How Healthcare Defines Innovation

“Innovation” is currently red-hot within healthcare circles. Dr. John Halamka, CIO extraordinaire of Beth Israel Deaconess Medical Center, summarized his #HIMSS2016 experience as “Innovate or Die”, a post in which he explains how vendors across the industry have replaced prior buzzwords with a single message: Healthcare must innovate to survive the transition to value-based patient care. We agree.

Jargon can be painful, however. Well-meaning influencers latch onto a word and don’t let go until all momentum has been squeezed out of it. Innovation is a critical concept that stretches up, down, and across healthcare. We share a duty to not let it become a buzzword.

One way to avoid jumping the shark is to provide actionable definitions of a term. Give people a lever to hold on to. Give them a reason to care. Help others connect the dots and understand a concept’s role in the bigger picture.

Innovation for healthcare needs a succinct explanation in order to prevent it being captured by over-saturation. This piece sets out to do just that.

What are my credentials?

Over the past two years, Datica has been running a series of interviews with some of healthcare’s biggest thinkers and doers, titled The Healthcare Innovation Series. We have completed 16 interviews to date with many more on the horizon. Each interview was about 30–60 minutes long, and conducted in a question-and-answer format. I probed each participant with questions around a central root inquiry “What is Innovation?” We have been astonished with the results: From health system CIOs to vendor CEOs to academic luminaries, everyone gave their insight on how healthcare innovates.

Since 2013, I have lead Datica, with my co-founder Mohan Balachandran, on the frontier of healthcare’s transformation. We started the company because we saw compliance and integration as roadblocks to innovation across the industry. Removing the burden for technology teams was our way of helping accelerate change.

Prior to Datica, from 2008–2013, I was editor of HIStalkMobile (now HIStalk Connect). In that role, I researched and discussed emerging digital health trends in the context of the broader healthcare IT landscape. I’ve also spoken at events such as HIMSS, the mHealth Summit, and SXSW on digital health.

Common Themes

A few threads weaved their way through all of our interviews, and frequently popped up during our conversations with the market participants. These are the nine most powerful themes we believe contribute to the definition of Innovation.

1. Innovation is a giant sandbox

Ideas are the lifeblood of Innovation, and creativity is its source. Creativity occurs when two ideas are smashed together and something unexpected emerges. Therefore the goal is to source and combine as many ideas as possible. I once heard it compared to being in a big sandbox as a kid. The more toys you have, the more ways you can combine them. Dr. Jordan Shlain, founder of HealthLoop, called it “open source thoughtware” during our interview. Innovative organizations must strive to create an environment that facilitates random ideas colliding spontaneously.

2. Innovation is 80% external, 20% internal

Where do we get ideas that spur creative thinking? From both the Innovation Series and industry conversations, we have heard time and again that the bulk of new innovations come from outside the walls of the organization. Dr. Molly Coye, while at her prior post as Chief Innovation Officer at UCLA Health, said to me in her interview, “10% to 20% [of innovation] — that’s internal, and much bigger percentage being external.”

This isn’t to say internal teams can’t innovate. No, this is just a situation of pure math: There are simply a larger quantity of people doing innovative things outside of a given institution. It’s up to the health system to engage with those innovations, whether they be from vendors, academia, colleagues, or the government.

3. Innovation is partnership

If we know innovative thinking comes from combining ideas that are mostly external, we begin to see the value of partnership. Dr. Thomas Graham, former CIO of The Cleveland Clinic, described partnership in his interview as the key component to “synergistic innovation,” which is the ultimate goal.

Partnership means different teams working together towards a common objective. It manifests in many ways. It can be a partnership between physicians and IT staff within a hospital, or different strata of your organization. It can be between a health system and a vendor. Or, as Dr. Graham highlighted, it can be across different industries. Dr. Graham spoke to a partnership he forged with Parker Hannifin, a company which creates motion control parts for vehicles. Who knew cardiologists at Cleveland Clinic and engineers at Parker Hannifin had a mutual interest in optimizing flow through tubes? A partnership emerged that led to an innovative medical device portfolio.

4. Innovation is feedback, not failure

We heard multiple times that Innovation requires a new cultural mindset. Organizations must shift away from a fear of failure. This is nothing new — other industries have been hammering this message for years.

But saying Innovation is cultural is squishy. It’s not very actionable. One suggestion is to not categorize unexpected outcomes as failure. Instead, think of it as feedback. Innovation requires an iterative loop. Closing the loop properly is called “Mindful Failure” according to Dr. Chris Wasden. He discussed the difference between “Mindful Failure” and “Mindless Failure”, which really is failure — you didn’t learn anything to help you iterate. But if you are setting up experiments properly and capturing feedback responsibly, you will come away knowing what worked and what didn’t work. Be mindful and treat results as feedback, not failure.

5. Innovation is measured outcomes

Ideas are just ideas. Innovation is only actualized when positive outcomes occur. Understanding how to measure projects is a crucial step to instituting Innovation.

Chris Belmont, CIO of MD Anderson, in his interview spoke of his time implementing metrics at Oschner. He said something surprising happened: When you make measurements a requirement, it creates focus. That focus accelerates Innovation.

6. Innovation is not incremental improvement

This is probably the biggest misunderstanding with Innovation. Improving an existing process or making a set of outcomes incrementally better is not innovation. It is incremental improvement. True innovation only happens when something is 10x better at a 10x reduction in cost or resources. We heard this description a lot.

