Category: Technology

Disruptive Innovation in Medicine

DoctorWaitingRoom.jpgSource of image:  http://online.wsj.com/article/SB114540135592529301.html?mod=home_personal_journal_middle

  

(p. D1) The dysfunctional doctor’s office is getting a makeover.

A growing number of programs around the country are helping doctors redesign their offices to wring more profit out of their practices and fix problems that have long frustrated patients: weeks-long delays to get appointments, hours in the waiting room, too-brief visits with the doctor, and the near impossibility of getting the physician on the phone.  While the goal is to improve care, the programs also aim to avert a looming shortage of primary-care doctors who are frustrated with low pay, long hours and rising overhead costs.

The new programs borrow lessons from other industries to help doctors work more efficiently, especially those in solo and small group practices who account for the majority of outpatient office visits.  One approach employs calculations used by airlines, hotels and restaurants to predict demand:  The idea is that doctors can cut patient waits much the way restaurant chains seat diners and turn over tables efficiently.  Others involve relatively simple changes, such as leaving afternoon appointments open for urgent visits, or having patients fill out paperwork ahead of time online.

Managed-care giant Kaiser Permanente is launching a program to help 12,000 doctors that contract with its health plan increase their efficiency with a new electronic-medical-records system.  Portland, Ore., physician Chuck Kilo, whose GreenField Health Systems helps restructure medical practices, and is assisting with the program, says that too many doctors’ appointments take up valuable office time with follow-up that could be accomplished with phone calls and email.

Other models involve more-radical change, such as one called "Ideal Micro Practice" that sharply reduces or even eliminates support staff.  With this blueprint, doctors rely on electronic health records and practice-management software to quickly dispense with administrative tasks.  And they may run their offices solo, greeting patients personally as they come in the door.

"The office practice hasn’t changed much in 50 years," says John Wasson, a Dartmouth Medical School professor and practice redesign expert who is helping to launch a national program to expand the Micro Practice concept.  "This is a disruptive innovation that can lead to increased quality and reduced costs."

 

For the full story, see: 

LAURA LANDRO. "Cutting Waits at the Doctor’s Office; New Programs Reorganize Practices to Be More Efficient; Applying ‘Queuing Theory’." The Wall Street Journal (Weds., April 19, 2006): D1 & D3.

  

  Source of graphic:  http://online.wsj.com/article/SB114540135592529301.html?mod=home_personal_journal_middle

 

 

“life is too short”

Source of book image:  http://www.amazon.com/gp/product/customer-reviews/0738204315/ref=cm_cr_dp_2_1/104-9985403-1047968?%5Fencoding=UTF8&customer-reviews.sort%5Fby=-SubmissionDate&n=283155

The Cluetrain Manifesto is a thought-provoking, entertaining, uneven, overly-mystical, somewhat dated classic on the impact of the internet on business and life.  Here is the book’s startling start:

WE DIE.

You will never hear those words spoken in a television ad.  Yet this central fact of human existence colors our world and how we perceive ourselves within it.  "Life is too short," we say, and it is.  Too short for office politics, for busywork and pointless paper chases, for jumping through hoops and covering our asses, for trying to please, to not offend, for constantly struggling to achieve some ever-receding definition of success.  (p. 1)

Locke, Christopher, Rick Levine, Doc Searls, and David Weinberger. The Cluetrain Manifesto: The End of Business as Usual. Cambridge, Mass.:  Perseus Books Group, 2001.

 

 

Radiologist Outsourcing Is Mainly a Myth

LeonhardtDavid.jpg David Leonhardt.  Source of image:  http://www.nytimes.com/2006/04/19/business/19leonhardt.html?_r=1&oref=slogin

 

A few years ago, stories about a scary new kind of outsourcing began making the rounds.  Apparently, hospitals were starting to send their radiology work to India, where doctors who make far less than American radiologists do were reading X-rays, M.R.I.’s and CT scans.

It quickly became a signature example of how globalization was moving up the food chain, threatening not just factory and call center workers but the so-called knowledge workers who were supposed to be immune.  If radiologists and their $350,000 average salaries weren’t safe from the jobs exodus, who was?

On ABC, George Will said the outsourcing of radiology could make health care affordable again, to which Senator Charles E. Schumer of New York retorted that thousands of American radiologists would lose their jobs.  On NPR, an economist said the pay of radiologists was already suffering. At the White House, an adviser to President Bush suggested that fewer medical students would enter the field in the future.

"We’re losing radiologists," Representative Sherrod Brown, an Ohio Democrat, said on CNN while Lou Dobbs listened approvingly.  "We’re losing all kinds of white-collar jobs, all kinds of jobs in addition to manufacturing jobs, which we’re losing by the droves in my state."

But up in Boston, Frank Levy, an economist at the Massachusetts Institute of Technology, realized that he still had not heard or read much about actual Indian radiologists.  Like the once elusive Snuffleupagus of Sesame Street, they were much discussed but rarely seen.  So Mr. Levy began looking.  He teamed up with two other M.I.T. researchers, Ari Goelman and Kyoung-Hee Yu, and they dug into the global radiology business.

In the end, they were able to find exactly one company in India that was reading images from American patients.  It employs three radiologists.  There may be other such radiologists scattered around India, but Mr. Levy says, "I think 20 is an overestimate."

Some exodus.

 

For the full story, see:

Leonhardt, David.  "Political Clout in the Age of Outsourcing."  The New York Times (Weds., April 19, 2006):  C1 & C4.

Google Evolves

Gary Hamel has recently penned some thoughtful observations about what practices of Google have led to its success.  An excerpt from that analysis appears below.  (Hamel earlier wrote a popular book in which he makes extensive use of Schumpeter’s process of creative destruction.)

