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CAE’s training simulators make us safer – from the hospitals to the heavens

The birth was seconds away. The mother rested on her back while a medical student sat at the foot of the bed, blue surgical gloves on her hands – a scene common to delivery rooms everywhere. Except the mom was a manikin, her fetus was a manikin and the student wore Microsoft HoloLens.

Using the device, the student looked at the mother’s abdomen and saw a hologram of the fetus inside the womb before it rotated and descended the birth canal. Then, her mixed-reality training session got tricky.

Suddenly, the baby’s shoulders became stuck inside the mother, a risky complication – but an emergency purposely triggered by a classroom instructor. The student had to act fast. She placed her hands on the tiny manikin and gently freed the shoulders, safely completing another digital delivery.

CAE LucinaAR – the first human-patient simulator augmented with HoloLens – simultaneously delivered another digital lesson. The technology comes from CAE, a Canadian company that offers virtual-to-live training solutions to assess human performance, improving overall safety from health care to civil aviation to defense operations.

A medical student practices delivering a baby with the use of a virtual-to-live patient simulator and Hololens.
A medical student practices delivering a baby with CAE LucinaAR and HoloLens.

“CAE operates in three sectors where the stakes are high, where there’s no room for error and where the people need to be properly trained to be ready for unlikely situations that could lead to catastrophes,” says Dr. Robert Amyot, president of CAE Healthcare, one of CAE’s three business segments.

“On-the-job training is dangerous and costly,” adds Amyot, a cardiologist by trade. “So, we train pilots to make flying safer. We train the forces in our defense and security division to make them more prepared for their missions. And we train clinicians and health care providers to improve patient safety.”

By going digital, each of those training regimens is becoming more precise at pegging and addressing human vulnerabilities, says Marc Parent, the CEO at CAE.

In the realm of aviation, CAE guides pilots to prep for potential airborne adversities by using individualized simulations built with artificial intelligence and the Internet of Things (IoT).

A new pilot trains on a CAE flight simulator.
A new pilot trains on a CAE flight simulator.

“Although it’s the safest mode of transportation in the world, pilots have long been assessed in a subjective way,” Parent says. “But now, by leveraging the data that our simulators are giving us – powered by the cloud – we can give them an objective assessment in real time. That’s invaluable.

“When the pilots go into our simulator, we are able to give them personalized insights into their skills, into how they perform different operational practices. This raises their level,” Parent says. “And practice makes perfect.”

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Microsoft, Amazon, Google, IBM, Oracle and Salesforce issue joint statement for healthcare interoperability

Photo credit: ITI
Pictured, L-R: Dean Garfield (ITI) – Alec Chalmers (Amazon) – Mark Dudman (IBM) – Peter Lee (Microsoft) –– Greg Moore (Google)

Interoperability is an overlapping set of technical and policy challenges, from data access to common data models to information exchange to workflow integration – and these challenges often pose a barrier to healthcare innovation. Microsoft has been engaged for many years on developing best practices for interoperability across industries. Today, as health IT community leaders get together at the CMS Blue Button 2.0 Developer Conference here in Washington, DC, we’re pleased to announce that Microsoft has joined with Amazon, Google, IBM, Oracle, and Salesforce in support of healthcare interoperability with the following statement:

We are jointly committed to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI. We share the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs.

In engaging in this dialogue, we start from these foundational assumptions:

  • The frictionless exchange of healthcare data, with appropriate permissions and controls, will lead to better patient care, higher user satisfaction, and lower costs across the entire health ecosystem. 
  • Healthcare data interoperability, to be successful, must account for the needs of all global stakeholders, empowering patients, healthcare providers, payers, app developers, device and pharmaceuticals manufacturers, employers, researchers, citizen scientists, and many others who will develop, test, refine, and scale the deployment of new tools and services. 
  • Open standards, open specifications, and open source tools are essential to facilitate frictionless data exchange. This requires a variety of technical strategies and ongoing collaboration for the industry to converge and embrace emerging standards for healthcare data interoperability, such as HL7 FHIR and the Argonaut Project. 
  • We understand that achieving frictionless health data exchange is an ongoing process, and we commit to actively engaging among open source and open standards communities for the development of healthcare standards, and conformity assessment to foster agility to account for the accelerated pace of innovation. 

Together, we believe that a robust industry dialogue about healthcare interoperability needs will advance this cause, and hence are pleased to issue this joint statement.

While I’m new here at Microsoft, I’ve been focused over the past decade on lowering the barriers to innovation in healthcare, working closely with open source and standards development communities. I’m happy that my first blog post here at Microsoft aligns so well with my charter to collaborate on open cloud architecture with the healthcare community.

