Tuesday, May 11, 2010


If you follow the health IT media, you cannot escape the new and obligatory word, Innovation. Every self-respecting article, blog post, press release or casual comment on line is not complete unless some reference is made to Innovation, its derivatives (innovators, innovative, etc.) or compounds (foster innovation, disruptive innovation, etc.). By now I am ready to add Innovation to the infamous Do Not Use category, along with Synergy, Turn-Key and One-Stop-Shop, to name a few.

According to Merriam Webster Dictionary Innovation means the introduction of something new or a new idea, method, or device. That’s probably a bit too vague for us. The Business Dictionary has a more interesting definition of Innovation: Process by which an idea or invention is translated into a good or service for which people will pay. Since Health IT is a business, this definition makes more sense. It turns out that there are various types of Innovation. From a user point of view there is Evolutionary Innovation, which requires very little learning from the end user and not much change to routine, and there is Revolutionary Innovation which completely disrupts routine and requires learning new ways of doing things.

So are we Evolutionary or Revolutionary in Health IT? If you ask physicians, they will probably say that EHR is revolutionary, since it forces them to change their workflow and the learning curve is very steep. If, on the other hand, you take a step back, it is clear that workflow hasn’t changed much. Patients still make appointments, show up at the front desk, wait in waiting rooms, have nurses bring them to the exam room, vitals are taken, doctor steps in and out and it all ends with a claim to the insurance company. The only change is that paper has been replaced by a computer, and computers are ubiquitous in everyday life. All the talk about workflow redesign boils down to minor simplifications due to the fact that the chart is available to all simultaneously. EHRs are only incremental evolutionary innovations.

Well then, maybe we need a more Revolutionary Innovation, one for which doctors will be willing to pay. This is definitely the prescription from new entrants, or hopeful entrants, to the EHR market: the legacy EHR incumbents have failed and we need a slew of low priced new products, preferably fragmented into sub products, so that physicians can pick and choose from an ever increasing array of choices. We currently have several hundred EHRs to choose from. Maybe if we had several thousand modular choices, every doctor will be able to find a combination that fits his specific needs. It’s all about choices, or is it? There are numerous studies showing that over a certain threshold, more choices only slow down purchase rates and actually make shoppers disenchanted with their purchase. Maybe if we had just a handful of EHRs, things would be different. Maybe too much of this type of innovation is detrimental to an industry as a whole.

More recently our hopes have turned to Democratizing Innovation and hoping that Innovation will come from consumers armed with medical records. It is very likely that a healthy crop of consumer applications will be created to analyze all those medical records, provide advice, second opinions and even therapies outside the established medical settings. Some will be good and some will be harmful. Caveat emptor, as always, will be the rule and we still need to find out if this idea can be translated into a good or service for which people will pay. Yes, pay, either by hard cash or by bartering their private information for services.

To judge by current developments in Health IT, we will be witnessing both Revolutionary Innovations mentioned above, in a few short years. Will they revolutionize Medicine and Health Care? Not very likely. The most likely revolution will come from administrative simplifications, payment reform, creation of Medical Homes, education, medical research and eventually, technology inventions similar in magnitude to the silicon chip. To be sure, Health IT has a major role in all these upcoming changes, and Health IT will have to incrementally create a standardized Clinical Information Highway on the Internet to support change and improvement, but we will not be revolutionizing health care, anymore than desktop publishing has revolutionized literature or financial IT has revolutionized Wall Street.


  1. Oh dear, and I just wrote a blog post that's chalk full of "innovation." I like that definition, though, it's certainly a great litmus test for judging how "innovative" or new a concept really is.

    The choice threshold is one that comes up all the time in design: too many choices leave the user confused and stumped, too few lead to dozens of clicks and frustration when the "right" choice isn't offered. Finding the balance is difficult enough in designing a single page or product, let alone an entire industry.

  2. Hey, innovation isn't bad, and your post was very nice. See my comment there...

    It's just that too much of a good thing is still too much. We have 3 distinct office packages: MS Office, Google Documents and Open Office (and maybe some tiny other stuff). Only 3 major choices. Lo and behold everybody is using one of those. Moaning and groaning sometimes, but using every day, all day. Maybe 3 is good enough... or 6... or 12, but not 300 and looking for a few hundred more. It's plain ridiculous. If HITECH manages to cut this number down by a factor of 10, I bet we'll see some serious adoption going on.

  3. Thanks for the comment Margalit, I appreciate having proof that someone's reading. And you didn't include WordPerfect in your list! Not that I use it anymore or know anyone who does, but still, it's the principle of the thing .... But you're right: too many choices are confusing and overwhelming. Imagine if we had to wade through 300 different types of cereal; that grocery store aisle is already long enough.

    However, in these early days of HITECH, we seem to be seeing more starting up (including Occam PM), not less. I've read John Lynn make the statement that perhaps, instead of 50 (or whatever number you like) EHRs, there are that many EHR markets, catering to niches with specific needs and requirements. That argument only goes so far though; many will just want to plug in with the big EHR market equivalent of Word. Certainly, we don't want to relive the late 90s Dot-Com boom/bust scenario in HIT.

  4. Personally, I feel that Eprescribing is the future of medicine, due its facilitation of safety, quality, and efficiency. The hitech act ensures the privacy and security of those involved in the process, a major concern of those who were on the fence about Eperscribing. DrFirst was the first company to realize the importance of connecting with both RxHub and Sure¬scripts, the first to systematically provide electronic prescription software services to EMR/EHR, PMS, and other health IT vendors. Check out their website at http://www.drfirst.com/.

  5. HI,
    Great information posted about innovation.. Really very nice article .. Thanks for sharing this blog..