7. Innovation is digital, data, design — combined

Dr. Robert Wachter, Chair of the Department of Medicine at the University of California, San Francisco, has an authoritative view on the digitization of healthcare. He discusses in his book, The Digital Doctor, and again in our interview that healthcare is undergoing two seminal changes: an increased value pressure, and the switch from analog to digital.

Make no mistake that digitization of everything in healthcare is the root driver to most modern Innovation, much like other industries before it. Changes to software, devices, and infrastructure spur Innovation.

The fruit of digitization is data. Interoperability and data liquidity is how we gain value from the growing sets of data. Integration across systems is a must.

But what good is all this data if it’s unusable? Herein lies a major challenge. Design is the answer. Intelligent workflows for users leads to better outcomes from data.

It’s only when all three are combined that a modern idea can be a platform for Innovation. Junk data, unusable software — these things actually slow down or prohibit 10x outcomes.

8. Innovation is an investment

In every sense of the word investment.

• It’s a financial investment. Capital must be made available via multiple instruments.
• It’s a process investment. Organizations must have the right apparatus in place to allow for ideas, experiments, and partnerships to flourish.
• It’s a relationship investment. Health system leaders must become partners. External vendors must introduce ideas and manage pilots the right way. Human connections must be made and nurtured.
• It’s a time investment. Results won’t come overnight.
• It’s an emotional investment. You have to believe that your projects are making a difference. You must be committed to the aim of delivering better, safer, more satisfying care at a lower cost.
• It’s a cultural investment. Fear of failure is only squashed when a culture acts like it.

9. Innovation solves a real problem

Sue Schade said it best in our interview: “It’s never technology for technology’s sake.” Innovation gains momentum when true problems affecting the value for patients is addressed.

The Definition

Given these common threads, how might one define Innovation for healthcare? This is our definition:

Innovation is a process of connecting ideas and partners together to solve a real problem in a novel way. The process requires both cultural buy-in and multiple forms of organizational investment. Innovation’s output is a measurable outcome which is an exponential improvement over the current state.

Innovation is not jargon. It is a collective effort towards meaningful progress. It’s a process that can be managed and nurtured.

Innovation is bigger than a buzzword. It is a framework for bettering health outcomes.

What this Means for Healthcare

We believe Innovation is the key for healthcare’s transformation from volume- to value-based patient care. Here are a few prescriptive suggestions on what Innovation means for healthcare.

1. Do or do not, there is no try

The ship has sailed on the industry shift from volume- to value-based care. The government has defined specific timelines, in the form of MACRA and MIPS, for the shifts in risk-based public payments to providers tied to the quality care delivered. Organizations must embrace Innovation, and do it quickly, if they are to remain viable in the healthcare system of tomorrow.

2. Integration is fundamental

If Innovation is stimulated by data and partnerships, and if most Innovation comes from outside the walls of the hospital, then getting serious about accelerating data integration is fundamental to real Innovation. It’s never been more true than right now, 2016, with the the explosion of Venture Capital investment into Digital Health and the tremendous growth of mobile devices and wearables. The “Internet of Things” is nothing without proper integration.

We have a cardinal belief that is core to Datica’s strategy: removing the burdens of integration will be one of the most simple yet powerful sparks for healthcare innovation. That is why we provide Datica Managed Integration, which treats integration as a process, not an piecemeal API or silver bullet. We abstract away all the hard parts of integration — VPNs, interface engines, HIPAA compliant infrastructure, scaling project management — and put the focus on relationships between the health system and vendor.

“Interoperability” is a term that one can argue has become jargon, sadly. Walk the HIMSS exhibit floor and you’ll quickly realize interoperability in healthcare has been “solved”, which of course it hasn’t. We believe the best first step towards the realization of interoperability is a stronger, easier way to integrate systems, without disrupting existing workflows (that’s a new paradigm in health IT), and maintain data integrity.

3. Compliance is complex. Remove it as a burden.

Healthcare is unique compared to its industry brethren like e-commerce, communications, social media, manufacturing, and so on. These are people’s lives at stake. Thus, we fully support the intent of government involvement and certain regulations like HIPAA. With that said, there is no question additional regulations create high barriers to entry for future innovators. Compliance is complex. Real Innovation doesn’t happen when people consistently duplicate efforts to address its complexity; it happens when people spend their energy focusing on real problems. Rapid Innovation will happen when re-inventing the wheel (the security and compliance wheel) on every project isn’t a requirement.

4. Default Yes, not Default No

Ransomware, hackers stealing PHI, breaches — there is a lot in the news for any CIO, CTO, or CISO to be alarmed. It can be tempting to have a Default No stance on new ideas or external partnerships. As the gatekeepers and instigators of Innovation, however, it’s crucial they view the world through a Default Yes lens. It’s up to them to maintain a process that properly cultivates and nurtures ideas. It’s up to the rest of healthcare to aid them by providing trusted and secure technology.

The Future

The health system of tomorrow will only loosely resemble the health system we know today. The cast of characters will be largely the the same as today — patient, providers, payers, life sciences — but the ways in which they interact will be vastly different. Tomorrow’s health system will have technology and data as a central part of it, and will be powered by HIPAA-compliant, scalable, interoperable infrastructure. Many of these technologies haven’t been built or haven’t been scaled and much of that data exists only in silos today.

What’s required is a commitment to Innovation as a process. We need innovative approaches to scaling technology and connecting data. In short, Innovation is the only path forward. Let’s all get out there and Innovate together!