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New Case Studies in Innosight Institute's Disruptive Innovations in Health Series

Sep 6, 2011, 1:36 AM

 Over the past several months the Innosight Institute, a think tank that applies Clayton Christensen’s theories of disruptive innovation to the social sector, has been exploring the critical factors necessary for facilitating disruptive innovation in health care in integrated delivery systems to achieve increased quality, reduced cost, and access improvements. The work, which is funded by the Pioneer Portfolio, has already produced five case studies, including recent additions that look at processes at Grand Valley Health Plan, Group Health Cooperative, and Presbyterian Healthcare Services.

To learn how Grand Valley provides a high level of access at a low cost of care, how Group Health is employing a successful Medical Home program and how scarcity became “the mother of invention” atPresbyterian Healthcare Services pleasecheck out the full case studies here.

What does mEvidence need to look like?

Aug 19, 2011, 4:40 AM, Posted by Al Shar

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There is something magical that happens when talking about mHealth. People start believing all of the wonderful things that a phone, together with the right gadget, can do: remind me to take my medicine, monitor my vitals, inform my doctor when something goes wrong, just plain automatically keep me healthy. The last few years have seen a huge growth in cell phone companies, technology companies, governments, application and device developers rushing to deliver product in this space. Just look at the over 500% increase in attendance between the 2009 and 2010 mHealth Summit (with the 2011 meeting promising to be even larger.) Along with the hype and the hope, people are beginning to ask for evidence and to question the value of growing a collection of isolated gadgets and apps.

I’d say that mHealth is somewhere around the asterisk on the “hype cycle” model developed by Gartner.

With that as context, RWJF’s Pioneer Portfolio, together with NIH, NSF, HHS and McKesson Foundation, organized a one day event to begin the process of advancing the Science of mHealth. What does mEvidence need to look like? What are the right methods to accelerate the evaluation of the efficacy of mHealth technologies?   First steps to address this have largely been focusing on attempts to demonstrate value by using a traditional randomized controlled trial, which is often ill suited to testing the interventions that mHealth enables. (It’s interesting to note that on August 14, Paul Meier died. I’d be interested in knowing what he’d be thinking.) When we first started to plan this meeting, I wondered how interested the field would be. After all, this is the drier, academic side of mobile health. I was surprised! We had 106 responses to our call for whitepapers of which we were able to choose 23. The demand for attendance was such that NIH had to arrange for a webcast.  Perhaps looking at transforming the way conduct research [in light of new technologies] is not so dry after all. While the attendees were predominantly US-based, academic, international and corporate interests were represented. The outcome was even more surprising. The group agreed that this was a good and important direction, that we needed to have a collaborative, ongoing and forward looking agenda and that the Science of mHealth was critical to achieving a high enough plateau of productivity. The group will soon issue a statement of direction and commitment, publish the key outcomes of the meeting and develop a longer-term agenda. We are also developing an online community so that we can keep the discussion going. In a couple of weeks the webinar will be available for people who missed it and we will work to keep the groundswell moving.

I’d be remiss not to include the fact that closely aligned is the ideas and ideals of Open mHealth and the work of Pioneer grantees Ida Sim and Deborah Estrin. Not only were they and a number of people in the open mHealth area participants, they organized a second day to help formulate how they were going to develop and move forward.

This is important and people are paying attention. One way that you can help is to respond to the request from the NIH Director’s Common Fund, which is designed to fund transformative research that is of interest to the health community. The Common Fund officials are looking for the community (that is you!) to weigh in on new ideas for funding. Go here to add your comments.

Tim O'Reilly to Host 'Unconference' for Health, Tech Leaders

Dec 2, 2010, 5:11 AM, Posted by RWJF Blog Team

Today we announced a grant to O’Reilly Media  to  sponsor the Foo Health Camp in 2011, a cross-discipline, immersive, informal 'unconference' that will take advantage of a growing interest in applying Web 2.0 and open-source thinking in health care to spark ideas that can expedite changes in the ecosystem of health care services. This event is being announced on the heels of last summer’s O’Reilly Open Source Convention, where we helped sponsor the event’s first-ever health track. A full report of that event’s takeaways is now on our Web site.

