Monday, May 18, 2015

Six Lessons in Health IT Innovation

I speak frequently on the intersection of HIT and Innovation.. especially around how can we be more innovative in using the HIT we already have in place via human centered design thinking ("ask, observe, think and feel" about what the end user has to deal with).  At a recent healthcare conference, I spoke about this topic based on a combination of my own professional experiences as well as learnings from the book I wrote about the intersection of HIT and Innovation (see this post and check out  I didn't realize that a reporter was in the room, but was pleasantly surprised a few days later when a nice article came out summarizing my "Top 6 Lessons in HIT Innovation".   A listing of these lessons is below, along with some expanded thoughts and examples: 

1. Identify the minimal viable innovation. Don't be afraid to borrow ideas from other people. "Fail early, Fail fast, Fail often and Fail cheap."  I often give the story of three organizations in the book all talking about the same issue (how to use their EMR to automate and delegate some routine preventive maintenance and disease management care).  Each organization had a different EMR and a different workflow, but the end result was similar- they figured out how to use the EMR to empower their staff to do more, resulting in a more efficient system with better quality.  The idea thus is not to exactly copy what any one of them did, but to understand the essence, and figure out how you can make it work at your organizations. 
2. People and processes are more important than the IT. Do not except technology to be a silver bullet. The people and processes behind the technology will be the forces that drive innovation.  So many of my best "innovations" are the result of creating some content and workflows to take advantage of having a single communication tool (the EMR) that links everyone in an organization and allows for creation of consistent templates and routing... which allowed us to set up a care coordination system all the way back in 2008 which resulted in better experiences for patients and providers along with better, faster and cheaper care (we even published on this data).  In the book, we hear other examples, such as how Children's National used their EMR to identify signals that indicated an "adverse events" had happened the night before (e.g. a low glucose, use of Narcan)... that was the easy part.  The more important solution was having a dedicated nurse reviewing that data every day, tracking down what happened, and working with a team to minimize it from every happening again... with spectacular results.  Another story involves the use of a ubiquitous technology Skype) to enable multiple hospitals across California to enable the concept of "virtual translators" across their disparate systems.  So even though these were all separately owned, the hospitals could "borrow" translators from each other and thus all ensure they had enough of the right language.  The innovation was less in the technology, and more in the idea- as well as the business agreement they had to set up.
3. You can start small. Innovation in health IT does not have to mean something big and radical from day one; In other words, little bets make for big wins. For example, we used a pilot of 5 iPads on the inpatient oncology floor to explore what happens if we offer free use of them while patients are "confined".  We immediately learned about workflow (how to distribute and track and clean the devices), as well as network issues we had to address as the top use of the iPads was to use FaceTime or Skype with friends and relatives... a use case we did not realize would be so popular.  The result immediate patient satisfaction as well as a much better understanding of what it will take to roll out a bigger effort in the future. 
4. Apply new innovations to old problems. This is about using some established innovation methodologies to really rethink how we practice healthcare.  I said "We are cutting the cost curve, but not as much as we need... and we must innovate or we will lose." An example I gave was use of "Video Ethnography" to better understand poorly controlled diabetics.  Working with gravitytank, a local innovation consultancy, we spent 2 hours with 8 separate patients and were able to understand this population in a whole new way.  We condensed their videos into a 20 minute summary which was used as a kick off for a half-day brainstorming session that created a slew of ideas that resulted in new ways to educate both patients and providers about diabetes (we moved away from trying to scare them and towards simplifying the message). 
5. Try different ideas and technologies that have found success in other industries. Thought leaders consistently point out that healthcare is fell behind so many other industries when it comes to technology and innovation. Try ideas from the airline or retail industries; perhaps one of these will spark rapid innovation in your organization.  I'm a big fan of "Innovation Safaris", also called analogous observations, in which we spend time in another industry to understand how they view quality or satisfaction or efficiency... and see what we can learn and bring back to healthcare.  I am fortunate to be part of a group (The Innovation Learning Network) in which we do this together every 6 months.. here is good write up of what it can be like. 
6. Embrace the power of physician happiness. Physicians can be both the source and users of innovation, but without them technology cannot go very far. "There is no quality without use" is a quote I've been using for many years in explaining that creating super-complicated systems might look good on paper, but they will not provide any real benfit if your end users are not using them in everyday practice.  Rather, we need to think about how we can use HIT to "Make life easier for physicians, while also making it better for patients". 

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