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Home Remedies for Innovation Constipation

June 26, 2017
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Unfortunately, moonshot thinking is driving a lot of interoperability efforts right now. Is it wise to bet the farm that one approach, such as FHIR, produced by a consensus group will succeed?

Healthcare is suffering from Innovation Constipation (IC). The signs and symptoms are everywhere with more appearing daily. The problem is particularly acute in healthcare IT (HIT). Despite enormous effort and investment, the healthcare industry struggles to prove ROI, drive out excess expense, align technology with strategy, enable tactical agility and create great consumer and end-user experiences. Too often, HIT solutions are neither intuitive nor work-flow friendly.

The diagnosis is particularly obvious when compared to progress in the rest of the digital economy. If you really want your eyes opened, talk to tech experts from other fields who have recently entered healthcare. They often shake their heads in wonder at some of our practices. Or, talk to patients. They get it. They live in the 21st century with an amazing array of apps and services designed to be user-friendly, effective and convenient. Except for healthcare.

What’s going on here? I’ve worked in healthcare for decades and I’ve concluded that the underlying mechanisms of IC rest on a combination of ineffective strategies, technologies and behaviors. The good news: there are home remedies for IC.

Moonshot Improvement Methods

A primary cause of IC is that healthcare organizations generally favor taking the Moonshot approach to improvement efforts. A moonshot consists of a large upfront investment in planning, followed by a big-bang implementation. 

The risks and costs of failure are real and potentially very high. There’s a non-zero chance of zero ROI. Frequently, big-bang efforts fall short resulting in additional costs and an extended period of optimization. The original performance goals may never be reached and can be difficult to sustain.

Agile Change Methods

By contrast, rapid-cycle change (RCC) methods, based on the work of Edwards Deming and others, approach improvement through a series of small tests of change. Each small investment of effort leads to additive improvement over time.

Essentially, there is always an ROI and no possibility of failure since the point is to learn from each small experiment and iterate. RCC tends to involve smaller, more diverse teams. It’s difficult to do if you don’t include both experts and end-users. So, to some degree, change management is baked into the approach. The same cannot be said for moonshots.

In general, RCC approaches are the preferred method whenever possible and practical. Sometimes you have no choice and must risk a Moonshot, but remember, even the original US Moonshot broke the challenge down into stages by first achieving Earth orbit and then building upon that success.

Moonshot Approaches to Interoperability

Unfortunately, moonshot thinking is driving a lot of interoperability efforts right now. I know this view may not be popular, but there is significant risk in only pursuing consensus-based approaches like FHIR. Advocates of this single-threaded approach hold out a vision of a single standard. But, is it wise to bet the farm that one approach produced by a consensus group will succeed? If it fails, or falls short, the consequences for healthcare are enormous.

To be clear, I am not against FHIR as a concept. My concern, which is shared by others, is relying on FHIR as the only solution. If history is any guide, we won’t end up with a single, widely-acceptable solution, but rather one that favors a few incumbents and drags out the interoperability crisis even longer. Given that there are alternative approaches, why are we taking this risk?

As pointed out in a recent Medical Economics article, other industries pursue more open, market-based approaches that share many of the characteristics and benefits of RCC methods. They enable a variety of solutions to rapidly enter the marketplace and create choice. Some will fail, but not all. Competition and experience winnows the field to the best performance at the best price. The risk/reward ratio is substantially altered. These industries have two other RCC-like qualities. They use APIs and they adopt highly collaborative business relationships.

APIs are Agile, Everything Else is a Moonshot