Innovation in the Cognitive Era

Throughout the industrial age there has been breakthrough innovation that has changed everything.

Way back when … most manufactured products were made by hand. A craftsman, or team of craftsmen, would create products by hand. They would use their skills, and hand tools, to create the individual parts before assembling them into the final product. The process was very labor intensive.   The assembly line, institutionalized by Henry Ford, changed everything. It also catapulted Ford to market leadership with The Model T and re-shaped the automobile industry … as well as the way all products are manufactured.

American railroads were originally planned to serve cities and their surrounding areas. It didn’t initially occur to city planners, or the railroad builders, that these networks might eventually need to connect with one another. This led to a mish mash of track and rail sizes (or gauges in railroad speak) … none of which were compatible. While some standardization was inevitable, by the 1870s, there were still over twenty different gauges in use in America. This stalled growth and hurt the industries ability to expand. Railroad standardization did eventually change everything and traveling by train became the de facto way people traveled long distances … at least until other travel innovations disrupted the railroad industry. Many supplemental innovation opportunities were created (such as luxury Pullman rail cars) as the transportation industry innovated its way forward, eventually adding new ways to travel (airplanes and automobiles).

Before the telephone and wireless radio (yes this was also before fax machines), the only way to send messages was by telegraph. The telegraph was a hard wired connection of send/receive points. I guess the use of smoke signals and homing pigeons had other imitations … like being too messy. Ever clean-up after a bunch of pigeons?

The telegraph was the primary form of long distance communication for the better part of a century … and Morse code was the language of the telegraph. Morse code was a system of dots (shown as asterisk below) and dashes, that when combined, formed words, letters and sentences. As you can imagine, it was highly inefficient. One of the last messages sent from The Titanic was:

*** ** * *

*** **** ** **,

*** ** * *

***- — -*– *- –* *.

Translated to English … it says, “FINE SHIP, FINE VOYAGE.”

I wonder when the ship started sinking how many messages didn’t get sent because the Morse coding and reassembly process was so cumbersome, time-consuming and error prone.

When Alexander Graham Bell invented the telephone … you guessed it … it changed everything. Many supplemental innovation opportunities were also created including wireless radio, broadcast television and every facet of communications.

These kinds of “change everything” opportunies don’t happen that often. So recognizing one as an innovation and business opportunity … may be more important then the innovation itself. After all, Ford, Bell and the Railroads only reaped a small fraction of the spoils. Entire massive industries in the transportation and communications were created. The savvy innovators and intrapreneurs understood the follow-on opportunities being created and capitalized on them.

Well .. most did. William Orten was not among them. He was the CEO of Western Union Telegraph Company in 1876. Western Union had a monopoly on the most advanced communications technology available (the telegraph) in 1876. Western Union was offered the patent on a Bell’s invention (the telephone), for $100,000 (or about $2M in 2014 dollars). The CEO (William Orten) considered the whole idea ridiculous and wrote directly to Alexander Graham Bell:

”After careful consideration of your invention, while it is a very interesting novelty, we have come to the conclusion that it has no commercial possibilities … What use could this company make of an electrical toy?”

Two years later, after the telephone began to take off, Orten realized the magnitude of his mistake, and spent years (unsuccessfully) challenging Bell’s patents. Ooops!!!

The computing industry is about to undergo a once on in a generation innovation opportunity. We are entering The Cognitve Era of computing.

The current computing model has reached it’s limits. The next level of value can’t be unlocked by current approaches. Data already flows from every device, replacing guessing and approximations with precise information … yet 80% of this data is unstructured … and therefore, invisible to computers and of limited use to business. There is simply too much information and most of it is noise. We need the ability to know what is relevant and useful.

More importantly, why don’t computers learn, adapt, reason and apply information the way I do?

We got here by first building computers that solved basic problems and/or enabled us to new things … before moving onto solving more advanced problems and/or raising the bar on our own ambition. It all got started in the late 19th century.

1890s – 1950s: The Tabulating Systems Era

  • Massive growth in people and things demanded single purpose systems that could count.
  • For the first time, a program like the US Social Security system was possible.

1950s – Today: The Programmable Systems Era

  • The increasing complexity of business and society demanded multipurpose systems that can apply logic to perform pre-programmed tasks.
  • For the first time, landing on the moon was possible.

Today: The Cognitive Systems Era

  • Continually changing scale and complexity now require real-time judgment from systems that can sense, learn and understand to help humans make decision and take action.
  • With technology augmenting and extending human intelligence, it’s difficult to imagine what is not possible.

Welcome to the The Cognitve Era … where cognitive systems can understand the world through sensing and interaction, reason using hypotheses and arguments and learn from experts and through data:

  • Understand unstructured data, through sensing and interaction.
  • Reason about it by generating hypotheses, considering, arguments, and recommendations.
  • Learn from training by experts, from every interaction, and from continually ingesting data. In fact, they never stop learning.

