The other day, the Indiana Business Journal ran a column entitled BioCrossroads drops dreams for hospital innovation. In it, the columnist commented fairly negatively on a report by BioCrossroads entitled Healthcare Driven Innovation: An assessment of opportunities in Central Indiana. As a new arrival to Indianapolis, I thought the commentary was a little bit disingenuous and somewhat of a needless putdown of what is really possible. So, I took the initiative and wrote a few comments, many of which are applicable to healthcare innovation in general.
Instead of bidding adieu to “dreams for hospital innovation,” the report simply confirmed what many health systems already know: It is hard to emulate the Cleveland Clinic, whether that is with regard to clinical processes, outcomes, and quality of care, or its innovation model. What the report said loud and clear between the lines, however, is worthwhile repeating: Healthcare in the US needs innovation to chart its way out of the mess it is in. And that is why I moved to the Indiana University School of Medicine/the Regenstrief Institute from the University of Pittsburgh and its juggernaut medical center.
I am a biomedical informatician, since my earliest uses of a computer always focused on solving practical problems. Whether it was writing software to calculate the value of standing timber for my father (a forest superintendent) or programming algorithms for materials testing in a manufacturing company, improving real-world outcomes was always front and center for me. Now, I work for an Institute that has the same priority.
The report astutely examines current local healthcare innovation efforts and outlines a path forward. Many aspects of this path are unknown, but its general shape is clear: Innovating successfully in healthcare requires a balanced amalgam of healthcare institutions (specifically hospitals), clinicians (not just physicians), and entrepreneurship embodied by companies large and small. In this triad, it is often the institutions who are their own worst enemies. While most want to be like Stanford, MIT, or, in this case, the Cleveland Clinic, academic and clinical institutions often create a dizzying array of disincentives and barriers to the innovations they intend to produce. At Temple University in 1989, my first job in the US, the research office was so dysfunctional that any thought of commercializing an innovation was ludicrous. When I started at the University of Pittsburgh in 2002, one of my senior colleagues in biomedical informatics said to me: “If you want to innovate and commercialize, go elsewhere.” Six or so unsuccessful innovation disclosures with Pitt’s Office of Technology Management later, I took his advice.
So, I decided to go to one of the historically most innovative places in healthcare informatics, the Regenstrief Institute Center for Biomedical Informatics (CBMI), as its third director. It helped that even as dental student in Germany I was familiar with the work of its founder, Clem McDonald. (I now have the honor of holding a professorship endowed in Clem’s name.)
In the aggregate, the BioCrossroads makes a few simple points. Healthcare innovation requires the involvement of physicians and other clinicians. Hospitals and other healthcare institutions need sensible strategies to support and nurture this innovation. We need the help of entrepreneurs and the business community to make these initiatives fly in the marketplace. We need to take advantage of local assets and resources. And, we need to collaborate.
I am personally not upset at all that the report concluded we can’t recreate the Cleveland Clinic Innovations model here. Maybe we shouldn’t. According to the report, the Cleveland Clinic started building its vertically integrated innovation and commercialization model in 1921. So, I’d say they have a pretty good head start. The commentary derides IU Health for its poor track record of commercialization through CHV Capital Inc. Well, if it’s any consolation, UMPC didn’t do a whole lot better, despite huge investments. So, the dream of the high-flying, royalty-gushing conveyor belt of startups might not be for many, anyway.
Taking a bright idea from its conception to successful commercialization is an extremely long and arduous road. Most startups in business in general fail. Thus it is in healthcare. As the report suggests, we may want to look at particular facets of the innovation value chain. Here are a few relevant comments:
- Most healthcare institutions love solving a local problem, whether it is in administration, clinical care or operations. Solving this kind of problem usually saves money, improves outcomes or both. Helping hospitals and other healthcare providers do that has important benefits for the economy, health and quality of life.
- Let’s create the right partnerships to help innovative ideas succeed. An innovative clinician needs partners on the business who understand the need, the solution and the potential market. I have seen a lot of good ideas go down the drain because the business people didn’t really understand what they were trying to market, who to market it to and why the innovation was needed in the first place.
- Let’s stop tying ourselves in knots with our own homemade rules. I have listened to endless arguments in academia on who exactly owns the IP, how the revenues should be split, who gets the right to license the technology, etc. Guess what? 80% of zero is still zero, so let’s cut to the chase and help new ideas take wing with the least amount of bureaucratic overhead.
- Healthcare is an information-intensive business. This will get only worse. According to a report from the Institute of Medicine, the number of data points required for individual clinical decisions will continue grow exponentially (reflecting our growing insights into the genomic and proteomic basis of disease). How do you do this without a computer? You don’t. Informatics and information technology are not just crucial for innovating in healthcare. They are crucial just for delivering basic care. Given the strength of Central Indiana in applied clinical informatics, we have huge opportunities in that space.
- But, to take advantage of these opportunities, we need to collaborate. The Indiana Network for Patient Care is a good example of what happens when you do that. It certainly is not the only health information exchange in the country, but it is the largest and most mature. In general, Central Indiana looks to me to be one of the more collaborative healthcare markets I have ever lived in. Certainly, the Philadelphia and Pittsburgh areas cannot be held up as paragons of collaboration in healthcare.
- The INPC provides us with possibilities that simply don’t exist anywhere else. Let me give you an example. The other day I was talking to a CBMI staff member about how to transmit health data from personal monitoring devices, such as health apps for blood pressure, glucose measurements, pulse rates, etc. Eventually, the discussion turned to the benefits of feeding patient-generated data directly into the INPC. The value of doing that to clinicians? Priceless.
- We need to stimulate the dialogue among parties who normally would not be talking to each other. One of my first experiences at CBMI was the Electronic Medical Record Summit, a conference which brought, with generous support by Merck, major and minor health information technology (HIT) companies together, including Epic, Cerner, Allscripts, iSalus and IHIE. For a day, we discussed HIT innovation in the context of Regenstrief’s cutting-edge technologies.
- Let’s not forget that Central Indiana is not the only place producing innovation. Right before I left Pittsburgh, I sat down with faculty colleagues at Carnegie Mellon University. I left with a whole bag of innovative technologies that were ready to be tested and evaluated in practice. Exactly the thing we could do in Central Indiana.
- The Report justifiably identifies clinical research as a significant opportunity for the region as a whole. The more attractive we collectively become as a location for major funders to conduct research, the more we can contribute to generating knowledge. And, we are very well positioned today, as the extremely positive review of our application for a Clinical and Translational Science Award from the NIH illustrated. At IU Health, we incentivize research by making part of the bonus for each hospital CEO dependent on the number of research participants recruited. We use tools such as ResNet (Research participant recruitment Network), to identify potential participants from electronic data. And, at Wishard, our G3 software suggests patients eligible for particular studies as physicians type their notes.
So, what are the opportunities in Central Indiana? Stellar. Forget what the Cleveland Clinic does. Let’s do it the Hoosier way!
Titus Schleyer, DMD, PhD, MBA
Clem McDonald Professor of Biomedical Informatics
Director, Center for Biomedical Informatics
Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012
Skype: titus.schleyer, Ph: (317) 423-5522 (direct), cell: (412) 638-3581, E-mail: email@example.com
Web: http://www.regenstrief.org/cbmi/, Blog: https://titusschleyer.wordpress.com, General: http://about.me/titusschleyer