CUA 2018: Disruptive Innovation in Urology: Are You Ready For It?

Halifax, Nova Scotia ( Brian Goldman, MD is an Emergency Room physician who is well recognized for his leadership in the field of disruptive innovation within the healthcare realm – he currently hosts a CBC show and is a prominent leader in the field. He gave a talk about Disruptive Innovation and tried to tailor it somewhat for the purposes of the urologic audience. 

He did start by recommending that everyone read the book entitled “The Innovator’s Prescription” by Clayton Christensen, an important book in the field of disruptive innovation specifically related to healthcare. 

Disruptive innovation, as described in that book, is “Innovation that creates new market/value network & eventually disrupts existing market… displacing established market leaders & alliances.” Often by introducing simplicity, convenience, accessibility, and affordability where complications and cost are the status quo.
  • The innovator often has a product outside the existing market – because they lack the means or access to the market itself
  • They offer a version of the leading product that performs worse compared to the leader on quality measures… quality measures often dictated by the leaders in the field!
  • They end of capturing the market anyway because their product is simpler, cheaper and more convenient
As an anecdote, he walked through the Uber story – though it is one of many examples, including Airbnb, etc. 

But how can an established market prepare for disruption?
  • Awareness and understanding potential for technology to drive disruption
  • Changing the culture – encourage and promote innovative practices
  • Organizational ability to redirect systems, assets, and people to address threats & opposition
  • Effective resources to enable change
64% of companies are struggling to prepare or are unprepared to be disrupted

Medical culture, unfortunately, is particularly susceptible to this because of some features of its culture:

1. Risk-averse – we fear complications, and one small complication or folly, and apologies need to be made
2. Defensive & ultra-sensitive to criticism and threats
3. We think we’re supposed to know everything – so we get offended when someone outside the system claims to know more!

He then reviewed some anecdotes of disruptive innovation that have already occurred in medicine – not initially accepted, occasionally outright ridiculed, but now standard of care.

1. Laparoscopy and laparoscopic surgery
2. Cystoscopy

3. Use of finasteride / medical therapy for BPH management – he notes on this one, pharma companies were smart and marketed the agent to family doctors and not urologists, so this bypassed urologists altogether!

Looking at the current landscape – there is a shortage of resources for physicians, too many physicians being trained. One disruptive innovation was to transfer skills from a highly costly but skilled personnel (physicians) to more affordable healthcare providers, often using technology. 

  • Doctors are not needed all the time!
  • Gave a few anecdotes of PA’s and NP’s filling the gap for healthcare needs and triaging care when needed
Urology is not immune to this, as mid-level providers have increased in Urology as well. Slower uptake in Canada, but rising:
UroToday CUA 2018 Disruptive Innovation in Urology Are you ready for it 1
Some other healthcare disruptive innovations:

1. Virtual doctor visits – now approved in BC and being paid for under provincial health care budget
2. PEEK – a mobile device add-on that has been trialed in Kenya to take pictures of patient’s retina’s in remote areas, read by a remote ophthalmologist, and provides quick diagnoses of basic ophthalmologic conditions. $600 (cost eventually will go down) vs. $120,000 for a state-of-the-art eye exam. 
3. Butterfly iq – an already approved hand-held US probe that can be attached to a mobile device. Already being used clinically. 

Deep-learning, new technology, will push these even further – not only will the tools be there for local physicians (and even patients!) to examine themselves, but eventually deep-learning may allow for immediate diagnosis of simple conditions. Pathologists and radiologists are in particular danger of being replaced by machine learning.

At this time, the biggest barrier to disruptive innovation in healthcare: concerns re: privacy. But he feels this is overrated – as younger generations have routinely expressed their view that they would be willing to sacrifice some privacy for convenience. 

Change is coming! disruptive innovation is needed! However, you should be prepared and be willing to change with the times. 

His take-home advice:
UroToday CUA 2018 Canadian Urology Workforce and Interprovincial Economics 2

Presented by: Brian Goldman, MD,  Mount Sinai Hospital, Toronto, ON

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto   Twitter: @tchandra_uromd at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia

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