What is Health Innovation?

Well, it’s kinda like porn: I know it when I see it. And, also like porn, not everything is going to work. And again, like porn, things work differently for different people. So, in a way, health innovation is porn.

Porn analogies aside, I’ve spent the past two months in San Francisco working for a health tech start up. I’ve been to events and happy hours, and met many people working on many projects (Steph has a great post characterizing the kinds of people out there). The only thing I have really learned is that nobody quite knows what’s going to work (but everyone is trying very hard).

Through this, I’ve noticed four different kinds of health innovation:

Entrepreneur-centric

Health 2.0 is very entrepreneur-friendly. People identify a problem (or are incentivized to find a problem) and create a solution to it. Sometimes the solution works out well, sometimes it doesn’t. But the emphasis is on trying to solve the problem. Often there’s a business plan behind the idea. Sometimes there’s a health behavior theory. But the underlying goal is to keep trying until something sticks.

Research-centric

Sex::Tech is the ISIS-run conference about sex and technology. Many of the presentations come from large, NIH-funded research studies. At the pre-conference for researchers, discussion focused around the difficulties of keeping up to speed on changing technology. When you have to submit an NIH grant proposal 6 months to a year before funding, it’s hard to anticipate what the technological landscape will be like when the money actually comes. Case in point: ISIS did a study around teens, social networking, and sexual health. Halfway through the development, there was a mass exodus from Myspace to Facebook. ISIS had been developing on Myspace, so they had to essentially start from scratch on Facebook.

Developer-centric

Rock Health is a health tech incubator in San Francisco. They brought in a bunch fo developers with ideas around fixing health care, and are giving them money, space, and support in hopes they’ll create something amazing (and they are!). Massive Health… well, I don’t really know what they do, but they have a really cool website. They were founded by Aza, an awesome designer formerly of Mozilla, in hopes of providing the design Renaissance in health care. Both companies are working to bring in outsiders to help re-shape our health care system.

Hospital-centric

My experience in large hospital organizations has been that innovation is confined to a department, and mostly consists of the strategic project management of large can’t-fail projects. Lots of really smart people in business suits, sitting in windowless meeting rooms talking about payment models and risk adjustment. Conversations often revolve around Health Care Homes (the Minnesotan version of Medical Homes) and Accountable Care Organizations. The projects are incredibly important. In some cases, the fate of the organization rests in the success of these projects. It’s a completely different kind of innovation.

So what will work?

None of these kinds of innovation will work on their own. Massive Health’s diabetes app is not going to single-handedly solve our fiscal problem and, similarly, an Accountable Care Organization is not going to solve diabetes. However, an Accountable Care Organization that encourages people to use a suite of tools, including Massive Health’s app, might actually make a difference.

At some point there will be a shake-up of health care, to the same degree that Napster disrupted the music industry. It won’t happen in the same way — medicine is too highly regulated to allow a complete outsider disrupt the entire system. That is, not matter how cool your app is, you still need a doctor to diagnose diseases and prescribe medications.

For health care to actually change, these four kinds of innovation need to take a collective, very large step closer to each other:

Entrepreneurs need to prove what they’re doing is effective. Maybe not initially, but it should be part of their roadmap and budget. Just because it’s a good idea and people use it doesn’t mean it’s going to save lives.
Government funders need to speed up the funding process. Give money to smart people, not to smart ideas — a smart idea today will probably be dated a year from now. A smart person today will probably continue to have smart ideas in a year.
Developers need to listen to the needs and wants of experienced health care providers. Sometimes, that might mean translating what you are doing/want to do into terms and concepts providers understand. But, ultimately, if you don’t have buy-in from current providers, you will not have the reach you could have otherwise. Doctors prescribe medications, and there’s no reason they can’t prescribe an app too (if they understand what it does).
Large hospitals need to realize that innovation doesn’t happen when you’re wearing a suit. The biggest (and perhaps most effective) change may come from someone wearing a hoodie and sitting on a lovesac.

Obviously, fixing health care is much more complicated than just the above. It requires having an IT infrastructure that supports using new technology (and not perpetuating IE6 because that’s what your EMR requires). It requires having technologically-competent providers and consumers (or people who can train them). It requires changing the health professional admission processes to make more Indu Sabaiyas, Jay Parkinsons, and Alan Greenes (physicians who understand “helping people” means more than just prescribing drugs when someone gets sick). It requires changing the financial model of health care by either convincing insurance companies to fund the implementation of innovation, or to move beyond insurance companies completely. But, ultimately, health innovation starts when we all start working together.