IEEE PULSE presents

What the Future Holds

January/February 2014

When it comes to BME today, innovation might just be the most important buzzword around. That’s not because it happens to be the trend of the day across industries already; it’s because in the face of skyrocketing health care costs, a rapidly aging global population, and multiplying cases of chronic diseases such as diabetes, cardiovascular disease, and cancer, we have no other choice. If our goal is ultimately to create a healthier, more vibrant global society, we must innovate—and radically.
Despite decades of research and billions in funding worldwide, advances in basic research are simply not making their way into clinics [1]. Nor are things likely to change if business continues as usual, given the rising constrictions for early stage research funding that have emerged as a consequence of national budget tightening and the trend toward global fiscal austerity measures. This means that we need to consider innovative new strategies to ramp up productivity and efficiency across the board. In other words: we all need to do more with less.
For BME, that means looking not just for the next great technology but for ways to create more efficient development processes, expand creative collaborations, engineer smarter health care systems, and strengthen translational and regulatory sciences to change the way basic science is done. It’s a matter of not just innovation but disruptive innovation—a term coined by Clayton Christensen, Kim B. Clark Professor of Business Administration at Harvard Business School, to describe innovation that transforms a once complicated and expensive product or ­service into something easy to use and affordable at the same time [2]. It’s what the printing press and Internet did for information sharing, what Napster did for music, and what we in BME need to do to prepare for the future of health care.

Understanding the Motivations for Innovation

In the last three decades, the global cost of health care has risen at a steady clip of 2.8% over the gross domestic product (GDP) on average every year [3]. Although that rise did slow after the 2008 global financial crisis, according to a 2013 report from the Organization for Economic Cooperation and Development (OECD) [4], it will return in force as global economies recover. How steep the new wave will be ultimately hinges on the balance between health care delivery, relative costs of medical care, and various economic forces (including competing costs from other social programs).
As of now, the combined public health care expenditures for 34 OECD countries (ranging from North and South America to Europe, Asia, and Australia) are expected to rise from 6% in 2013 to 9.5% in 2060, assuming that measures are taken to control costs. Without action, spending could increase to as much as 14% of the GDP by 2060. Even more precipitous are the forecasts for Brazil, Russia, India, Indonesia, China, and South Africa, which will climb from the current average of 2.5% to between 5.3% and 9.8% of the GDP. The United States, meanwhile, already hit the 17.6% GDP mark four years ago, with The Netherlands (12%), France and Germany (11.6%), and Canada and Switzerland (11.4%) right behind.
The rapid aging of the global population has only fueled these soaring costs. According to the World Health Organization, the proportion of the world’s population aged more than 60 years is expected to double from approximately 11% to 22% between 2000 and 2050; In hard numbers, this means a jump from 605 million to 2 billion people [5]. And of course, as age increases, so too does the incidence of associated comorbidities such as diabetes, cardiovascular disease, and dementia. Such disorders not only add to the cost but also the complexity of health care, and their prevalence demands a shift in focus from mere life-extension measures to better long-term quality of life care—as well as giving more attention to value-enhancing innovations in place of developing and marketing any medical advance regardless of its cost relative to its benefit.
Global Healthcare Innovation
Up to this point, however, relatively few key innovations have successfully increased quality of care while decreasing the overall cost (the development of antibiotics is one of the exceptions). But with falling government funding levels as well as the day-to-day restrictions placed on locally based initiatives and regionally escalating cases of noncommunicable diseases, we now have an imperative to deliver new lower-cost, high-value solutions.

Innovation Imperatives

“We need approaches to the solutions that aren’t just arithmetic and additive but are in some sense logarithmic,” noted Jeffrey Flier, M.D., dean of the Faculty of Medicine at Harvard University, in the 2012 Forum on Healthcare Innovation report jointly prepared by Harvard Business School and Harvard Medical School [6]. “This will require us to reach across historic boundaries and unlock the potential of collaboration across the usual disciplines,” he said.
The report identified five key imperatives for health care innovation that could help break the lockstep of traditional solutions and open the field to more creative avenues and better patient outcomes. These imperatives include:

  • reinforcing the need for value to become the primary objective of health care
  • focusing resources on process improvement
  • organizing systems around patient needs while simultaneously enabling patients to become active agents in their own care
  • decentralizing approaches to health care solutions and delivery
  • integrating new knowledge into established organizations and practices.

