Wednesday, May 21, 2008

Disruptive Innovation - A Major Disruptive Innovation = Doing Away with the Paperwork

“…Disruptive innovations – cheaper, simpler, more convenient…”

Clayton Christensen, Richard Bohmer, and John Kenagy, “Will Disruptive Innovations Cure Heallh Care?’ Harvard Business Review, September-October, 2000

I just attended a conference on strategic innovation. At a pre-proceedings greeting dinner, the group leader asked, “Name the most disruptive innovation that has changed society forever.” Or words to that effect.

The audience included senior executives of a global company and a handful of experts representing various spheres of economic activities affecting society and business. I was the “expert” on health care trends, a title I so richly deserve but so seldom get.

These answers, some profound, some trivial, came back:

“Television.”
“The Personal Computer”
“The Internet”
“Google.”
“E-mails”
“Post-It Notes”
“Bottled water.”
“Cellphones,”
“I-Pods”
“Boneless chicken wings.”

At my table in the rear of the room, a health care guy, I was in a jocular mood. So I threw out “virtual colonoscopy” as a disruptive innovation, or perhaps I should say, a non-disruptive procedure. I was there, after all, to talk of health care trends. One trend I foresaw was minimally invasive procedures.

That Damned Paperwork

Suddenly the mood turned serious among our little subgroup, and we collectively concluded that the single most disruptive innovation that could even happen, was, “Getting rid of that damn paperwork.”

Detailed paperwork – get down the demographics, note past and present diagnoses, record the history, state the chief complaint, list allergies and drugs, identify the person to notify in care of emergency, document the encounter, and above all, confirm who is paying – is the bane of patients and doctors alike.

Perils of Paperwork


Paperwork is, well, so complex, duplicative, time-consuming, and, so frequently irrelevant, to the task at hand. Finding out what’s wrong and what to do about it the case of the patient; practicing what you’re trained to do in a cost effective and timely manner, in the case of the doctor, the waste of everybody’s valuable time, and one of the singularly most inefficient aspects of the health system.

Patients indignantly ask, “How many times do I have to go through this routine?” Or, “Don’t you people ever talk to each other?” Doctors, in their turn, ask,” Why do I have to do this?” “what the hell does this have to do with being a doctor?” “Why hasn’t this been done ahead of time?” Or, “Why can’t I have all this information in front of me when I see the patient?”

The paperwork involved, as everybody with any sense at all, knows, is a giant invoice, rather than a communication document.

And, to compound the problem, EMRs, until now, have been nothing, more or less, than a huge electronic invoice. This may be about to change, and the pressure is coming from multiple commercial enterprises =- WebMD, Google, and Microsoft, and others – who see simplifying the problem as a giant opportunity to streamline the patient-doctor encounter in the form of personal health records, owned by patients, frontloaded with patient data, and designed to be continually updated by patients and their doctors – as the vehicle for transforming health care and making it more efficient.

Not a Sure Thing

Sure, personal health records have privacy, security, and data entry hassles and concerns. Sure, patients and doctors alike may find it complicated at first, as they did personal computers, the Internet, e-mails, and those damn EMRs. But, these records have the potential of dramatically simplifying the patient-doctor encounter and making it more convenient, satisfying , and productive. It may even help get rid of that damn paperwork.

Meanwhile, disruptive innovations have yet to “cure: health care, as I noted in the opening quote.

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