This is an enterprise that is, complex and risky, and at the same time, a potential rich productive and creative, process. Such is underpinned by a Schumpeterian view of innovation that emphasises dynamic creative destructionof technologies, organisations and economies.
In my opinion, eHealth innovation is an arduous process of perfection. Through a creative destruction that underpins the engineering and scaling eHealth functionally, geographically and organisationally. Capturing benefits requires relentless innovation at both enabling hospital and national levels.
The current interests and investments in eHealth informatics is an example of a productive and creative potential. The collection, collation, storage and analysis of distributed and messy health data for supporting quality and efficient healthcare delivery, typify most recent eHealth implementations. Certainly, harnessing the power of human and computer networks to derive knowledge and wisdom from massive and unstructured demographic, genetic, biomedical and pharmaceutical data, is bound to be revolutionary for personalised, clinical and public healthcare. Nonetheless, limited interests shown to innovation for harnessing Big Data, can frustrate benefits realization.
Given eHealth users are fastidious and demanding, then, the supporting technologies organisational processes and economies are bound to undergo regular and continuous innovation. The hardware and software technologies must be constantly invented and engineered for adapting to these users’ needs and preferences. Such dynamic innovation takes place at both the hospital and national levels.
eHealth creative destruction
The productive and creative engine of eHealth innovation of this and all kinds also needs a concomitant destructive one. To optimally harness Big Data, converging computing, medical and telecommunication software and hardware, have to be networked and interoperable. And these, for one reason or the other, may not be user or environment- compatible, and/or may in time of use become outdated or obsolete. Necessitating a need for relentless innovation – constant improvement and upgrading.
Procuring and assembling computers and digitalised medical devices, come easy. But, tweaking, tinkering and upgrading them to doctors’ and nurses’ workflow or to patients’ clinical pathways, is a complex and dynamic process. Most existing hardware come as inflexible, non-standardised, thus frustrating the required re-inventions and integration. Imagine how difficult it would be for a hospital to digitalise images from an old X-ray machine. The machine would not have, for instance, a USB port, and thus would not compatibly network with a computerised picture archiving and communication system (PACS). Even if the machine was digitally-enabled, it would probably be fitted with clunky software that would not be as smart or intuitive as Android or iOS. In the same line of thought, a Smartphone-based telehealth or telecare system built for remote personalised wellness monitoring, might be technically tasking to integrate with an inflexible hospital electronic health record (EHR). A similar constraint can be encountered with the use of wearable consumer electronics for eHealth purposes.
Google Glass, for example, could enhance a surgeon’s capability during an operation. Aside from a likely issue of testing eye-hand coordination (something I observed when I tried one at the Ovum Future Work Summit in London), networking could be a challenge. A brief experiment carried out by the University of California-San Francisco, informs that an issue of a hospital-telecommunication hardware incompatibility, can constrain a seamless integration of the Glass into surgical care pathways.
The inherent complexity involved in integrating different technologies together, further underscores need for relentless innovation. Same can also be said of adapting eHealth software to users and their organizations.
Software might seem easy to re-code once procured; however, to become optimally useful, eHealth software have to be flexible and adaptable. For instance, a successful adoption of an EHR, calls for continuous and regular recoding, in order to meet varying and changing functions and processes, required by demanding and fastidious clinical and managerial organization in hospitals and clinics. Of course, poor interoperability and non-conforming data standards further make optimal integration and utilization, more frustrating.
The adaptation of eHealth software for optimal performance is more complex than for hardware’s. Mimicry – successfully adapting and reproducing software to real-life actions, events and contingencies, is how to make the software works optimally in the long run. This conundrum is understood by the Tasmanian Government in Australia. It identified that upgrading eHealth software is more complex and costly than for hardware, as it is planning to integrate its regional system with the national one. The need for long-term mimicry can often be underestimated.
