Behind the Microsoft skepticism on Health IT

It's a good piece. It warns that we need to focus on the goals and not the technology. Electronic medical records (EMRs) won't solve the problem of chronic disease or our problems with the way we pay for care, he writes.

Absolutely.

But why is it, with everyone who went to HIMSS now praising the money and lining up for their share of the spoils, is Microsoft being the skunk at the picnic?

The reason is Microsoft is not yet the leader in this market. IBM is better-positioned in many ways. If there's a rush by hospitals and medical clinics to quickly install EMR software, Microsoft is not going to get its customary lion's share.

Better then, to lay down a marker saying "it'll never work" because, in the short run, it won't. EMRs by themselves don't solve medical problems. They are just a small piece of a much larger solution:

• They have to be fully integrated with Personal Health Records (PHRs) in order to be of use to patients. That doesn't just mean PHR systems like HealthVault, but applications built on those systems.
• They have to share data structures if research is to be done with them. The real health IT battle is going to be fought in the clouds, not on the ground.
• They don't change the rules of the health care game by themselves. They point to the direction of reform, but the big contracts come once the direction of reform is set.

Yet at the same time EMRs are a wrenching change for a hospital or medical practice. In the short run an EMR system actually reduces productivity, until everyone in the office learns the new system and adapts to it.

Think of the EMR opportunity as round one in a long fight over health IT, something worth not $19 billion but trillions of dollars. Neupert is positioning Microsoft for the larger game.