memorial Hospital

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2

University of Minnesota Physicians

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..

3

Mississippi Valley Surgery Center

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....

3

Gentiva Health Services

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...................

4

Pharmaceutical and Biotechnology Companies

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..................

6

MedPointe

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................................
........

6

Aventis

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................................
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.............

7

The PHOENIX

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..

7

Rosetta Genomics

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............................

8

Health Insurers

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................................
....

8

BlueCross BlueShield of South Carolina

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..........................

9

Clalit Health Service
s

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.......................

9

Government and Private Employers

................................
................................
................................
..

10

Massachusetts Health and Human Services

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.................

10

Microsoft

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.........

11

A Brief Look at Microsoft Technology

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..............................

11

Web Services

................................
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.....

12

Tools

................................
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..................

12

Clients

................................
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................

12

Servers

................................
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..............

12

Experiences and Applications

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................................
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............

13

Summary

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................................
................................
................................
..............

13

For More Information

................................
................................
................................
..........................

15


1

Introduction

The Microsoft Healthcare Industry Solutions Group believes the time is right for technology to have a
dramatic and fundamental impact in improving healthcare

across the spectrum


including healthcare
delivery, pharmaceutical development, health payment and personal health management. Microsoft
believes it is time for healthcare without boundaries.

We call it
Healthcare Without Boundaries
. It’s a vision for a
time when physicians and nurses can
securely access patient information anytime, anywhere, and on any device; when referrals,
authorizations, and insurance claims are transmitted and processed electronically; when prescriptions are
written and renewed on
-
l
ine; when new drugs and treatments come to market in months instead of years;
when consumers control their medical information and grant permission to those who need it, whenever
and wherever it’s needed. It’s a vision that acknowledges the true value of i
nformation in what is perhaps
the most information
-
intensive environment of all

healthcare.

There’s no doubt that healthcare relies heavily on information workers. Patient care is defined by the work
of skilled professionals who acquire, analyze, document
, and share information. Yet healthcare has been
slow to adopt information technologies that have helped workers in other industries be more productive
and improve the quality of the goods and services they provide. Healthcare workers are also highly
mobil
e. Clinicians are always on the move. They travel between rooms, corridors, floors, offices and
institutions. They have unique requirements for the devices that move with them and provide rapid access
to information at the point of care, wherever that may
be.

These mobile professionals also require applications that are intuitive and easy to use; that share a
common look and feel so users know what to do and how to do it no matter where the applications are
encountered. And when it comes to data that is as

personal and confidential as that contained in medical
records, it needs to be secure. There simply is no room for compromise.

Breaking
Down

Boundaries

Breaking down boundaries to enable information integration solutions has long been one of the big
chall
enges in healthcare, simply because there are so many disparate systems


many of them legacy
mainframes


that can’t easily share data. The healthcare industry is like an ecosystem, with its key
constituents


providers, health insurers, pharmaceutical an
d biotechnology companies, and employers


centered on the healthcare consumer. All the constituents are dependent upon the timely, accurate,
complete and secure flow of information.

But disparate systems block the flow. Each constituent stands as an isol
ated silo of information that can’t
be easily shared with the other constituents.
Adding to the complexity is that w
ithin each silo of data are
additional silos of information that can’t be easily shared. For example, one insurer may have a
mainframe syste
m for handling Medicaid claims that can’t easily exchange information with another
mainframe system used for provider claims. On the provider side, a single hospital may have several
computing systems that can’t easily share data


one system for radiology
, another for
lab

tests and
another for accounts receivables and so on


none of which can interact with the systems running a
physician’s office. Across the healthcare landscape are hundreds of noncompatible systems, many of
them well
-
entrenched legacy ma
inframes, that isolate information.

The need to unify disparate systems led to the Health Insurance Portability and Accountability Act
(HIPAA), Health Level Seven (HL7) and other initiatives that seek to standardize the storage and
exchange of data.

This i
s where Microsoft can help. With its consumer
-
centric strategy and end
-
to
-
end platform solutions,
Microsoft is uniquely positioned to bridge information islands in an efficient and cost
-
effective way for
healthcare organizations, integrating systems and in
formation workers across the enterprise and beyond,
from handheld devices to the most powerful datacenters. Microsoft technology can integrate systems and
empower healthcare workers, giving them the information they need when they need it, including at the

point of care, where physicians can see the latest lab reports, access electronic medical records, and

2

enter prescriptions electronically from a handheld device such as a Pocket PC or Tablet PC.

The Benefits of Integrating
Data from Disparate Systems

The
benefits of unifying disparate systems would be enormous. Approximately 70 percent of healthcare
transactions today are paper
-
based, resulting in administrative costs of up to 20
cents

of each dollar
spent. In the U.S. marketplace alone, the yearly cost of

processing and administering claims is about

$90 billion. The current practice of moving paper around and making telephone calls to track and confirm
information compares unfavorably with the seamless efficiency of the banking industry’s automated teller

machine (ATM) system. Some healthcare industry analysts believe administrative costs could be slashed
to $5 billion or less by moving from a paper
-
based system to a coordinated and integrated digital system.

Saving $85 billion a year would be just one of
the benefits to emerge if industry standards were used to
unify healthcare’s disparate systems. The benefits span the field
:



A parent traveling in another state or country could take their child to a physician and provide
immediate access to the child’s me
dical records by logging onto their personal health Web site.



Physicians would benefit from having instant access to vital patient information, including lab reports
and electronic medical records, available at the point of care on a mobile device such as
a Pocket PC
or Tablet PC.



Pharmaceutical companies could reduce the time required for clinical trials, streamline manufacturing
and enhance distribution.



