The US medical system is the best in the world, by the simple measure of patients voting with their feet. How many US patients flee the US so they can enjoy the superior medical care in other countries? How many foreign patients come to the US in order to benefit from the superior medical care available here? This simple measure allows you to cut through the rhetoric and find the truth: instead of listening to what people say, watch what they do.

The US medical system would also benefit from radical change. It is not nearly as good as it could be. It’s not lacking new ideas, or more of the currently fashionable “innovation;” it needs to apply methods, systems and technology that are proven in wide-spread application in non-medical applications, suitably adapted for medical use.

I’ve already hit on a couple of juicy subjects in this blog. But they only scratch the surface. Here are some of the things I’m thinking about and will be blogging about.

Financial technology and healthcare technology

Both are heavily burdened by giant organizations, heavy regulation, ancient and expensive IT, and deep resistance to anything but surface change. But fintech is in a renaissance of game-changing innovation, while healthcare is a laggard by comparison. What’s this about? One simple example: in finance, when I applied for credit 30 years ago, I went to the bank and was subjected to an interview by a bank officer, who personally determined my credit-worthiness; today, complete automation yields better results with less time and cost. In healthcare, when I have disease symptoms, I go to a doctor who makes a diagnosis and recommends a treatment. It was the same 30 years ago, only now there's much more overhead typing stuff into computer systems, mostly for the benefit of various bureaucracies.

Drug discovery

In drug discovery, there is a huge gap between what we are capable of and what we let ourselves accomplish. As usual, regulations and bureaucracy impose expensive and outmoded barriers, resulting in widespread preventable deaths.

Innovation and best practices

There is a natural tension between assuring that patients are treated according to best practices, while allowing for innovation and expert adaptation. Our methods for resolving this tension are sadly deficient compared to non-medical fields.

Bad science

You would think that as a science-created and science-dominated field, there would be only the best science in medicine. Sadly, this is not the case. There is shockingly bad science at both the detail level and the global level.

Training and credentials

Healthcare is filled with extensive training requirements, certifications and tests. These are accepted as part of life in the field. Some of the credential requirements are well-intentioned — but others are little but thin veneers of good intentions on top of a pile of self-dealing, and often make things worse for patients.This is best seen by comparison to other countries and other fields.

IT

The level of IT implemented at an average e-commerce website is, in general, vastly superior to the IT implemented at the very best medical institutions. On multiple dimensions, including cost, effectiveness, quality, and level of automation. If done well, excellent IT could be the foundation of a revolutionary wave of excellence in healthcare delivery and continuous innovation.

Conclusion and disclosure

I’ll be addressing these issues and more in future posts on this blog. But I’d like to emphasize: I’m taking the trouble to write this stuff down and make it available because it’s what I really think. I’m proud to be part of a partnership which invests in and supports leading-edge groups that are trying to change healthcare for the better, and I may refer to such companies in the future as I already have. But these posts and thoughts are promotional only in the sense that they promote concepts and practices that would raise the game in healthcare for everyone concerned.

There is lots of noise about “innovation” and its importance. Not only are there books, articles and conferences, large organizations increasingly employ Chief Innovation Officers to make sure innovation really does take place – otherwise, it might not, and what a horror that would be!

Innovation seems to be a big, important, mysterious thing that isn’t one bit obvious. Lots of people have to get together to figure out this grand new thing. Here’s a typical example:

I must be missing something. I agree that making things better is real important, and I’m happy to call that “innovation.” But it appears to me that, in most cases, the innovation that most of the people served by an organization would value most highly is simple and obvious.

For example, in football, people focus on all sorts of fancy things. But what wins most games most of the time? Getting real good at blocking and tackling.

In most non-sports organizations, doing the equivalent of blocking and tackling makes things better. Since most organizations use computers a fair amount, the process is simple:

1. People should do their jobs. Completely. Correctly. On time.
2. Computers should help people do their jobs, and monitor whether they’ve done them correctly.
3. Computers should do things that people used to do.

No magic, no mystery, no focus groups required. It’s simple: Do it right! Then computer-enhance it! Finally, automate the human element! If this bothers you in any way, ask yourself whether you’d prefer to wait until the bank is open, walk into it, wait in line for a teller and get your money – or whether you’d just as soon walk or drive up to an ATM any time you please and get your money from a machine. Hmmmm.

