The Value of Innovation
And then there is medical technology. There are many parallels. In clinical areas with growing procedure demand, manufacturers are also on an annual innovation cycle: Every year, manufacturers launch the next generation of their technology. If they don’t innovate, physicians will eventually change their supplier.
However, a lot of things are not the same between iPhones and medical technology. The end user of iPhones is the consumer, you and me. The end user of medical technology is not really the doctor, but the patient population that gets better care because of the technology. The doctor, however, has the strongest voice of all in deciding what technology to use. As a health system, in terms of innovation, we very much trust the doctor’s evaluation of new generations of medical devices. We count on him/her to determine that innovation is valuable.
The problem is that the real determination of innovation value is not about the doctor’s user experience. It is the improvement in patient care value, and these two yardsticks don’t necessarily measure the same thing. And in healthcare, we don’t actually have a yardstick for measuring the care value of medical device innovation. We listen to the doctor and pay up.
We listen to the doctor and pay up.
Consider for example the clinical area of electrophysiology. Heart Rhythm Society is the organization and annual conference that organizes everybody in electrophysiology. Heart Rhythm Society (HRS) has established a conference specific to innovation – HRX (this year in early September). It gathers “clinicians, engineers, developers, researchers, entrepreneurs and investors” to discuss and share innovation, which sounds great, except who represents the patient care perspective? Shouldn’t there be some hospital administrators, patient organizations, or value analysis team members there?
The HRX gathering is creating a great environment for technology-based innovation, which also very much characterizes electrophysiology in general and, specifically, how the doctor is looking at new technology and innovation. Clinical trials are focused on two things: Efficacy (outcome) and patient safety, which makes sense. In addition, the doctor is looking for advanced functionality (that doesn’t necessarily translate to better outcome).
...the doctor is looking for advanced functionality (that doesn’t necessarily translate to better outcome).
But there are many forms of medical device innovation that benefit a care-perspective that simple technology evaluation does not consider:
Innovation that makes procedures shorter: I recently had the opportunity to watch a Pulsed Field Ablation (PGA) procedure. Pulsed Field ablation is seemingly safer, and the procedures are done faster. When procedures are done faster, the lab can treat more patients. This is good innovation from a patient-based innovation perspective. The fact that a PFA catheter costs 2-3 times more than other ablation catheters obviously should be considered as well. Since our healthcare system only has so much money, the value of innovation has to be calculated as patient care value relative to the extra cost of innovation.
Innovation that makes technology utilization easier: It is a strange by-product of events like HRX that new technologies seem to offer more functionality, but also are more complex than the technologies they replace. This means that many new innovations in medical technology actually narrows the field of doctors who can master the use of the technology. This means that fewer patients get access to procedures done with the newest technology (as in all professions, not all doctors are equally good at what they do). Innovation that democratizes (makes more accessible to more doctors) technology is good innovation from a patient-based innovation perspective. But we rarely see it.
Innovation that allows procedures to be performed in less expensive locations: The migration of procedures in orthopedics, ENT, etc. from the hospital to the surgery center or the office-based lab has dramatically reduced the cost of these procedures. When we reduce the cost of procedures, ultimately, our healthcare system has more resources to treat more patients – so this is a good thing. Innovation that provides extra safety in procedures and simplify technology utilization are good innovation from a patient-based innovation perspective, because they allow procedures to move out of the hospital.
Innovation that reduces environmental harm and slows the climate change: Medical technology is a major contributor to global warming. Lots of medical devices are thrown away after a single use. In fact, healthcare as a sector is one of the greatest contributors to carbon emissions and global warming. Global warming and climate change have a demonstrably negative effect on population health. Innovation that replaces single-use devices with reusable devices or introduces reprocessability are good innovation from a patient-based innovation perspective
...healthcare as a sector is one of the greatest contributors to carbon emissions and global warming.
Innovation that reduces overall technology costs: New medical technology that combines the functionality of several devices to reduce the overall cost of the basket of devices used in a procedure are good innovation from a patient-based innovation perspective. I have never seen this, simply because this type of innovation cuts into manufacturer profits and therefore will never happen. The problem here is that the $-value of technology costs happens to be exactly equal to the revenue earned by the manufacturer.
I have to admit that HRX has great value in the electrophysiology space. I do believe that it speeds up and focuses innovation. But HRX is not good enough as long as a care-perspective on innovation value is not represented. Healthcare is not about doctors and technologists. Healthcare is about patients and care quality. We need a watchdog, an innovation value index, or the like, to allow the level of end-user scrutiny that always makes Apple perform its best.