Providers and health insurers could proactively address the requirements of HIPAA and turn them
into c
ompetitive advantages.



Employers could enhance employee well
-
being and reduce healthcare costs by providing access to
preventive healthcare information.



Removing the boundaries to information flow would help provide the life
-
saving solutions being called
f
or by The Leapfrog Group for patient safety.

Microsoft and its industry solution partners are working to create a new generation of applications and
devices that address the needs of both the people who work in healthcare and their patients. That’s why
we
call it
Healthcare Without Boundaries
, because it’s ultimately about much more than information. It’s
about maintaining good health and saving lives.

Creating Solutions With Microsoft Technology

Progressive healthcare organizations are already breaking dow
n information barriers, using both
Microsoft and solutions from its industry partners that benefit from the breadth and integration of the
Microsoft platform and its $5 billion in annual research and development. Here’s a sampling of how
Microsoft technolo
gy is being put to work across the healthcare spectrum.

Providers

To improve the quality of care while reducing costs, hospitals, clinicians and other providers require
technology that enables them to share mission
-
critical information across the healthcar
e continuum,
including at the point of care.

Healthcare executives know the importance of having information technology that can help them improve
market competitiveness, enhance efficiencies, improve clinical and service quality, and support overall
outco
mes management. This section provides a brief look at how progressive healthcare organizations
and Microsoft partners are creating real
-
world solutions.

Abington Memorial Hospital

Abington Memorial Hospital (AMH) is a not
-
for
-
profit, 508
-
bed community te
aching hospital in Abington,
Pa. AMH is using Microsoft technology, including the Tablet PC and Eclipsys’ SunriseXA advanced

3

clinical information system, to stay on the leading edge in implementing recommendations from the
National Academy of Sciences’
Ins
titute of Medicine and The Leapfrog Group to improve patient safety.

The Tablet PC offers the full power of the Microsoft Windows XP Professional operating system, with
additional features that allow a user to control the computer by using a digital pen to

make notes and
convert them into typed text for use in other applications. With digital pen and speech recognition
capabilities, the
T
ablet is easily carried and offers maximum mobility.

Abington is using TabletXA, Eclipsys’ mobile clinical solution for
the Tablet PC, which works in
conjunction with SunriseXA. The Eclipsys solution includes computerized physician order entry (CPOE),
which eliminates illegible handwriting, reduces medical errors and improves patient care. CPOE
accomplishes this by ensuring

order legibility and minimizing transcription errors, increasing timeliness
and coordination of care, and enhancing preventive care and cost control. For example, the system
lowers the chance of medication errors because it eliminates written prescription
s that can be difficult to
read. In addition, the system’s knowledge base instantly checks prescriptions for dosages, allergies and
other complicating factors, so potential problems are avoided before the order is made. Lab values and
test results are auto
matically sent to the patient’s electronic medical record.

“Implementing CPOE was the first phase of our mission to improve patient safety,” said Alison Ferren,
Abington’s chief information officer. “Moving to TabletXA is the second phase and will play a k
ey role in
further improving patient safety and workflow. Not only will it provide real
-
time access to the computerized
patient record, reducing time spent on documentation and eliminating dependency on paper, TabletXA
will also enhance communication among

our clinicians to help them care for patients more efficiently.”

The SunriseXA solution is hosted on a Microsoft platform that includes Microsoft Windows 2000 and
Windows XP, Microsoft Internet Explorer, Visual Studio, Application Center 2000, SQL Server
2000, and
Windows 2000 Advanced and Datacenter Server.

University of Minnesota Physicians

University of Minnesota Physicians (UMPhysicians) prides itself
on

“specializing in breakthroughs,” a
progressive attitude that carries over into choosing the tools
used to support electronic medical records
(EMR). The organization is a group medical practice comprising physicians who also are faculty members
at the Universi
ty of Minnesota Medical School, in Minneapolis.

As a major research institution, the University

of Minnesota has a long
-
standing tradition for
breakthroughs, priding itself on the world’s first successful open
-
heart surgery performed in 1952. And
researchers at the group’s Stem Cell Institute published groundbreaking findings in 2002 that showed
ste
m cells taken from bone marrow in mice and rats can form tissue for most of the organs in the body.

When the group researched the best way to implement EMR and bring lifesaving information to
physicians at the point of care, they chose the Microsoft
-
based
technology of Allscripts Healthcare
Solutions (A
H
S). AHS’ TouchWorks software is a modular electronic medical record and clinical
information solution that enhances productivity for a physician using a wireless handheld device, Tablet
PC or desktop worksta
tion. TouchWorks automates physicians’
most
-
common
activities, including
prescribing, capturing charges, dictating, ordering lab results and viewing those results, providing patient
education, and taking clinical notes. AHS
, headquartered just outside of C
hicago, IL,

provides software
and services to more than 20,000 physicians across the United States.

“We are
pleased to be able

to implement an electronic record that is physician
-
owned, archived for our
practice, and linked to our hospital partner for data

access,”
said Dr. Roby C. Thompson Jr., Chairman of
the B
oard and CEO for University of Minnesota Physicians.
"We specialize in breakthroughs and we
think this will be another one for our faculty.

We deployed the TouchWorks set of solutions as part of ou
r
ongoing efforts to provide our physicians with the support they need to access patient information
whenever and where
ver they need it.”

Mississippi Valley Surgery Center

Microsoft technology can be used to gather and analyze data to provide a better pict
ure of cost

4

structures. For example, the physician
-
owned outpatient clinic Mississippi Valley Surgery Center needed
a powerful yet flexible database that supported exacting cost analysis to help it reduce its fees while
retaining profitability. Using Micro
soft Windows 2000 Advanced Server, SQL Server 2000 and the
Windows
-
based AdvantX surgical center management tool from
Birmingham, Ala.
-
based
HealthIS,
Mississippi Valley Surgery Center created a win
-
win solution for patients, insurers and itself.