This changes everything!

And like those other once in a generation innovation opportunities, now is the time to get involved. Start by educating yourself and begin experimenting. Look for cognitive innovation in these five areas:

  1. Deeper Human Engagement: Cognitive businesses create more fully human interactions with people—based on the mode, form and quality each person prefers. They take advantage of what is available today to create a fine-grained picture of individuals—geo-location data, web interactions, transaction history, loyalty program patterns, EMRs, data from wearables—and add to that picture details that have been hard or impossible to detect: tone, sentiment, emotional state, environmental conditions, strength and nature of a person’s relationships. They reason through the sum total of all this structured and unstructured data to find what really matters in engaging a person. By continuously learning, these engagements deliver greater and greater value, and become more natural, anticipatory and emotionally meaningful.
  2. Elevated Expertise: Every industry and profession’s knowledge is expanding at a rate faster than any professional can keep up with—journals, new protocols, new legislation, new practices, and entire new fields.
  3. Cognitive Products and Services: Cognition enables new classes of products and services to sense, reason and learn about their users and the world around them. This allows for continuous improvement and adaptation, and augments their ability to deliver on products and services not previously imagined.
  4. Cognitive Processes and Operations: Cognition also transforms how a company operates and functions. Business processes infused with cognitive capabilities capitalize on the phenomenon of data, from internal and external sources. This gives them heightened awareness of workflows, context and environment—leading to continuous learning, better forecasting and operational effectiveness—along with decision-making at the speed of today’s data.
  5. Intelligent Exploration and Discovery: Ultimately, the most powerful tool that cognitive businesses will possess is far better “headlights” into an increasingly volatile and complex future. Such headlights are becoming more important, as leaders in all industries are compelled to place big bets—on drug development, on complex financial modeling, on materials science innovation, and on launching a startup. By applying cognitive technologies to vast amounts of data, leaders can uncover patterns, opportunities and actionable hypotheses that would be virtually impossible to discover using traditional research or programmable systems alone.

Innovators, entrepreneurs and intrapreneurs should all be licking their chops at the numerous ways to capitalize on this.

This does change everything! … hopefully you agree.  More from IBM on The Cognitive Era … check out the short video.

As always, leave me your thoughts and ideas here.

Why Bigger Should Always Be Faster … and Better

Let me say upfront that I was rooting for Golaith, not David.

I was recently asked to speak about some of IBM’s intrapreneurship initiatives at the upcoming Intrapreneurship Conference in New York during October 21-23. I have been conducting my own research on corporate entrepreneurship and have gotten to know the folks behind this organization .. it should be a good event. I will be speaking on the first day and shared some thoughts on this in a recent interview.

As I reflected on the interview .. it occurred to me how tired I am of all of the rhetoric in business publications these days about it being easy and commonplace for small innovative companies to disrupt large established ones. Some articles and books even pretend there’s a formula for doing this. It’s as if these much larger and proven companies are incompetent, have lost their way and are filled with unmotivated, slow witted human zombie idiot robots. To think that David always slays Goliath is too idealistic. It might help sell books or increase readership … but it’s not a predictor of business success or outcomes. It’s also foolish to underestimate any competitor by reducing them to a cliché … especially the ones who can squash you.  Has anyone noticed that Gillette didn’t lay down and die when Dollar Shave Club and Harry’s started a subscription service to try to disrupt Gillette’s core profit source of razor blades.

In an entrepreneurial and intrapreneurial career has spanned both start-ups and large corporations … I have been in key roles in both types of companies, and can tell you that there are advantages and disadvantages to each type.

Being fast, nimble and adaptable are essential traits when starting a new business or bringing a new innovative offering to market. These are even definitional attributes of start-ups. But no matter how nimble you are, you can’t birth of baby in one month if you put nine pregnant women on the job.

Large companies have significant and undeniable advantages over smaller (and allegedly more nimble) companies … notably resources and customers. The larger, the better. When mobilized properly, these advantages can be leveraged and rapidly applied in ways not possible by smaller, less resourced would-be competitors. Sure … large companies can be complex and have too much politics and red tape … but bring it on.  I’ll take money and customers every time.

That fact is, nothing can be as productive as working on an important initiative with a highly motivated and excited team of the most talented people you can imagine.

BOOM .. and there it is.   An Intrapreneurial Business Team. Done right, it’s like being on an all-star team … even exhilarating. You get to work with the best people or have access to subject matter expertise that start-ups can only dream of.

Where do you find Intrapreneurial Business Teams? In large companies, of course. It’s really the only way that a large matrixed organization can operate in a “start-up” like mode.

A small empowered team(s) approach is essential when siloed reporting, resource allocation and decision making model(s) are the norm. The typical large company model fundamentally disables a single person’s ability to lead all aspects of a innovation commercialization project.

Even though the fundamental goals and skills are the same for both types/sizes of companies … but the execution model and processes needed are completely different.