The debates that are following the recent US HealthCare.gov website’s setback in my view are underplaying relentless innovation imperative. The cause of the reported ‘software glitches’, was seemingly, a breakdown in communication between the procuring national government and the multiple contractors. A case of a static institutional capacity, not growing quickly enough to meet and address the contingencies of a large-scale technology implementation. Nonetheless, I am of the opinion that much time is needed to unravel and minimize implementation complexity, so as to give room for evolutionary adaptation and invention.
The reported difficulties being encountered with the use of England's NHS 111 health phoneline service, in my view, is a case of lagging institutional innovation trailing behind the implementation of a new eHealth service. Issues of financial constraints aside, giving ample time for users, organizations and technologies to co-adapt, would drive-up adoption and utilization.
Mimicry is often difficult to attain in a short-time, thus, the reason for a continuous and regular accommodation of changes and pursuit of relentless innovation.
The pursuit of relentless innovation, in my view is essential and needed.
Coming back to the topical issue of Big Data, to enable high-yielding and beneficial bioinformatics, software must mimic users and organisations and hardware must be flexible and network-able. Most essentially, eHealth technologies must be standardised, interoperable and adaptable. It is my reckoning that seamless integration and interoperability of converging consumer and enterprise technologies are necessary to realize benefits.
Given that eHealth engineering is a long-term process. Then, both hardware and software must in the course, be flexible and pliable enough for both contingent adaptation and re-invention. And such require relentless innovation to happen.
Continuous and regular changes underpin an inevitable creative destruction of technologies, processes and economies. Such are necessary to minimise short-to-medium -term adoption and utilisation risks, and open a door of opportunity for eHealth service and technological creativity and productivity. Under this dynamic condition, hospitals’ organizational processes and national economies have to be innovation-capable and ready.
Enabling hospitals and nations
The pursuit of relentless innovation begins with the users. eHealth users often struggle to effectively adopt and utilize technologies for care and management. Thus, organisational change must quickly accompany and meet users’ needs and technological demands. It is imperative that doctors, nurses and managers be constantly trained, so as for them to quickly adapt to new or upgraded technologies.
Hospitals have to be capable of supporting in-house re-invention and upgrade of eHealth software and hardware. Trained engineers must be on stand-by to remedy user-technology conflicts and if possible fabricate spare parts for hardware and recode software. A well-equipped and financed engineering unit must be capable of liaising with technology contractors, vendors and manufacturers.
Innovation in Hospitals requires a supportive and conducive ambience. The state of a country’s eHealth innovation capability is thus essential for relentless innovation.
Countries with established enterprises in the design and manufacturing of medical, telecommunication and computing converging and combining devices, are more likely to response quicker and better to engineering risks that complicate eHealth implementations. The US hosts a vertically integrated company, GE, which prepares the country to address the likely risks of convergence and combination. To emphasise the resourcefulness of domestic companies for relentless eHealth innovation, is to appreciate how quickly Google, Oracle and others, on behest of the US national government, came to the rescue of the malfunctioning HealthCare.gov website. Not surprisingly, widely recognised beacons of EHR implementation success are US-based Mayo Clinic, Kaiser Permanente and Veterans Health Administration. The latter is regarded as a global leader in telehealth implementation and utilization.
South Korea is a country that is making considerable progress with its national eHealth implementation. It also hosts a vertically integrated multinational such as Samsung, which manufactures medical, telecommunication and computing technologies. And might soon become a major producer of technologies for the country's burgeoning national implementation.
The emergence in the UK of innovative eHealth software start-ups (few of which I have had discussions with their Founders), promises to generate innovations from which trusts and GP polyclinics can benefit. But, translating promises to gains would require the NHS and the Central Government to incentivize innovation, investment and adoption.
By stressing that relentless eHealth innovation in hospitals will be difficult and frustrating without a supportive national environment, is akin to say that a fish cannot survive without being in water. Same goes for understanding how to make eHealth scale and sustain.
Big Data thrives on digitalisation and informatics, but without regular and continuous innovation, it will be a struggle to derive and create clinical and commercial values.
Scaling and engineering eHealth is as Lexus marketing slogan says: A relentless pursuit of perfection.