Topic: Bringing Disruptive Innovation to Healthcare
Christensen: A good way to visualize how disruptive innovations transform an industry is if you think of the geography of an industry as a set of concentric circles.
I’m Clayton Christensen, the Robert and Jane Cizik Professor of Business Administration at the Harvard Business School.
Question: How can disruptive innovation transform healthcare?
Christensen: The advent of sophisticated healthcare technology in the form of surgical suites and advanced imaging equipment and these big high speed multi-channel blood testing and analytical equipment has driven a centralization of the healthcare industry, so we have to take the patients to the hospital rather than to bring the solution to the problem. Now, do you think hospitals will ever become cheap by competing against each other? No. They’ll actually become more expensive. So what we need to do is drive the disruptive decentralization of the healthcare industry and we do that by bringing technology to outpatient clinics, so you can begin doing there the simplest of the things that within the past required a hospital and then keep driving that technology so that they can do more and more and more sophisticated things in that setting. And then we bring technology to doctor’s offices so they can begin doing the simplest of the things that previously had to be referred to a more expensive clinic and then drive that technology so that you can do in the doctors' office more and more the things that were required at the higher cost clinic. And then use technology to drive care to the home. And in a similar way, do you think healthcare will become cost effective if we just expect doctors to take pay cuts? That will never happen but instead we need to bring technology to physicians assistants and nurse practitioners so that they can begin doing the simplest of things that previously required a doctor and then drive that technology so that they can do more and more of those things. In other words, it’s by enabling lower cost venues of care and lower cost caregivers to become more and more capable of doing more remarkable things. That’s the mechanism by which healthcare becomes affordable not by expecting the expensive ones to become cheap.
Question: What specific innovations are most vital to the future of healthcare?
Christensen: Personal electronic medical records are very important to the future of healthcare. The challenge that we have to confront is care has to be coordinated and the reason why care has to be coordinated is there are interactions amongst drugs which if one provider prescribes a patient to take one set of drugs and another provider prescribes a different set for different disorders, those two things might interact in the patient’s body in really adverse ways and create real problems. One provider needs to know what other providers have previously done, so that we know whether or not a patient responded to a therapy so that we don’t duplicate tests and so on. Electronic medical records are really very important to assure that the right care is delivered to the right people without duplication or contradiction. In the past, a doctor could provide all of that coordination. The problem is there are so many more drugs now and so much more is known about how these drugs interact with each other and the system is fragmented enough that coordinating a patient’s care is actually beyond the cognitive ability of the world’s smartest doctors. They simply cannot keep in their mind a coordinated picture of all of the possible interactions and all of the possible sequences of care that all of their patients are experiencing. The only way to do it is to have the coordination be done by an information technology system where information about these issues is brought together and algorithms exist that will flag for the doctor and for the patient where there are problems or where there are experiences in the past from which we can learn. So these records are really very important. I think the perception in Washington of the state of digital medical records is very skewed. What they see is the patient with the doctor in the doctor’s office and the doctor continuing to write prescriptions on paper and keep the records on paper but that’s kind of the equivalent in telecom of the last 50 feet of the last mile and that indeed hasn’t been well-digitized, but 97% of all transactions and activities in the healthcare systems already are digitized and so the drug companies, the pharmacies, pharmacy benefit managers, insurance companies, everything they do is digitized. The major healthcare systems like Kaiser Permanente or Intermountain Health, Geisinger or here in the Boston area Partners, their activities are all digitized. So 97% of the data is already there. The problem is that as a natural first step in creating these electronic systems, the systems are not yet compatible. So each company has its own system and that’s a very natural first step. Now, we need technology that virtualizes the interface that enables the systems to talk to each other. That’s the problem and it will just take a little bit of time but it’s been solved in many other contexts. So it used to be that financial records were kept by different companies in different formats but they were able to ultimately virtualize those records so that all of us have a single place we can go to get our credit score even though the inputs come from many different people. This will happen.
Question: Are any low-cost technologies transforming the industry?