Here is an overview to the similarities and differences of the two approaches:

Intrapreneurs – Similarities

•   Requires vision and strategy.

•   Needs leadership and strong execution to succeed.

•   Needs internal funding.

•   Similar “learning” process of validate, plan, build, launch and grow.

•   Opportunity driven.

Entrepreneurs – Similarities

•   Requires vision and strategy.

•   Needs leadership and strong execution to succeed.

•   Needs external funding.

•   Similar “learning” process of validate, plan, build, launch and grow.

•   Opportunity driven.

Intrapreneurs – Differences

•   Mostly fearful including fear of failure, peer perception, embarrassment and confrontation.

•   Stakeholders motives are not just financial and include NIH syndrome, lack of alignment, skills, priorities or reward system.

•   Has to navigate existing culture and processes … and may have little or no influence over this.

•   Has advantages/starting points – ability to leverage customers, assets, brand and track record.

•   Funding is NOT guaranteed once secured.

•   Depends on Team Based Leadership

Entrepreneurs – Differences

•   Mostly fearless who are more likely to take risks, start over or have a pivot mentality

•   Stakeholder motives are almost exclusively financial or performance related (keeping investors happy is a top priority).

•   Has to create a new culture and must build teams, culture and more.

•   Starting from a blank page without track record – must secure customers and build trust

•   Funding is guaranteed once obtained.

•   Depends on a Strong Individual Leader

By embracing on these similarities and differences, large organizations can move as fast or faster than start-ups. Importantly, start-ups should study large companies they are taking aim at … before taking them on. Avoid the ones who are operating Intrapreneurially as shown above.

Lastly, if you are a publicly traded company … your organization must be committed to these principles (from the top down). Public companies have a fundamental conflict of interest in that innovation projects are usually longer term investments with unclear ROI in many cases. There is a natural tension between organic innovation investment and fiduciary shareholder budget responsibility … where innovation projects almost always lose out. Quarter to quarter financial decisions (cutbacks) have unintended downstream innovation consequences. Projects without a clear ROI, or without committed revenue, are usually the first place that cuts get made when the belt needs to be tightened. The larger the company, the more acute the problem. Watch out for this dynamic. It’s difficult to overcome without a top down commitment to change and innovation commercialization. Shareholders are always sitting in the first chair. These are the people paying for Goliath’s projects and they expect a return (and soon).

I am definitely looking forward to speaking at the Intrapreneurship Conference. I’ll talk more about Intrapreneurial Business Teams and will feature the Intrapreneurship@IBM program … a program designed to foster corporate entrepreneurship and help bring IBM’s innovation to market.

I founded the Intrapreneurship@IBM program and community as well as the associated 8 Minute Pitch program. I will cover some successes, challenges and failures as well as our future plans for these programs. I will also cover a deeper set of findings from a benchmark survey I recently conducted with over 500 innovation professionals (both non-IBM and IBM respondents).

Lastly, IBM has set out on a “moonshot” attempt at transforming healthcare. Bringing our innovation to market to part of that strategy and Intrapreneurship is a key success factor of this initiative. I plan to cover some of our innovation in healthcare including the innovative and world-renowned IBM Watson family of healthcare solutions.

I hope to see you in New York at the conference … and as always leave your thoughts and comments below.

A Personal Perspective on Entrepreneurship and Intrapreneurship in Africa

The first time I heard of Africa was probably my mother saying “clean your plate, there are children starving in Ethiopia” … at the dinner time (when I wouldn’t eat my vegetables on numerous occasions). The infamous famine was over 30 years ago now (remember Bob Geldof and Live Aid).  I don’t remember us studying Africa in school but I suppose we did … and until recently; many of my personal perceptions of the continent were out-of-date – probably too similar to that of most insulated Americans, which were very different from today’s reality.

It turns out, that Africa is on the rise.  According to the McKinsey Global Institute, by 2020 Africa’s nominal GDP is expected to reach US $2.6 Trillion (eclipsing Canada $2.19 Trillion and close to India’s $2.9 Trillion). 54 cities in Africa (more than Europe) have over 1 million people each.  400 million Africans live in cities (India has 340M).  Smartphone users are expected to increase from 67 million to 360 million by 2025.

Growth prospects for Africa remain positive and the region’s GDP growth is projected to rise.  African households in the middle income group are projected to rise to 128 million in 10 years.  The continent has more than 500 million people of working age (15-64). By 2040, that number is projected to exceed 1.1 billion … or more than in China or India.

I met some remarkable people this week who happen to come from Africa.  About this time last year, I became aware of an organization called The Young African Leadership Initiative (YALI) through my employer (IBM) … who sponsors this organization in part.  IBM is one of a handful of companies who are actively involved with YALI.  The United States’ commitment to Africa is long-standing and deep.  The United States has invested in development partnerships with Africans to foster sustained economic growth as well as improved quality of life issues.

