Webinar presentation for the mHealth Israel community by Joe Jankowski, PhD, Director, Innovation, Henry Ford Innovation Institute at the Henry Ford Health System in Detroit, Michigan. This is a systematic review of the key barriers inhibiting adoption of new technologies across health systems, with an emphasis on specific challenges for startups. Key factors include existing workflows, noise in the system, procurement cycle, costs, IT issues, self interests, value proposition, validation plan, Payer inefficiencies. Suggestion is to partner early, align to a major current problem and to focus on the health system rather than your own product. Also, build out a diverse team of stakeholders, use retrospective data to conduct scenario analysis, set appropriate expectations for time and cost.

1. Hospitals:
Overcoming
Barriers to
Adoption
Joseph Jankowski, PhD
Director, Henry Ford Innovations

2. Poised for Digital Transformation
• Healthcare in need of change and digital innovation takes advantage
of capital efficiency trend; cost to get software product to market is in
constant decline and much lower than a device or drug
• Analytics and AI can reduce/eliminate errors that cost lives and
money; >$17 billion spent on measurable medical errors annually in
US
• IT can reduce the absurd 25% of healthcare costs that are based on
back-office administration

3. So Why So Slow to Adopt?

4. Simply, a strong “Yes”
2106 American medical Association survey yielded high interest and enthusiasm for
digital health tools
But, there are practical reasons why adoption is slow. In the following slides, we’ll
discuss several examples.
Are Doctors Interested?

5. Workflows
Noise In the System
Procurement Cycle
Costs
IT Issues
Self Interests
Value Proposition
Validation Plan
Payer Inefficiencies
Adoption Barriers

6. Hurdle 1: Workflows
• Safety and efficacy are requisites, but not sole needs. Practical fit of solution into
existing care path is critical.
• Who has to be trained, hired? How do I purchase, dispose, respond?
• “I’ll gladly take $1 dollar today over $2 tomorrow” and “Do no harm” are
prevailing mentalities

7. 2106 American medical Association survey yielded high interest and enthusiasm for
digital health tools. The top three characteristics physicians find attractive in digital
health tools are their capacity to improve work efficiency, increase patient safety,
and their diagnostic ability.
Of physicians, 85 percent said they view digital health solutions as being
advantageous to improving patient care, so long as they don't reduce face time
with patients.
Physicians said quality digital tools must be at least as effective as current methods
of patient care, easy to use, have liability coverage and data privacy elements, and
they should be paid for time spent using the tools.
Are Doctors Interested?
(Remember this slide?)

8. Hurdle 2: Noise in the System
• Quite simply, there is always a bottleneck.
• Traditionally, it was the time to develop, inclusive of regulatory navigation.
• With emerging digital health, it is the “activation energy” required to consider,
test and implement a new solution.
• There are simply too many emerging patient engagement platforms and decision
support algorithms to consider
• And many have over-promised.

9. Hurdle 3: Procurement Cycle
• The sales cycle in hospitals is both, long and disintegrated.
• ‘Health systems are a mosaic of individual hospitals, and hospitals a mosaic of
departments.’
• While integrated care is the target, most purchasing is made unit by unit.

10. Hurdle 4: Costs
• Theoretical cost savings are rarely considered. Rather “accounted” costs
dominate.
• Accordingly, preventive value propositions (reduction of errors or downstream
costs) are not valued as much as they should be.
• Volume-based care still dominates thinking and economics, while value-based
care remains the aspiration

11. Hurdle 5: IT integration and security
• Once digital solution is viewed as warranting adoption, practical
issues of IT administration, redundancy and security are paramount
• Bugs or system failings are death-knells
• Perceived security risks are critical detriments to young firms.

12. Hurdle 6: Incumbent self-interests
• The existing corporate players do not want disruption
• Lack of interoperability intentional
• High costs to integrate limit adoption (consider Epic’s App Orchard)

13. Hurdle 7: Practitioner Self-interests
• Automation eliminates jobs in all sectors; not lost of clinicians
• AI for radiology and digital pathology works, but resistance is clear (and logical)
• Automation of triage needed and practical, but it will be fought
• So, “decision support” reigns and this may add costs
• Also, positive self-interest can add features and costs that are not conserved by
the decision makers

14. Hurdle 8: Lack of value proposition
• Digital firms don’t usually “miss the target”, rather, they do not know what the
target is.
• "So many companies have overpromised and under-delivered in terms of
effective software and solving an underlying problem," he told Healthcare Dive.
"You have to know your pain point really well." -- Amino CEO, David Vivero
• What are you selling, why would we buy?
• Ref blood bank example

15. • Tech-based firms often underestimate or don’t even consider validation protocols
• Lack of understanding risk, cost and current pathways erodes “legitimacy”
• Also, leads to absurd economic expectations: remember healthcare “profit” is
about 2-3%
Hurdle 9: Lack of validation plan

16. Hurdle 10: Payer Inefficiencies
• 3rd party Payer System is inefficient, in that it adds another hurdle that is a “black
box”
• A “Chicken and an Egg” paradigm ensues
• Payers may cover once utility is demonstrated; coverage and adoption are
needed in order to prove utility.

17. What Can We Do to Alleviate?
With respect to hospitals
• Partner early
• Align to major current problems
• Focus on system, not product

18. What Can We Do to Alleviate?
Internally
• Buildout diverse teams
• Utilize retrospective data and in silico modeling to reduce costs and
conduct scenario analysis
• Set appropriate expectations internally for time and costs (and garner
investment appropriately)

19. "If you want to disrupt an
industry [like healthcare],
you have to do it in a non-
disruptive way."
– Sami Inkinen
Thank You!