“To keep
our costs under control, we do what I call micro case
-
costing on every case that goes through
our surgery center,” said David Dooley, information manager for
the Davenport, IA
-
based
Mississippi
Valley Surgery Center. “This case
-
costing is vital to successf
ully contracting with health insurance
companies and health maintenance organizations that increasingly want to establish a set fee for a
procedure.

“Our center performs a lot of orthopedic implant surgeries, and depending on the case and the surgeon,
diff
erent implants will be used,” Dooley said. “The implant choice can create a pricing difference of
perhaps $5,000. Typically, a hospital will set the price according to the most expensive case option, and
then some. We use case
-
costing to provide a more exa
ct, and competitive, fee.”

But the center’s database didn’t provide the openness and flexibility required for sophisticated case
-
costing. In addition, patient information had to be re
-
entered each time a new billing unit was used.

“Our old system wouldn’t

support the transfer of patient and insurance data from one billing unit to
another,” Dooley said. “This meant that patient information that had been entered during their first visit
with a surgeon would have to be typed in again if they saw an anesthesio
logist, typed in again if they had
a lab test, and entered again if they visited a physical therapist. The patient information had to be typed
into every individual billing system.”

Dooley found that the HealthIS AdvantX system provided an exceptionally we
ll
-
integrated suite of
modules to simplify management of a surgical center. And he found that the Windows 2000 platform with
SQL Server 2000 provided the powerful and robust platform he needed. Patient data is now entered just
once and is accessible across

the system. And with SQL Server 2000 as the database, the AdvantX
system can be used to perform extensive case
-
costing analysis. Dooley has seen other gains.

“The stability of Windows 2000 has been unbelievable,” Dooley said. “And SQL Server has given us
speed increases of 50 to 60 percent over our previous database.”



Gentiva Health Services

Gentiva Health Services, the nation’s leading provider of home healthcare services, is piloting point of
care applications on Microsoft Windows
-
based Tablet PCs to s
implify
life for its employees. Gentiva,
based in Melville, NY,
considers its 30,000 remote workers, nurses, therapists and other trained
specialists to be its most valuable resource. The Tablet PCs are replacing a paper
-
based system,
slashing the time req
uired to update client records and increasing employee job satisfaction.

Home healthcare, and healthcare in general, involves significant amounts of paperwork and
recordkeeping, including clinical records, claims, and benefits
-
related forms and documentati
on. A
significant portion of a healthcare professional’s time involves this paperwork.

The company has created a prototype for a Tablet PC
-
based solution using Microsoft Visual Studio .NET
with C# and XML programming languages, along with the
i
nk controls

included with the Tablet PC
platform software development kit (SDK). Ink
-
enabled Microsoft Office applications ease documentation
and communications tasks by allowing the user
to
use a digital pen to work with forms on the screen.

Because Windows XP Table
t PC Edition is a superset of the Windows XP Professional operating system,
it addresses issues that were previously difficult and expensive for Gentiva to solve with traditional mobile
devices. For example, Windows XP can

help

protect patient information
security and privacy by offering
robust, industry
-
standard security and encryption features such as the Encrypted File System (EFS), and
public key infrastructure (PKI) and virtual private network (VPN) features and protocols.

Also, because the Tablet PC
is a powerful personal computer and, as such, includes support for USB
devices, additional peripherals, such as digital cameras for patient identification and wound
-
care

5

documentation photos, data backup devices for field
-
based, automated backups
,

and colo
r printers for
producing patient education materials, can be added easily.

“The Tablet PC technology has the potential to make a dramatic difference to our nurses,” said Bob
Creamer, chief information officer and senior vice president for financial operat
ions at Gentiva Health
Services. “This type of technology could give our company a competitive edge for recruiting and retaining
nursing staff, which is crucial to delivering good service to our patients.”


6

Pharmaceutical and Biotechnology Companies

Pharma
ceutical and biotechnology companies face the challenges of a rapidly changing marketplace and
a demanding regulatory environment.

For their organizations to thrive, pharmaceutical executives know it is important to break down
informational barriers, to e
nhance the ability of their scientists and information workers to communicate,
collaborate and accelerate the building of innovative pharmaceutical insights.

The challenges include optimizing the capacity and asset value of legacy systems, and unifying di
sparate
systems, applications and platforms, to improve the overall effectiveness of information management. In
addition, pharmaceutical information systems need to seamlessly link with contract research
organizations, regulatory agencies, clinical study s
ites and other business partners. The rewards for
integrated systems can include enhanced drug discovery efforts, shortened clinical trials, accelerated
approval of new drugs, increased enterprise operational efficiency, and improved sales and marketing.

MedPointe

It is harder than ever for professional sales representatives from pharmaceutical companies to get face
time with physicians. Today, 87 percent of the calls they make on physicians are drop
-
ins and are mostly
spent providing samples and registeri
ng the physician for educational events. On an average call, a
representative gets just 1.6 minutes (96 seconds) per primary product with a physician. During this time, a
representative must educate the physician about a product, acquire the physician’s si
gnature for the
samples, and register the physician for events.

Somerset, N.J.
-
based MedPointe
Pharmaceuticals

has the added burden of specializing in short
-
term
therapies, such as respiratory (including ASTELIN nasal spray and cough/cold products),
pedia
tric
and
central nervous system (including muscular relaxants and anti
-
epilepsy) therapies. When a firm with more
long
-
term patient usage programs persuades a physician to prescribe its treatment for a patient, it locks in
a recurring revenue stream. But M
edPointe sales representatives must consistently and effectively
position the benefits of ASTELIN and MedPointe’s other therapies at each call, effectively making the
sales representative earn each prescription.

