The Technology Disrupting Healthcare

At our 2019 Clinical Advisory Board event, our final panel focused on the science and technology disrupting healthcare. The panel was comprised of physicians who are world-leading innovators in their respective fields. In case you don’t have time to watch the full video, (we highly recommend it) here is an overview of the presenters and the key takeaways from the discussion.

Dr. Daniel Hashimoto is driven to democratize surgical expertise. Working with collaborators at Harvard, his research uses artificial intelligence to develop a database of surgical expertise that will function as a collective surgical consciousness for improving the quality of surgical training around the world.

Dr. Hutchins is an anesthesiologist, Executive Director, and Chief Medical Officer at the University of Minnesota Health’s Ambulatory Surgery Center. As a pain expert committed to combatting the opioid epidemic, he travels the world sharing his research regarding multi-modal analgesics and explaining how new approaches to pain management could relieve society of the opioid epidemic.

Dr. Killeen is an emergency department physician and faculty member at the University of California San Diego, where he works tirelessly to develop systems that get the right patient data to the right practitioners at the right time. His work facilitating the data flow from ambulances to emergency departments, has dramatically decreased the time it takes patients to get from the ambulance to the appropriate specialists.

Dr. Lillegard splits his time between Minnesota Children’s Hospital where he conducts some of the world’s most challenging fetal surgeries and the Mayo Clinic where he conducts groundbreaking gene correction research. He’s motivated by the belief that it’s better for patients and society to intervene with diseases earlier rather than later and to cure diseases rather than manage them.

Each of the panelists explained that their technological innovations exist within a cultural framework. Their technologies can only improve healthcare outcomes if the innovators can strategically navigate the cultural and regulatory milieu. Dr. Killeen stated that innovation is as much about culture change as it is about new technologies, “We’re constantly changing the culture and challenging our colleagues on the culture change.” His goal of making sure each patient’s data is in the right place at the right time requires practitioners to change the way they view routine data entry. He explained, “When we meet with patients, we become the creators and stewards of the data, so it’s important that we create the nomenclature, so the patient’s future doctors can understand everything we wrote and can treat the patient effectively.” Developing an EMR system that guarantees a patient’s data travels with them, requires practitioners to view data entry standards as a critical component of their jobs. It’s as much of a cultural transformation as it is a technological one.

“You’ve had the surgeon general say opioids aren’t addicting, you’ve had the pharmaceutical companies saying push this, push this, push this.”

The cultural barriers preventing adoption of a new way of thinking were most obvious in Dr. Hutchins’ work addressing the opioid epidemic. Regarding the history of opioid administration, he said, “You’ve had the surgeon general say opioids aren’t addicting, you’ve had the pharmaceutical companies saying push this, push this, push this.” Dr. Hutchins’ research on how multi-modal analgesics can reduce the need for opioids directly challenges the status quo of pain management. Sticking to his research and beliefs about what is right, has led Dr. Hutchins to say no to prescribing opioids despite pressure from his patients and institution. Pain management is a complicated science that can’t be reduced to the typical talking points regarding the opioid epidemic. Because Dr. Hutchins’ work embraces that complexity, he finds that his innovations receive some resistance, since they don’t fit neatly into the agenda of the pro-opioid pharmaceutical companies or the anti-opioid activists.

The projects of Dr. Hashimoto demonstrated how global cultural perspectives can affect the adoption of new technologies. When talking about developing the algorithms for AI assisted surgeries, Dr. Hashimoto explained that the values built into the system must be reflective of what society values. Citing the MIT Moral Machine Study, he explained that there is no global consensus about the values that should be built into AI. This means, his research team must be in constant conversation with people from different disciplines and cultural perspectives to ensure that they build systems in line with the needs of the diverse cultures of the world.

Dr. Lillegard explained how the regulatory environment affects the adoption of his discoveries. He expressed sadness that millions of people in the world still suffer from diseases that have proven to be curable. The field of genetic therapy is growing faster than the FDA can keep up. These gene therapy technologies are poised to cure diseases quickly and at an exponentially lower cost to the healthcare system, but the time and expenses associated with gaining FDA approval limits gene correction technology’s ability to disrupt the healthcare market.

The experience of these four doctors, highlights how the technology is just a small piece of the innovation puzzle. To truly disrupt the healthcare industry, you must be able to understand and navigate the cultural and regulatory environment as well.

New technologies require people to think differently about the work they do and the problems they focus on solving. A person can only think about so many things at one time, so it is important that the new technologies do not put too much of a cognitive burden on practitioners. When asked about the most important factors for successfully implementing a new technology Dr. Killeen said, “It’s really all about reducing cognitive load.”

“Physicians who weren’t pain specialists were being told to control their patients’ pain, and they were also being told they had to use a computer for everything when in the early 2000s most physicians had never used a computer before. It was too much to ask for.”

Dr. Hutchins showed how putting too much cognitive load on physicians can have devastating consequences on society. He explained how the simultaneous implementation of pain ratings and EMRs overwhelmed doctors, “Physicians who weren’t pain specialists were being told to control their patients’ pain, and they were also being told they had to use a computer for everything when in the early 2000s most physicians had never used a computer before. It was too much to ask for.” The physicians’ discomfort with EMRs and lack of expertise regarding pain management led many physicians to prescribe a high number of pills to every patient, because it meant they didn’t have to change their default settings and would reduce their time spent interacting with the EMR. This flooded society with many more opioids than patients needed, and the effects have been tragic.

The need to recognize practitioner limitations extends to the operating room as well. Dr. Hashimoto spoke about the importance of recognizing the cognitive capacity and existing paradigms of surgeons. When asked about sophisticated operating room devices that might resemble Xbox controllers he said, “When these technologies come out there will be a whole span of different generations of doctors using the technology. My father’s sixty-four and he’s still operating. I’m operating in my thirties and we have a totally different conceptualization of using some of these devices.” Some tools might be great for some doctors and overwhelming for others. Anytime a practitioner has to dedicate attention to figuring out how a tool works, it takes their attention away from providing the best possible patient experience.

Developing successful innovations depends on creating technologies and operational procedures that minimize the cognitive load of practitioners. The ideas that allow practitioners to direct more of their attention on their patients will improve the patient experience and disrupt the healthcare industry.

As shown by the four panelists, productively disrupting the healthcare industry requires a collection of skills. You must have the technical capabilities to develop the technologies, while also understanding the limitations of each practitioner, and courageously challenging the existing mindsets that prevent the adoption of new technologies.

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