Things & Thinks XIII
In this issue of my fortnightly newsletter, I reflect upon healthcare innovation using two different perspectives-repairing after disruptive innovation and time horizon for seeing impact of innovation. I also curate some of the important news from the digital health world, and we end with a Chart of the Fortnight and a Tweet of the Fortnight.
Innovation reflections- Disruptions and Repairing
I read a new report about AI interventions in healthcare, focusing on Sepsis Watch, an innovative AI that helps in managing sepsis. Many of the comments by the authors really hit the bull’s eye.
Innovating in healthcare is fraught with challenges that come with the field-fragmentation, silos and multiple handoffs. When you place an innovative solution in this ‘messy’ environment, there is always a risk that the many hidden, complex interplays (that were not considered/were kept out of development) will add to the usually well known bumps of the change management plans.
The report authors call attention to this exact issue, especially for disruptive innovations, where typically a new path is found that bypasses/surmounts the current complications. However this very act of new path would lead to ‘forms of breakage, upsetting existing power hierarchies or rerouting information flows ’.
Sepsis Watch is designed to alert hospital staff about possibility of developing sepsis for a given patient, based on a machine learning algorithm. This is quite different from how physicians currently access this risk and hence the new system created many issues including miscommunication about handling of the alerts, distrust of the new methodology and overall confusion amongst teams.
The report suggests, for these and other AI based interventions, that the breakages must be repaired in order for the intervention to work effectively in a particular context and highlight how this is often neglected in healthcare innovation-
Repair work is not about recovering a status quo but rather about creating a new set of practices and possibilities. This kind of repair work is necessary, consistently undervalued, and often rendered invisible.
Innovation reflections- How long should we wait?
One of my favorite authors is Tim Harford, who writes contrarian views mainly about economics but also about technology, innovation and many other things.
In this BBC article from 2017, he has written beautifully about how innovation takes time to penetrate and assimilate through the many layers of the society. He uses electricity and its impact on manufacturing to illustrate this diffusion. Here are some fascinating insights-
- In 1881, Edison built electricity generating stations at Pearl Street in Manhattan and Holborn in London. But until about 1910, plenty of entrepreneurs looked at the new electrical drive system and opted for good old-fashioned steam.
- There were plenty of good reasons to adapt to the new technology (electricity), including efficiency, cleaner workplaces and less accidents. However the changes required were plenty too-the architecture of the factories, the production process and of course staffing processes including new hiring, training and payslips.
- In the end change happened and gains started to be reflected-productivity in American manufacturing soared in 1920s.
- When the electric dynamo was as old as the web is now, factory owners were still attached to steam. The really big changes were only just appearing on the horizon.
Reading this really helped me with looking at the impact of innovative solutions in healthcare. Especially considering the interlinkages and dependencies, it is definitely going to require us to consider a longer timeframe, updating many other parts of the ecosystem and finally just continue chipping at it!
So here’s a fine lesson by Harford-
The thing about a revolutionary technology is that it changes everything — that’s why we call it revolutionary. And changing everything takes time and imagination and courage — and sometimes just a lot of hard work.
Digital Healthcare news-New partners, Confusions and Funding update
Lyft-the second largest ridesharing company in US- continued making healthcare partnerships and signed a deal with Epic for an integrated method for for patients from Epic’s medical records system. This is Lyft’s second such linkage with an insurance firm, after a 2018 deal with Allscripts.
The newly formed partnership between Teladoc and Livongo has already landed their first client for the combined service. Guidewell Health, an existing Teladoc user will now also offer Livongo’s diabetes platform to 50,000 of its members.
Google’s purchase of Fitbit will take longer, with the EU antitrust decision now delayed to 2021. Google reportedly said that ‘the deal is “about devices, not data”!’.
On the Indian digital health side, the confusion about National Digital Health ID continues-there were reports that digitized IDs would be used for COVID vaccine distribution however the health ministry clarified that digital IDs might not be mandatory after all.
Eight Indian digital health companies received $40m in VC funds in Q3 2020, Practo getting 80% of the pie. For comparison, US-based digital health startups raised $4B in the same period.
Tidbits
- Healthcare Chart of the Fortnight: India is one of the worst countries on the Global Hunger Index. Of particular concern is the trend in prevalence of wasting in children under five years, which seems to have worsened over the last decade-
- Healthcare Tweet of the Fortnight: The weirdness that’s American healthcare system and the economics that drives it!