Big Fat Personal Example of the need for simple Innovation

I had an appointment to see a doctor at one of the top hospitals in the US: Mount Sinai in NYC. Lest you think this was a no-big-deal appointment, let me just say I’m taking a drug that can have really bad (but hidden) side effects, and this was to check on how I’m doing. I wasn’t feeling casual about it.

I had written confirmation of the appointment, an on-line reminder of the appointment, and a robo-call reminder of the appointment the day before. Efficient! So I took the couple hours required to get to the hospital in plenty of time. The place where I usually sign in had my appointment in their system, but told me to go to another desk. They also had my appointment, but told me that unfortunately, my doctor was on vacation. They were polite, but the doctor wasn’t there, so the appointment wasn’t going to happen.

Assuring the innocent person giving me the bad news that I wasn’t mad, I asked what he would recommend as the best thing I could do to rattle someone’s cage about this unfortunate event. He got a supervisor to come out. The supervisor apologized and explained that a lady who’s out today was supposed to call me, but obviously didn’t. She’s sorry. Can she pay for my parking or something? Since I know Mount Sinai uses Epic, I asked whether she could get an alert put in to catch cases like this. She acted like she thought it was a good idea. But given how IT works at places like this, I’m not holding my breath. And there were actually two problems: the robo-call should have been cancelled, and a call to re-schedule me should have taken place. Not to mention e-mails, etc.

Mount Sinai’s medicine and doctors are among the best anywhere. But the hospital’s blocking and tackling is abysmal. The day before I was scheduled for an MRI they called to say my appointment was cancelled because they had no pre-authorization. Personal appeals to hold the appointment, followed by frantic phone calls, uncovered than Mt. Sinai has a whole department that does pre-auth’s. My doctor had placed the order correctly, but the pre-auth didn’t happen. My doctor’s assistant said it happens all the time, and is tired of catching the blame for it. It took a couple hours of phone time to get me the go-ahead.

Mt. Sinai thinks all sorts of things are important and worth spending money on. They have big TV’s blaring away in waiting rooms. They have iPad’s available to patients to amuse themselves while waiting. They have signs announcing how great they are marching down many NYC streets. They have classes on meditation and all sorts of activities directed at Arabic-reading people of the Islamic persuasion, judging from displays in the waiting rooms. All of these things are apparently more worthy of attention than blocking-and-tackling for boring, trivial things like appointments and pre-authorizations. And, sadly, I have lots more similar examples.

Mount Sinai hospital and Innovation

Mount Sinai has made its position on innovation clear: they’re for it. They have a whole department in charge of it. They have hosted at least one conference on innovation featuring all sorts of important people. They tout their innovative computer technology, including Epic. I neither dispute nor disparage any of this. But it’s kind of like a surgeon who does genuinely wonderful surgery, but disdains to wash his hands or double-check whether he’s operating on the right thing. They have indeed purchased and installed one of the most advanced, complex EMR systems – but they fail to get it to do the most basic things. And my personal experience is the tip of an iceberg. The waste and inefficiency within the hospital that I have observed that results from failing to pay attention to simple things like scheduling is simply monstrous.

I can’t resist giving just one juicy example. Where I check in, there is a whole line of check-in people who have to enter lots of stuff into the computer while you sit there. I noticed a little speaker on the wall that would sometimes make discrete little sounds. There was no one waiting behind me, so I asked the operator about it. It turns out that the speaker was installed some time ago and everyone like her trained to listen, because it tells you when it’s safe to hit submit on a new entry. The computer is so overloaded most of the time that unless you wait for the “it’s OK” audible signal, all your work will be thrown away and you have to start over.

As a life-long computer geek, my jaw didn’t just hit the floor; it blasted through it and was finally halted in its downward descent when it hit the bedrock under the island of Manhattan. I think I’m still working on putting it back. I’m so blown away I have no words – even sarcasm, my go-to mode, escapes me. Enough said.

Innovation made simple

I like cool new stuff. There should be more of it. It should even work.

But if you’re willing to pay attention to what actually matters, even though it may be pedestrian and boring, you can make a huge impact at nearly any organization without the benefit of a single conference, book or hi-falutin consultant. You can “innovate” by doing the equivalent of blocking and tackling, i.e., taking care of basics. In other words: Make sure every job is done, and everyone does his job. Then assist and enhance them with computers. Then, to the extent you can, replace human labor with full automation, including calling for human attention only when it’s needed. These simple steps are frequently and painfully not done; if they were done, surprising amounts of money and time would be freed for doing the complicated “cool” stuff that most people call “innovation.”