The urgency to innovate in healthcare
During the COVID pandemic, healthcare organizations learned they could change course quickly. Many are looking to innovate around technology to improve care and operations.
The drive to inject innovation in healthcare is gaining momentum, driven by a variety of economic forces, surging expectations, and an industry anxious to innovate, particularly after seeing how well it assimilated change during the COVID-19 pandemic.
Healthcare organizations are looking for new ways to improve operations and care delivery, particularly as digital technologies mature and other capabilities show significant promise. April’s annual conference of the Healthcare Information Management and Systems Society showed heightened interest in capabilities such as artificial intelligence, natural language processing tools and advanced computing capabilities.
The fever to innovate is rising among providers, with organizations having announced the creation of at least four dozen innovation centers in recent years. And there’s rising research cooperation among major institutions, looking to solve large, vexing challenges.
However, there’s growing concern about rapid adoption of highly hyped technologies – for example, in March, the Future of Life Institute circulated a letter calling for a pause on the training of artificial intelligence models larger than GPT-4 for six months. The letter now has nearly 28,000 signatories. And in healthcare, the Coalition for Health AI recently released an initial blueprint for a trustworthy AI implementation guide for healthcare to provide direction and guardrails for the ethical, unbiased and appropriate use of the technology.
It's a confluence of technology and urgency pushing innovation forward, both from within the industry and beyond traditional walls, says Scott Arnold, executive vice president and CIO at Tampa General Hospital, who manages innovation efforts there.
“It’s not just about technology,” Arnold explains. “Innovation is hard to do when you have a busy health system and busy administrators. To do it, you have to have some leaders with vision to push the boundary to fix the broken healthcare system. If we don’t lower (care) costs ourselves, the government will do it for us.”
Boom and bust cycle
With the increasing digitization of healthcare, hopes have soared for years that technology could be used in innovative ways. Often, technologies have risen and crashed along the Gartner Hype cycle, being buoyed by overoptimistic expectations then running into obstacles or resistance in implementation at healthcare organizations.
For example, a 2016 article in The New England Journal of Medicine predicted that “machine learning will displace much of the work of radiologists and anatomical pathologists” set off a furor two months later at the Radiological Society of North America conference, creating a negative perception of artificial intelligence at the outset. Years later, much work remains to successfully incorporate AI in radiology, according to presenters at an RSNA session.
Such cycles of hype occur frequently in healthcare technology, but often result in reasonable adoption in practical use cases. That trend was evident at HIMSS23, with ChatGPT getting much of the buzz at the show. The natural language processing tool enables users to have human-like conversations with chatbots, and can be used to write emails, notes and computer code.
Launched as a prototype in November 2022, expectations are high for how ChatGPT can facilitate or automate burdensome efforts in healthcare. Some foresee at least a dozen possible uses for the technology, ranging from clinical decision support, assistance for patient interactions and help in medical documentation.
And it's not just conjecture – during the week of HIMSS23, Microsoft and Epic announced the expansion of a strategic partnership to develop and integrate generative AI into healthcare. The companies say they expect to combine the power of Microsoft’s Azure OpenAI Service with Epic’s electronic health record, with the intent of increasing productivity, enhancing patient care and improving financial performance. Subsequent efforts are expected to enable the use of natural language queries and interactive data analysis to Epic analytic tools.
While ChatGPT represented a lot of the buzz at HIMSS23, other innovations showing progress included other uses of artificial intelligence, quantum computing, virtual reality and other technologies that can enable virtual care or the seamless exchange of healthcare information.
The industry’s residual resistance to change or technology adoption was lowered because of the COVID-19 pandemic, and now, increasing financial pressures and the need to better support overburdened clinicians with their workloads is heightening the interest in innovation.
That, and the maturing of advanced computing approaches, such as the cloud, data exchange and analytics, have resulted in growing research in innovation, exemplified by the growing number of innovation centers, experts say.
In search of practical application
Healthcare organizations are looking to be selective in picking which forms of innovation to pursue, says John Tippetts, chief architect at Intermountain Healthcare, who is responsible for leading teams in enterprise and business architecture, enterprise solution architecture and emerging technologies.
“With so many new technologies coming every day, such as generative AI, there are cool tools that come to the technology landscape and we have to pick and choose,” he says. Intermountain assesses the potential of innovations by four metrics – improving patient outcomes, containing costs, and improving patient and physician experiences within the system.
Increasingly, organizations that want to innovate are looking inward, seeking to gain participation and input from those in the organization.
“We have an innovation hub on our campus, which is a physical manifestation of getting input from the front lines,” says Tampa General’s Arnold. “We have 14,000 innovators at our company, not just a small handful.”
Impetus for innovation at Tampa General also comes from its executives, and it seeks input from all levels, Arnold says. “We see trends at a leadership level – we feel strongly that healthcare is headed to lower cost settings, as an example.” In response to the belief that this trend would result in more care being provided at patients’ homes, Tampa General worked with Shields Capital in 2022 to develop Shields at Home, which helps health systems and hospitals design, implement and operate Hospital at Home programs. Shields at Home’s inaugural Hospital at Home program was launched in 2022 in partnership with Tampa General.
“We seek to lower the cost of healthcare by providing it in the lowest cost setting,” Arnold says. “The only people in the hospital should be the sickest. From a financial perspective, we’re hurting ourselves, but it is the right thing to do. It will help us with a capacity issue that we will have anyway.”
In seeking to develop innovative efforts, Tampa General aims to focus investments on its strategic imperatives, which include care quality, operational efficiency, market growth, supporting consumerism and physician alignment. It uses information systems from Epic, but executives know that it must look to other technologies to fill gaps.
