Is it Disruptive?


It’s hard to hear a pitch, listen to a speech, or read blogs without hearing/seeing a claim that some cool new thing is distruptive. Most innovations are sustaining innovations. Here’s a good checklist for whether something is a disruptive innovation (via this post in HBR):

  • Does the product either target overserved customers (by offering lower performance at a lower price) or create a new market (by targeting customers who couldn’t use or afford the existing product)?
  • Does it create “asymmetric motivation,” meaning that while the disrupter is motivated to enter higher performance segments over time, existing players aren’t motivated to fight it?
  • Can it improve performance fast enough to keep pace with customers’ expectations while retaining its low cost structure?
  • Does it create new value networks, including sales channels?
  • Does it disrupt all incumbents, or can an existing player exploit the opportunity?
  • Does it disrupt all incumbents, or can an existing player exploit the opportunity?

3rd Platform for Health IT

For the low-low price of $4500 (that's $500 per page) you can buy this 9 page report on how the athenahealth-BIDMC alignment is evidence that cloud-based information technology will form the basis of tomorrow's health IT solutions.  Obviously, I've not read the report.  It's not clear if Bernie Monegan has either, but she's written an article about it, which has generated some buzz on the Internet in recent days.  (One wonders about a relationship between HIMSS – which owns Healthcare IT News – and ICD – but I don't recall that there is one) .. 

Let me save you $4500.  

Where the data lives doesn't make this new.   SMS (which became Siemens and of course is now Cerner) hosted hospitals' data in their data center in Malvern 25 years ago.  Call that a "cloud" in 2015 parlance, but a hosting facility is a hosting facility.  

Yes – there are some differences.  Traditional hosting is single-tenant.  The server(s) are dedicated to a given facility, and they're mirrored to a redundant facility for disaster preparedness.  The server looks, acts and feels like is in the hospital basement rather than in some data center in a secret mountain in Colorado – and there is a (virtual) dedicated wire that goes from the hospital to the data center.  The CIO can tour the data center and the guy with a pocket protector can point to "your" servers – and there they are – lights blinking away, fans whirring.  

And "cloud" these days invokes a multi-tenant model.  One big data bucket, and one big application layer, with a technical architecture that separates patients and providers in a way that privacy and security are managed well, but that eliminates redundant hardware and software.  The data and the software services are distributed logically and often physically.  There isn't one server where "your" data lives.  It's everywhere – inherently redundant.  athenahealth and PracticeFusion are obvious models of this in the ambulatory domain, while RazorInsights and iCare are examples of acute care products like this. 

This isn't the interesting part of "3rd platform" for health IT.  Yes – it's self-evident that distributed computing, mobile endpoints, and "loosely coupled" services will be part of the future health IT infrastructure.  Ho-hum.  The rest of the world has been there already for a half-decade.  Hosting your own Microsoft Exchange server in 2016 will be akin to driving a Chevy Nova.  Health care will catch up.  Slowly.  We'll see initial progress in the value based primary care settings:  Iora Health, Chen Med, Oak Street Health, and Qliance are already adopting entirely new care models – with entirely novel health IT platforms to support these models. 

After value based primary care, we'll see innovation in the LTPAC space. They are relative non-consumers of health IT, and therefore represent a unique breeding ground for innovation and creative applications of technology.  

The unique feature here isn't that the tools will "live in the cloud."  What's unique is that the tools will be centered around the goals of the individual rather than the goals of the care delivery organization.

We chose careers in health care because we wanted to have impact.  To help.  To make the world a better place.  Atul Gawande’s wonderful book, Being Mortal, reminds us that the profession of medicine has failed miserably at doing what is in fact most important:  understanding the goals of individuals, and helping us navigate that path. Together.  The book isn’t about death.  I had actually avoided it initially – worried that it was.  It’s about our pervasive and persistent inability to do what’s right in health care, and tells a handful of stories about some amazing people who are breaking with tradition and doing what’s right – with impressive results.

As I read the book – I pressed “replay” on vignettes from my career as a family physician, a parent, a software developer, a federal servant, and a son.   I ask myself how I fared in this context.  When I supported a patient’s decision to decline a medication that I thought would help them feel better, was I helping or hurting?  If I “took a strong position” on immunizing children, was I alienating parents from the care delivery system altogether, or “holding firm” on a “scientific fact?”  When I helped to create regulations that explicitly expressed certification requirements for health IT systems, was I protecting the public interest, or stifling innovation?  The answers, of course, are foggy.  What was the “right” answer for one individual may be different from what is right for another.  What's "essential guidance" for one software company may be "prescriptive regulation" to another.  One size does not fit all.

What's the 3rd platform?  It's the individual.  Designing our systems (not just our IT systems) in a way that helps us discover the priorities of each individual, and then adapt to support them. Driverless cars?  Of course.  Just tell me where you want to go.  Technology is an essential component of the solution.  But humans define where we are going.