Selected from roughly 50,000 applications, the class of 2015 YALI Mandela Washington Fellows represents the promise of an emerging generation of entrepreneurs and intrapreneurs.  Mandela Washington Fellows have proven track records of leadership and demonstrate a strong commitment to contributing their skills and talents to strengthening and serving their communities.

The current class of Fellows represents all 49 countries in sub-Saharan Africa and included equal numbers of men and women.  Many of them operate their own businesses.  Nearly all Fellows were the first in their families to visit the United States.  They are in the US for six plus jam-packed weeks of education and experiences.

I was asked to teach an all day course on entrepreneurship at the University of Notre Dame – one of the hosting campuses.

Even with a lifetime of both entrepreneurial and intrapreneurial experiences to draw upon, I was a little uncertain how to approach the class.  As I read the biographies of the Fellows, it was obvious that many in this group of people had a very different lifetime of experiences than I did.  I could only imagine the motivation they had to draw upon.  I was actually a little concerned that I might not be able to relate to them and the class might not go well.

Once the class started, all of these fears were washed away.  It turns out that the language of entrepreneurship is universal.  Defining a market, creating competitive differentiation or figuring out a SWOT Analysis is universal … regardless of where you come from, what you have done in your past or whether you eat your vegetables.

Hopefully the information I presented will help them succeed with their various endeavors.  I felt as if I connected with many of the students and in some cases, created relationships that will stand the test of time.  One student even gave me a personal momento he brought from his country. This small gesture touched me.

I am proud to be associated with YALI. The prospects for companies who choose to do business in Africa looks bright.  Most importantly, the future for this group of people is brightest of all.

As a side note … President Obama is scheduled to speak the upcoming 6th Global Entrepreneurship Summit being held in Nairobi.  President Obama elevated entrepreneurship to the forefront of the United States’ engagement agenda during a historic speech in Cairo in 2009. The GES has expanded each year, subsequently hosted by the governments of Turkey, the United Arab Emirates, Malaysia, and Morocco.  This is the 6th annual gathering of entrepreneurs at all stages of business development, business leaders, mentors, and high-level government officials.

Leave me your thoughts and comments.

Have You Started Your Data Expedition Yet?

In 1803, Thomas Jefferson sent Meriwether Lewis and William Clark on their now famous expedition. The initial goal was to find a water-based route to the Pacific Ocean in addition to exploring the unmapped West. They imagined they’d find woolly mammoths, mountains of pure salt, lava-spewing volcanoes and never before seen creatures. What they found was quite different. Why did they even risk life and limb to do this in the first place?

It turns out that Thomas Jefferson was a visionary and a bit of an intrapreneur. When Jefferson took office in 1801, one of his top priorities was to gain control of the port of New Orleans. He saw this important water access point as an enabler of economic growth for farming. In one move, he more than doubled the size of the country for what turned out to be the real estate deal of all time … at the bargain price of less than three cents an acre. He paid $11.25 million in 1803 or roughly $234 billion in today’s dollars. That investment has paid for itself in incalculable terms in 1803. Of note, part or all of 15 states were created from this transaction. Ironically, Jefferson’s desire to control New Orleans what is the motive for the deal and the rest of the territory was pretty much a throw-in. This transaction is probably his greatest legacy and was arguably the most important step taken to build The USA into what it is today.

What would you do if you found yourself sitting on a massive untapped asset … and no one knew what it contained … or what to really do with it?

Jefferson decided to conduct an expedition of discovery by creating the Corps of Discovery in 1804 to explore his new acquisition.

Ironically, if you are a healthcare provider, have the same opportunity. Your big data is your untapped asset. What are you doing to explore, understand and leverage it? Leading providers are already conducting data expeditions of discovery. Most importantly, they are creating new streams of revenue from what they are learning.

Jefferson turned to trusted allies .. James Monroe to negotiate the Louisiana Purchase and Meriwether Lewis (who added William Clark) to lead the expedition of the acquired territory. Along the journey, other team members joined them (Sacagawea and Touissant Charbonneau).

You will need trusted allies and partner also for your expedition. You also need to think outside the box. In order to take advantage of new insights, it will require new thinking and new business models.

The Corps of Discovery faced nearly every obstacle and hardship imaginable on their trip. They braved dangerous waters and harsh weather and endured hunger, illness, injury, and fatigue. Along the way, Lewis kept a detailed journal and collected samples of plants and animals he encountered. It’s no wonder that it became known as the wild wild West.

You may not face hunger, illness and injury on your data expedition journey (insert IT joke here) but you will need the right kind of tools to prosper from it. Most importantly, navigating your way through big data will require advanced technologies … especially since more than 80% of it is unstructured in nature.

What the Corps of Discovery found was mind-boggling … some 300 species unknown to science, nearly 50 Indian tribes, and the Rockies (the mountains, not the baseball team).  They created the foundation and landscape for future governing states and grateful future generations and citizens.

