Tuesday, May 11, 2010


If 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 The only change is that paper has been replaced by a computer, and computers are ubiquitous in everyday life.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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