This article from the Santa Cruz Sentinel newspaper outlines a growing trend in service design for healthcare; using email to get a quick answer directly from your doctor.

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An online system, which made it possible for 120,000 patients at Santa Cruz Medical Foundation to check their medical records online, receive lab results and make an appointment for free, now allows them to e-mail their doctor for a fee of $5 a month.Patients will have to decide whether they would rather phone for free or pay to use e-mail.

In the Palo Alto area, which implemented a secure online system several years ago, about 45 percent of patients signed for the free services. About 6 percent use the e-mail message service for which there is a charge.In Santa Cruz, about 16 percent of patients have taken advantage of the online system since it become available a year ago.

About 36 percent of doctors in the United States communicated with patients online last year, up from 31 percent in 2007, according to a survey by Manhattan Research. Those who don’t communicate online are concerned about privacy issues or legal liability — or they feel they should be paid for the time they spend answering e-mail.

Medicare doesn’t allow doctors to bill for e-mail or e-visits, but doctors are hopeful that policy will change eventually.

A book which had a big influence on our thinking back in the late 1990s was "The Innovator’s Dilemma" by Clayton M. Christensen, a Harvard professor who illustrated in very simple and elegant terms how disruptive innovation is brought about not by the folks with the big R&D budgets, but by smaller companies who "thought differently." Instead of adding feature upon feature, these innovator’s create products and services that are "good enough" at dramatically lower (and disruptive) price-points. Christensen and his colleagues have now set their sites on one of the biggest and toughest issues now facing the United States; healthcare.

In the recently published "The Innovator’s Prescription: A Disruptive Solution for Health Care" Christensen, along with co-authors Jerome H. Grossman M.D. and Jason Hwang M.D. lay out some very fundamental and easy-to-understand concepts as to why the current healthcare system is broken. You can read an extended excerpt of the book at the Forbes website, and we have chosen some of the "best of the best" ideas below.

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In order to understand how to "fix" hospitals, first it’s important to understand the value proposition of hospitals. Hospitals have become the workshops within which physicians could be trained and practice their intuitive craft, clinical laboratories where complex medical cases could be solved and unanticipated emergencies and complications could be resolved with as much certainty as possible.

This value proposition has been a great fit for solving poorly understood problems of the past, such as tuberculosis in the early 1900s, poliomyelitis in the 1950s and AIDS in the 1980s. When these diseases were first encountered, they had to be addressed in hospitals. However, in terms of the complexity of diagnosing and treating disease, for a century hospitals have been on a relentless upmarket march on the trajectory of sustaining innovation.
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