Exploring disruptive innovations in health care

"The new products were usually cheaper and easier to use, and so people or companies who were not rich or sophisticated enough for the old ones started buying the new ones, and there were so many more of the regular people than there were of the rich, sophisticated people that the companies making the new products prospered. [Clayton] Christensen called these low-end products “disruptive technologies,” because, rather than sustaining technological progress toward better performance, they disrupted it."

This excerpt from a recent New Yorker profile of Clayton Christensen traces the now legendary concept of disruptive innovation back to Christensen's study of mainframe computer disk drives at the cusp of the PC revolution.

Panelists at the closing media panel of the 2012 Pacific Health Summit applied this concept to health care. Every June, the Summit organizers convene decisionmakers to discuss how to work toward a healthier future through the effective utilization of scientific advances, combined with industrial innovation and appropriate policies. The Wellcome Trust and National Bureau of Asian Research hosted the 2012 incarnation.

Breaking the Gold Standard

The notion of disrupting the medical "gold standard" as the status quo was brought up at panels and in conversations around One Great George Street, blocks from Big Ben. In other words, many participants questioned the idea that the global health community should be trying to bring the most advanced health care to all corners of the globe. It's a counter-intuitive notion in health care, but one that kept audiences a-Twitter.

"Customers in [LMICs] can't access the gold standard," said Dr. Jason Hwang of the the Innosight Institute, noting that this pointed to the need for disruptive innovation. "Disruption is inherently simpler – you can get good quality and lower cost," he said. Dr. Hwang, a coauthor with Christensen on The Innovator's Prescription, said that the consumer had the power to disrupt the status quo. Others in attendance also pointed to the need to carefully design innovations for the end user.

"The use of technological innovation in healthcare delivery is required to bring down the cost of services in hard-to-reach regions of the world, whether we are considering diagnostics, treatment or treatment follow up," wrote Ashok Jhunjhunwala and Suma Prashant of the Indian Institute of Technology in Madras, in the publication Game Changers: Affordability and Technologies for Health.

Dr. Jhunjhunwala and Ms. Prashant advised in their essay that those developing health technologies or assessing their efficacy should consider whether technologies are:

• Low cost and appropriate
• Do not intimidate the end user and are in tune with their lifestyle and culture -- and will therefore be easily accepted
• Can accommodate usage by a wide spectrum of end users, including those who are semi-literate and illiterate; for example, any service that requires patients to use text messaging for communication would be limited to literate users only only, whereas the same service, when provided using voice communication could be utilized by a much broader demographic
• Will work in an environment with limited infrastructure

CHMI currently profiles more than 300 health innovations using information communication technology to improve access to health care in LMICs. Many innovations leverage technology to extend health access to remote areas, a finding recently reported in the WHO Bulletin issue on e-health.

Leveraging Rural Providers

The IIT Madras authors also pointed to the need to leverage rural healthcare practitioners using technology, training them and linking them with remote doctors via telemedicine to strengthen the quality of their work in the field.

In India, according to Dr. Kanav Kahol of the Public Health Foundation of India, it's about understanding the principle "More features for Less money for More people (MLM)."

The two-hundred fifty Pacific Health Summit delegates represented 45 countries, with one of every four delegates hailing from the private sector. During the three-day meeting, innovators like Sameer Sawarkar--who developed the ReMeDi telemedicine device used in SkyHealth telemedicine centers run by World Health Partners with IIT Madras collaborators--conversed with business leaders like Mike Hess from Medtronic, researchers like Dr. Hwang and other actors in the space.

Hess said that medical procedures that could be delivered by health care providers with less training or in less specialized settings had the potential to be adopted more rapidly and to have a greater impact.

Calls for Collaboration

A number of organizations announced calls for collaboration, which are publicly available here. Among those worth noting:

• A call for partners to share expertise and experience in social business models and/or point-of-care diagnostic tests to inform the introduction of the tests to pregnant women and babies in Peru
• A call for partners to assess the impact, and inform the scale-up, of smartphone-based ultrasound imaging technology
• Call for partners from health priority-setting institutions to support global and domestic health technology assessment systems
• Call for telecommunications providers to partner with health insurance providers in Southeast Asia and Africa to develop new business models and payment collection solutions

More information and resources are available at the Pacific Health Summit site here.