Clinical Innovations

In reading my latest New England Journal of Medicine, I ran across this passage,

“Some clinicians see the recent explosion of interest in health care innovation as a fad incapable of yielding sustained contributions…Calls for innovation can sound hollow to practicing clinicians, who know that when it comes to intractable challenges like patients repeatedly admitted for health failure, there’s not app for that (David Asch, MD, and Roy Rosin, MBA, “Innovation as Discipline, Not Fad,” NEJM, August 13, 2015).

Why the pessimism? There are multiple reasons: So far most clinicians have not benefited from the explosion of online Apps. Most have websites and electronic health records (EHRs). Most glean data from the Internet, and more and more use e-mail to communicate with patients. But many find EHRs unwieldy, expensive, time-wasters, non-operative, and non-revenue wasters. And many do not like to be judged by data they enter into the computer. They yearn for professional as well as patient privacy.

There is another seldom-mentioned reason as well, lack of benefits of online scale. Most social media entrepreneurs (Facebook, Twitter, Instagram) and members of the medical industrial complex (insurers, suppliers, hospitals, and drug companies) have advantages of scale. They can reach millions through the click of a mouse.

But medicine is a one-on-one business – one patient visit at a time, one disease episode at a time, one individual problem at a time. It is true, of course, that clinicians can go to the net to find information to supplement these one-time occasions, and it is true one can aggregate this information over their patient populations.

tale of three surgeons comes to mind. Three surgeons were boasting about their accomplishments. The English surgeon said, “I once performed brain surgery on a deaf mute and restored him to full hearing and speaking.” The American said, “I did a spinal cord transplant on a quadriplegic and restored him to full movement.” The Russian said,” I removed a man’s tonsils “The English and American surgeons, astonished, asked, ”What’s so miraculous about that?” “Because, “explained the Russian, “In my country, people are afraid of opening their mouths, and I have to remove them by coming from a different direction.” Innovation is about coming from a different direction, but the results are not always beneficial to the patient.

Note that the three surgeons were all talking about one memorable patient, not a population of patients. Note also that they are not speaking of a clinical team that made the surgery possible. Note that they did not mention the organizational environment in which they operated. And finally note that all were speaking of gee-whiz technologies.

In modern day medicine, innovation is mostly about empowerment of patients and empowerment of organizations using connective online technologies. That is behind the astonishing successes of Silicon Valley companies and social media entrepreneurs. The successes of physicians is also related to technologies – stents, endoscopy surgeries, joint replacements, new cataract surgery techniques, statin drugs, insulin pumps, and wearable and implanted monitoring devices – but for the typical clinician, these technologies apple to a limited number of patients and are ordered or performed one at a time.

So how can physicians expand the scale of what they do?

They can collaborate with hospitals to help them market to larger audiences.

They can initiate “focused factories, “ diagnostic and therapeutic facilities, offering intensive and repetitive services for specific services and in which they have an ownership interest.

They can offer convenient accessible outpatient services, such as urgent care centers, in which all comers are welcome, not matter what their insurance coverage.

They can go into concierge medicine or direct cash practices, devoid of the regulatory impediments and coding requirements – inherent in government or insurance coverage.

They can develop health –related products that can be sold and marketed through commercial online, radio, or television venues.

They can offer different services - home care, virtual telemedicine consultations, and they can develop patient-empowerment products that allow patients to order their own diagnostic tests before consulting with the clinician.

They can bundle their services and offer transparent pricing so patients know exactly what they are paying for.