The Four-Legged Stool of Health Care Innovation

Imagine for a moment a four-legged stool. It’s a useful device, but only if all four legs are of equal length so that the stool is “stable” and meets the use for which it was intended. Now, think of the stool as your library, and think of its legs as the four components that make up how you deliver services and/or products. The four legs represent People, Processes, Organization, and Technology.

Jan A. Baltzer, Computers and Libraries, April 2000

October 24, 2011 - Health care innovation is a four-legged stool.

The four legs are:

• One, Government (Medicare, Medicaid, and Tricare) - CMS spends nearly $1 trillion on health care, and its spending is the fastest growing component of our $15 trillion national debt. This year, government will account for 50% of health spending.

• Two, Physicians – Together, largely through physicians ordering through their pens and computers, pysicians now account for the other 50% of spending, much or most of it in hospitals and in other high tech facilities.

• Three, Patients - Upon whom the money is expended for their benefit and the benefit of those who provide the care.

• Four, The Health Care Industry - The vast medical industrial complex, which includes venture capitalists, investors, suppliers, drug companies, health plans, and the information technologists. The latter helps bind it all together.

A Wild and Crazy Idea

I have this wild and crazy idea that the convergence of the IT social media – Facebook, Twitter, and other sites – and the wireless technologies and devices and smartphones and those vast server farms called “the cloud” that care can be interconnected, accessed, optimized, and documented into a more harmonious whole, just as Steve Jobs did for IT with the Microsoft computer , Ipad, Ipod, and Iphone.

I have the equally crazy idea that each leg of the stool is indispensible, can’t stand alone, and must depend on the other three legs for maximum benefit to society. This realization comes at a critical time, for the four legs have been striving to get a leg up on each other and have expressed skepticism on the motives of each other.

Each with a Role to Play

Yet each has a role to play – each best understands their own infrastructure and culture – but each relies on the others for support and coordination. No one stands alone. Only then can the knowledge of each be supported with sufficient capital to get the collective job done.

Without monetary incentives, innovations to keep the stool upright usually fail and fall onto fallow ground. Even social justice measures and safety net improvements require margins to carry out their missions.

An Example - Hospital Readmissions

Consider this specific example (and there are thousands of others) - readmission of recently discharged patients to the hospital. This readmission occurs with 20% of patients.

Readmissions are a significant expense for Medicare, running about $1 billion per year. Most of these readmissions are preventable.

Physicians and nurses are critical in preventing these readmissions, but these patients have such chronic diseases as heart failure and chronic obstructive lung disease and are bed-ridden and home-bound and beyond the immediate reach of medical personnel when complications occur.

The patients themselves usually know that complications are occurring within their bodies. but they may have difficulty communicating their problem to caregivers in medical settings such as their physician’s office or the hospital.

Enter innovation entrepreneurs from the hospital industry. According to a November 2007 report by Venture Wire, American Telecare, a remote health-care device maker in Eden Prairie, Minnesota, m Remote healthcare-device maker American maker of communication devices and technology for remote healthcare monitoring, raised $1.6 million from angel investors. The company has previously raised $16 million from angels.

The company places an audio-visual device at the bedside of home-bound patients. When the patient wishes to communicate with doctors over a perceived complication , patients can initiate an audiovisual conversation over ordinary phone lines.

Not only does the device permit voice and visual contact, but it permits the doctor or nurse to record weights and blood pressures, record blood oxygen levels, and listen to the chest with a stethoscope. Patients quickly become knowledgeable about complications and when to call. In one Telecare study, this approach reduced readmissions to virtually zero for patients with chronic heart failure.

Perhaps this approach could be extended to a vast new audience of patients using Skype technologies. After all, as of September 2011, 663 million people around the world were Skype users.

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