BY JAY GREENEThe two physician developers of

Azyxxi—a unifying health-intelli-gence software program thatenables hundreds of administra-tive and clinical systems to com-municate with each other—lis-tened to many offers to sellbefore Microsoft Corp. came aknockin’.

“We agonized for some timebefore deciding to do any deal,”says Craig Feied, M.D., formerdirector of the Institute forMedical Informatics at MedStarHealth, a six-hospital systembased in Columbia, Md. “We hadmany suitors over the years ask-ing to do a deal, and we alwayssaid ‘no.’ Hundreds of hospitalCEOs have asked us to sell thissystem, but we needed to wait forthe right commercial partner.”

Azyxxi (pronounced “Azixie” like“Trixie”) initially was developed in

1995 using Microsoft’s SQLServer database software. Feiedand co-developer Mark Smith,M.D., have worked together on

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medical informatics since 1983.“This health-intelligence engine I

believe will solve a lot of unsolvedproblems in medicine today,” says

Modern Physician | October 2006 • 2

But doc-developers, MedStar mum on how much they’ll make on deal with Microsoft

Smith, chairman of emergencymedicine at MedStar’s 786-bedWashington (D.C.) Hospital Center.“The big problem is data is local-ized in separate information silos.You get multiplicative power bybringing all that data together.”

Azyxxi works by managing hun-dreds of terabytes of live data frompatient records that include electro-cardiograms, scanned documents,X-rays, CT scans, magnetic reso-nance imaging scans, positronemission tomography scans,angiograms and ultrasound images.The program also integrates busi-ness, financial, administrative andvendor information, and stores his-toric data for quick retrieval.

“It will make any hospital program10 times more effective,” Feiedsays. Smith adds: “It has the abilityto transform healthcare in thiscountry. The tools and the power ofinformatics have finally caught upwith the vision and the need.”

Feied and Smith—two emer-gency physicians with decades ofinformation technology experi-ence—say Microsoft has theresources and the desire to suc-cessfully mass market Azyxxi.

“We went as far as we could goon our own,” says Feied, addingthat MedStar did not have thefinancial resources and vendorsupport staff to sell and supportAzyxxi. “Microsoft stands to bethat vendor.”

Feied says when Microsoftinquired about purchasing Azyxxi

Big announcement: Smith, far right, and Feied, second from right, revealthe sale with executives from MedStar, Washington Hospital and Microsoft.

A deal they justcouldn’t refuse

for an undisclosed amount, “Wewere thrilled. This is the besttechnology around in healthcare,and being picked up by thelargest software company in theworld will help us get this toevery hospital.”

In September 2005, Microsoftentered the healthcare field whenit formed its Health SolutionsGroup to tap into the federal gov-ernment’s recent interest in help-ing providers implement electronicsystems to reduce medical errorsand costs, and improve qualityand patient safety.

In July, the Institute of Medicineissued a report recommendingthat doctors and hospitals adopte-prescribing by 2010 to reducethe estimated 1.5 million annualpreventable drug errors.

Feied says while it may takesome time for Microsoft to startselling Azyxxi commercially, “It willget done. You can’t scareMicrosoft out of the market.”

Before the sale, Azyxxi was co-owned by two companies foundedby Feied and Smith—DatomicsLicensing and General Datomics—and MedStar Health. In a strategicalliance, Washington HospitalCenter will serve as Microsoft’sdevelopment laboratory.

As part of the deal, 40 MedStaremployees have become Microsoftemployees, including Feied andFidrik Iskandar, Azyxxi’s lead pro-grammer who has been involved inthe project since 1995.

Feied, who recently spent a dayin orientation training at Microsoft,will become the general managerof Azyxxi development.

“It is quite different to be oneday embedded in the health cul-

ture surrounded by patients andthe next day around Microsoft peo-ple,” he says.

