Innovation: Curious Word

you follow the health IT media, you cannot escape the new and
obligatory word, Innovation. Every self-respecting article, blog post,
press release or casual comment on line is not complete unless some
reference is made to Innovation, its derivatives (innovators,
innovative, etc.) or compounds (foster innovation, disruptive
innovation, etc.). By now I am ready to add Innovation to the infamous
Do Not Use category, along with Synergy, Turn-Key and One-Stop-Shop, to
name a few.

According to Merriam Webster Dictionary Innovation means the introduction of something new or a new idea, method, or device. That’s probably a bit too vague for us. The Business Dictionary has a more interesting definition of Innovation: Process by which an idea or invention is translated into a good or service for which people will pay.
Since Health IT is a business, this definition makes more sense. It
turns out that there are various types of Innovation. From a user point
of view there is Evolutionary Innovation, which requires very little
learning from the end user and not much change to routine, and there is
Revolutionary Innovation which completely disrupts routine and requires
learning new ways of doing things.

So are we Evolutionary or Revolutionary in Health IT? If you ask
physicians, they will probably say that EHR is revolutionary, since it
forces them to change their workflow and the learning curve is very
steep. If, on the other hand, you take a step back, it is clear that
workflow hasn’t changed much. Patients still make appointments, show up
at the front desk, wait in waiting rooms, have nurses bring them to the
exam room, vitals are taken, doctor steps in and out and it all ends
with a claim to the insurance company. The only change is that paper
has been replaced by a computer, and computers are ubiquitous in
everyday life. All the talk about workflow redesign boils down to minor
simplifications due to the fact that the chart is available to all
simultaneously. EHRs are only incremental evolutionary innovations.

Well then, maybe we need a more Revolutionary Innovation, one for which
doctors will be willing to pay. This is definitely the prescription
from new entrants, or hopeful entrants, to the EHR market: the legacy
EHR incumbents have failed and we need a slew of low priced new
products, preferably fragmented into sub products, so that physicians
can pick and choose from an ever increasing array of choices. We
currently have several hundred EHRs to choose from. Maybe if we had
several thousand modular choices, every doctor will be able to find a
combination that fits his specific needs. It’s all about choices, or is
it? There are numerous studies
showing that over a certain threshold, more choices only slow down
purchase rates and actually make shoppers disenchanted with their
purchase. Maybe if we had just a handful of EHRs, things would be
different. Maybe too much of this type of innovation is detrimental to
an industry as a whole.

More recently our hopes have turned to Democratizing Innovation
and hoping that Innovation will come from consumers armed with medical
records. It is very likely that a healthy crop of consumer applications
will be created to analyze all those medical records, provide advice,
second opinions and even therapies outside the established medical
settings. Some will be good and some will be harmful. Caveat emptor, as
always, will be the rule and we still need to find out if this idea can
be translated into a good or service for which people will pay. Yes, pay, either by hard cash or by bartering their private information for services.

To judge by current developments in Health IT, we will be witnessing
both Revolutionary Innovations mentioned above, in a few short years.
Will they revolutionize Medicine and Health Care? Not very likely. The
most likely revolution will come from administrative simplifications,
payment reform, creation of Medical Homes, education, medical research
and eventually, technology inventions similar in magnitude to the
silicon chip. To be sure, Health IT has a major role in all these
upcoming changes, and Health IT will have to incrementally create a
standardized Clinical Information Highway on the Internet to support
change and improvement, but we will not be revolutionizing health care,
anymore than desktop publishing has revolutionized literature or
financial IT has revolutionized Wall Street.

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Margalit Gur-ArieMerle Bushkin Recent comment authors
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Margalit Gur-Arie

This, I completely agree with!

Merle Bushkin

Margalit, what I mean by “easy to use” is not “some new concept never before seen in software.” We can do wonderful things with what we have if we try. What I mean is a system that simplifies the process of assembling and generating patient information so docs can easily enter, access, retrieve and manage their patients’ medical information. To accomplish this, developers first must understand their objective. It is to meet the needs of the user — so they must adopt the perspective of the user, not the developer. Once the objective is clear, implementation becomes clear, too. It… Read more »

Margalit Gur-Arie

Merle, Hilary was my biggest disappointment after Al Gore. Oh well, I need to get over that…. 🙂 As to EMRs, I agree with almost everything you wrote. The only problem I have is in the definition of “easy to use”. What does it mean? Is it some new concept never before seen in software? I think it might be, but if it’s not, then it will be only incrementally better than what is out there today. Maybe like the difference between salesforce.com and, say, SAP. It’s not a revolution or a major disruption. If you talk to doctors, you… Read more »

Merle Bushkin

Margalit, I appreciate your point of view but must disagree with you. The concept of disruptive innovation is far broader than you recognize. It applies to markets as diverse as manufacturing companies, schools, political campaigns and, yes, the world of healthcare IT. It has nothing to do with B2B, B2C or other such tactical issues. It involves disrupting an established “marketplace” by offering a different kind of product, one that meets needs currently unmet by established products or services. The techniques of disruption will differ by market but the results will be the same — the established market leaders will… Read more »

Margalit Gur-Arie

Merle, I have the utmost respect for Prof. Christensen’s work, but I don’t think it is entirely applicable to our small part of the world. The common opinion regarding legacy EMRs is that they pack too much functionality, so it stands to reason that if we could come up with a stripped down version, it would be both cheaper and easier to use, much like the famed Southwest Airlines disruptive model. Southwest discovered that one type of airplane and removal of food service and seating reservations (amongst other things) were acceptable to customers. So what reductions would be acceptable to… Read more »

Merle Bushkin

Margalit, You have defined innovation as “Evolutionary Innovation, which requires very little learning from the end user and not much change to routine, and. . . Revolutionary Innovation which completely disrupts routine and requires learning new ways of doing things.” I’m afraid these definitions lead you down the wrong path and to erroneous conclusions. I suggest you consider definitions used by Clay Christensen in his landmark book, Innovator’s Dilemma, namely, sustaining innovation and disruptive innovation. Sustaining Innovation relates to improving existing products by adding features. This type of innovation ultimately results in over-engineered, over-featured products that far exceed the needs… Read more »