Health Care's Buggy Whips and Segways

In a thought-provoking piece, Joseph Caddell and Robert Stiegel warn of "misinnovation."  They talk about it in the context of national security and intelligence technologies, but health care should pay attention. 

By "misinnovation," they aren't talking about bad ideas, or even good ideas done badly.  Misinnovation is actually innovation -- just not the right innovation.  They characterize it into two immediately recognizable types:

• Buggy Whip Misinnovation: "innovating along a well-established technological arc for too long":
• Segway Misinnovation: "mismatching innovation to a need, often by jumping on the wrong technological arc"

The buggy whip problem goes back to the infancy of the automobiles.  Some people saw the future and bet on the new technology, while others thought buggies and buggy whips had served us well for centuries and would continue to do so.  They focused their efforts on making those as good as possible, not realizing until too late that they'd lost the market.

It's the old "what business are you in" question: buggies or transportation?

Dr. Caddell and Col. Stiegel cite the famous (and possibility apocryphal) Henry Ford quote:

Or perhaps better buggy whips.

Segways, on the other hand, were supposed to be the future.  Details of the secret invention were few and far between, but expectations were high.  It was said to be bigger than the PC, bigger than the Internet.  Seriously.

And what we got was, well, those goofy things security guards ride in malls. 

It's not that Segways are poor technology.  Far from it; they are pretty slick, and good at what they do.  It's not that they are of no use or that no one buys them.  It's more that not many of us think they solve a need that we have. 

When you think about it, misinnovation abounds.  Think about Microsoft introducing Zune just before the original iPhone was released, or the last generation of propeller fighter planes, that were immediately made obsolete by jets. 

Or, in an era of the internet, the companies who continue to improve the much maligned fax machine. 

Or upgrading stethoscopes (200 years old) and x-rays (125 years old) when portable ultrasounds, and ultra-low dose CT scans are available, respectively. 

Oh, that's right; faxes, stethoscopes, and x-rays continue in widespread daily use. 

In health care, misinnovation thrives. 

Health care has no shortage of innovation. There are plenty of innovators who are working diligently to bring new ideas to it.  The innovation is coming both from within the industry and from other industries.  We see innovations like wearables, Big Data, gene therapy, nanobots, 3D printing, to name a few.  It's an exciting time to be in health care.

What we don't see is enough thought and discussion about which of these are truly innovation and which will, at some point in the future, be viewed as misinnovation.

Let's think about the two types of misinnovation as they relate to health care.

There is a lot of money spent on "reinventing" hospitals. There is much effort on redesigning them to improve the patient experience.   Politico just ran a series of articles looking at the future of hospitals, such as virtual hospitals, McHospitals, more community-oriented hospitals, even hospitals less focused on beds.  UPMC announced they were spending $2b to revamp its hospitals into "digitally based specialty" hospitals.

These are all well intentioned, may help patients -- but fall into the "better buggy whip" category.

Hospitals are curious places.  We put a vulnerable people together with people who have often exotic  germs.  We put debilitated people into environments where they often become even more debilitated.  We put people who need care and comfort into emotionally sterile settings with not enough staff to give it to them.

We don't need better hospitals.  We need the thing that will take the place of hospitals.

Similarly, there is a revolution in smartphone-based apps for health care.  The list of things you can now do on your smartphone is amazing.  For years, Dr. Eric Topol has been evangelizing what they can do now and will increasingly be able to for our health.  If you're not impressed and astonished, you're not paying enough attention.

This is all exciting.  It's helping democratize our health care, and may even help improve our health.   And it fits into the Segway category.

There's a need for more ubiquitous monitoring, analysis, and advice in health care, but simply putting more apps on our mobile devices is not the solution.  We don't need fifty -- a hundred! -- health-related apps telling us how we're doing and what we should do about it.  We certainly don't need competing apps that give us conflicting results and/or advice.  We don't want to have to pick the right apps to ask the right question in order to get the right answer.

We don't need more apps.  We need the thing that makes sense of what they can tell us.

The list could go on and on.  Invasive surgeries or intensive radiation therapy are buggy whips.  More kinds of long-term use prescription medicines are Segways. 

If we're doing damage to the patient, even in the interest of curing them, it is an approach for which we should be thinking about alternatives.  If we're doing things that help people live with their condition or limitation, we should be thinking instead of how to get rid of it. 

Try to think about what we're doing as someone from the future might look at it -- like Star Trek's Dr. McCoy finding himself in 1986:

We're not in the 23rd century.  We don't have those kinds of technologies yet.  But we're not in the 20th century anymore either, much less the 19th century.  We should be looking at technologies and approaches from those times with great skepticism, and not spending too much time further innovating them. 

Our innovations should be more recognizable to someone from the 23rd century than to someone from the 19th.

Nor should we be doing cool things just because they're cool, as Kirti Patel recently put it.  We should be doing things that consumers need and that will help them be healthier.  We have a health care system that seems like it would rather put someone in a fancy motorized wheelchair -- or a Segway! -- than to get them to walk more while they still can. 

I love innovation.  Health care needs it more than ever.  But let's try to be sure it actually is innovation, not misinnovation.