Such items pose an undeniable challenge, it’s true—and yet, certain tools with the potential to meet these imperatives are in development. Telehealth and home visits that rely on existing infrastructure, mobile care and diagnostic services that bring diagnostic capabilities closer to the patient, and standardized, manufacturing-like procedures that minimize waste and maximize efficiency are already here in various degrees, and they all offer the potential to be exactly the sort of effective, disruptive innovations required.
Then, too, “open innovation” has the potential to contribute new ideas to the mix. Developed by Henry Chesbrough, executive director of the Center for Open Innovation at the University of California, Berkeley, open innovation relies on the movement of knowledge—not only within organizations but across borders—to accelerate the innovation cycle. Reflecting this trend, the latest Global Innovation Index (GII) reported that 2013 marked the highest monetary amount ever put toward research and development worldwide. What’s more, the report observed, burgeoning innovation clusters and regional innovation hubs around the world are finally beginning to seriously and positively impact nations’ ability to meet new challenges and stay globally competitive [7]. At the same time, government incentives that promote innovation like those recently implemented in the United Kingdom, combined with regional innovation centers popping up around the globe, offer successful models and shared system methodologies to support innovation efforts. Finally, new financial schemes such as crowdfunding and crowdsourcing are adding to this trend, as they supplement traditional government and investor funding models and open the innovation arena to ideas at potentially every level of ideation.
Indeed, the entire biomedical field is ripe with possibilities. Emerging research into the brain, nanotechnology, imaging modalites, computational biology, microelectronics, and personalized medicine—to name just a few areas—are all on the cusp of major change. If we can maintain this transformative mindset and these nontraditional research and funding processes, and continue our investment in education and partnerships between industry, academia, and supportive institutions, the disruptive innovations we so badly need may be well within our reach.
And yet, barriers remain. As much as we speak about open innovation and shared knowledge and expertise, significant connectivity gaps remain among health care players. Technologists, clinicians, researchers, insurers, regulators, health care businesses, and entrepreneurs all have important roles in designing solutions, but all too often, their input is missing from the actual debates and decision making. Meanwhile, of course, the search for the next best tech continues to trump the less seductive, but equally (if not more) crucial, pull of the clinic and sometimes even the individual patient, and regulatory bottlenecks and financial hurdles leave potential solutions languishing in translation. And it should come as no surprise that many of the current health care delivery systems can best be described as inefficient and, at worst, ineffective.
But what is the purpose of history if not to learn from it? We are poised at the precipice of a challenging future, and our collective resources are set in place to change the direction of innovation. Now, as we move forward, it is up to us to ask: What global or local society do we envision? What are our health care goals? How do we define our role in this scenario?
As Osman Sultan, CEO of du in the United Arab Emirates, reminded us in his GII address: “Innovation is more than just a process; it is a belief, a philosophy that embeds itself in the fundamental elements of governance, sustainability, efficiency, and the competitive agility needed to deliver value” [7].
Delivering more value for less cost is health care’s innovation challenge—and our call to arms.

References

  1.  G. W. Daniel. (2012, Nov. 30). Biomedical Innovation in a Challenging Fiscal Environment. Brookings Institute. [Online].
  2. C. Christenson. (2009, Apr.). On disrupting health care, Harvard Business School, Working Knowledge. [Online].
  3. V. R. Fuchs, “New priorities for future biomedical innovations,” New Engl. J. Med., vol. 363, no. 8, pp. 704–706, Aug. 2010.
  4. C. de la Maisonneuve and J. O. Martins. Public spending on health and long-term care: A new set of projections, OECD, Paris. [Online].
  5. World Health Organization. (2013, May 30). Ageing and life course: Care and independence in older age. [Online].
  6. W. W. Chin, R. G. Hamermesh, R. S. Huckman, B. J. McNeil, and J. P. Newhouse. (2012). Forum on Healthcare Innovation: Five imperatives addressing health care’s innovation challenge, Harvard Business School and Harvard School of Medicine. [Online].
  7. Cornell University, INSEAD, and WIPO. (2013). The Global Innovation Index 2013: The local dynamics of innovation, Geneva, Ithaca, and Fontainebleau. [Online].

Related Articles