Christensen: There are a lot of wonderful devices that are simple and affordable that is driving the decentralization of healthcare. One set of devices have come a Seattle based company called SonoSite and from GE Medical Systems and this a little handheld ultrasound, a piece of ultrasound equipment. Now, if you ask the radiologist who has a very expensive Philips cart-based ultrasound system, these little handheld devices are just really crummy, don’t have anywhere near the functionality that the big system has. But if instead you bring that handheld system to the primary care physician or a nurse practitioner who is doing your annual physical exam, you know, in the past, the only way they could sense what was going on in the body was to feel for it or to listen for it with the test stethoscope and you give this people this little handheld ultrasound equipment, and my goodness, now they can look inside your body and do so much better a job at identifying nasant problems that might be emerging. And so at the periphery, at the distributed end of this disruptive decentralization, we’re bringing much greater capability to be more precise in the practice of medicine. The very same technology tried to deliver in the middle of the circle actually compromises quality. So that’s just one example. Let’s see…. other examples are the ability to determine whether you're pregnant or not, the ability to measure how quickly your blood clots. Point of care diagnostics are distributing the ability to figure out what’s gone wrong too a much larger population of people who can then act on that without the advise or direction of the experts in the middle.
Discuss
Jennifer Best on June 17, 2009, 7:04 PM
half the healthcare that is provided in America is unnecessary?! What are we paying for then? Here’s a crazy story, so a friend of mine has had some major heart operations and there is a metal device in his chest. Twice in recent years, he’s gone to two different cardiologists and both have sent him to get an MRI. Careless? Maybe. But also acting on the motivation that somehow this helps their bottom line. An MRI, it is my understanding, could be pretty harmful to this person’s health — the MRI is like a magnet.
Doctors need to be motivated by results, not measurements!
Mark Douglas on June 19, 2009, 3:42 PM
When my HMO doctor is very busy, I see the nurse practitoner. She is professional, smart and efficient. She also takes more time to speak with me. The doctor is always in a rush because he has been given too many patients to see in one day. The waiting time for the nurse is shorter too. I prefer to see the nurse. They are saving everyone both time and money. I feel badly for these overworked doctors at HMO’s and clinics. I don’t feel the same way for the doctors in private practice who make you wait an hour, see you for ten minutes and shove a prescription in your hand. Where is the dedication to serving the patient?
Pamela Smith on July 1, 2009, 4:24 PM
As a nurse practitioner I definitely agree with Tom’s idea to transfer more duties into the hands of nurse practitioners and other like qualified individuals. I’ve paid my dues and spent hours learning what it takes to perform tasks that doctors did in the past, and I can assure you that I know what I’m doing.
Nothing gets my goat more than seeing doctors doing work that they don’t need to be doing. It’s a waste of time and the hospital’s resources.
The only problem I can see is that doctors form many of their strong relationships with their patients during some of the more mundane aspects of health care visits. One of the biggest reasons why humans are necessary in many health care interactions is that there are complex judgments that must be made based on limited information between the health care professionals and patients. These judgments depend on free-flowing information, which in turn depends on a trusting, open relationship between doctors and patients.
I’m not saying that I and other nurse practitioners can’t handle these situations. It just means, though, that doctors would have a less personal role in the health care system.
Terry Chevrette on July 25, 2009, 7:58 AM
What about consumer driven healthcare? There are benefit plans out there that are not insurance but discount care with doctors that agree to the discounted payment. Doctors agree to take out the red tape of having to fill out claim forms, having insurance companies play “doctor”, and receiving cash for their services up front. These plans also have negotiators to knock down costs of emergency room visits (let’s face it, one tylenol does not cost $6!) Looking for thoughts on this topic? www.betterbenefits.info
Terry Chevrette on July 25, 2009, 8:05 AM
Sometimes I feel like I’m being had by a used car salesman when I go to the doctor. Are tests/ procedures necessary or just done for the money they get from your insurance company? I’ve had medicaid and also had really good health insurance in the past. It’s amazing how many more tests/procedures I “need” when I have the good insurance. Even prescriptions vary depending on my insurance. This might be one reason insurance costs is on the rise!
