CAN “INNOVATION” MAKE HEALTHCARE WORSE? 7 COMMON INNOVATION ANTI-PATTERNS
I work with a lot of healthcare organisations who, quite rightly, have a significant interest in “innovation”, and how new approaches, techniques and technologies can help them improve the quality, safety and efficiency of the healthcare services that they deliver.
I’m genuinely excited by the potential of some of this innovation, which could transform our health systems in exciting and positive ways. However, much of what passes for “innovation” falls short of being genuinely innovative.
Having watched this space for some time, I’ve noticed a number of common mistakes that healthcare organisations and their vendors make. I describe these below as 7 common innovation anti-patterns, where an anti-pattern can be described (via Wikipedia) as:
a common response to a recurring problem that is usually ineffective and risks being highly counterproductive.
My top 7 innovation anti-patterns are as follows:
1. The “Healthcare is Just Like Financial Services” Fallacy
Innovation and digital disruption in financial services has brought rapid change to this industry. Technology has supported the creation of new currencies, massively changed the way that we approach payments, and facilitated the rise of new online banks and lenders.
This rapid change has turned parts of the financial services industry upside down, empowering consumers, driving competition and generally disrupting the status quo, all within the space of a few short years.
Consequently, many innovators in healthcare see what has happened in financial services (and the taxi industry with Uber, and the accomodation industry with AirBnb) and assume that this can be replicated in healthcare, in the same timeframe. They assume that radically new models of healthcare delivery can be achieved in a very short space of time.
Whilst I wish this was true, it is not. Healthcare is an immensely complex endeavour, with deeply entrenched cultures, behaviours and incentivisation models. Whether we like it or not, it will take a generation (or more) to change healthcare. Many innovators won’t stay the course, either through a lack of patience, or through financial failure. Healthcare innovation is a long-term game for resilient innovators who have a deep understanding of how healthcare systems operate.
2. The New Data Silo
Many digital health solutions, particularly mobile health apps, gather large amounts of data. Much of this data isn’t of particular interest to clinicians, but some is.
For the data that has clinical significance, many digital health solutions, particularly mobile health apps, trap this valuable data in new silos. As if we didn’t have enough trouble with data silos in healthcare already! If a patient is reduced to showing their healthcare provider some data on the screen of their smartphone then it’s hard to see this as genuine innovation.
The best digital health solutions see themselves as part of a broader model of care, connecting patients, carers and their data to health providers and their electronic medical records using appropriate interoperability standards.
3. The Data Firehose
Some digital health solutions, particularly remote monitoring and consumer health devices can generate large amounts of data. Many of the “innovative” solutions that I’ve seen are determined to present all of it to already time-poor health providers. Here, drink from this low value data firehose…
What is innovative, and of high value, is to mine high volume data streams for signals of clinical value. Separate the signal from the noise.
Rather than presenting a health provider with a detailed breakdown of my Fitbit step data, how about a brief, aggregated, summarised picture that focuses on periods that are different to the norm.
Rather than sharing a chart of my resting heart rate, how about highlighting the period where my resting heart rate increased suddenly, and show how this correlates with a significant drop-off in physical exercise and increased patient reports of pain.
That’s value. Large amounts of raw data just makes things worse, not better.
4. The Solution Waiting for a New Funding Model
I see a lot of great, innovative digital health solutions that will never succeed. Why? Because their creators have no idea how their solution will make money. They assume that because it’s a great idea, and good for patients, that somebody, somewhere must be willing to pay for it.
It doesn’t work that way. Most of healthcare remains funded on a fee-for-service basis. Although fee-for-outcome funding models are slowly being introduced into some areas of healthcare, and will undoubtedly bring with them a greater desire for the efficiencies that digital health solutions can bring, the reality is that most solutions need to make money right now, in our current fee-for-service world. And that’s hard, because the incentives for digital efficiency are not great under this model.
As I say to the digital health organisations that I coach – it’s not enough to assume that somebody will buy what you are selling because it can transform the health system. You need to know who will buy it right now, in a fee-for-service model, with what money, and why.
A lack of understanding of this important dynamic will mean that 90% of current digital health companies will fail.
5. The Rebadged Dinosaur
In the race to be innovative, it turns out that some legacy vendors seem to get away with large amounts of marketing, and a just a little bit of lipstick on the pigs of their ageing clinical information systems.
You know who you are…😉
Can a solution that was largely written in the 1990’s, which commits a significant number of “user experience war crimes” and now has a patient portal really be held up as innovation?
Can’t we do just a little bit better before all health providers get completely disillusioned?
6. The “Anybody Can Build an App” Fallacy
The early days of the Apple and Google Play app stores strongly implied that anybody could build an app, which would then benefit from the massive marketing engines of these vast online stores.
If this was ever true, it’s not true now. With an estimated 300,000+ health, fitness and medical apps in the Apple and Google Play app stores, only the strong survive.
Sure, you can still create your own app and publish it, but don’t expect viral success and millions of downloads. There’s a 99% chance that somebody has gotten there before you. And it turns out that success generally needs lots of marketing. And marketing costs money. Lots of money.
Despite this, I still see health organisations encouraging individual health providers to produce their own apps. Whilst part of me loves the idea of democratised, front-line innovation, we need to be real about this. Consumer expectations of apps are SO high. The small percentage of apps that genuinely succeed with health consumers have huge amounts of effort and skill put into the development of their user experience, and significant work on freshness – i.e. regular new content and app functionality updates. Best practice for successful digital health apps is a new release every 2 weeks.
Sad as it may be, the reality is this – the Cambrian explosion of mobile health apps may soon come to an end with the realisation that the cost of developing successful apps that meet consumer expectations is simply too high for individuals, and non-specialised organisations to compete.
7. The Lack of a Proper Market Scan
Many health provider organisations I work with are trying to be innovative. Some even have innovation divisions. I think that’s a great thing.
However, what I find concerning is that I often see organisations undertaking pilots with the worst solution in a product category. Often over-excitement at the first solution they saw, or persistence on the part of the vendor, results in pushing ahead with something that is innovative relative to current practice, but ultimately not as good as many of the alternatives.
Now sure, it’s hard to keep up in a world that is changing so quickly. But please, let’s reach out and do a proper (international) market scan before committing time, energy and valuable dollars to a pilot.