You are almost certain to find many new ideas, insights that are really opportunities waiting for you to identify and exploit them.  Most amazingly, you have the same opportunity to impact the lives of generations of the yet unborn .. just in a different manner.

But unless you act now and start your own expedition … you are going to fall too far behind. Here’s why … new business models and new ways of delivering healthcare are already emerging.

Plus, you might swallowed up by big data bigfoot. A big data bigfoot … really!?!!(yes, I know this is a stretch)

By 2020, the footprint of medical data will double every 73 days according to the University of Iowa, Carver College of Medicine in 2014 (get it … bigfoot … as in footprint).

Seriously, This is going to change everything!

Data is going to become imaginably big. Get ready for a new term … Exogenous Data or data originating from outside (derived externally) … as in data from Apple Watch, Fitbit, medical devices, smartphones … you get the idea.

Exogenous Person The future of health is all about the individual and having a complete picture of the many factors that affect a person’s health. But we need better ways to tap into and analyze health information in real time to help doctors, researchers, insurers, case workers and other stakeholders determine the best approaches, and give the patient greater control over his or her own care. This is where you fit in. Bring your own data and take advantage of this now before others do. Start your data expedition here!

Like every other industry, healthcare is being disrupted and transformed by the exponential growth in data, such as medical records and clinical research, and these growing pools of information are difficult to share because they are fragmented. In addition, they do not readily incorporate critical information about individuals’ non-clinical conditions, which may have a strong bearing on health.

As a result, patients and their healthcare providers are forced to make decisions that are not based on all the evidence. And the problem is expected to get worse: between electronic medical records, digitized diagnostics and wearable medical devices, the average person will likely leave a trail of more than 1 million gigabytes of health-related data in his or her lifetime … the equivalent of about 300 million books. Those on data expeditions today will be at the forefront of capitalizing on new business opportunities that come out of all of this transformation.

Advances in data availability, analytics and connectivity are giving doctors, researchers and other health professionals the tools they need to make better, faster and more cost-effective decisions and individuals the insights they need to understand more about their health and receive personalized care. There is a vast amount of meaningful data that can help tell the whole story about an individual’s health and needs. We plan to help stakeholders in the care ecosystem use that foundation to improve the quality, effectiveness and cost of their care.

Have you started your data expedition yet?  If not, what’s holding you back?  Take advantage of your untapped assets before the opportunity disappears.  After all, there are going to be any other Louisiana purchases … cheap land is pretty much gone.

Land is purchased at a premium these days and that model is to your business advantage now. Don’t be one of those laggards who will end up looking for wooly mammoths or mountains of salt when there is so much more out there. Put your data to work for you!

In simple terms — do three things:

  1. Start by taking inventory of the various types of data you have – pay close attention to the unstructured data.
  2. Take another step by forming a team to study how to benefit internally from re-use of that data (better reporting, process improvements, etc.).
  3. Also assemble a group of intrapreneurs to figure our out to leverage that data into new business areas (licensing of data, partnering on IP, etc.).

“I like the dreams of the future better than the history of the past.”   I have to agree with Thomas Jefferson on that.

I will be speaking at a couple of upcoming conferences on these topics and more as I share details from IBM’s data expeditions:

Watson Health builds on IBM’s unique strengths to create the ecosystem needed to transform the global healthcare system, as well as to provide the open, secure and scalable platform of data, insights and solutions needed to make it all possible. Information on IBM Watson Heath can be found here. My recent posts …

As always, please comment below … or feel free to reach out to me directly.

This is a Revolution (not a Transformation) – Five Key Areas for Disruptive Innovation in Healthcare

If you are like me, when you hear the word innovation you imagine big things … putting a man on the moon … flying cars … low cost renewable energy … even a cure for cancer.  I can hear The Jetsons music playing in my head as I write this.

We are only limited by our imaginations.  I bet you have never considered how postal workers might participate in delivering healthcare?  In fact, you could make the case that postal carriers are contributing some of the most innovative ideas to transforming healthcare.  YES… Postal workers.  NO… I am not kidding.  Keep reading.

We are on the precipice of a new age in healthcare.  Like the industrial revolution that shaped America in the 1800s … the healthcare industry is entering that same type of business revolution.  Are you frenzied by this yet?  You should be.  The most aggressive and innovative organizations will win … and reap the benefits.

Clayton Christensen defined innovation in specific terms when he wrote the The Innovator’s Dilemma in 1997. Christensen’s book suggests that successful organizations put too much emphasis on current needs, and fail to adopt new technology or business models that will meet unstated or future needs. He argues that such organizations will eventually fall behind. Christensen calls the anticipation of future needs “disruptive innovation”. The concept of disruptive innovation is contrasted in the book with smaller, more obvious, incremental or “sustained innovation”.

Look around and count how many healthcare companies are making this exact mistake. Too many organizations are focused on current needs only. Both types of innovation are needed for ongoing growth and a healthy organization (pun intended).

