Disruptive innovation.
Clayton Christensen, a Harvard Business School professor and author, pretty
much copyrighted this term in his writings, including "The Innovator's
Dilemma."
"But what is it?" you're probably wondering.
In a recent interview published in the journal "Health Affairs," he defines
"disruptive innovation" as "a technology that brings a much more affordable
product or service that is much simpler to use into a market."
An example is the personal computer that took over many functions much more
cheaply, efficiently, and conveniently from the mainframe computer. As
Christensen says, "so we're all better off, except the mainframe companies
who got disrupted."
Part of the disruption process often involves simplifying complex tasks. In
the computer example, computer programs make burdensome tasks almost
routine. Other examples include using income tax or spreadsheet software on
your personal computer.
Some medical disruptions are already underway.
Christensen describes examples from his own experience in managing his
diabetes. About a year after his diabetes diagnosis, he started using his
own handheld blood glucose meter. He used it to observe how his blood sugar
responded to the food he was eating, the exercise he was doing and other
life activities. He then also figured out how much insulin he needed to
control his own blood glucose level from one hour to the next.
He then knew much more about his body's response to his diabetes than his
doctors ever could. Even so, he still had to see the doctor once a year to
get a fancier HbA1c test (glycosylated hemoglobin) to check on long-term
control of his diabetes.
Christensen had to spend three hours at the hospital to get blood drawn out.
"And then they would report the results not to me but to my physician" so he
would have to call the doctor to get the information. Because of the time
and inconvenience, he didn't get the test very often.
But then a new company offered a $16 do-it-yourself test kit. He "put two
drops of blood on a strip, mailed it back to them, and three days later,
they sent me my HbA1c score." The same thing happened with the microglobulin
test, which checks how his kidneys are doing. This also cost a lot of time
and inconvenience.
These mail-order tests cut out the medical and hospital middlemen. And, life
is much better. "I can actually fudge and eat ice cream because I know
exactly how many units of insulin I have to take in order to offset the
impact of the glucose in my blood," Christensen says.
But the federal Clinical Laboratory Improvement Act (CLIA) prohibits most
people for owning and using the fruits of such advanced medical diagnostic
technology.
"The federal government tightly controls the facilities and personnel
allowed to make diagnostic measurements on human specimens," according to
biochemist Arthur Robinson, Ph.D., writing in the spring 2007 edition of the
Journal of American Physicians and Surgeons (JPANDS).
Robinson is president and research professor of the Oregon Institute of
Science and Medicine.
Thirty-five years ago, with Linus Pauling and others, Dr. Robinson invented
a new scientific discipline now called "metabolomics." In measuring dozens
of normal chemical byproducts of human metabolism, they found a unique
pattern in every individual examined. They used mass spectrometers to make
the measurements and computers to analyze the floods of data, very expensive
technologies at the time.
But, following Moore's law, the cost of both the chemical and computer
equipment fell over time and continues to fall, with Christensen's gizmos
examples of the trend.
In the future, a breath-analyzing device hooked up to an individual's
personal computer will likely be able to analyze the computer user's
metabolic (biochemical) profile, generating hundreds of data points of
hundreds of different chemicals, according to Robinson. He speculates that
this will stimulate a new, competitive, Internet-based industry in
interpreting all the new data.
In a similar way, Health Savings Accounts (HSAs) might disrupt the medical
system by giving account owners more information about their health spending
and a cash incentive to do something about it.
Under most employer-provided prepaid medical care, employees have little
financial incentive to manage their own health.
I once heard a lawyer and part-time local judge describe how his new,
government-provided comprehensive health covered everything. Because of the
complete coverage, he planned to see the doctor for every little sniffle he
suffered, instead of managing minor medical conditions himself.
Many employees have a similar "see-the-doctor-about-everything" mindset. And
most have little idea how much their employer spends for the medical
insurance.
As personal Health Savings Accounts (HSAs) cover more millions of people,
more people are thinking twice before running off to the doctor for every
headache. They are doing so because they've changed their mindset resulting
in better use of their time and money.
If Health Savings Accounts (HSAs) continue to transform mindsets then they
will also disrupt the current health insurance system.
Moore's law and the information age may further erode the current regulatory
monopolies in medicine (medical licensure, drug prescribing, diagnostic
testing, health insurance and medical devices), and lawyering (the "tort
tax" estimated to average over $9,000 per family every year). Then we'd
likely see medical practitioners with a wide variety of training and
expertise offering their services in a wide variety of convenience, price,
and quality.
Now, THAT would be disruptive.
Editor's Note: Robert J. Cihak wrote this week's column.