Electronic Health Records (EHRs) are approaching universal adoption in US hospitals and ambulatory practices, thanks in part to the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs. The 21st Century Cures Act will make digital health data even more accessible with the call for open APIs.

In the context of US healthcare, many health record systems have focused on consistent representation for a key set of data elements defined by the Meaningful Use Common Clinical Data Set. As support for this common data set grows, it becomes easier to plug new tools into clinical workflows, analyze clinical histories, collect new data, and coordinate care. Many of these technical capabilities have been available within small, tight-knit health systems for a long time – but developing these capabilities has required complex, custom engineering and ongoing maintenance and support. Driving toward open architecture makes adoption faster, easier and cheaper.

As a medical student, I used to practice what I called “rogue interop” – connecting to services where I could, and cobbling together the data platform I wanted. It all worked, but it was a nightmare to maintain. Later when I joined the research faculty at Boston Children’s Hospital and started work on the SMART Health IT Platform, we wanted to build a robust platform to isolate app developers from the underlying details of an EHR system, so we started by designing new, open APIs from scratch and bridging to the underlying vendor system.

This work caught the attention of Health Level Seven (HL7), the healthcare standards development organization responsible for several generations of health data standards. When HL7 convened a “Fresh Look Task Force” to invite perspectives about newer, API-based approaches to data exchange, I was pleased to participate, sharing my experience from SMART.

This task force (among many influences) ultimately inspired the creation of Fast Healthcare Interoperability Resources (FHIR) – a more open, agile approach to the development of healthcare standards. I got involved with the FHIR community early when I wrote the first open-source FHIR server. Five years later, it’s been inspiring to see so many vendors, including Microsoft, supporting the emerging FHIR standard.

I joined Microsoft because it is among the largest contributors to open standards and open source. We actively contribute innovative technology to standards efforts in many industries, and we implement thousands of standards in our products that are formulated by a broad diversity of standards bodies. Just over the past year we’ve seen deep commitments to cross-cloud consumer data portability through the Data Transfer Project, an interoperable ecosystem for AI models through the Open Neural Network Exchange (ONNX), and the world’s leading software development platform through the acquisition of GitHub.

We at Microsoft are taking a collaborative approach to building open tools that will help the healthcare community, including cloud-hosted APIs and services for AI and machine learning. Microsoft understands that true interoperability in healthcare requires end-to end solutions, rather than independent pieces, which may not work together.

Most recently, we’ve added support for FHIR to the Dynamics Business Application Platform through the Dynamics 365 Healthcare Accelerator, and developed an open source Azure Security and Compliance Blueprint for Health Data and AI for deploying a FHIR-enabled, HIPAA/HITRUST in Azure. These solutions are results of Microsoft teams working closely with our partners to ensure all components of our product portfolio work together to serve the unique needs of healthcare scenarios.

Transforming healthcare means working together with organizations across the ecosystem. Today’s joint interoperability statement reflects the feedback from our healthcare customers and partners, and together we will lay a technical foundation to support value-based care. We expect that the assumptions from our joint statement will continue to evolve and be refined based on this open dialog with the industry.

Please join the conversation. You can find me on Twitter @JoshCMandel. If you want to participate, comment or learn more about FHIR, you can reach our FHIR Community chat at

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The power and promise of digital healthcare in the Middle East and Africa

Mirembe, 24, lives in a rural village in north-east Uganda, where access to healthcare is limited. Mirembe is pregnant and walks, cradling her swollen belly and fanning herself from the heat, 15 kilometres to the closest clinic to check on her unborn child.

Hundreds of expectant mothers, elderly men and women, and sickly children line the corridors of the clinic patiently awaiting medical attention. Midwives and nurses are few, and they wearily dart from patient to patient doing what they can to help. Mirembe will wait six hours to be attended to.

When she’s finally seen, she’s told the clinic doesn’t have an ultrasound machine. If she wants to have an ultrasound, she must travel to the Mulago Hospital in Kampala, Uganda’s largest public hospital, where she must pay 20,000 Ugandan shillings, equivalent to about US$5, for a prenatal visit. In this part of the world, that is a significant amount of money.

According to the World Health Organisation (WHO), about 830 women die from pregnancy or childbirth-related complications around the world every day. It’s estimated that in 2015, roughly 303 000 women died during and after pregnancy and childbirth. Many of these deaths were in low-resource locations like Uganda, and most could have been prevented.

However, technology is helping to eliminate some of the challenges of distance and lack of trained medical staff. Mirembe can now hear her unborn child’s heartbeat from the comfort of her own home through an innovative app call WinSenga, which reassures her that both she and her baby are healthy.