Paula Enyeart on July 25, 2009, 2:33 PM
Jon E L Ermshar on July 26, 2009, 1:35 AM
Computers make mistakes too. Do not forget it. What about the personal error introduced when the physician/provider spends too much time with the computer screen and fails to notice the patients real signs and symptoms. This is a new an yet unrealized source of medical error. Who’s at fault there? the doctor or the computer.
Medical care is not beyond the cognitive capacity of even the average caring physician who is given the time to render that care. Get out of the way insurance, get out of the way computers, get out of the way washington. These entities each create an unacceptable barrier to necessary patient care. However, each thinks that it is the best fix for the problem.
Jon E L Ermshar, MD
Kim miller on July 26, 2009, 3:14 AM
Perhaps you should assume your friends care and you can order the appropriate tests.
Kim miller on July 26, 2009, 3:39 AM
I have practiced medicine for 23 years. I do agree that some of the more common problems can be handled in a walk in clinic run by NPs and PAs, but when a lawsuit comes, and a lawsuit will come, who is responsible. And if this gentleman had a clue of what it takes to practice medicine, he would not dare to try and simplify it like adding a column of numbers. When he has to worry about being sued for missing something or even having a patient threatening to sue because they are not happy with the way things “turned out”, then he can speculate on how easy it is to practice medicine.
Shahin Tavackoli on July 26, 2009, 7:28 PM
Shahin Tavackoli on July 26, 2009, 7:50 PM
It is funny how no one really talks about the real problems that we encounter in the world of medicine that increase healthcare costs. Probably one of the biggest costs to everyone is the money that is gobbled up by the insurance companies. Yet, no one mentions this. I think there is a problem when we are all alarmed by the rising “cost” of healthcare but no one is alarmed by the fact that the UnitedHealthcare CEO is worth more than a billion dollars. If the difference between the payments received by UnitedHealthcare and that paid out by it, is large enough for the company to pay its CEO that much money, there is something wrong, I think. I don’t think anyone deserves to be paid that much even if they walk around and turn everything into gold by touching them (ala Midas). Meanwhile, the doctors’ pay should be cut because the cost of healthcare is going up. CMS and medicare are slated to cut the fees for some of my services by somewhere around 20 – 40%! My take home from my office after I pay my employees and the cost of my office is about 40% of what I bring in. Cutting my fees by that much will put me out of work. The insurance companies always follow the cuts made by medicare and CMS, and while my fees are cut, the cost of insuring myself and my employees will go up by 10% next year? Does anyone see a problem here? The professor likes to allocate your care to a NP or PA, but who signs the prescriptions and the notes at the end of the day? Who is responsible ultimately? Can nurse practitioners and PA’s read echocardiograms and perform cardiac catheterizations? Does anyone care that a medical student getting out of medical school these days owes close to $200,000? How is he supposed to pay this off if medicare and CMS keep cutting the rates. Do I think there is no abuse of the system by the doctors? No, of course not. But, at the same time, the proportion of waste of money and allocation of healthcare dollars to individuals and companies who have nothing to offer to healthcare (namely insurance bullies, I mean companies) is tremendous. I maybe in the minorityh amongst doctors, but I see no way out of this mess other than making a one payor system, do away with all insurance companies and see how much money you will save.
Another area is that of the futile care, this has been mentioned here before, but we as a society have to realize that keeping a decerebrate individual on life support that costs thousands of dollars per day is inappropriate not to mention inhumane. A tremendous amount of healthcare dollars is also spent taking care of the elderly with procedures and means that are overly expensive. I think we as a society have to come to grips with what life and death really mean. How worthwhile is it for a 90 year old bedbound, demented patient to have a pacemaker implanted because they have heartblock? I do not advocate putting age limits on our services, but I think there has to be common sense and reason for the provision of these services. The proper distribution and applicable limitations of these services is not easily determined of course, but I do not think there is an easy fix to this problem.
Finally, no one that has not gone to medical school and does not deal with families, patients, insurance companies and hospital administrations, will ever realize how difficult it is to be a doctor. If you are not a doctor, please try not to pretend like you understand.
Add a Comment
You must be logged in to comment. Log in or Register