The Foo Camp-unconference format was pioneered by visionary Web leaders Tim O’Reilly and Sara Winge of O'Reilly Media. O’Reilly Media is a leading technology publisher, conference organizer and supporter of the free-software and open-source movements (Foo stands for “Friends of O’Reilly). The format, in which attendees design the agenda on the spot, produces more brainstorming and group problem solving than formal presentations – which is clearly conducive to catalyzing the type of outside-the-box thinking needed to transform health and health care.

This health camp will be an invitation-only meeting, bringing together about 150 key players from health care and emerging technology, including researchers, funders, health care executives, software developers, entrepreneurs, journalists, policy experts, thought leaders and Robert Wood Johnson Foundation team members.

We will be sure to fill you in on more details as they become available, including how to participate in the conversation via social media.

For more on Tim O’Reilly’s vision on how technology will change health and health care – and why O’Reilly Media is jumping into the field – you can watch his interview with Pioneer Team Leader Paul Tarini below. Then leave a comment and let us know what you think!

Time to Accelerate Innovation: Takeaways from this Year's mHealth Summit

Nov 10, 2010, 6:03 AM, Posted by Al Shar

I just returned from the mHealth Summit in Washington, D.C. We’ve been sponsors of the event for 2009 and 2010 – both years it’s been held. Last year there were about 400 people who attended. This year there were about 2,500, including prominent guest speakers like Francis Collins, Bill Gates and Aneesh Chopra, among others. There was also a large hall with lots of exhibitors and an extensive poster session. I guess this means that means mobile health is coming of age.

I liked it a lot, but not for the reason you might think. At most of these types of events the presentations tend to expand on the great things that are going on in the field. Here there was a good, healthy dose of skepticism. And there’s a lot to be skeptical about. There are the “show me” skeptics, the ones that ask for evidence that it actually works. There are the regulation skeptics, the ones who know the problems in getting devices approved by the responsible government agencies. There are the “disruptive innovation won’t work here” skeptics. There are the “who will pay for it?” skeptics, not to mention the standards, open source, proprietary, silo, etc. skeptics. It makes my head spin and wonder how we’ll ever get there.

There are two reasons I’m still optimistic. First, in spite of all this, the field is growing and there are big players in the field. Second, many of the issues are starting to be formally addressed at what seems to be appropriate levels. That’s good. There is an area where I think more can be done, and that’s in developing better methods for validation and evidence. There’s still a huge emphasis on the traditional clinical trials model, which sets up a fixed and structured experiment, collects data over a period of time, consolidates and analyzes the data at the end of the trial, and, after a long period of time (maybe five years), reports the outcome.

The field shouldn’t have to wait five years to understand the effects of what by then will be an obsolete intervention. In addition, this is a field where there should be continuous improvement, where tinkerers thrive, where prototypes are the rule. It makes little sense to freeze development when you learn something that will make it better. One solution might be the type of adaptive trial that pharmaceutical companies are investigating. This is one where results at various stages in a trial can effect changes in the trial model. You might change the sample size, the target population, the delivery method, the formulation, etc., based upon analyzing data internal or external to the experiment. Analysis of this model is complex but can be manageable. In the end you should be able to deliver a safer, more effective product sooner.

That’s the germ of one idea for being able to develop an evidence base for mHealth quicker and better than today. These are my thoughts. I’m sure that there are smart and thoughtful people who have others.

Innosight Institute Explores Disruptive Innovations in Health Care

Aug 11, 2010, 12:46 PM, Posted by RWJF Blog Team

This week the Innosight Institute, a not-for-profit, non-partisan think tank, released the first of six whitepapersexamining how disruptive innovations in integrated health care systems are generating higher quality care at a lower cost. We funded this research to identify critical factors necessary for facilitating disruptive innovation in health care. We’ve been long-time fans of Professor Clayton M. Christensen, and are excited to work with him because we believe that the principles of his theory of disruptive innovation could lead to significant positive changes in health care delivery.

This first case study focuses on HealthPartners, America's largest consumer-governed, nonprofit health care organization. HealthPartners’ integrated health system acts as both insurer and provider of care. According to Innosight’s research, this system design, which includes functions such as ranking physicians, providing patients control over physicians’ schedules and incorporating dental services and coverage has led HealthPartners to deliver a high quality of care at a cost that is even less than Minnesota’s already low average (30 percent below the national average).

We will highlight the additional whitepapers – which will focus on other health organizations with integrated delivery models – as they launch in the coming weeks. In the meantime, we look forward to your thoughts on HealthPartners’ approach to delivering high-quality care at a lower cost.