An article in today’s Wall Street Journal discusses how hospitals are using the consumer version of the online virtual reality game, “Second Life,” to train nurses, doctors and administrators in dealing with “what if” scenarios. If, as in other news out today, the U.S. actually does face a shortage of 150,000 doctors in the coming years, then watch for this type of training to become pervasive. A two minute video overview of the simulation is here (along with a 15 second obligatory commercial):

When we engage with a client for service design, one of the things we always do is scan their industry, as well as other industries, for any technology that might be a good fit for their particular solution. Too often, companies are inclined to believe that their problem is so unique that only a custom application will do. But by spending some time on deep research, this “re-purposing” ultimately saves our clients tremendous amounts of time and money. One of the areas we have learned to tap into is the U.S. government. With the right search methods, you can uncover a treasure trove of data, software, and intellectual capital that is available for the asking.

An article in today’s Wall Street Journal shows how software, already funded by the U.S. taxpayers, could be the lynch pin to solve one of the most dysfunctional aspects of the U.S. health care crisis. The potential solution lies in a software system that was designed to manage the medical records for Veteran’s Administration hospitals across the country. The software, dubbed VistA (Veteran’s Health Information Systems and Technology Architecture) has been created with several billion dollars of taxpayer funds over the past two decades. The system is now used in over 1,400 VA facilities and the source code is now in the public domain.

According to the paper, “Paperless technologies have revolutionized banking and retailing. But even after a decade-long effort to modernize health care, fewer than 2% of the nation’s 5,000 non-VA hospitals have what could be considered a comparable full-fledged system, according to a recent survey in the New England Journal of Medicine. Hospitals say they haven’t been able to afford the cost of the systems, which range from $20 million to $100 million, and the current economic crisis isn’t helping.”
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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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