Are You a Disruptor and Is Anyone Paying Attention?

Have you ever been a part of a conversation with a large group of people, and you can't get a word in edgewise? You have to use your “outside” voice and make yourself be heard. This can be disruptive and perhaps rude. However, you now can make your point. At least you hope that the group is now listening to you, even if they aren't really paying attention. Well, oftentimes many of us have presented the concepts and the “proof” that telemedicine is a viable tool, only to be shunned or perhaps even ignored. This can be frustrating and discouraging. You keep at it, and eventually you have sparked a conversation that soon ignites a fire. Of course, you want that fire to burn brightly, providing warmth and comfort, but not be destructive, metaphorically speaking.

Are you a disruptor? Have you tried to initiate a telemedicine effort? Has anyone paid attention? Many of us have hundreds, perhaps thousands, of similar experiences about this very paradox. The evidence clearly points to telemedicine's success, cost savings, better healthcare, better outcomes, better compliance, better—you get the point! However, there may be an underlying theme or issue that is the problem. Some of us have posited that telemedicine will in fact act as disruptive innovation.

Certainly, there are several innovations that have disrupted the thinking of the day. Just think of Laennec and his stethoscope in the early 19th Century (1815) ushering in change in heart and lung auscultation. He was up against the “standard-of-care.” The “Establishment”! The established protocol! The same can be said about Semmelweis and hand washing. He was ridiculed by his colleagues for taking the advice of a midwife and instituting the concept of washing hands between obstetric patients. The “standard-of-care” at this period of time in history (1840s) did not include hand washing! According to an American physician in Philadelphia, Charles Meigs, “Doctors are gentleman and a gentleman's hands are always clean.” These two individuals clearly could be labeled as disruptors! What they tried to do was change the status quo to improve healthcare against some pretty stiff odds. Today, there is no real difference in only “disruptors,” people trying to implement change. Of course, the technology is much different. We must ask ourselves as policy makers, as manufacturers, as clinicians, or as administrators, “Is what we do about patient care or about paying the bills?” There is no question there is an underlying protectionist theme. Perhaps we must look at healthcare in a different way. What is best for the patient? That is a “disruptive” idea!

Disruptive innovation—new technologies or approaches for doing a task—can be quite a challenge in adoption or adaptation. Rotheram-Borus et al. ¹ discussed the efficacy of “evidence-based intervention.” They included telemedicine in the same category as $2 generic eyeglasses and automated teller machines. Although many of these devices or systems have been widely distributed and integrated into daily life, the United States appears to be a late adopter in many areas. Technology and media-driven delivery systems were a focus. The use of mobile phones and the Internet are clearly establishing a strong evidence base. The scalability of mobile health and telemedicine is extremely exponential. Just think about the number of mobile phones there are in the world today—over 6 billion. Soon every single person on earth could have a phone or perhaps two. No other technology can even come close to this. Mobile phones are inexpensive and ubiquitous. They are also capable of many things related to daily life, including our health; just check out the App Store!

In a Harvard Business Review article, Christensen et al. ² discussed where disruptive innovations can cure healthcare. They cited several highly effective, accurate, and inexpensive technologies that would add tremendous value to healthcare but that never see the light of day. Why? As Christensen et al. ² put it, “It threatens their business model and their livelihoods.” Ever hear that one before? These authors posited that often innovation can and does provide low-cost alternatives and that once consumers become aware, the market forces, or more importantly consumerism, take over. In retrospect, the phone on the wall was a great device in the home until it became your phone and computing device that is in your pocket and with you all the time. This paradigm shift from home phone to mobile phone has resulted in a change in the communications industry. Christensen et al. ² have developed an effective model of how innovation enters into the market at the lowest level, often while the industry leaders are busy improving their products. As they put it, “think of over-engineered computers.” When a technology leader focuses on improving what it perceives the consumer(s) want, disruptive technologies emerge that do the same thing at lower costs, more simply, and more conveniently. Sort of like letting the patients remain at home and be monitored from their location rather than travel to the physician's office. Christensen et al. ² stated that the model indicates the innovation eventually takes over and replaces the “status quo.” The minute clinics that are being deployed in grocery stores, where consumers can get basic medical treatment, are really disruptive to the established practice of medicine. This model makes perfect sense.

Some states prevent nonphysician personnel from diagnosing and treating simple illnesses. This approach is transformative and can be challenging. However, the consumer wants and expects innovation in care delivery. Telemedicine is one of those disruptive innovations.

The future of healthcare must be balanced by need, by effectively managing resources, and by integrity. Yellowlees et al. ³ discussed disruptive innovation and asynchronous telemedicine where the doctor–patient interaction is separated using tools like Web-based systems. Weinstein et al. ⁴ further this discussion with the opportunities and barriers of mobile health approaches in telemedicine and telehealth.

Hwang et al. ⁵ have indicated that disruptive innovation in the healthcare sector has two key issues: (1) transference of skills from high to low using technology as a tool and (2) shifting from traditional “hospital-based settings” into clinics and patients' homes. This implies that through the integration of technology, a highly trained specialist should concentrate on complex medical issues and that basic health issues should be addressed with more affordable providers. ⁵

There are plenty of other examples that can be used to illustrate the point. Imagine how the 1905 truck driver was ridiculed by the ranchers and blacksmiths of the day. Not too many blacksmiths around today, are there? Every innovation we use today upset someone's business model. Yet it spurred new approaches to doing things, which in turn drove change. Healthcare is coming along at its own pace. It will, of course, have to change faster to keep pace with innovation, as we understand the current model is no longer financially viable. It is time for a disruptor!

You can use the mounting evidence in this Journal to fortify your position. Be a disruptor! If they don't listen now, you can bet they'll listen soon enough!

A Little News About This Issue

At this time of year, the American Telemedicine Association (ATA) holds its annual meeting where anyone who is interested in telemedicine, telehealth, e-health, etc., gathers to see new technologies, visit with colleagues through a growing network, and listen to researchers who are pushing forward in developing a strong “evidence base.” Our publisher, through an agreement with the ATA, publishes the abstracts of the oral and poster presentations. They appear online but are linked to this issue—Issue 5—of the Journal.

In addition, there are several articles worth noting. The one by Bashshur et al. ⁶ looks at the empirical evidence of telemedicine intervention in diabetes management. Vo et al. ⁷ review a national framework for telemedicine and Meaningful Use. Rogov et al. ⁸ provide a summary of the portability of telemedicine. In addition, there are several other important articles that will serve you as guides in your quest for adopting or adapting telemedicine in your practice.