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Steady as she goes or down with the ship, a parable for healthcare

Stug doorvaren of met schip en al zinken

Last week I was visiting Microsoft customers and partners in Stockholm, Sweden. Today’s blog post starts with a story that reminds me of the challenges and opportunities for healthcare systems around the world, and the potential for information technology to transform the way healthcare is delivered.

The story begins with an ambitious King who commissioned what was to be one of the most beautiful and fiercest fighting ships in the world. Teams of craftsmen and artisans labored for two years to produce a warship that was as much a work of art as it was a fighting machine.

There had been early warnings during construction that the unusual design of the ship, with two decks of cannon, little room for ballast, and a height too tall for its beam, might cause the ship to be unstable in a squall. But work continued and the ship was completed. On August 10th, 1628, it set sail on its maiden voyage. No more than 1000 meters out into Stockholm Harbor the ship encountered a sudden gale and listed violently to one side. Sea water rush into the lower, open cannon ports. Despite the best efforts of its captain and a crew to right the ship, the Vasa quickly sank to a depth of 33 meters. At least 30 of the 200 or so sailors and visitors aboard the ship lost their lives. For 333 years, the Vasa sat upright and partially submerged in mud at the bottom of Stockholm Harbor. It wasn’t until 1961 that a curious man with a hunch rediscovered its location. A dangerous, arduous and extremely expensive salvage effort ensured, and the Vasa was brought to the surface once again. Restoration and preservation of the ship continues to this day.

If you ever come to Stockholm, I can highly recommend a visit to the Vasa Museum. There you will see the largest and oldest wooden sailing vessel ever salvaged and brought to the surface. More than 95 percent of the ship is original. At the museum you’ll learn about the ship and the daily life of 17th century sailors. You’ll even see the skeletal remains and belongings of many of the lost souls who went down with the ship. It is definitely a 5-star attraction.

So what does this have to do with healthcare delivery systems, EMRs, mHealth and eHealth technologies? It strikes me that many of the health systems and information technology solutions I see around the world are a little bit like the Vasa–unsteady at the base. On this trip I met with clinicians, healthcare executives, EMR developers and IT staff from some of the finest institutions in the country (including the world famous Karolinska Institute). I heard the same stories I hear almost everywhere I go in the developed world—stories of healthcare systems with perverse incentives that make sick care preferable to prevention; that inhibit innovation while maintaining the status quo; that fail to meet the needs of a growing population of patients who have increasing expectations and an ever higher incidence of chronic disease. All of this ends up costing society more than we can really afford. In addition, many of today’s hospitals and clinics continue to use information technology that is well past its prime–technology that was designed for another era. Everyone seems to agree that modernization is needed, but complex governance, over regulation, constrained budgets and wavering political support inhibit the widespread deployment of available new technologies that could transform medical practice and healthcare delivery .

That is not to say progress isn’t being made. There are plenty of great ideas and innovations all around. They just rarely get implemented at scale. I think it is time to clear the drawing board, remove the barriers, correct the design flaws and start anew. I must say I was thoroughly impressed by so many of the clinicians and healthcare executives I met on this trip. Their passion for improving health and healthcare is inspiring.

With a new generation of highly mobile devices, powerful yet intuitive apps and leaner, cloud-based solutions, I’m pretty sure we have the technologies we need to help right the ship. Won’t you please join the crew!

My next stop is Oslo, Norway, for the World Hospital Congress. Perhaps I’ll see some of you there.

Bill Crounse, MD Senior Director
Worldwide Health, Microsoft