Why is this relevant?  The fact is … healthcare organizations will have to compete, based on the value they deliver, in the not too distant future.  We haven’t seen this type of transformational business opportunity since the industrial revolution days of Cornelius Vanderbilt, Nelson Rockefeller, Henry Ford, Andrew Carnegie and J.P. Morgan.  These men all understood what was happening and then transformed their industries through innovative business techniques and approaches.  Most just watched them do it.  In healthcare, the organizations innovating now will lead this revolution and reap the spoils.  This is a completely different way of thinking about healthcare.  New markets and segments will seem to appear out of thin air.  It will be fueled by innovation … disruptive innovation.

Cleveland Clinic CEO Dr. Delos Cosgrove gets this.  98% of the people that request a same day appointment at the Cleveland Clinic get one, and there were over one million such appointments last year.  Focusing on costs doesn’t have to come at the expense of the patient.  Do you get that level of service from your local provider?  Why not?

Led by Joe Dickinson, postal workers on the small island of Jersey (off the coast of France) get this too. The island of Jersey has the same aging population issues as the rest of the world but the postal workers in Jersey have come up with an incredibly innovative way to extend their role and value through a new “Call & Check” service.  This is easily the coolest thing I’ve seen in quite some time.

By using postal delivery people in a community care model, any citizen can request a “Call & Check” at their home … and the postal delivery person whose has that route will stop at the home of the frail elderly person and do a “call and check”.  Here is a person who’s job it is to visit every house everyday any way, why not leverage that?

In other words, a friendly face comes by when needed to help, provide company or just look in.  The check can be — do you have the medications you need, is there a rug you could trip over, can you reach the top shelf without failing. Is there a nick in the skin of the lower extremity, can someone take you to see the doctor for your appointment scheduled this week. These “call and checks” are many of the things that make it possible for us to keep seniors in their homes longer.  It’s well-documented that “in-home” senior care is the optimal model and this type of service seems like a sensible and needed component.

Check out the video on how the “Call & Check” service works.

I am a big fan of Dr. Atul Gawande. In 2009, he published the breakthrough book: The Checklist Manifesto: How to Get Things Right. This book was a bestseller and lauded as an effective way to innovate and improve things.  Since then, Dr. Gawande has gone on to write several other books and is clearly an expert in his field.

However, at the time I read his book I did not have the same reaction as the rest of the industry. I was actually quite shocked that key healthcare processes like pre- and post-surgical processes weren’t already rigorously managed by checklists (or other proven methods) to ensure that surgical sponges, or instruments, weren’t going to be forgotten about and left in patients.  After all, there are published references to the use of checklists dating back to the 1800s and quite possibly earlier than that.  Quality approaches to processes (such as ISO 9001, Six Sigma, etc.) have existed for decades.  It’s a sad state of affairs, that nearly two centuries later, the adoption of checklists in healthcare is seen as innovative.  Maybe this isn’t a fair example, but it’s hard to see the industry as being innovative when so many people got that excited over checklists.

Score one for the postal workers!

The reality is that those who invest in and embrace technology today will be the leaders of tomorrow.  Many physicians are embracing new technologies like IBM Watson Oncology Advisor … but sadly, some are still resisting using checklists.

When you look around the healthcare industry today, there is not enough disruptive innovation. There are examples of sustained innovation but very little is going on that would qualify as disruptive.  Most of the efforts that get labeled as innovative in healthcare are in support of the “triple aim”.

If you are not familiar with this term, the IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance (simultaneously) in three dimensions:

  • Improving the patient experience of care (including quality and satisfaction).
  • Improving the health of populations.
  • Reducing the per capita cost of healthcare.

The IHI website highlights that The US healthcare system is the most costly in the world, accounting for 17% of the gross domestic product with estimates that percentage will grow to nearly 20% by 2020.  At the same time, countries with health systems that out-perform the US are also under pressure to derive greater value for the resources devoted to their health care systems.  Aging populations and increased longevity, coupled with chronic health problems, have become a global challenge, putting new demands on medical and social services.  Only technology-enabled innovation can enable this fundamental and simultaneous degree of change.

Of course, there are numerous barriers making this incredibly difficult to achieve … not the least of which is the continued widespread use of fee-for-service-based payment models.   This is a core business model, process and foundational problem. The wrong incentives cause the wrong behavior and actions that lead to poor (and costly) outcomes.

The Center for Medicare & Medicaid Innovation (The Innovation Center) is helping by supporting the development and testing of innovative health care payment and service delivery models. These are important incremental steps, to transforming the industry … but we have to go faster in five key innovation areas.  The current rate of innovation is being measured with calendars when it should be measured with a stopwatch.