WinSenga is a mobile tool, supported by Microsoft technologies, which helps mothers with prenatal care. The idea was conceived when the Microsoft Imagine Cup competition inspired then-university students Okello and Aaron Tushabe to use their computer science skills to tackle some of Africa’s biggest problems. They were motivated by the plight of mothers like Mirembe who live outside the reach of modern medical care.

The handheld device scans the womb of a pregnant woman and reports foetal weight, position, breathing patterns, gestational age, and heart rate. The app makes use of a trumpet-shaped device and a microphone which transmits the data to a smart phone. The mobile application plays the part of the nurse’s ear and recommends a course of action. The analysis and recommendations are uploaded to the cloud and can be accessed by a doctor anywhere.

man touching a smart tablet

This is just one example of how Africa, a continent that bears one-quarter of the global disease burden but only has two percent of the world’s doctors, could outperform developed nations’ healthcare systems by leapfrogging over inefficiencies and legacy infrastructure.

In fact, digital healthcare in the Middle East and Africa (MEA) region is booming with the proliferation of disruptive solutions underpinned by 21st century innovations like cloud, mobile, Internet of Things (IoT) and Artificial Intelligence (AI).

Let’s talk telemedicine

One trend revolutionising the delivery of healthcare in MEA is telemedicine, which is the use of telecommunication and IT to provide clinical healthcare over long distances. Given the region’s high rate of mobile penetration, telemedicine is growing rapidly. In fact, the telemedicine market in MEA was estimated at $2.19 billion in 2015 and is projected to reach $3.67 billion in 2020.

Forward-thinking countries like Botswana are making swift progress when it comes to the implementation of sustainable telemedicine projects.  Microsoft and the Botswana Innovation Hub launched Africa’s first telemedicine service over TV white spaces in 2017. Through this initiative, clinics in outlying areas of Botswana can now access specialised care remotely using TV white spaces, which are unused broadcasting frequencies in the wireless spectrum.

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Q&A: How genomic data can boost patient-centered care

Simon kos headshotGenomic data provides the foundation for the delivery of personalized medicine, although cost-effective and secure management of this data is challenging. BC Platforms, a Microsoft partner and world leader in genomic data management and analysis solutions, created GeneVision for Precision Medicine, Built on Microsoft Cloud technology. GeneVision is an end-to-end genomic data management and analysis solution empowering physicians with clear, actionable insights, facilitating evidence-based treatment decisions.

We interviewed Simon Kos, Chief Medical Officer and Senior Director of Worldwide Health at Microsoft, to learn more about how digital transformation is enabling the delivery of personalized medicine at scale.

David Turcotte: What led to your transition from a clinical provider to a leader within the healthcare technology industry?
Simon Kos:
It wasn’t intentional. In critical care medicine, having the right information on hand to make patient decisions, and being able to team effectively with other clinicians is essential. I felt that the technology we were using didn’t help, and I saw that as a risk to good quality care. This insight led to an interest, and the hobby eventually became a career as I got more exposure to all the incredible solutions out there that really do improve healthcare.

Given your unique perspective within the healthcare technology industry, how do you see digital transformation progressing in healthcare?

Digitization efforts have been underway for more than thirty years. As an industry, healthcare is moving slower than others. It’s heavily regulated, complex, and there is a large legacy of niche systems. However, the shift is occurring, and it needs to happen. We have a fundamental sustainability issue, with healthcare expenditure climbing around the world, and our model of healthcare needs to change emphasis from treating sick people in hospitals to preventing chronic disease in the community setting. Each day I see new clinical models that can only be achieved by leveraging technology, enabling us to treat patients more effectively at lower cost.

How are you and other healthcare leaders managing the shift from fee-for-service to a value-based care model?

My role in the shift to value-based care is building capability within the Microsoft Partner Network—which is over 12,000 companies in health worldwide—and bringing visibility to those that support value-based care. For healthcare leaders more directly involved in either the provision or reimbursement side, the challenge is more commercial. Delivering the same kind of care won’t be as profitable, but adapting business processes comes with its own set of risks. I think the stories of organizations that have successfully transitioned to value-based care, the processes they use, and the technology they leverage, will be important for those who desire more clarity before progressing with their own journeys

What role does precision medicine play in delivering value-based care?

