A Doctor’s Reaction to Harvard Business School's List of Ten Health Care Transformative Innovations

I just ran across the Harvard Business School’s list of ten innovations written by Gardiner Morse for its Health Care Innovation Insight Center. You can find it on Google under "Ten Innovations That Will Transform Medicine."

Here is how I react on a scale of One to Ten as someone who has frequently trekked down the health care innovation road.

ONE, CHECK LISTS- Hospitals will require health care providers to follow strict protocols for procedures that benefit from routinization—from preparing a patient for surgery to inserting a central line.

I’ll give this a EIGHT , But with this caveat: giving a doctor a checklist for each patient is not the same as giving pilot a checklist when 200 passengers are on board.

TWO, BEHAVIORAL ECONOMICS - Health care will incorporate insights from behavioral economics–everything from weight loss incentives to using peer pressure to change how doctors work.

Barely a SEVEN. Put me down as dubious. Changing ingrained lifestyles and doctors’ practice styles isn’t easy.


THREE, PATIENT PORTALS - Consumers will use secure web connections to make and check appointments, see lab results, renew prescriptions, and communicate with doctors and nurses.

Definitely an EIGHT. We’re getting there as personal computers with broad band access become ubiquitous.


FOUR, PAYMENT INNOVATION - Payment schemes that reward good outcomes and value rather than volume of procedures will become the norm.

At best a FOUR. Good patient outcomes are often beyond the reach of doctors. Patients may return to bad habits and often don’t comply with instructions.

FIVE, EVIDENCE-BASED DECISION MAKING - Electronic medical records collect important information for coordinated care, and physicians and nurses are alerted to potential errors and best practices.

A mere FIVE. The thesis that EMRs improve care is unproven. EMRS may generate more errors. Medicine is still full of uncertainties without evidence and is still Art as well as Science. Still depends on relationships, not necessarily on”facts,” and the placebo effect is powerful.

SIX, ACCOUNTABLE CARE ORGANIZATIONS – Hospitals and doctors will coordinate care for shared patients in order to keep them well-rather than simply treat them when they’re sick-and share in savings that result from improved quality.

A weak FIVE. This assumes doctors will join multispecialty groups and integrated delivery systems, often hospital-based. Reverse may be occurring as patients seek more private personal care, and as doctors form concierge and cash-only practices and shun 3rd party care.

SEVEN, REGENERATIVE MEDICINE - Stem cell research will lead to treatments for cancer, multiple sclerosis, spinal cord injuries, and other intractable conditions.

A hopeful FIVE- I hope this is so, but I have yet to see concrete evidence. Body remains a mysterious “black box.” Mysteries may take years to unravel.

EIGHT, VIRTUAL VISITS - Health care will be done at a distance with videoconferencing and remote monitoring of blood sugar, blood pressure, heart rate, and other health data.

A strong
NINE. I agree, as this is happening rather fast as health plans pay for virtual visits and as remote monitoring improves. Problems remain on how to pay for it, how to across care jurisdictions, and how to minimize malpractice tangles.

NINE, GENETIC MEDICINE - Individual genetic profiles will help doctors to prescribe the most effective treatments, tailored to the patient.

A SEVEN. This is becoming routine in evaluating predisposition to breast cancer. And I notice Walgreen put a kit for 42 DNA profiles on market before withdrawing it. We shall see what happens in this political controversy fraught field which smacks of social engineering.

TEN, SURGICAL ROBOTICS -Though ready for prime time technologically, the technology may be ahead of the usefulness. They don’t—yet—necessarily improve outcomes or deliver better value but may offer exciting potential.

A pragmatic NINE – We’re already there, as hospitals and specialists seek marketing edge, and 833 hospitals have purchased de Vinci surgical robot.