  • Business and payment model innovation such as shared risk, capitation, bundled payments, self insuring and more is starting to happen but taking too long.  Every payer and provider should have multiple experiments going in these areas now.  Acquiring this experience now is essential so that when the big money is at stake you’re not starting from scratch.  Continued industry consolidation will eventually help enable new forms of business model innovation but only after these acquisitions get integrated and are made to work functionally.  Too much consolidation could actually slow down business model innovation.  Net-net … We need to be much more aggressive in moving away from fee-for-service. Ultimately, it will be innovative technology solutions like practice management analytics and care (case) management that factor in process level care delivery costs that enable this to happen.
  • Business process innovation is not getting very much attention anywhere in healthcare.  When Lou Gerstner turned around IBM in the 1990s, one of his top initiatives was to blow-up and re-engineer the core business processes.  Hanging onto the fee-for-service business model is a slow lethal poison.  It’s toxic.  A fee-for-service business culture breeds ignorance of how to control costs effectively (and still deliver quality care).  In other industries, key organizational processes are measured by using techniques like time and motion studies to understand costs at a very granular level.  Not in healthcare.  Many core processes aren’t well understood at all.  This disables any chance to innovate through processes, which can reduce operating costs significantly.
  • Care delivery model innovation is also taking far too long to reach the mainstream.  Community care models and telehealth are examples of things that should be much farther along then they are.  The notable exception to this is the adoption of Patient Centered Medical Home as driven by organizations like the Patient-Centered Primary Care Collaborative.  Every payer and provider should have a population health management solution deployed today.  The ability to organize and manage based on population health … and to use that information to personalize care delivery is a major enabling piece of innovation.  The value of these solutions are well proven and anyone who is not using one of these is already well behind.  Phytel even offers a guaranteed Return on Investment of at least 3x.  That’s pretty innovative all by itself.  What have you got to lose?
  • Organization innovation is laughable.  The United States is the only major economy where healthcare and social programs are two separate things.  The connection between the social determinants of health and delivering good patient outcomes is undeniable … yet politics, system silos, and other overcome-able obstacles prevent our caregivers from using this critical information to deliver low cost care and better outcomes.  By some estimates, over 60% of the best healthcare outcomes are derived by using social determinants.  What are you doing to integrate social determinates into your systems, processes and decision making?
  • New technological innovation is perhaps the most obvious way to think about innovation.  If you have not already invested in cognitive computing, analytics, mobile, cloud, population health and care management solutions then you are in the stone ages and well behind … because your competition has.  George Jetson didn’t have Watson at Spacely Sprokets, but he did have R.U.D.I. (Referential Universal Differential Indexer). R.U.D.I. was George’s work computer and one of his best friends (next to his dog, Astro).

This is a revolution .. not an evolution !! 

Vanderbilt, Rockefeller, Ford, Carnegie and Morgan didn’t wait for the next round of incentives .. they SEIZED on their opportunities .. you should too.  It will be the pioneers of today who are the winners in tomorrow’s competitive healthcare industry

Spacely Sprockets may have had R.U.D.I. but we (at IBM) are taking disruptive innovation seriously with our growing family of Watson Healthcare solutions, innovation in population health analytics, IBM Smarter Care solutions (including care management) and new joint mobile healthcare solutions from our strategic alliance with Apple.

NOW is when is the disruptive innovation needs to happen … what will yours be?

I will be at HIMSS in Chicago on April 12-16th. (IBM Booth 1425).  Stop by and say hello.

Healthcare Delivery Innovation Needs to Happen Faster

I was recently asked to chair a panel and moderate a roundtable at the upcoming 2015 State Healthcare IT Connect Summit in Baltimore, MD on March 23th and 24th.

I am hosting a roundtable entitled Turning Insight into Action with Patient-Centered Care Management on Monday the 23rd at 1:00pm … and the panel is entitled Community Analytics, Care Coordination and Managing Complex Conditions takes place on Tuesday the 24th at 10:10am. I will be joined by an impressive list of State IT Executives for the panel and we will all be sharing our respective points of view. Judging from the attendee list, this is shaping up to be a terrific conference.

As I started to prepare for these sessions it started to bother me that this transformation (using analytics to enable better care delivery) is taking too long. Not enough organizations are aggressively embracing this model despite the types of outcomes that are now within our reach.

It’s been over four years since Doctor Atul Gawande opened everyone’s eyes to the power of combining community (social) data with clinical data to identify which patients are the most in need of care.   In case you were lost in Antartica, that New Yorker Article The Hot Spotters was groundbreaking. It opened our eyes to the value of non-clinical sources and types of information. As an example, if you are trying to reduce infant mortality, it would certainly be handy to analyze which infants live in buildings that still have lead paint.

It goes without saying … that the sooner you figure out who is in the most need, you can intervene to get the best possible outcome. This might seem simple but the real magic comes from combining different types (structured, unstructured) and sources of data (clinical, social programs, environmental) that can unlock new and powerful insights.

