Disruptive health technologies:Implications for HTA.

Don Husereau BScPharm, MSc dhusereau@ihe.ca

(1) Senior Associate, Institute of Health Economics, Edmonton, Alberta

(2) Adjunct Professor, Department of Epidemiology and Community Medicine, University of Ottawa

(3) Senior Scientist, Institute for Public Health, Medical Decision Making and Health Technology Assessment UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik GmbH

Presentation to CADTH Sympoisum Panel Session, – St. Johns, NF

Date: Tuesday May 7th, 203: 10:15 – 11:45

Objectives

• Objective is to explore what might need to change in an era of disruptive technologies.

• What is a disruptive technology?

• Examples of disruptive technology?

• What challenges did it bring?

• Are HTA methods sufficient?

• How to recognize and prepare?

Disruptive or “Game-changing”?

Christensen CM, Grossman JH, Hwang J. (2009) The Innovator’s Prescription: A

Disruptive Solution for Health Care. New York, NY. McGraw-Hill

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Lucas Jr. HC, Goh JM. Disruptive technology: How Kodak missed the digital photography revolution. The Journal of Strategic Information Systems. 2009 Mar;18(1):46–55.

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Lucas Jr. HC, Goh JM. Disruptive technology: How Kodak missed the digital photography revolution. The Journal of Strategic Information Systems. 2009 Mar;18(1):46–55.

Business Models

• Solution Shop – e.g., heart institute

• Value-added business – e.g., hernia repair at Shouldice (hips/knees in Kemptville)

• Facilitated network – e.g., Ontario Family Health Networks

Examples

• Diagnostic Imaging– MR guided focused ultrasound

– Computing in radiology

– Mobile computing platform in radiology

– Picture Archiving and Communication

– Molecular Imaging

• Personalized Medicine/ Genomics– Gene based vaccines

• Hospital Based Care– Single specialty hospital

– Ambulatory surgery centre

– Operating room organization

– Operating room of the future

– Orthopedics (several technologies)

– Pediatric Surgery

– Surgical robotics07/05/2013 8

Examples (cont.)

• Patient Self Care– Health care Tourism

– Social Media

•

• Primary Care/Community Care– Retail clinics

– Workplace clinics

– E‐Clinic for Drugs

– Extension for Community Health Care Outcomes

– Community Health Networks

– Community Nursing Center

Service or Technology?

• No real difference

– Technology is knowledge applied

– Always has a context

– HTA often misperceived

• HTA is value capture

– How to best capture value?

Value capture – how?

• Organizational culture has a very important role in its response to technology-enabled transformations1

• An organization culture that promotes hierarchy and maintaining the status quo will be resistant to disruptive technologies

• Culture defines what the organization does, but it also defines what it cannot do, and in this respect can be a disability when confronting a new innovation.2

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1. Burke, 2002 W.W. Burke, Organization Change: Theory and Practice, Sage, Thousand Oaks, CA (2002).

2. Christensen and Overdorf, 2000 C.M. Christensen and M. Overdorf, Meeting the challenge of disruptive change. Harvard

Business Review, 78 2 (2000), pp. 66–76.

Value capture – how?

• Deliberative processes– Are knowledge-based – require explicit factual

input – highlight knowledge gaps

– Will focus on patient-centered values – we are all providers or patients or future patients

– Foster dynamic capabilities – “tools that manipulate resource configurations”1

– Improve responsiveness to real (i.e., disruptive) innovation2

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1. Eisenhardt and Martin, 2000 K. Eisenhardt and J. Martin, Dynamic capabilities: what are they. Strategic Management

Journal, 21 10–11 (2000), pp. 1105–1121

2. Christensen and Overdorf, 2000 C.M. Christensen and M. Overdorf, Meeting the challenge of disruptive change. Harvard

Business Review, 78 2 (2000), pp. 66–76.

What does it need?

• Quality culture

• Medical group leadership

• Source of technology assessments

• Physician/analyst partnerships

• Resources and processes that are timely and relevant

• Willingness to start somewhere and be persistent

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Lessons from Alberta

1. Patient-centered health information is critical for game-changing innovation

2. Game-changing innovation doesn’t just happen. Promote and create incentives for innovation, then evaluate. Expect failure.

3. Game-changing innovation requires public engagement traditional boundaries must be crossed today.

4. Value is the new goal. When we aim to create value, we will create accessible, affordable, and high quality health care.

Concluding Remarks

• Many values - value capture is more important than value – then consider opportunities

• Organizational culture defines what an organization cannot do

• Responding to innovation requires a culture of knowledge and deliberation

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Don Husereau

+16132994379

d h u s e r e a u @ i h e . c a

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