Funding for digital health startups in the United States hit $38 billion in 2021, up 75% from the year before. With billions and billions of dollars being pumped into hundreds of entrepreneurial companies and thousands of healthcare innovations being developed, one has to ask: Why isn’t U.S. healthcare already undergoing a radical technological revolution? And why is healthcare the only industry in which over the past two decades the introduction of computers, data analytics, robotics and AI have raised, not lowered, costs and failed to make a major improvement in quality outcomes?
I offered three reasons this week in my keynote address at the 2022 InnovatorMD World Congress in San Francisco (Aug 18-20), the nation’s largest physician innovation event. The host of the conference is Uli K. Chettipally, MD., MPH. Not only is he the InnovatorMD president and founder, he’s also a talented colleague. During his time with The Permanente Medical Group (Kaiser Permanente), Uli was an excellent emergency physician and chair of the emergency department.
He asked me to speak at this year’s event about the intersection of technology and medical culture to help attendees better understand why some innovations flourish in American medicine while others fail. To that end, I offered three reasons why great innovations and new technologies are NOT adopted in medicine.
Reason 1: The innovators
About once a week, I meet with entrepreneurs who tell me they have the best IT professionals in the country working on an amazing new product. One CEO recently told me that his company has developed a tool that saves healthcare professionals three hours every day.
Unfortuantely, doctors weren’t purchasing it.
“So, Dr. Pearl, what do you think the problem is?” the CEO asked.
I paused, thought carefully about my response, and told the young CEO, “The problem is you’re delusional. Any product that saves doctors three hours a day doesn’t need a better marketing plan. If this product does what you claim, you should have a line out the door.”
The problem, too often, is that innovators start by creating a “brilliant” technology and then ask the question: How can I sell it? They have their eyes on grabbing a slice of the $4.1 trillion healthcare industry rather than on solving real-life, day to day problems clinicians and healthcare leaders face. This technology-in-search-of-an-application approach rarely works.
My advice to innovators: Begin by figuring out the problems clinicians want solved, and then see if there is a technology that can address them.
Reason 2: The doctors
Innovators and their innovations are not the only reason great technologies fail. Some of it has to do with the medical profession.
Those who choose medicine as a career dedicate a decade or more of their prime years to learning the required skills. They are both deeply passionate about the work they do and consistently overwhelmed by its demands and challenges. To understand why certain innovations flourish or fail in healthcare, you need to understand the people who comprise this bizarre and often mysterious profession.
Starting in medical school and residency, doctors are taught a unique set of values, beliefs and norms—which combine to form the culture of medicine. One of unwritten rules of this culture—a rule that informs many of the decisions that physicians make—involves the role that technology plays in their lives.
In short, any innovation that lowers the status of the doctor will be rejected while innovations that elevate the status of the physician will be embraced. While there are some rare exceptions, this rule has held firm throughout medical history. Doctors rejected Daniel Fahrenheit’s miraculous thermometer because it threatened to obviate a skill that 18th-century physicians were very proud of (the ability to take a patient’s temperature and assess fever, manually). And today they are resistant to data analytics and AI, since they challenge the judgement and status of the physician.
In contrast, surgeons love using multimillion-dollar surgical robots because they’re exquisitely cool and raise the prestige of the physician who uses them, even though they raise costs and have never been proven to improve clinical outcomes or reduce complications to any major degree.
My advice to innovators: Understand the culture of medicine better than you think do today before you begin, rather than waiting until the technology is ready to be marketed.
Reason 3: The payers
There is a lot of finger-pointing in healthcare today. It happens any time someone asks the question: Who’s going to pay for this?
Take home-monitoring devices as an example. Patients think the doctors who prescribe them should pay. In turn, doctors point to insurers and insurers point right back to the patient. No matter how great the technology, it won’t be embraced unless someone is willing to pay for it.
That’s the trouble with artificial intelligence. Studies confirm AI is more accurate at reading mammogram studies than even the best radiologists. Knowing this, you’d think that every radiology department in the nation would be using AI to double-check the accuracy of a diagnosis and inform the radiologist when there might be a missed cancer. But this approach would take more time and would not be reimbursed by insurers, so it is rarely done despite the lives it might save.
My advice: Recognize how difficult it may be to monetize your technological solution before you start and figure out who will pay for it once it is developed.
I closed my talk by speaking about the future and the impact companies like Amazon will have on healthcare. I pointed out that they will put the patient first, and that they won’t be willing to purchase technology that doesn’t improve quality and lower costs. I predicted that the hurdle to adoption will be higher in the future, but the opportunity to make a difference in the lives of people will be 10x greater. And as a result, I am optimistic that through innovation and advanced technology that we can make American healthcare once again, the best in the world.
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Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. All profits from the book go to Doctors Without Borders.