In her recent book The American Health Care Paradox: Why Spending More is Getting Us Less, Dr. Elizabeth H. Bradley from Yale University asserts that when you combine social services spending with healthcare spending you can achieve more. Unlike the rest of the world, the United States archaic division of health and social services is hurting our outcomes. The book offers a unique and fresh perspective on the problems the Affordable Care Act won’t solve. She also asserts that 60% of outcomes can be attributed to social, environmental and behavioral.

At IBM, we have seen similar eye-popping results when combining different types and sources information. I have blogged about some of these examples:

I plan to talk about these examples, and more, at the conference. As we talk to State healthcare officials, it seems while almost everyone is embracing some flavor of analytics and care management … many seem to assume they only have limited access to data though, usually claims data.

It’s time to start thinking outside of the box. State governments are in a unique position. Tthey have access to unique sets of data (social programs, environmental, safety, crime, others), that when combined, can deliver the kind of outcomes that Dr. Gawande was talking about over four years ago. The extra effort required to collaborate and share data is well worth the opportunity to achieve these types of outcomes.

I hope to see you at the upcoming 2015 State Healthcare IT Connect Summit in Baltimore, MD on March 23th and 24th.

Trick or Treating for State Healthcare Innovation Treats

When I was a wee lad, I loved to go trick or treating each Halloween. Nothing was better then dressing up in a great costume and walking door-to-door to get my plastic orange pumpkin filled up with candy. My favorite was those little root beer barrel hard candies … YUMMY!

I think my best costume was the year I went out dressed as Elvis. Imagine a 12 year old dressed as Vegas Elvis, with the white jumpsuit, big lapels and the mutton chop sideburns. I got alot of root beer barrels that year. This year I went to the 27th Annual NASHP Conference in Atlanta dressed as a confused IBM Executive.

As part of my role in IBM Smarter Care, I have recently been focused on understanding the government healthcare transformation strategies of the US States in the wake of the Affordable Care Act.

What a better place to get the goodies then the NASHP Conference. The event attracts a “who’s who” of state healthcare policy people who also drive the content and focus of the conference. I may have gone confused but came back armed with answers (my treats).

My plastic pumpkin was filled with goodies by the end of the pre-conference on the first day. The best treat (for me) was the keynote delivered by Dr. Elizabeth H. Bradley from Yale University. Her keynote was based on her new book The American Health Care Paradox: Why Spending More is Getting Us Less. Her point of view asserts that when you combine social services spending with healthcare spending you can achieve more. Our archaic division of health and social services, and our allergy to government programs, is hurting us. The book offers a unique and fresh perspective on the problems the Affordable Care Act won’t solve.

There were other treats as well. The pre-conference on care coordination was led by NASHP Program Manager, Dr. Barbara Wirth. It featured an all-star line-up of state executives sharing how they were using CMS Innovation Funding to improve state healthcare outcomes on behavioral health, infant mortality, long-term care and supporting services using care models such as Patient Centered Medical Homes, Health Homes and more.

The one treat that I really wanted … I didn’t get (and it wasn’t root beer barrels).  It was an understanding of the technology being used to help achieve the outcomes being cited in the sessions. Software is essential to enabling care models where patients are crossing care settlings, caregivers, locations and even care programs. There is no way this can be done economically using the good old fashioned way of paper, folders, faxes and phone calls.

Realistically, it’s too early for many of these new programs to expect a lot of detail on this. On the other hand, the omission(s) makes me scared (get the pun) that this may not be on the radar screen of those making policy decisions … and those responsible for rolling out these innovative programs.

Healthcare reform is not just about innovative payment models, policy design and care delivery models. It must also include innovative technology to deliver on the promise of consistent quality, scalable delivery and affordable care. The use of big data (not just EMRs), analytics and care coordination software all help enable the benefits Dr. Bradley spoke about where social programs and healthcare come together to enable better outcomes at lower costs. Dynamically linking these technologies to health policy is where innovation can and will happen. Not linking them may cause your programs end-up like an old Haunted House where dust and cobwebs cover up ghoulish and ghastly looking programs (ok, really sorry for the pun).

Maybe next year I’ll pull out my Elvis costume when I go to NASHP in Dallas (October 19-21, 2015) even though I know it’s far too small for me.

In the mean time, I’ll urge NASHP to push this technology agenda, along with all of those implementing reform through government healthcare transformation. Start thinking and planning for the technology that will power your initiative now.

For me, Halloween comes twice this year. The IBM Health and Social Programs Summit is being held October 20-21st in Washington, DC. This event convenes a global network of thought leaders, industry experts and practitioners to discuss industry trends and directions, and compare best practices and leading technology innovations in the fields of Health and Social Programs. I will be speaking, as will Dr. Barbara Wirth from NASHP, along with The Honorable Patrick J. Kennedy, Dr. Paul Grundy, Dr. Stephen Morgan and many more. I hope to see you there … and bring some root beer barrels!  There will be plenty of treats for you too.