To help its sales representatives maximize t
he value of their time with physicians, MedPointe deployed a
selling system for its entire national sales force using a Proscape Technologies solution, developed with
Microsoft Visual Studio .NET. Running on a Tablet PC platform, the integrated solution co
mbines the
Proscape pharmaceutical solution with sales force automation (SFA) software for territory management
and precall planning.

The solution uses the Microsoft Windows Active Directory
®

directory service, which provides the
representative with secur
e Single Sign
-
On capabilities with automatic authentication. With the solution’s
Electronic Visual Aid (EVA) feature, the Tablet PC replaces all paper
-
based presentation and clinical
materials previously used by the sales force. Sales representatives typic
ally begin with a preformatted
presentation tailored to individual physician or patient types, but with EVA they can link to authorized
information on the fly. This capability provides a “bottomless bag” of visual aids, clinical studies, opinion
-
leader vid
eo, and real
-
time marketing and training materials that can be drawn on to answer a physician’s
questions or objections.

The MedPointe marketing team makes extensive use of the

Fort Washington, PA
-
based

Proscape
’s

pharmaceutical solution’s ability to prov
ide two
-
way communication in the field by surveying physicians on
a variety of topics to gain quick, direct insight into doctors


concerns, needs and interests. The information
is used to continually refine presentation material. The solution leverages the

Microsoft .NET Framework
to move Extensible Markup Language (XML) packets up to the Microsoft SQL Server 2000 database and
back out to the Microsoft Excel reporting tool on the Tablet PC.

The SFA software provides the sales staff with the ability to recor
d and catalog physician data, determine
whom to call on, and schedule sales calls. When the MedPointe representative leaves samples, the SFA
software manages the sampling activity and helps pharmaceutical companies comply with the

7

Prescription Drug Marketi
ng Act of 1987 (PDMA) and Title 21 Code of Federal Regulations (CFR) Part 11
guidelines. The system also allows MedPointe to get an electronic signature from the physician. This
sample/signature capture capability is fully integrated with the EVA feature s
o that the representative can
maximize time spent with the physician during the sampling process.

MedPointe reports that the solution is enabling sales representatives to double the time they spend with
physicians teaching them about ASTELIN nasal spray. G
ary Lee Evans, vice president of field sales for
MedPointe Pharmaceuticals, said, “Thanks to the Proscape pharmaceutical solution based on the
Microsoft .NET Framework and the advent of pen
-
based computing, we have found a technology that
provides value fo
r physicians by enabling our representatives to deliver detailed information specifically
targeted to the physician’s practice and to immediately access the clinical reference information required
to answer questions and facilitate discussion.”

Aventis

Any
thing that can enhance the efficiency of clinical trials can have significant value for pharmaceutical
firms. Aventis, a global pharmaceutical company employing nearly 70,000 people with a network that
spans 127 countries, found potentially significant ben
efits when it evaluated the Tablet PC running
Microsoft Windows XP Tablet PC Edition as a new productivity tool for the lab and the field.

Aventis, a leader in prescription drugs, human vaccines and therapeutic proteins, has numerous areas in
the company
that require a mobile work force. Aventis
, with corporate headquarters in
Strasbourg,
France
,

employs hundreds of clinical trial associates (CTAs) and study managers who work in the field
with physicians who are conducting clinical trials. These associates

monitor the progress of each clinical
study site, which requires travel from their home base every four to eight weeks.

Because pharmaceutical research is governed by strict federal regulations, it is essential to properly
document clinical trials. As a
result, when in the field, CTAs often choose pen and paper over a notebook
PC while interviewing physicians and gathering data. Laboratory chemists also are required to maintain
extensive documentation. They usually tabulate, record and paste instrumentati
on results into large,
signed notebooks that are sealed and stored offsite.

When Aventis learned about the Tablet PC, the company began to envision ways that this latest evolution
of the personal computer could provide business value by advancing its goals

for technology: to improve
collaboration, speed data capture and help bring drugs to market more quickly. Aventis piloted the Fujitsu
Tablet PC to three user groups: clinical trial monitors, research chemists and several Aventis managers,
who replaced the
ir notebook computers with a Tablet PC loaded with the Microsoft Office XP productivity
suite.

Aventis also is considering installing the chemists’ instrumentation applications on the Tablet PC.
Combining the note
-
taking capabilities with instrumentation
data and archiving everything into a read
-
only
medium could reduce the paper
-
based process used today.

“In our global environment, Aventis knowledge workers are often managing diverse activities in different
parts of the world,” said Peter Loupos, vice pr
esident of Aventis Information Solutions at Aventis. “We are
in the knowledge creation business, and it is the speed and quality with which we generate and deliver
knowledge that will provide a competitive edge. Tablet PCs and their wireless capabilities h
ave the
potential to make this knowledge available to the worker wherever he or she is.”

The PHOENIX

Microsoft technology helps organizations seamlessly integrate data across applications and platforms.
The PHOENIX, a contract research organization with a
list of clients including Abbott and Bayer, has
always been able to perform clinical trial work quickly and cost
-
effectively. But it has made a leap forward
through the use of an integrated, Microsoft technology
-
based clinical trial management solution cal
led
DataLabs CTMS.

Developers at the Irvine, CA
-
based
DataLabs created

XML
-
based

Web services through the Microsoft
.NET Framework and Visual Studio to form the core of the company’s flagship product, DataLabs CTMS.

