Trishan Panch: More disruption please?

As an NHS GP I learned that healthcare is fundamentally locally provided and delivered through fostering long term relationships. However, the convergence of mobile technology and big data have the potential to profoundly change the way care is delivered. Should existing power brokers see this as an opportunity or a threat and what does this mean for the NHS?

This week, we were privileged to receive a delegation of UK health leaders at MIT’s shining temple of innovation, The Media Lab. In a brilliant white conference room, myself and four other MIT affiliated engineers and physicians discussed technology and health. We discussed a question that stuck in my mind and has inspired this post, “is it best to leave the Americans to do the trial and error and then take what works back to the UK?”

Implicit in this question are the assertions that either the current method of care delivery is simply too robust to be superseded, or that such supersedence is not of concern. But are either of these assertions true and do US Healthcare organisations share the same perspective? To answer this question, it is worth taking a step back and looking at the concept of disruptive innovation.

The study of manufacturing and retail are littered with examples of dominant companies who grew oblivious to the shifting sands of customer preference and emergent technologies and, one after another, perished. Kodak’s dramatic fall from grace as photography moved digital, the cannibalism of travel agents by the very networks of computerised flight reservation they created, and Japan’s decimation of the US auto industry, all feature companies who were leaders in their fields and who are now struggling or obsolete. Of course their mistakes are obvious in retrospect but what does this mean in health? Can the NHS or US healthcare organisations really be “disrupted?”

As mobile technology and big data converge on quality improvement initiatives, it will become possible to provide care in the home as effectively as in the clinic with lesser trained healthcare workers or patients themselves, supported by intelligent computer systems leading the charge. It will become possible to analyse the effectiveness and safety of care without an unwieldy scaffolding of controlled research and to create ever better ways of sensing pathology before it emerges as symptoms or signs. Surely all modern health systems should be investing heavily to realise this vision.

But what kind of organisations should be fostered to wrestle with these problems? In America, the home of the start-up, where a college drop out formed Apple—currently the world’s largest technology company—the call is loud: “more start-ups, more disruption please!”

Outside its shores of course, America has become notorious for its libertarian attitude to health. However, recently financial reality and political imperatives have seen health skilfully reframed as an issue of public concern by framing it as an economic issue: traditionally the most important kind of issue for the American voter. The healthcare sector, responsible for almost one in every five dollars spent in the US economy, has finally begun to attract young entrepreneurs and there has been a commensurate influx of investors eager to realise a return through funding health ventures.

Most investments have as yet shown little return but the amount invested continues to increase and every year more conferences, meet ups, and innovation awards emerge. There seems to be a widespread belief that a trailblazing success story is imminent even though the health system has been stubbornly resistant to change for decades. Maybe in fact, ever hopeful, Americans always believe that success is just around the corner. As John Steinbeck purportedly said in 1966 “socialism never took root in America because the poor see themselves not as an exploited proletariat, but as temporarily embarrassed millionaires.”

At the same time, the government is increasingly involved in healthcare much to the chagrin of the right. The prevailing sentiment seems to be that regulation is necessary to ensure safety and promote equity, but not at the expense of allowing new kinds of hitherto unimagined healthcare organisations armed with new technologies to emerge and flourish. It is accepted that there will be some turnover of current providers as well as significant mergers and acquisitions. In the NHS context, where an emphasis on universality and equity have become the guiding principles, is this cost too high?

Maybe it is best for the NHS to wait and see what works. The road to technological success is perhaps simply too haphazard to devote precious financial resources to fostering technology start ups at the expense of addressing current needs in the UK? Or maybe it is time for UK start-ups and investors to join their US counterparts in leading the charge. Time will tell of course, however if we agree that healthcare is essentially local, shouldn’t disruption be as well?

Trishan Panch was a GP Partner in London from 2007 to 2010. He since studied health policy and management at Harvard and was an MIT lecturer in health sciences and technology (2010-2012.) He is the inaugural recipient of Harvard’s Public Health Innovator of the Year award (2012) and co-founder of Wellframe, a health technology start-up.