Microsoft's delicate dance in the health IT market mirrors its challenges of the last decade, struggling to go "up the stack" in applications without destroying the ecosystem on which its power rests.
CEO Steve Ballmer was in Nashville recently doing the dance. It's not the brash dance of his famous developers, developers video. It's more of a minuet, balancing politics on many levels.
Ballmer spoke to the Nashville Health Care Council, which is trying to make that city pre-eminent within the industry.
Nashville wants to turn its convention center into a wholesale mart for the health industry. That's a delicate political dance in itself, since a national company doesn't want to be seen boosting one city over others.
Ballmer was also in town to hand out $1.25 million in "Innovation in Technology Grants" -- its $1 million in software is backed by $250,000 in cash from Hospital Corp. of America, a big, big customer. Another delicate minuet.
Which brings up yet-another delicate dance. Nashville bills itself, informally, as the capital of for-profit medicine. The Health Care Council's YouTube channel favors Republicans. But the big health IT stimulus checks on which the industry now depends is coming from Democrats.
Ballmer also had to be careful in pitching his company's Amalga hospital software, in no small part because many of its competitors also run on Microsoft Windows. (Amalga doesn't even own its own Web address -- amalga.com is owned by an English construction company.)
Thus Ballmer's remarks were on the safe side. Focus on the patient, he said. The market is 10 years behind the times only because buying and selling is confused and the target market isn't focused on IT, he added. Mea culpa, never attack the customers.
It's a top-down approach, focused on big orders trickling down to smaller players, with Microsoft winning whether or not its own application dominates. But in a rapidly-scaling market, a buyer's universe expanding exponentially, the question remains whether that approach will work.
The stimulus has made this a fast-growing market interested in a quick turnaround in order to grab that sweet, sweet federal cash. Standards matter less than results, "meaningful use" defined not as installing gear so much as driving change based on data.
Thus Microsoft faces not only other hospital tech outfits like Cerner and McKesson, but a host of SaaS, cloud and Web-based competitors promising small practices they will give them a share of that cash. The top-down approach may not work here.
But time will tell, and not much time at that.