Ex-Microsoft healthcare exec Crounse: Seek inspiration from the outside

Dr. Bill Crounse retired last week from his job as senior director for worldwide health at Microsoft after 14 years with the company.

His career also featured 7 years as CIO of Overlake Hospital Medical Center in Bellevue, Washington, stints at Seattle’s Virginia Mason Medical Center and Group Health, some startup work during the dot-com boom and 20 years as a TV broadcaster, including for ABC News.

In all that time, he has seen some profound changes in the healthcare industry, but also the perpetuation of more than a few poor practices. He’s also seen things come back after long stretches in the wilderness; the promise of accountable care today is a lot like what people said about managed care in the 1980s and ’90s.

In his first interview since leaving Microsoft, Crounse discussed numerous topics related to health IT and healthcare reform. He often often came back to the themes of technology acceptance and willingness to look outside the walls of the institution or the borders of the nation for inspiration.

Many healthcare organizations shut down good ideas because they are afraid to do things differently, according to Crounse. This suggests that healthcare organizations could benefit from younger, more diverse leadership that understands social and mobile technologies, he said.

On startups:

Crounse helped incubate and mentor numerous startups while at both Overlake Hospital and at Microsoft. He said quite a few entrepreneurs are “naive” about the complexities of healthcare. For example, many startups — even well-funded ones like 23andMe — aren’t prepared for the “red line” of regulation that triggers government scrutiny. “That’s a red line you don’t want to cross,” he said.

Sometimes, though the idea is sound but the timing is wrong.

Around the turn of the millennium, Crounse co-founded Doctor Goodwell, a spinoff from Overlake Hospital’s in-house business incubator. That company, which like Microsoft, was based in Redmond, Washington, claimed to be the first to offer virtual physician visits over the Internet — the prototype for modern video telemedicine.

But Doctor Goodwell, which mostly worked with large employers, fizzled because consumers were slow to embrace the concept. “We were 15 years or more ahead of the market,” Crounse said.

One of the pilot sites for Doctor Goodwell was Microsoft, and Crounse spent a lot of time working with the Redmond Empire, so it seemed only natural that Microsoft would offer him a job in 2002.

On electronic medical records and Meaningful Use:

“All Meaningful Use did was catch America up with the rest of the world,” in terms of health IT adoption, Crounse said. It fizzled as the requirements increased, though. “This is like filling out another tax form,” he said.

When he joined Microsoft, Crounse focused on North America, but he gained worldwide responsibilities starting in 2005. The international experience opened his eyes.

“We’re a bit brainwashed in America” into thinking that we have the most advanced healthcare technology anywhere, and that may be true when it comes to diagnostic medicine. But not in other arenas.

“In IT, we suck. We’re average at best,” Crounse said. “We were late to the game on the EMR.” In Western Europe and developed regions of Asia, clinicians tend to be more involved in IT design and implementation than they are in the U.S., he said.

Those parts of the world also were faster to embrace the cloud in healthcare, whereas large enterprise EMR systems here still are predominantly legacy client-server installations.

This, according to Crounse, is one reason American health IT vendors have had less success on the global market, though it is not the only factor. EMRs in the U.S. were originally designed more for billing than for clinical documentation, and that makes sense, given that fee-for-service has long been the norm here.

On healthcare reform:

“The challenge for American healthcare systems is that they still have feet in both worlds,” namely fee-for-service and value-based payment in which payer and provider incentives are aligned. This is why the leaders in health IT, in Crounse’s opinion, are tightly integrated organizations with employed physicians and their own health plans, such as Kaiser Permanente and Geisinger Health System.

Fee-for-service is “not sustainable,” Crounse said.

On the future:

He’s optimistic about genomics/personalized medicine, big data and machine learning. “These are going to have profound impacts not only on patients, but also on the workforce,” Crounse said. Diagnosticians may find their roles diminished in the future, he suggested, because they will be relying much more on computers, though he does not believe the medical profession will go away.

Photo: Twitter user Bill Crounse, MD