8

The first fully integrated trial
-
manage
ment product in the biopharmaceutical industry, DataLabs CTMS is
designed to lower drug
-
development costs, reduce time to market, increase efficiencies and enhance the
quality of research. The DataLabs system allows pharmaceutical companies to consolidate,

analyze,
integrate and process data from clinical trials being conducted worldwide.

By integrating all document, data and project management functions in a single Web
-
based solution, The
PHOENIX has increased the number of trials it manages by 70 percent
while reducing its internal costs.
And it has completed assignments several weeks faster than it could before.

“There’s great joy in this business if you beat the timeline,” said Mike Gleeson, executive vice president of
The PHOENIX. “The average drug gene
rates $200 million per year in sales. If a manufacturer can get
that drug to market even one day earlier, it is looking at millions of dollars in sales. It is also looking at a
longer patent life and increased ability to generate a good return on investmen
t.”

Rosetta Genomics

Pharmaceutical and biotechnology companies must often work with huge data sets as they search for
potential therapeutic agents. The high performance and scalability of the Microsoft platform delivers
superior business value for deployi
ng large database solutions.

Rosetta Genomics
, an Israeli
-
based genomic
-
data analysis company,

used Microsoft SQL Server 2000
Enterprise Edition to create the tools required to analyze the massive amounts of data being produced by
the human
-
genome
-
sequenc
ing project. These tools have produced amazing performance statistics. The
cost of the SQL Server 2000 solution is just one
-
fifth the cost of comparable supercomputing solutions
and provides an easy and affordable means to scale up as the genomic database
grows.

Genomics is a vital area of research, but powerful search tools are required to assemble raw data into the
keys to creating new therapeutic agents. “After all the initial excitement over the huge achievement in
mapping the human genome, it became ev
ident that all this information would be meaningless and
useless if tools could not be found to process, analyze and understand it,” said Dr. Zahon Bentwich,
chairman and chief executive officer of Rosetta Genomics.

The genomic d
atabase amounts to
20 bill
ion records totaling 2.7 terabytes. Rosetta Genomics recognized
the need to make genomic
-
sequence data analysis and data mining tools available to the greatest
number of partners. The company set out to provide a solution as well as a service. It would off
er analysis
services running on Rosetta’s own system, but eventually would offer a solution that would allow
customers to affordably build their own systems as well.

“In effect, the challenge was to develop a solution that would enable the analysis of com
plex genomic
information at one
-
fifth to one
-
tenth the cost required in a supercomputer environment,” Bentwich said.
“The Microsoft platform has allowed us to do this.”

Health Insurers

No one
know
s

more
than health insurance executives
about the need for
h
ealthcare without boundaries
,
because they are at the crossroads of dataflow between employers, providers and consumers. In
addition, they must handle both administrative and clinical information from many disparate systems
across large geographic regions.


The success of health insurers depends on how well they can manage and act on data flows to and from
multiple sources to feed multiple processes: claims payment, rate setting, pricing, marketing, care
management, prescription benefits, eligibility verifi
cation, clearinghouse transactions and referral
management.

In their position
, health insurers need to know the information they send and receive across boundaries is
trusted and trustworthy. And they need standards
-
based solutions that support HIPAA
-
mand
ated
electronic data interchange (EDI) transactions.


9

BlueCross BlueShield of South Carolina

BlueCross BlueShield of South Carolina
, based in Columbia, S.C.,

has an award
-
winning Web site
(
http://
www.southcarolinablues.com
/
) that provides a variety of featu
res and tools designed to assist the
company’s physician partners, broker agents and customers.



Doctors and other healthcare professionals can check the status of claims and/or eligibility, submit
referrals

and

confirm the status of those referrals. The s
ite also offers an Ask Provider Services
feature
,
through
which providers
can

ask questions and receive responses in a
n environment with


enhanced security technology.

B
y March 2002, more than 9,500 physicians had registered to use the
site’s My Insuranc
e Manager

through DirectorySmart
.



Broker agents can access a variety of business management tools to improve sales and promote
BlueCross products and services.



Benefits coordinators can access online forms and enrollment procedures.



Members can check the
ir claim status, view their explanation of benefits (EOBs), order identification
cards, and more.

But the popularity of the site soon overwhelmed its original infrastructure
, which was

based on the
Sun/iPlanet Web platform using two directory servers, with

one operating as the “supplier,” or master,
meaning it held the authority to write to and replicate with the other
,

“consumer
,
” directories. According to
Bry Curry, .NET
systems director
for BlueCross, this supplier
-
consumer server configuration required
constant replication, which significantly slowed down authentication. As the number of registered users
grew, Curry
said
, the company couldn’t tolerate recurring downtimes and slow replication and
authentication, making a multi
master directory configuratio
n a must. BlueCross needed the assurance
that if a directory server was unavailable
,

for whatever reason
,

updates and replication would continue
without affecting end

users.
In addition, the original deployment carried a $2 per directory user charge.
BlueC
ross needed an identity management solution that offered low
-
cost or no
-
cost directory licensing.

BlueCross worked with OpenNetwork Technologies
, headquartered in Tampa Bay, FL,

and asked the
company to prepare a technical profile on a variety of d
irector
y services on the market. This led

BlueCross to choose a solution built with Windows 2000 Advanced Server and Active Directory directory
service.
BlueCross made

an initial investment of $310,000
and

now offers its Web users a faster, more
reliable portal t
o the company’s products and services. The Microsoft
-
based
identity manag
ement
solut
ion helped BlueCross avoid cost
-
prohibitive licensing fees totaling $1.34 million over the next five
years. The Microsoft solution also helped BlueCross address its securit
y concerns.

“As we expand and improve our e
-
business solutions, Active Directory and DirectorySmart give us a
unified and manageable security infrastructure,” said Steve Wiggins,
chief information officer with

BlueCross BlueShield of South Carolina. “Combi
ned, they enable us to reduce our security risks and
help
protect the privacy of our members by simplifying the complexities of managing identities, privileges and
security operations both within and beyond the enterprise.”