Right now, precision medicine seems to be narrowly confined to genetic profiling in oncology to determine which chemotherapy agents to use. That’s important since these drugs are expensive, and with cancer it’s imperative to start on a therapy that will work as soon as possible. However, I think the promise of precision medicine is so much broader than this. In understanding an individual’s risk profile through multi-omic analysis (i.e. genomics), we can finally get ahead of disease before it manifests, empower people with more targeted education, screen more diligently, and when patients do get unwell, intervene more effectively. Shifting some of the care burden to the patient, preventing disease, intervening early, and getting therapy right the first time, will drive the return on investment that makes value-based care economically viable.

As genomics continues to become more democratized, how will we continue to see it affect precision medicine?

It’s already scaling out beyond oncology. I expect to see genomics have increasing impact in areas like autoimmune disease, rare disease, and chronic disease. In doing so, I think precision medicine will cease to be something that primary care and specialists refer a patient on to a clinical geneticist or oncologist, instead they will integrate it into their model of care. I also see a role for the patients themselves to get more directly involved. As we continue to understand more about the human genome, the value of having your genome sequenced will increase. I see a day when knowing your genome is as common as knowing your blood type.

What role can technology play in closing the gap between genomics researchers and providers?

I think technology can federate genomics research. Research collaboration would tremendously increase the data researchers have to work with, which will accelerate breakthroughs. The more we understand about the genome, the more relevant it becomes to all providers. I also think machine learning has a role to play. Project Hanover aims to take the grunt work out of aggregating research literature. Finally, I think genomics needs to make its way into the electronic medical records that providers use, ideally with the automated clinical decision support that help them use it effectively.

What challenges are healthcare leaders facing when implementing a long-term, scalable genomics strategy?

On the technical side, compute and storage of genomic information are key considerations. The cloud is quickly becoming the only viable way to solve for this. Using the cloud requires a well-considered security and privacy approach. On the research side, there’s still so much we have to learn about the genome. As we learn more it will open new avenues of care. Finally, on the business side, we have resourcing and reimbursement. The talent pool of genomics today is insufficient for a world where precision medicine is mainstream. These specialized resources are costly, and even with the cost of sequencing coming down, staffing a genomics business is expensive. And then there’s the reality of reimbursement – right now only certain conditions qualify for NGS. So, I think any genomics business needs to start with what will be reimbursed but be ready to expand as the landscape evolves.

How do genomic solutions like BC Platforms’ GeneVision for Precision Medicine have the potential to transform a provider’s approach to patient care?

Providers are busy, and more demands are being placed on them to see more patients, see them faster, but also to personalize their care and deliver excellent outcomes. BC Platforms’ GeneVision allows insights to be surfaced from the system level raw data and delivered to the clinician to assist them in meeting these demands. The clinical reports that can be leveraged through GeneVision enable providers to make critical decisions about therapies and treatment within the context of their existing workflows.

In addition to report generation, GeneVision optimizes usage of stored genomic data so that when it is produced, it can be repeatedly re-utilized by merging it with clinical data as many times as a patient enters the health care system. GeneVision makes this possible through BC Platforms’ unique architecture, the dynamic storage capabilities of Microsoft Azure cloud technology, and Microsoft Genomics services. Together, these capabilities make genomic solutions like GeneVision a key factor in delivering patient-centered care at scale.

What will it take for genomics to become a part of routine patient care?

The initial barrier was cost. I think we are past that, with NGS dipping below $1000 and continuing to fall. Research into the genome is the current challenge. Genomics will eventually touch all aspects of medicine, but given the previous cost constraints we are the most advanced in oncology today. A key benefit of GeneVision is that it supports both whole genome sequencing and genotyping, which is currently the more cost-effective method to generate and store genomic data.  Although the cost of whole genome sequencing is coming down, this flexibility is essential to enabling rapid proliferation of genomics applications in healthcare. The future challenge will be educating the clinical provider workforce and introducing new models of care that leverage genomics. I think the reimbursement restrictions will melt away organically, as it becomes clearly more effective to take a precision approach to patient care.

What future applications of genomics in healthcare are you most excited about?

I’m really excited about the evolution of CRISPR and gene editing. Finding that you have a genetic variant that increases your risk of certain diseases can be helpful of course—it allows you to be aware, to screen, and take preventative steps. The ability to go a step further though and remediate that variant I think is incredibly powerful. At the same time, gene editing opens all sorts of other ethical issues, and I don’t yet think we have a mature approach to considering how we tackle that challenge.

BC Platforms GeneVision for Precision Medicine, Built on Microsoft Cloud technology, is available now on AppSource. Learn how GeneVision equips physicians with the tools they need to improve and accelerate patient outcomes by trying the demo today.

