Why experts are slowing the emergence of digital health

Peter Nichol
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Why experts are slowing the emergence of digital health

Article originally published on CIO.com.

Digital transformation visions crumble from a lack expertise. Don’t let yours be one of them.

Digital health is the convergence of the Digital and Genomic Revolutions specifically health, healthcare, living and society. Personal empowerment is the heartbeat of digital health making our lives better by managing, tracking and improving wellness for a healthier tomorrow. The realization of this healthier and seamlessly connected future will require orchestration between the physical and digital world. This orchestration will be conducted by digital experts.

What does it take to be an industry expert? Is it pure raw intelligence or is there a subtler side to expertise? In some instances, experts that are required to transform organizations and tap into top-line innovation growth, may be the same experts preventing adoption of your organization’s digital capabilities. There is a lack of expertise when it comes to digital transformations and applying digital technology to dramatically improve performance of an enterprise in all aspects of human society. 

There is something sacred about the word “expert.” This role can’t be given; it can’t be won; and it isn’t issued with a promotion – it’s earned.

Two types of expertise

There are fundamentally two types of expertise: Routine and adaptive. Routine experts often assume that their current knowledge and their problem definitions are correct. Adaptive experts have the ability to apply knowledge to novel problems or atypical business challenges and reshape problem definitions.

Routine expertise

Digital transformation visions crumble because of a lack of experts or the wrong kind.  

Giyoo Hatano of Dokkyo University and Kayoko Inagaki of Chiba University” studied aspects of cognitive development in the 1980’s. The updated translation is that digital transformation is impossible when companies are made up of only routine experts.

Routine experts are unable to think beyond their models built on procedural knowledge. Routine experts rely on similar experiences from their past when building a solution framework.  When problems arise that are atypical and do not fit historical problems, they get stuck. For example, the problem may require a new model such as introducing digital disruption. 

Digital disruption occurs when new technology affects existing business models and how products and services create value. Those regarded as routine experts would apply the same models they have used for the last twenty years and find they do not work. This illustrates the real problem preventing digital disruption, attempting to solve new problems with procedural expertise.

That’s not to say routine experts are not effective. Procedural skills are used to efficiently solve everyday problems in stable environments. Unfortunately, stable does not describe the digital environment that influences business today.

Adaptive expertise

Another type of expert is the adaptive (or conceptual) expert. These experts not only retain procedural skills, the base of routine expertise, but they also understand the reasoning behind the skills they demonstrate. They internalize the need for invention and they have the desire to understand the meaning behind these procedural skills. Routine expertise has a pattern that is prevalent in every industry. The test is to be able to describe ‘why’ something works, not ‘how.’ The combination of the past knowledge and the reason why it works enables adaptive experts to grasp the full domain of information surrounding the skill. Taking this past knowledge, adaptive experts will then identify even more efficient methods of performing the skill.

Bottom of Form

In 1983 Gentner and Stevens introduced the concept of mental models, in their book of the same name. Mental Models help us visualize the theory with a series of short studies. They explain that individuals can run mental simulations and make predictions on conceptual outcomes. We can logically infer that conceptual experts step beyond the cultural limits procedural experts experience and are able to explore problems more deeply than with simple trial-and-error. The desire to learn unlocks new thinking, removes conventional mental barriers, exposing raw talent.

Consider the following exercise:

 “Two men played five games of checkers. Each won three games. How is this possible?”

Clearly, if the two men are playing against each other this problem is impossible to solve. Adaptive experts will already assume information is missing, constraints are flawed, and their problem is larger than what is being suggested.

After a few minutes most routine experts will realize the two men were not playing against each other and that the problem was indeed solvable. This example of restricted problem spaces, demonstrates how individuals build restricted definitions of problems. When you look at companies that are digitally innovative and companies that are not, the primary differentiating factor is the talent; each company defined the problem differently.

Growing digital innovation initiatives requires adaptive expertise to create a highly metacognitive organizational environment that promotes content knowledge, domain knowledge, and experimentation. Adaptive expertise is defined in the mind and fueled by the attitude that drives it.

The next time a team is assembled to deliver the next dermable (a type wearable that goes on your skin and can stand out like a tattoo, or blend into the color of your skin), swallowable, or nanobot, rethink who’s an expert.

