Disruptive innovation in healthcare IT: Spreading it to the masses

Photo: Paul Anderson/Creative Commons

The term disruptive innovation – introduced by Harvard Business School’s Clayton Christensen in a 1995 article  — has been used by technology-development stakeholders to describe radical innovations and their implications for market entry strategies. Christensen describes the term on his website:

“An innovation that is disruptive allows a whole new population of consumers access to a product or service that was historically only accessible to consumers with a lot of money or a lot of skill.”

Last week I heard Christensen speak at an event hosted by Vodafone, the world’s largest telecommunications company (the U.S. extension being Verizon Wireless). Vodafone organized the event to raise awareness of its interest in mobile healthcare and to brainstorm its role in the constantly changing technology landscape of healthcare. After the talk, we debated how to encourage disruptive innovation in healthcare to create better outcomes at lower cost. Christensen drew largely from his book, Innovator’s Prescription, providing a nice framework for this discussion.

My contribution was to suggest that if stakeholders want to see a measurable improvement in the value offered by healthcare, they should provide capital support to develop and validate Clinical Decision-Support Systems, or CDSSs, and help integrate them into everyday medical practice.

As a market analyst in the Technology and Innovation Development Office at Children’s Hospital Boston, I see CDSSs as a way to bring hospitals’ medical excellence and informatics expertise to patient care more broadly. In my mind, CDSSs perfectly embody disruptive innovation, with the attributes and evolutionary path Christensen outlined as follows:

  • Change in end-user and cost – Initially, a problem can be solved only by highly skilled users with substantial expertise, using expensive technology and associated infrastructure. But once a disruptive approach is introduced, less trained end-users can reach the same solution with much simpler, less expensive technology.
  • Location change – Initially, solutions come from technology housed at a centralized location. With a disruptive approach, the technology goes directly to the decentralized location where the problem resides. (A real world example: the transition from mainframe computers to minicomputers and finally personal computers.)
  • A three-part trajectory of technology development, comprised of 1) an initial intuitive approach, involving highly skilled end-users drawing on rare, hard-to-come-by expertise or complex tools; 2) a pattern recognition stage, in which end-users begin to find common principles for arriving at those solutions; and 3) creation of rules from the patterns that can generate solutions repeatedly, with increased scale and reliability, even among users with rudimentary experience and simple tools.

Under these principles, CDSSs seem to be in the pattern recognition phase. With biosensors, increased capture of phenotypic and genotypic data and new informatics techniques, we can now recognize pathological patterns the unaided eye can’t see. The next step is to translate these patterns into algorithmic rules to aid physicians in making clinical decisions.

If Christensen is right and rules-based technology is what we need to decentralize healthcare, then CDSSs – which would codify best practices at the nation’s leading healthcare centers — should be a top priority.

CCDSs do come with significant technical and integration risk. They require an artificial intelligence approach to medicine, which is a challenge. Also, each healthcare institution has its own clinical protocols, so a cross-institution, one-size-fits all solution may not be possible.

But stakeholders would surely see a return on investment if they helped de-risk these technologies. Why? Because if we can put the expertise of a few thought-leader physicians, using expensive technology, into the hands of clinics everywhere, we could see better outcomes at lower price.

By seeing the potential for impact on the other end of the “valley of death” for these technologies, and understanding the principles outlined by Christensen, we could see healthcare rapidly disrupted in our lifetime.