In stark contrast to the many businesses beating a path to Washington to beg for money, Microsoft is urging caution as the government looks to spend billions on digitizing health care.
Peter Neupert, the former Drugstore.com CEO, who now heads Microsoft's health care unit, said investment is a "necessary, but not sufficient" condition for improvement and said that spending money on computer technology may not even be the right first step.
"I'm trying to transform the discussion just a little bit," he said in an interview on Wednesday. "Don't focus on spending money on tech per se. Focus on what outcomes do we want."
Neupert, who is due to testify before a congressional committee on Thursday, likens it to when the government set out to put a man on the moon.
"When we decided to go to the moon, we didn't say let's build a great...rocket," Neupert said. "We said let's go to the moon...I feel a little bit of the conversation is lets build a great rocket and hope we get to the moon."
The hearing, to be chaired by Senator Barbara A. Mikulski (D-Md.) is titled "Investing in Health IT: A Stimulus for a Healthier America." Even the title suggests that the spending itself is a main priority, although background information also talks about the need to reduce medical errors and give health care providers quicker access to patient data.
It's not that Microsoft doesn't want to see spending on health care technology. Far from it. With the recession putting a crimp on business technology spending, Neupert would love to see some government dollars.
"We know technology is an important part of it," he said, adding that one of the big reasons past efforts to spur digital health records went nowhere was that there weren't dollars to back up the talk.
But, he's worried that in a rush to spend money to boost the economy, political and other leaders may be losing focus on the goal.
"If the country is going to invest $50 (billion) in incremental health IT--we all want it to be invested wisely, Neupert said in a blog posting earlier this week. "We should be building an asset with this investment--and the asset is not an application...but a health data asset that can be used to improve both individual outcomes and the performance of the institutions and the system overall."
That's the message he hopes to deliver in person to the Senate committee Thursday, as he joins others in the industry, including Health Leadership Council President Mary Grealy, Permanente Federation Executive Director Jack Cochran and Valerie Melvin, director of information technology for the Government Accounting Office.
There's already been considerable effort made in the e-health space, though from a variety of different angles, without much in the way of standards and interoperability. Microsoft and Google have been pushing for consumer access to health records, while other companies have helped specific parts of the industry--such as hospitals and pharmacies--to digitize their processes.
One of the things that's needed is room for experimentation, he said.
"I'd rather have five people trying to do it than have somebody in an office in Washington with one way how to do it...even though I'd get the money faster," Neupert said.
The problem, he said, is complex. It's not just government that needs to be willing to experiment. Insurance companies--those that pay many of the country's health care bills--also need to be willing to try new things.
He points to chronic care management, an area that governments and insurance companies spend billions on. Currently, most plans reimburse a doctor when a patient comes into the office, but not when the patient and doctor exchange e-mails about care done at home and other steps critical to managing long-term illnesses like diabetes.
By contrast, Neupert says veterinary offices are much further along in terms of things like e-mail reminders and preventative care because theirs is a cash business.
"The reimbursement system has to also be adjusted," Neupert said, referring to how doctors are compensated. "If they don't get paid for it they can't innovate."
Ultimately, said he'd like to see something like what happened with online banking, where there was strong security, privacy and interoperability. While that exists today, he notes that Intuit did not exactly get a warm embrace when it asked those that held financial data to make it easy for consumers to access via Quicken.
"The banks weren't very cooperative for the first five years," he said.