Smith, who remains at MedStar,will serve as chief liaison toMicrosoft. “We developed Azyxxibecause we wanted a systemdesigned by clinicians, for clinicians,”he says. “It helps patient care, helpshospitals run better, and it helps thebottom line. … Microsoft is the rightfit. I wanted to see Azyxxi acquired

by a company that shared our visionof its potential.”

Before they went to medicalschool, Smith and Feied weretrained in computer science.

Feied, a California native who

graduated in 1978 with a degreein biophysics from the Universityof California at Berkeley, paid hisway through medical school byforming his own information serv-ices mail-order company thatdeveloped software programs.

“I had formal training in engi-neering and computer science, butit was mostly in mainframes,” hesays. In 1982, he received a med-ical degree from the University of

California at San Diego.“I will miss patient care,” says

the 52-year-old Feied, who also isa professor of emergency medi-cine in the Georgetown UniversitySchool of Medicine.

“As an ER doctor I cared formore than 50,000 patients, but Iwill be working on something thatcould affect millions of patientsby reducing errors and improvingdecisionmaking,” he says. In2005, Feied won Microsoft’sPhysician of the Year Award.Smith, who also is professor andchairman of emergency medicineat Georgetown, received a mas-ter’s degree in computer sciencefrom Stanford University in 1971.

“I studied computer science ingraduate school, but I wanted toconnect more directly with peo-ple,” says Smith, 59, a native ofNew York. In 1977, he earned amedical degree from YaleUniversity School of Medicine.

“My observation back then, andit still holds true today, is thathealthcare lags other industriesby more than 20 years in theapplication of information tech-nology to the service of its mis-sion,” Smith says. “Most gratify-ing to me is that Azyxxi has enor-mous potential to transformhealthcare and provide doctorswith tools to save lives.”

First installed in 1996 in theemergency department atWashington Hospital Center, Azyxxiis now used in all of MedStar’s

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Modern Physician | October 2006 • 3

Bringing it all together: Its developers say Azyxxi manages hundreds ofterabytes of data from various patient records, along with business data.

Columbia Department of Healthfor management of such mass-casualty incidents as a bioterror-ism attack and in a variety of othersettings in Arizona, Maryland andVirginia. The Cleveland Clinicrecently installed the system in apilot project as an imaging anddata integration system.

“It has helped us dou-ble the amount ofpatients seen in theemergency departmentover the years,” Smithsays, “and it has helpedus improve processes ofcare and identify opportu-nities to save money,improve coding accuracyand billing.” But Azyxxi’score contribution is to“help clinicians providesafer, better and fastercare,” Smith says.

Feied says he plans to help fur-ther develop Azyxxi, but he alsohopes to delve into other projects.“We want to develop the personalhealth record,” he says. “Therewill be a fair number of initiativesto tie hospitals back into the com-munity through regional healthinformation networks, where labs,hospitals, doctors, pharmaciesand clinics share information tomake it more accessible.” ■

teaching, community and rehabili-tation hospitals. “In each hospi-tal, the underlying informationtechnology structure is different,”Feied says.

Regardless of the type of infor-mation system, Azyxxi allowsusers—in an eighth of a sec-ond—to “view all thedata about a patient,which had beensequestered in differentelectronic silos,” Smithsays. “What the Azyxxisystem does is takescopies of each dataatom from the differentelectronic silos (as thedata atom is generated)and puts them into auniform Azyxxi store.”

Iskandar says Azyxxiinterfaces with “hun-dreds of sources” at WashingtonHospital Center. “It works seam-lessly, with nearly instantaneousresponse time, and it is simple touse,” he says. “It takes five or 10minutes … to learn the system.”

It also is used by the District of

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Iskandar was thelead programmeron the project.

Modern Physician | October 2006 • 4

Jay Greene is a former ModernHealthcare reporter and now afreelance healthcare writer basedin St. Paul, Minn. Contact Greeneat jaywriter@comcast.net

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