“There are ‘white spaces’ that remain unfilled,” Arnold notes. “We look to different sorts of technologies to find innovators that are really cool.”
Tampa General’s investment approach is somewhat similar to that of Providence, which operates Providence Ventures, a health technology incubator. Providence has spun out two digital health companies from its digital innovation group and invested in other digital health companies. Providence operates “on a much larger scale. We’re trying to make good investments that will help do two things – solve a problem and generate a little revenue.”
A crucible for ideas
Similarly, Intermountain fosters innovation with participation from internal caregivers. The 22-hospital system operates its Gardner Transformation Center as well as Intermountain Ventures, which is dedicated to innovation incubation and developing commercial opportunities with Intermountain departments.
The Ventures initiative includes the Intermountain Foundry, a program designed to help caregivers develop business products and models. “The Intermountain Foundry helps Intermountain inventors, innovators and entrepreneurs determine the commercial viability of their business concepts and scale them throughout Intermountain Healthcare and the broader healthcare industry,” the organization notes on its website.
One such innovation developed through the program is a real-time electronic decision support system called ePNa that helps clinicians treat patients by making recommendations at the bedside about optimal courses of treatment.
Intermountain fosters a culture of innovation “up and down the chain of command, from the CEO all the way to individual caregivers,” Tibbetts says. It uses daily huddles as a systemwide mechanism not just to identify issues but also to collect ideas “that can improve the care and the operations of the business,” he says. “These can make their way up to the executive leadership team.”
The system also conducts innovation workshops based on the methodologies of Clayton Christensen, the late author of several books on innovation who used to serve on Intermountain’s board of directors. Part of that approach involves “looking at how to disrupt some processes that may have stagnated over the years,” Tibbetts explains.
New industry cooperation
Intermountain and many other health systems pursuing innovation have mounted collaborative efforts, which include working with other organizations across the nation and vendors, both large and small.
Intermountain “has partnerships with consulting groups, and we have an innovation partnership with Microsoft and we work with Salesforce,” Tibbetts says. “Working closely with big tech is another piece of our innovation strategy.”
In addition, Intermountain is working with Stanford Medicine, which operates the Stanford Healthcare Innovation Lab, Atrium Health, which participates in Charlotte’s Innovation District, and other provider organizations on innovation initiatives.
Similarly, Tampa General has a “network of partners” that includes other health systems from across the country, Arnold says. “It’s interesting how fast word spreads if you’re trying to solve a problem,” he notes. Tampa General is also a member of AVIA, a digital transformation partner for healthcare organizations, which offers memberships and advisory services that link provider organizations to innovative digital technology solutions.
The Mayo Clinic also is working with other organizations on collaborative innovation, says John Halamka, MD, who is president of the Mayo Clinic Platform, directing a portfolio of platform businesses focused on transforming healthcare by leveraging artificial intelligence, connected health care devices and a network of trusted partners.
“What the COVID pandemic did do was reduce competitive angst,” says Halamka, who’s also the International Healthcare Innovation Professor at Harvard’s Medical School. “We found we couldn’t solve problems unless we worked together.” Among the organizations Mayo is collaborating with are Stanford, Kaiser Permanente and Anthropos, a technology innovator seeking to improve patient monitoring in the home to detect health changes.
“I don’t think any of these hospitals in the mid-2000s would have worked together,” Halamka says. “But now, we don’t need to centralize data – we can have a federated approach where each organization can hold its own data. Technology now is good enough, and there is policy and regulatory relaxation, and the cultural change has accelerated us. It's kind of a perfect storm for innovation.”
And healthcare is an industry ripe for a fresh look at technology-enabled change, he adds. “It’s most exciting that we’re able to move forward quickly. Mayo’s approach is to start small, think big and move fast. We want to do that with providing hospital care in the patient’s living room.”
Change is still hard
Economic forces, patient preferences and the need for clinician support and clinical improvement soon will drive a wide range of innovation, executives believe.
Tippetts sees potential in technologies supporting advanced visualization engineering, ranging from 3D printing to virtual reality. Advancements in printing technology and the ability to build models easily based on MRI and CT scans can support the needs of surgeons, or alternatively, a 3D model can be imported into a Microsoft HoloLens to enable visualization in mixed reality settings. Intermountain is pursuing advanced visualization in liver transplant surgery and in radiation therapy, Tippetts says.
Arnold sees the greatest need to increase innovation in care coordination, supporting both clinicians and patients in navigating healthcare systems. “That needs to be disrupted for good, and right now, I have not met a health system that does this really well. It needs to be improved for all sorts of disease states – it’s ripe for disruption.”
Disruption must lead to innovation, and he sees hopes in the hundreds of new vendors that come to the HIMSS conference annually, populating small booths and setting forth innovative solutions. There’s room for a lot of work, tailoring solutions that creatively meet organizations’ needs.
“Innovation is a fancy word and it’s a little overused – the way that health systems are approaching it to me reminds me of the notion that when you see one system, you’ve seen only one. Everyone is approaching innovation a little differently," Arnold notes. "The No. 1 key for success is to have the culture at the top, opening the way to change things.”
Achieving innovation is hard work, still, in healthcare. “When leaders get together that have innovation teams, it’s a little bit of therapy for all of them. It’s a struggle with innovation getting something into (the workflow) – there’s friction, there’s pushback, there’s pressure. The majority are just trying to solve problems for their healthcare organizations. You need a focused effort, and you need people with the full-time job of looking over the horizon.”