Ikispiration: Why Apple, Amazon, JP Morgan Chase and Berkshire Hathaway Can Easily Fail in Healthcare | Dave Levin, M.D. | Healthcare Blogs Skip to content Skip to navigation

Ikispiration: Why Apple, Amazon, JP Morgan Chase and Berkshire Hathaway Can Easily Fail in Healthcare

February 27, 2018
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What awaits Jeff Bezos, Warren Buffet and Jamie Diamond on their most excellent adventure to introduce transformative technology to healthcare?

Years ago, I read an article in Smithsonian Magazine about Dr. Yoshiro Nakamatsu, a.k.a. "Sir Dr. NakaMats," who claimed to have more than 3,300 patents—including the original floppy disk. He had some interesting things to say about successful innovation:

That early floppy, he says, is perhaps the purest embodiment of Ikispiration, the Dr. NakaMats system of creativity. It has three essential elements: suji (“theory”), pika (“inspiration”) and iki (“practicality”). “To be a successful invention, all three are needed,” says Dr. NakaMats. “Many inventors have pika, but not the iki to realize their dreams.”

I was reminded of Ikispiration recently when Apple rolled out a patient-facing personal health application and Amazon, JP Morgan Chase and Berkshire Hathaway announced they were launching a new company to innovate healthcare:

"The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent healthcare at a reasonable cost."

These announcements have garnered a lot of attention and a mix of enthusiasm and skepticism. One well-seasoned healthcare IT colleague responded to the above quote with a sarcastic, “Gee, why didn’t we think of that!” Echoing a famous healthcare newbie, another said, “Who knew healthcare was so complicated?” and then added, “Pretty much everyone who has worked in healthcare or dealt with serious illness!”

Decades of experience have taught me that we must seek ideas from outside healthcare if we are serious about transformation. There is a lot to learn about efficiency, safety, quality and satisfaction from other industries. There is also much to gain by studying marketing, behavioral economics, human factors design, organizational culture and many other fields. So, I strive (and sometimes fail) to be an open-minded skeptic, to maintain equipoise between unbridled enthusiasm and rank cynicism.

However, it’s not a biased conceit to say that healthcare really is different from other industries. That’s because healthcare is:

  • Very personal and touches much that is sacred about us as human beings. Patients are not exactly like consumers, but they are more alike than we have previously recognized.
  • Pervasive and spans the continuum of care from home to school to work and everything in between.
  • Very simple or exceedingly complex or both.
  • Diverse, encompassing everything from wellness and prevention to chronic disease to palliative care and hospice.
  • Mostly focused on “sick care” and only deals with a small part of what actually drives health outcomes.
  • Culturally complex and highly stratified with distinct tribes and clans who must collaborate and have different knowledge, power, biases and motivations.
  • Hobbled by economic and business models that don’t align well and affect 1/5 of U.S. GDP.
  • Highly regulated.

For all these reasons, Ikispiration makes me skeptical about these new entrants in the race to fix healthcare. They are likely long on pika (“inspiration”), short on suji (“theory”) and shorter still on iki (“practicality”). It’s a pattern I see all the time. A very cool, even inspired idea is put forth, but those suggesting it don’t know much about the theory that drives healthcare delivery and reimbursement. Frequently, they lack meaningful practical knowledge of how things actually work in healthcare (as opposed to the theory) and how to effect change in culturally complex environments.

They also tend to overlook the iron triad of “people, process and technology” that determines the success of most improvement efforts in healthcare. Deploying technology solutions is pretty worthless if you don’t address underlying processes (typically workflow) and people’s needs, motivations and culture through substantial change management efforts.

Consider Apple’s new personal health app. It “checks the boxes” on inspiration and theory. A mobile personal health record (PHR) could be a big win. Apple’s ability to deploy simple, elegant solutions could make it a formidable competitor in this arena. But dig a bit deeper and you will find that the data exchange is limited and hangs by a single, narrow thread: FHIR (Fast Healthcare Interoperability Resources). Sorry, but that’s only practical for getting a very limited subset of data out of EMRs (electronic medical records). Worse yet, FHIR implementations vary from EMR vendor-to-vendor compromising its ability to be a consistent standard.

This reminds me of the early days of personal finance programs that only let you download transactions for a few banks and none for credit cards. Only the most obsessed users were willing to do all that data entry. Personal finance took off when banking achieved meaningful interoperability. PHRs will be the same.