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New team assembled to unlock the innovation potential in healthcare data

Peter Lee, Joshua Mandel and Jim Weinstein
From left, Peter Lee, Joshua Mandel and Jim Weinstein of Microsoft Healthcare. Photo: Dan DeLong for Microsoft

It’s an exciting time to be working shoulder-to-shoulder with our healthcare partners and customers, who represent some of the brightest minds in this important industry. We have been approaching the complexities of the healthcare industry with a growth mindset, and for the past two years our team has worked across Microsoft to accelerate healthcare innovation through artificial intelligence and cloud computing, with our initiative Healthcare NExT (New Experiences and Technologies). We shared some updates earlier this year on our work in cloud architectures, empowering clinicians and care teams, and precision medicine, and I’ve been thrilled to see the progress and reaction across the industry.

Today we are building on that progress. I’m very pleased to welcome two prominent experts in the science, technology and practice of value-based healthcare to the team. Jim Weinstein and Josh Mandel will be joining Microsoft Healthcare – which integrates Healthcare NExT and its research-driven efforts – with an added focus of creating strategic partnerships, and driving the cross-company strategy for healthcare and life sciences.

Jim Weinstein, Vice President, Microsoft Healthcare, Head of Innovation and Health Equity

Jim Weinstein will work closely with organizations on the front lines of healthcare delivery as we aim to support health systems, empower clinicians and enable the systems of care as they move to the cloud. He will be my partner in developing the strategic vision for Microsoft Healthcare, and will provide leadership that is grounded in decades of health industry experience. A widely respected visionary, author, surgeon and leader in the future of healthcare delivery who has advised three administrations on healthcare policy, Jim most recently served as CEO and president of Dartmouth-Hitchcock and the Dartmouth-Hitchcock Health system, and is the past director of the Dartmouth Institute, home of the Dartmouth Atlas of Health Care. Jim is also the co-founder and inaugural executive director of the national High Value Healthcare Collaborative, which brings together some of the nation’s top healthcare systems to share data, develop insights and advance the causes of better healthcare outcomes. He recently chaired the “Communities in Action, Pathways to Health Equity” report for the National Academy of Medicine. His book “Unraveled” looks at the broken healthcare system and how it might be repaired with patient-based clinical insights.

Joshua Mandel, Chief Architect, Microsoft Healthcare

Joshua Mandel will work closely with customers, partners and the open standards community to lay the groundwork for an open cloud architecture to unlock the value of healthcare for the entire health ecosystem. As a tireless evangelist for the importance of open standards, Josh will continue his work to help systems across the industry become more agile and interoperable. Josh’s impressive background as a physician and brilliant software architect has set him apart as a leader in the development of next-generation standards for healthcare data interoperability.  In his most recent role, Josh led the health IT ecosystem work at Verily (Google Life Sciences). He is a member of the research faculty at the Boston Children’s Hospital Computational Health Informatics Program where he served as lead architect for SMART Health IT, and is a visiting scientist at the Harvard Medical School Department of Biomedical Informatics. Josh earned his bachelor of science degree in electrical engineering and computer science from Massachusetts Institute of Technology, and his M.D. from Tufts University of Medicine.

Jim and Josh join us at an exciting time, as healthcare processes undergo a digital transformation. This transformation has created a wealth of healthcare data that has potential to help identify diseases earlier, create and improve treatments and improve the lives of patients across the globe. Unfortunately, even with advances in data protection and governance, healthcare data is not easily accessible by the researchers and doctors who need it to help us all realize the potential. And so, for a variety of regulatory, technological and political reasons, we see what is called the “health data funnel,” which holds back the case of scalable innovation in healthcare.

At Microsoft, we’re confident that many aspects of the IT foundations for healthcare will move from on-premise doctors’ offices and clinics to live in the cloud. We ask the questions: Can we take advantage of this huge sea change in healthcare to unlock the innovation potential in healthcare data? Can we work as a community to ensure that we don’t simply re-create the same data silos that we have today?

We think that together, we can solve these problems. We are taking concrete steps with an initial “blueprint” intended to standardize the process for the compliant, privacy-preserving movement of a patient’s personal health information to the cloud and the automated tracking of its exposure to machine learning and data science, for example to support external audit. This is a small first step, but progress toward an open architecture that ultimately will benefit doctors, nurses and clinicians in how they interact with patients, and also allow more time for patients to spend face-to-face with their care providers. It also opens up research opportunities for this data to be shared, and to be done under the same compliance and regulatory standards which protect your health data today; all with the goal of leading to advancements in medical science.

We have our work cut out for us but know that we have the right team in place. We’re looking forward to sharing more later this year about what we’re doing to help unlock the power of healthcare data and create opportunities for the entire health ecosystem.

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