Sunday, October 4, 2009

Why it's taking so long for me to write about Innovator's Prescription

In a comment on my Verizon Wireless post the other day, someone asked if I'm going to write more about The Innovator's Prescription, the book that's been sitting in my "Currently Reading" widget since June. Since I just pulled it out to continue, this is a good time to fess up to what's going on.

This book is breaking my head, in good ways. It's taking me a long time to think about all of its insights, assimilate them, and let them filter down into the nooks and crannies of my thinking about healthcare.

As one indication, here's a snapshot (courtesy of my webcam, as I sit on this Virgin America flight to a conference in San Francisco) of a two-page spread of the book. Now, I don't usually make this many marks in a book when I read it; I only mark up things I really want to remember, really want to come back and study again. But this single two-page spread has many underlines, circles, margin notes and highlights.

This book is dense, and I mean its information content, not its writing style. And what the authors say about healthcare delivery systems - and how industries evolve - is resonating with my experience both as a patient and as someone who's watched industries evolve, from inside and out, for decades.

Two weeks from now I'm speaking at a conference in Philadelphia with Jason Hwang, co-author of the book, so I want to get it wrapped up by then. (He's the opening keynote; I speak that afternoon.) But just to give a hint of how much juice there is in this book, here are some notes I've scribbled on the inside cover about potential blog posts:

  • The three approaches to achieving data interoperability (p. 138)
  • Toyota's approach to the "right data in the right place at the right time" problem (p. 138)
  • Our health data must be open, not held hostage - vendors must learn to make money by adding value not locking up our data in their private vault (p. 142)
  • As the data become commoditized (not locked up), the software tools that add value will become decommoditized, and this is where new vendors will make money... as old-wave vendors will suffocate. (p. 142)
  • 3/4 of our direct healthcare costs are related to chronic disease, not acute illness. Any approach that doesn't address this can only dent the surface. (p. 150)
  • Their study across industries over the years has shown that the improvements brought about by disruption require new business models too, not just new technology. The business model (the cost structure!) of physicians and hospitals is appropriate for acute illness (relatively brief time from diagnosis to cure or death) and isn't viable for conditions that last for years. (p. 150)
  • The importance of finding why a pattern happens - the underlying mechanism that explains our observations and predicts what's likely next. (p. 151)
Each of those points is important enough that I'd be willing to write a post about it or give a whole speech about it. And that's in a 13 page segment... of which pp 143-148 are a chapter's endnotes.

Mind you, I have some concerns about limitations of their view, but before I spout about that, I want to have finished it!

Look, this is an important book. It's not political; these guys are trying to drum into our skulls that they've found something that's important to understand.

I know not all great healthcare minds agree with their prescription, and only time will tell whether they nailed it. But if I had a half million to invest, I'd be avidly sizing up my options in light of the Christensen/Hwang framework.

It's entirely readable (no geek credentials required, no HITSP ARRA alphabet soup). There is no magic to this. Be old-fashioned: read a book, and understand it for yourself. :-)


  1. So true Dave !.
    This book puzzles me on a day-to-day bases. The insight are so strong and some of them could be quickly implemented with strong leadership. Even in the Netherlands where we have a fair health-system : we need a more participative way of healthcare.

    This is a step-by-step journey, just as our passion on Health 2.0 is on the whole. I often refer to it as (r)evolution Health 2.0 :

    The insights of the authors are mind-boglling to me and some of my colleagues, especially on how to get this up and running, knowing this HAS to be the heading and we have to point out the waypoints.

    People like you are needed to make a wake-up-call every day, over and over again. I'm confident this one day will be a viral ;-)

    please keep up the great work and find more e-patients, keeping us awake and helping us to wake others.

    Many greets, Lucien

    Lucien Engelen (@zorg20)
    Radboud University Nijmegen Medical Centre, the Netherlands
    Health 2.0 Ambassdor

  2. LOL, just last night I was trying to read this tome, put it down and actually said aloud to myself, "this book is giving me a headache."
    I agree about the insights, and agree that not all of them may be on target (for instance, there is evidence that the Minute clinics are not making enough $$ to cover their startup costs, WSJ a couple weeks ago.)
    See also my efforts to engage Paul Levy on his blog, the first post on Kaizen corner.
    Look forward to your thoughts when you (and I) finally finish this thing! Race ya, haha!


  3. In case you’re not subscribed to the e-patient blog yet (you should be), check out THIS new item: Christensen and Hwang just published a new article today in The Atlantic, Power to the Patients”. Incredible opening.


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