Clalit Health Services

Providin
g real
-
time business intelligence
to

information workers
helps them

improve service while
optimizing expenses.

Clalit Health Services, the largest
health service provider
,

or
HMO
,

in Israel

and the second
-
largest
worldwide, used the Microsoft platform and
Boise, ID
-
based
ProClarity

data analysis as the front

end to
provide real
-
time business intelligence. The solution gives every clinic manager an
d doctor timely access
to multi
dimensional analysis of the vast database containing hundreds of millions of reco
rds on patient
hospitalization and pharmacological history, medical resource utilization and other operational
information.

After evaluating alternative solutions,
Clalit decided to

adopt Microsoft’s SQL Server 2000 Enterprise
Edition Analysis Services in
a centralized configuration. An
eight
-
processor Unisys ES7000 server with an
EMC Symetrix storage area network was selected for the hardware platform.
Because of

the robust
platform and the superior performance of SQL Server 2000, the response to most anal
ysis queries is

10

almost instantaneous
;

within a few seconds the user can get a freshly calculated view of the data,
updated to the minute.

Initially, the solution covered 15 “worlds
,

or

subject areas such as hospitalization, lab tests, medicine use
histor
y, prescription statistics and demographics. Every world includes multiple world

views,
the various
aspects of the data

cubes that are generated by SQL Server 2000 Analysis Services on the fly. The
deployment has been so successful that additional “worlds”

come online at a rate of
two

per month


a
testimony to the ease with which the solution is scalable and
users’

eager an
ticipation for more
information
.


“Dealing in medical and financial information required top
-
notch security and manageability, which
di
ctated a centralized solution,” said Gadi Gilon,
chief information officer for
Clalit Health Services. “This
in turn demanded a very high performance level, which our legacy systems couldn’t deliver. To be useful
to non
-
IT users, a graphical, easy
-
to
-
use f
ront

end was mandatory. And
to
attract the user base
,

it had to
provide update
d, relevant information in near
-
real
time, which leads back to performance and the ability to
achieve high levels of it with a reasonable outlay.”

Government and Private Employer
s

G
overnment and private
-
sector employers face the problem of dealing with the continu
ing

increase in the
cost of providing medical care.
T
o date
,

a maze of disparate systems have made it difficult to analyze
expenditures.

Massachusetts Health and Human Se
rvices

Governments especially face a problem of multiple legacy information systems that don’t easily share
information. A study of Massachusetts Health and Human Services found that 15 agencies each had their
own mainframes and proprietary databases, with

no way to talk to each other.

This problem can be found throughout local, state and federal governments. Until the separate silos of
data can be united, it will be difficult to develop the kind of consolidated data required to make better
decisions on he
althcare spending.

BizTalk Server provides great orchestration in uniting data from disparate systems. BizTalk Server
understands legacy data in a variety of formats and can translate data to XML format for export to other
processes or Web services.

In th
e case of Massachusetts Health and Human Services, data from the 15 agencies was brought into a
centralized secure repository residing on Microsoft SQL Server 2000 databases to create what was called
the MassCARES system. An analytical layer, powered by on
line analytical processing (OLAP), enables
analysis of anonymous client data by authorized staff, and a public layer gives access to preformatted
reports on client population, services, performance and such. Microsoft technology allowed this unification
of

data to occur without altering legacy systems.

“We couldn’t rip and replace,”

sai
d Alan Day, president of
Systems Engineering Inc. (SEI), a
Massachusetts development house and Microsoft Gold Certified eCommerce Solution Provider with
expertise in state go
vernment.
“We couldn’
t modify every legacy system to accommodate the data of
every other legacy system. We couldn’t demand that everyone change their applications. The only way to
do it was to link to the legacy databases by providing a Web additive. We ha
d to find a technology that
everybody had on their desktop

and

that everybody was familiar with, that allowed us to add value and
give universal fully understood access to fairly complicated capabilities. For this, Microsoft tool sets wer
e
really the only
choice.”

The MassCARES unification of 15 disparate legacy systems provides a model of what can be done
throughout the healthcare field.



11

Microsoft

Microsoft has found from its own experience that good things happen when consumer
s are empowered

to
improve t
he quality of their healthcare. In recent years, Microsoft, like most other businesses operating in
the United States, has seen its annual employee healthcare costs rising
,
often by more than 10 percent a
year. While some companies have shifted the increas
ed costs of healthcare to employees, Microsoft
wants to continue to attract and retain the very best minds, which means providing an attractive and
competitive healthcare package.

In line with its Healthcare Without Boundaries initiative, Microsoft
, based
in Redmond, WA,

believes that
the key to controlling healthcare costs is to provide employees with better access to their own healthcare
information. This would be simple to do with

the company’
s intranet. But studies show that it is often the
nonemployee
spouse or same
-
sex domestic partner (who doesn’t have access to the corporate intranet)
who acts as the family healthcare manager. “We wanted to be innovative and empower our employees
and family members to be better and more effective managers of their ow
n healthcare,”
said

Tom
McPherson,
health benefits manager at Microsoft
. “And given that we are a technology company, we
wanted to leverag
e technology to accomplish this
in the form of a Web portal.”

Microsoft partnered with
Portland
-
based
health communica
tion company WellMed Inc. (now a part of
WebMD ) to build an employee portal called MicrosoftHealth, where employees and their family members
can research health questions, track cholesterol, blood sugar, blood pressure and other key metrics, and
enjoy a r
ange of features dedicated to helping them improve their health. Using Microsoft Passport, family
members can access the site from home.

