Disruption and Innovation in Health Care

Brook, Robert H.

doi:10.1001/jama.2009.1427

Cited by 17 publications

(7 citation statements)

References 6 publications

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“…However, the full potential of these systems to support other critical activities of integrated care are not being fully realized, which can be attributable to implementation determinants as depicted in the three narratives presented. We explore these determinants from the perspective of integrated care as examples of a disruptive innovation [ 53 , 54 ] in the health system, as the model alters the status quo in health care service delivery with an aim of higher quality more efficient care delivery [ 55 , 56 ]. Where eHealth is argued to be a driver of innovation [ 17 ], our study suggests that technology use in these cases remains limited to old ways of working, often creating process inefficiencies and the need for complex workaround strategies.…”

Section: Discussionmentioning

confidence: 99%

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

et al. 2018

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BackgroundInformation communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption.MethodsWe take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis.ResultsDespite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability.ConclusionsEven in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.

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Section: Discussionmentioning

confidence: 99%

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

et al. 2018

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“…In this new world, a visit to a physician might be seen as a failure just as Internet providers believe that a visit to a store is a failure. 5 Perhaps in 20 years, seeing a physician will represent a failure rather than a revenue-generating event. Wouldn't it be nice if the education of physicians were guided not by how many hours need to be spent in the hospital or in outpatient care, but rather by what physicians need to do to reduce dramatically these activities by helping people improve and maintain health?…”

Section: 23mentioning

confidence: 99%

Vision and Persistence: Changing the Education of Physicians is Possible

Brook

2012

J GEN INTERN MED

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“…Consequently, as we evolve into a society of hyperspecialization, it becomes increasingly paramount that we move away from professional isolationism and develop into a culture that fosters interdisciplinary collaboration and collective effort 78–81 . Only in this kind of environment can disruptive innovation flourish and lead to creative solutions which overcome technological impedance and move us forward in healthcare delivery 82 …”

Section: Putting It All Together: Impedance and The Future Of Stem Cellsmentioning

confidence: 99%

Impedance of Novel Therapeutic Technologies: The Case of Stem Cells

Zacharias

Nelson

Mueller

et al. 2012

Clinical Translational Sci

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Human embryonic stem (hES) cell technology has advanced for more than a decade and has come to be regarded as "the gold standard" in the stem cell fi eld.1,2 Th ese cells have met the most stringent standards for pluripotency and demonstrate immense promise for diagnostic and therapeutic capabilities.3 Nevertheless, hES research has given rise to social confl ict and nations remain divided regarding its regulation. 4 We aim to distinguish between the scientifi c and clinical realities of hES technology and highlight the ethical, legal, and social issues concerning its use in the United States (US). In light of obstacles that impede the progression of these technologies, we consider what the future may look like for stem cell research. Scientifi c and Clinical Applications of hES CellsSince isolation in 1981, nonhuman embryonic stem (ES) cells have proven suffi cient to give rise to all tissues of the adult organism across all three embryological germ layers.5-8 Twenty-seven years later in 1998, the fi rst hES cells were isolated from frozen embryos and have since contributed enormously to our understanding of cellular pluripotency. 3 , 9 Although no hES treatments are available for clinical use in nonstudy settings in the US, the fi rst FDA-approved Phase I clinical trials for hES technology are underway assessing the safety of hES cell-derived oligodendrocyte progenitor cells in patients with spinal cord injury and retinal pigmented epithelial cells in patients with age-related macular degeneration and Stargardt's macular dystrophy.10-14 Despite these advances, several practical contstraints impede translation of hES technology into clinical practice.Because of the plasticity and unrestricted growth potential of hES cells, one major concern of using transplanted hES cells in humans is the risk for teratoma formation and tumorigenesis, a challenge faced by all pluripotent stem cell platforms. [15][16][17] As recently reviewed, a number of animal studies have shown an increased risk for tumor formation arising from transplanted hES cells.18 Clearly, such an adverse eff ect must be addressed before hES technology can be off ered as an approved therapeutic product. Another risk inherent to allogeneic stem cell transplants is immune rejection. 19,20 Because hES cells are not "self " tissue, recipients would require immunosuppressive therapy similar to a patient receiving an organ transplant. For example, the Geron Phase I clinical trial stipulates that patients undergoing allogeneic hES cell transplants must receive immunosuppressive therapy for at least 4 months and be monitored for 15 years thereaft er to evaluate for rejection. 21Another concern for hES technology is resource availability. Given the absence of FDA-approved treatments based on hES cells, this topic has yet to be fully addressed. But as the research now shift s from the laboratory to the clinic in hopes of curing hundreds of diseases that aff ect millions of people, we will need to assess practically whether embryos derived from in vitro fertiliza...

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Disruption and Innovation in Health Care

Cited by 17 publications

References 6 publications

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

Vision and Persistence: Changing the Education of Physicians is Possible

Impedance of Novel Therapeutic Technologies: The Case of Stem Cells

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