Divergent thinking is essential for digital health creativity.

Healthcare’s Two Biggest Problems Going Into 2016: No Sugar Added

Peter Nichol
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Healthcare’s Two Biggest Problems Going Into 2016: No Sugar Added

Healthcare’s natural evolution from a fee-for-service to value-based outcome models will remain out of reach, until interoperability and payment reform are removed as barriers to provide patient care.

 

Interoperability

Overall, it’s widely accepted that the Health Information Technology for Economic and Clinical Health (HITECH) Act, as a policy was a success. It’s not surprising when the percentage of US Hospitals using digital records skyrocketed from 9.4% to 75.5% between 2008 and 2014, according to a recent brief by the Office of the National Coordinator for Health Information Technology. However, as we include the patient experience into the definition of success, perspectives change. For example, you have a simple annual checkup at your primary care physician locally, and then a week later you travel to a neighboring town and end up in the hospital. The hospital doesn’t have any record of your recent visit a week ago, no access to labs, and won’t even know to ask unless you mention it. Is it an effective meaningful use application? The primary challenge continues to be that providers and payers are not accountable for interoperability under HITECH. The result is a fragmented national healthcare that only hurts the patients we’re trying to help. HITECH was a significant investment with a staggering $35 billion committed for the program, according to Robert A. Sunshine, Acting Director Congressional Budget Office (CBO) in his response to Charles B. Rangel, U.S. House of Representatives, Chairman for the Committee on Ways and Means. The program initially committed to savings from Medicaid and Medicare of $12.0 billion between 2011 – 2019. Have the US consumers and patients realized that savings? Why of course not, there is limited interoperability when making clinical decisions with existing EMR technologies.

 

Interoperability is a monumental challenge that is rarely discussed nationally, and this critical issue needs to be confronted before costs are driven down opening access and allowing providers to explore models for improved quality in patient care.

 

Payment Reform

The method healthcare providers are paid must be changed from a fee-for-service payment system. Without heavy healthcare payment reform, the realization of better access to higher quality care at lower costs, will not happen. Payers won’t do it. Providers won’t do it. We as patients must spearhead this change. Otherwise, we’ll be passing the burden to the next generation.

 

The Center for Healthcare Quality and Payment Reform identified ten major barriers of healthcare payment reform 1. Continued use of fee-for-service payment models, 2. Expecting providers to be responsible for costs they cannot control, 3. Physical compensation based on volume not value, 4. Lack of data for setting payment amounts, 5. Lack of patient engagement, 6. Inadequate measures 7. Lack of alignment among payers, 8. Negative impacts on hospitals (inefficiencies), 9. Policies favoring large provider organizations, and 10. Lack of neutral convening and coordination mechanisms. These issues are complex and will require payers, providers and patients all working together for a healthier tomorrow. This realization will be nearly impossible without payment reform considering we have a payment system incented not to keep patients healthy and a dis-coordinated delivery system at the patient level.

 

In an effort to push down costs, consumers are demanding price transparency. Will healthcare transparency reduce costs? It sounds like it should. Price transparency protects consumers from unfair pricing, and helps to determine the true product evaluation, while building consumer trust. Empowering consumers with price allows, consumers make decisions based on cost and quality information, before care is obtained not after. Better decisions do save money. West Health Policy Institute’s latest analysis indicated, that price transparency could cut $100 billion over 10 years from health spending. However, there can be adverse effects of price transparency, and according to the Health Care Cost Institute, in markets where pricing is very transparent, pricing narrows and the average cost rises. As employers force consumers toward contribution models, selections become difficult and price transparency may not be the single solution. Price transparency creates behavior changes in employees and also in employers.

 

We can only hope the behavior changes in employers soon start to favor the employee.

 

 

References

HTA. (2015). Using The PCAT Formula During Conversational Hypnosis To Solve Problems (online image). Retrieved November 15, 2015, from http://hypnosistrainingacademy.com/using-the-pcat-formula-to-help-people-solve-problems-during-conversational-hypnosis/

 

Peter Nichol, empowers organizations to think different for different results. You can follow Peter on Twitter or on his blog. Peter can be reached at pnichol [dot] spamarrest.com.

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