“The MicrosoftHealth site is a beginning point for bringing the consumer



in this case, our employees
and their family

members



into the center and giving them access to the information they need to make
better healthcare decisions,” said David Lubinski,
general manager of the

Healthcare Industry Solutions
Group

at Microsoft
.

Microsoft sees the WellMed solution, which is

based on Microsoft technology, reducing “worried well”
doctor visits, providing an ROI of 142 percent by the end of its current (2003) fiscal year and a cumulative
ROI of 195 percent by the end of fiscal year 2006.

WellMed chose to build its solution usi
ng Microsoft technology because it provides a platform with
innovative security features to help protect confidentiality.

“We have more than a million people accessing personal health information on our WellMed systems,
which we’ve upgraded to Windows 2000

and SQL Server 2000,” said Craig Froude,
c
hairman and CEO
of WellMed. “We’ve never considered switching from Microsoft technology because it has scaled as we
needed to scale
,

and it is easy to administer.”

Microsoft Technology

Overview

Microsoft .NET is s
oftware that connects information, people, systems and devices. Microsoft .NET
connects a broad range of personal and business technologies, enabling
the user

to access and use
important information, whenever and wher
ever it is needed. Built on
Web service
s standards, .NET
services enable both new and existing applications to connect with software and services across
platforms, applications and programming languages. Working with Microsoft .NET
-
connected software
means using industry
-
standard protocols that

unify existing code, systems and applications
,

and unlock
their value. Microsoft technology helps bridge islands of information to create Healthcare Without
Boundaries.

And Microsoft
provides

trustworthy computing. Microsoft delivers systems that are secu
re by design,
secure by default

and

secure
by

deployment, and provides ongoing communications to customers to help
them easily and quickly update systems to
help
protect health information and reduce their risk of security
compromise.

Microsoft also provid
es excellent business value. Microsoft offers the most cost
-
effective, flexible and
integrated enterprise platform with powerful security features for developing and deploying healthcare
solutions. Microsoft Windows 2000 and the forthcoming Microsoft Windo
ws Server


2003 support the

12

latest technology advances and standards, and provide a standards
-
based integration point for legacy
systems.

Powered by XML and
Web services, Microsoft technology harnesses a constellation of applications,
services and devices

to create a whole new generation of software that works as an integrated service to
help healthcare organizations thrive in the digital age.

Web Services

With the power of
Web services, Microsoft helps increase business agility. It empowers organizations
to
quickly build, expand and integrate applications that help all healthcare constituents collaborate across
the enterprise and close the gaps in the continuum of care.

Web services offer programmable and reusable technologies that leverage the flexibilit
y of the Internet.
Now constellations of connected applications
can run

on multiple platforms delivering information to all
the constituencies in the
healthcare continuum
.
Web services are based on a set of common open
standards including XML, SOAP, WSDL a
nd UDDI, as defined by the World Wide Web Consortium
(W3C)
and other standards bodies.
Web
s
ervices applications
provide

access to information regardless of
platform and programming languages boundaries
. F
rom the schedule for a doctor’s office to the
catal
oging of medical images to tracking parti
cipants in new drug trials,
Web services can be used to
produce highly personal, intelligent computing experiences.


Tools

Microsoft developer tools provide quick and easy means to develop powerful and feature
-
r
ich
applications, including
Web services. Microsoft Visual Studio .NET is a multilanguage suite of
programming tools for building .NET
-
connected applications. The .NET Framework is a component of
Microsoft Windows that provides a progra
mming model and runtime
for
Web services, Web applications
and smart client applications.

The .NET Framework was built for integration. Applications built using the .NET Framework can connect
with existing systems and packaged applications across a

range of platforms via
Web ser
vices and other
.NET services. This gives
the user

the ability to leverage existing legacy investments while providing a
solid foundation for future expansions throughout the organization and onto the Internet.

Clients

Microsoft delivers a set of operatin
g systems for computers and other smart devices, including Windows
XP for desktop and laptop machines and Windows Powered Tablet PCs and Windows Powered Pocket
PCs. This smart client software helps PCs and devices work more effectively
,

online or offline.
The result
is empowered information workers. The Microsoft Windows family of client operating systems lets
users

get the information
they

need when
they

need it


whether
they are

working online, offline, in the field or
at the point of care.

Servers

Micr
osoft Windows 2000 and the forthcoming Microsoft Windows 2003
family of operating systems,
combined with Microsoft’s enterprise servers,

provide the best infrastructure for building, deploying and
operating healthcare solutions across the enterprise. Just
some of the powerful building blocks of the
Microsoft platform include

the following
:



Microsoft Application Center to deploy and manage highly available and scalable Web applications
.




Microsoft BizTalk Server to build XML
-
based business processes across a
pplications and
organizations. And Microsoft BizTalk Accelerator for HIPAA gives healthcare organizations the ability
to quickly implement and continually maintain the new transaction standards set by HIPAA.


13



Microsoft Commerce Server 2002 for quickly build
ing scalable e
-
commerce solutions
.



Microsoft Content Management Server
to manage content for dynamic e
-
business Web sites across
an organization.



Microsoft Exchange Server to enable messaging and co
llaboration any time, any place.



Microsoft Host Integratio
n Server for bridging to data and applications on legacy mainframe systems
.




Microsoft Internet Security and Acceleration Server for secure, fast Internet connectivity
.




Microsoft Mobile Information Server to enable application support by mobile devices su
ch as cell
phones
.




Microsoft Operations Manager delivers enterprise
-
class solutions for operations management of
Windows 2000, the Microsoft Active Directory an
d other Microsoft
.NET Enterprise S
erver
applications
.



