Health IT

How the illegal, sneaky can inspire healthcare innovation

The Greeks leveraged the sneaky Trojan Horse tactic to win the war after 10 years of futile war making. That can be a model for innovation in healthcare.

Trojan Horse

Sometimes the end very much justifies the means.

And it was very interesting that at the recently-concluded Stanford Medicine X  conference, Stanford, California, a top health IT innovator/CEO and an innovator-turned government official exhorted the idea of the illegal and sneaky (Trojan Horse) as a model for healthcare innovation.

Exhibit 1: athenahealth CEO Jonathan Bush

Bush fired up the audience in his keynote speech repeatedly referring to Uber and AirBnb that have upset the apple cart of the transportation service and the hotel industries.

“Uber and AirBnb were actually illegal,” he said later in an interview. “But they were able to grow so quickly and once people knew what they were missing out on, the lawmakers feared losing their seats by enforcing the law, so they adjusted the law.”

As a result, the stranglehold of those industry bodies governing prices and setting capacity was broken because of the vox populi.

A similar situation exists in healthcare, Bush argued.

“When I look at the details underneath a lot of medical visits, there’s a fair amount of what goes on that is uneconomical for the patient and uninteresting for the doctor,” he said.

All those years of studying and obtaining licenses and what many doctors are doing is trying to diagnose a cough, Bush pointed out.

“So what if I could rally an army of people who could go to their houses. How could we… democratize the treatment outside of those with all those fancy licenses?”

Some of that is already occurring. Take Uber for instance. Last year it provided flu shots to people in 35 U.S. cities. In New York City exists Pager, an on-demand service that connects patients with healthcare in their home, office or hotel. So the model for limited capacity at pricey rate is being challenged

However, the scale that Uber, Lyft and AirBnb have garnered leading to relevant changes in laws is something that healthcare will be hard pressed to replicate.

“I don’t think medicine will brook that kind of revolutionary behavior, partly because most of the costs of medicine are for a small number of people, so [lawmakers] can’t get elected on the 6% of people that are using hospitals in the U.S. on any given day,” Bush declared. “So my metaphor is what’s the functional equivalent of that [in medicine]. If  the people who have redistributed, locked up overpriced capacity — not overpriced but too-expensive-for-us capacity [in healthcare] — have done it by breaking the law, is there a way that we can sneak it through the law?”

Another person is all for this kind of sneaky behavior.

Exhibit 2: Susannah Fox, chief technology officer, Health and Human Services

Fox has embraced the Trojan Horse model for healthcare innovation (co-incidentally both Fox and Bush went to college together, and have stayed in touch).

Here’s a quick refresher for anyone who has forgotten how the Greeks won the Trojan war after battling fruitlessly for 10 years. The Greeks built a massive wooden Horse, hid a select few inside it and pretended to sail away. The gullible Trojans assumed the Greeks had left,  brought the horse within the city walls thinking it to be a gift for the gods and had a big party to celebrate. Soon after, the hidden Greek soldiers came out and opened the city gates to let their compatriots in. Checkmate Trojans.

Fox believes that technology can be that Trojan Horse for change, innovation and disruption in healthcare.

“It’s very difficult for something that is disruptive to come in through the front door,” she said in an interview at Stanford Medicine X. “That is partly why the image of the Trojan Horse came to my mind.”

Fox talked about herself and Todd Park, who co-founded athenahealth but was also HHS’ chief technology officer, as part of a “rebel alliance” that brought the entrepreneurial spirit to the department and began talking about open data, innovation and prize competitions. The same spirit makes her eyes light up when she talks about the Maker Movement in healthcare and her efforts to shine the light on their efforts within HHS.

But Fox also tipped her hat to certain pockets within government that welcome the disruption that she and others have been striving toward.

“When the Trojan Horse of technology pulled up outside the gates of NIH [National Institutes of Health], it was the librarian who opened the gate and welcomed in the Trojan Horse,” she recalled. “Everyone who worked at the National Library of Medicine recognized that there’s going to be an opportunity for opening up their archives to the outside world for better pursuit of science.”

Photo: Wikimedia Commons