Microsoft Project Server to securely dev
elop and successfully deploy best practices for project
management across an organization
.



Microsoft SharePoint™ Portal Server to share information within an organization and with outside key
suppliers, partners and clients
.



Microsoft SQL Server to store,
retrieve and analyze structured XML data
.



Microsoft
Systems Management Server
to provide cost
-
effective, scalable change and configuration
management for Microsoft Windows

based desktop and server systems.

Experiences and Applications

The combination o
f M
icrosoft tools, clients,
Web services and servers create an information environment
that empowers information workers. Microsoft technology puts information at
users’

fingertips,
providing
them

with the most powerful, easy
-
to
-
use, productivity software. Mi
crosoft Office XP helps
users

quickly
perform common business tasks, including word processing, e
-
mail, presentations, data management
and analysis. Microsoft Visio
®

provides a powerful tool for creating flow charts and diagrams to create
new procedures an
d systems. Microsoft Project is an excellent planning tool. Microsoft MapPoint
®

brings
precision to navigation. And

Microsoft

Windows Media
®

and
real
-
t
ime
c
ommunication support facilitate
collaboration across the enterprise.

In addition, Microsoft consumer

and

business services
such as

MSN
®
, Passport
,

and bCentral


can help
empower consumers and businesses to exchange medical information and other services in a secure,
standardized and user
-
friendly manner to help improve
the
quality of care and streamline
the healthcare
delivery system.

Summary

The Microsoft platform provides the standards
-
based technology the healthcare industry needs to break
down the information barriers that have blocked the exchange of data between the disparate IT
environments of the
key constituents of healthcare
:

provider organizations and physicians,
pharmaceutical and medical device companies, government and private
-
sector employers, health
insurers
, and consumers.

With
its

consumer
-
centric strategy and end
-
to
-
end platform solution
s, Microsoft is uniquely positioned to
bridge information islands in an efficient and

cost
-
effective way for healthcare organizations. Microsoft
technology and Microsoft partner solutions can be used to integrate these disparate systems, without
requiring
alterations to existing legacy programs.

Across the healthcare industry, this means empowering healthcare worker
s
, giving them the information
they need, when they need it.

For providers this can mean bringing data to the point of care where physicians c
an see the latest lab
reports, access electronic medical records, and enter prescriptions
electronically on

a handheld device
such as a Pocket PC or Tablet PC.


14

For pharmaceutical and biotechnology companies
,

Microsoft technology can mean optimizing the
ca
pacity and asset value of legacy systems, and unifying disparate systems, applications and platforms to
improve the overall effectiveness of information management. The rewards for integrated systems can
include enhanced drug discovery efforts, shortened c
linical trials, accelerated approval, increased
enterprise operational efficiency, improved sales and marketing, and the ability to seamlessly link with
contract research organizations, regulatory agencies, clinical study sites and other business partners.

For health insurers
,

Microsoft technology can mean achieving the dataflow they need between
employers, providers and consumers
,

handling administrative and clinical information from many
disparate systems distributed across large geographic regions.
Insur
ers

can manage and act on data
flows to and from multiple sources to feed multiple processes: claims payment, rate setting, pricing,
marketing, care management, prescription benefits, eligibility verification, clearinghouse transactions and
referral manage
ment.

For government and private
-
sector employers, Microsoft technology can connect what can otherwise

be a
maze of disparate systems, and provide the data needed
to analyze expenditures and find ways to deal
with the continual increase in the cost of pro
viding medical care.

Progressive healthcare organizations are already using both Microsoft and industry partners solutions to
break down the information barriers and enjoy the benefits of healthcare without boundaries.


15


For More Information

To learn more

about Microsoft’s healthcare industry solutions
,

visit
http://
www.microsoft.com/healthcare
/

or call
(
800
)
426
-
9400.

To see Mi
crosoft case studies about the

companies
mentioned in this paper, as well as the stories of
other organizations
benefiting from Mi
crosoft solutions, please go to:
www.microsoft.com/casestudies
.


Customers Highlighted in this White Paper

To learn more about Abington Memorial Hospital, visit

http://
www.amh.org
/.


To learn more about

Aventis, visit http://
www.aventis.com
/.

To learn more about BlueCross BlueShield of South Carolina, visit http://
www.bcbssc.com
/.

To learn more about Clalit Health Services, visit http://
www.klalit.co.il/clalitE/default.asp
.

To learn more about Gentiva He
alth Services, visit http://
www.gentiva.com
/.

To learn more about MassCARES, visit http://
www.masscares.org
/.

To learn more about MedPointe, visit
http://www.medpointeinc.com/
.

To learn more about Mississippi
Valley Surgery Center, call 563
-
344
-
6600.

To learn more about Rosetta Genomics, visit http://
www.rosettagenomics.com
/.

To learn more about University of Minnesota Physicians, visit
http://
www.ahc.umn.edu/ahc_content/colleges/um_physicians
/.



Microsoft Ind
ustry Solution Partners Highlighted in this White Paper

To learn more about Allscripts Healthcare Solutions, visit
http://www.allscripts.com/
.

To learn more about DataLabs, visit http://
www.datalabs.com
/.

To lear
n more about Eclipsys Technologies Corp., visit http://
www.eclipsys.com
/.

To learn more about HealthIS, visit http://
www.healthis.com
/.

To learn more about OpenNetwork Technologies, visit http://
www.opennetwork.com
/.

To learn more about ProClarity Corp., visit http://
www.proclarity.com
/.

To learn more about Proscape Technologies, visi
t
http://www.proscape.com/
.

To learn more about Systems Engineering Inc
.
, visit

http://
www.seng
i.com
/.

To learn more about WellMed, visit

http://
www.wellmed.com
/.