Only time will tell whether Google has succeeded in building an evolutionary advantage.  But consider:  Since it’s founding, it has repeatedly morphed its business model.  Google 1.0 was a search engine that crawled the Web but generated little revenue; which led to Google 2.0, a company that sold its search capacity to AOL/Netscape, Yahoo and other major portals; which gave way to Google 3.0, an Internet contrarian that rejected banner ads and instead sold simple text ads linked to search results; which spawned Google 4.0, an increasingly global entity that found a way to insert relevant ads into any and all Web content, dramatically enlarging the online ad business; which mutated into Google 5.0, an innovation factory that produces a torrent of new Web-based services, including Gmail, Google Desktop, and Google Base.  More than likely, 6.0 is around the corner.

Of course Google may ultimately fall victim to hubris and imperial overstretch as it takes on Microsoft, Yahoo, eBay, the occasional telecom giant and pretty much everyone else in cyberspace.  Or like Microsoft, it may simply become like every other big company as it grows.  But that’s not the way I’d bet.  Google seems to have grasped the new century’s most important business lesson:  The capacity to evolve is the most important advantage of all.

 

For the full commentary, see:

Hamel, Gary.  "Management à la Google."  The Wall Street Journal  (Weds., April 26, 2006):  A16.

 

 

 

And here is the information on Hamel’s most recent book:

 

Hamel, Gary. Leading the Revolution: How to Thrive in Turbulent Times by Making Innovation a Way of Life. Revised & Updated ed.  Harvard Business School Press, 2002.

 

 Source of image: http://www.amazon.com/gp/product/B000EPFVBE/sr=8-1/qid=1146333251/ref=pd_bbs_1/104-5668094-9083929?%5Fencoding=UTF8

Europe’s Antitrust Policies Based on “Pathological Revulsion” to Creative Destruction

One of the EU’s findings is that Microsoft uses its desktop dominance to capture the market for Web server software, and now the EU further charges Microsoft with failing to honor its ruling.  So Microsoft’s takeover of serverware proceeds apace?  Er, Brussels we have a problem.

At last count,  Apache-Linux had 62% of the market, Windows 25%,  with various others capturing smaller slices.  True, Microsoft saw a nearly five-point increase in market share last quarter thanks to GoDaddy.com shifting its 3.5 million hosted sites from Linux to Windows.  Maybe the EU should subpoena GoDaddy on grounds that for Microsoft to compete successfully for a customer is illegal.

The other pillar of Europe’s case is Microsoft’s alleged ability to foreclose the market to rival media-playing software.  This week, EU lawyers are trying to swat down the inconvenient fact that, since their ruling, Apple’s iTunes and Macromedia’s Flash Player have carved out big niches for themselves.  The Apple example is worth inspecting up close.  It demonstrates that people don’t buy computers to run software, but to consume information and entertainment "content."  Apple gave them the music they wanted, and its software easily found a home on their computers.

Yet the EU simply rejects the example as irrelevant because it doesn’t fit its mental category about what constitutes a "media player."  More than stupid — this suggests a pathological revulsion against the kind of disorder in which an Apple can come along and upend all the procrustean assumptions of the EU’s drearily youthful staff of economists and lawyers.  We’re not kidding when we say there’s a connection between the Microsoft case and the European 20-somethings who riot in the streets because they’d rather have no job than take a job from which they might fail and be fired.

 

For the full commentary, see: 

HOLMAN W. JENKINS, JR.  "BUSINESS WORLD; The Land (and Antitrust Case) That Time Forgot."  The Wall Street Journal  (Weds., April 26, 2006):  A17.

Endangered Fish Thrive on Oil Platforms

Large numbers of rockfish and other fish near the Gilda oil platform off the Ventura coast.  Source of image: http://www.lovelab.id.ucsb.edu/Check.html

 

SANTA BARBARA, Calif., March 11 – A marine biologist has found that 27 oil platforms off California’s Central Coast may be havens for bocaccio, cowcod and other fish.  

 . . .

Since the 1950’s, when heavy fishing began in the region, some species have been reduced to 6 percent of their previous numbers, Dr. Love said.  Overfishing has led to an economic disaster, leading some fisheries to close.

Dr. Love films fish around the platforms from a submarine and then counts them in his laboratory.

Among his findings are that large fish prefer crevices at the platforms’ base, and smaller ones like the middle section above their predators.

At Platform Gail, which stands in 739 feet of water nine miles off the Ventura coast, Dr. Love found what he believes to be the highest density of two species of overfished rockfish in Southern California.

Dr. Love emphasizes that his research does not draw conclusions about whether the platforms should be removed.  He says his personal view is that the rigs should stay in place, cut below the waterline so that ships can pass safely over them.

Dr. Love gets about 80 percent of his research money from the government, and the rest from the California Artificial Reef Enhancement Program, a Sacramento nonprofit group financed almost entirely by oil companies.  The group has contributed about $100,000 a year to his research since 1999, said its executive director, George Steinbach.  Dr. Love said oil industry money could not sway his research.

 

For the full story, see:

"Citing Oil Rigs as Fish Havens, Companies Resist Removal."  The New York Times  (Mon., March 13, 2006):  A18.

Doctors Erect Barriers to Keep Out Competition

RadiologistBangalore.jpg A Bangalore radiologist.  One of three radiologists in India known to be reading U.S. scans.  Each of the three has a U.S. degree, as required by U.S. law.  Source of image:  http://www.nytimes.com/2006/04/19/business/19leonhardt.html?_r=1&oref=slogin

 

(p. C1) Radiologists seem like just the sort of workers who should be scared.  Computer networks can now send an electronic image to India faster than a messenger can take it from one hospital floor to another.  Often, those images are taken during emergencies at night, when radiologists here are sleeping and radiologists in India are not.

There also happens to be a shortage of radiologists in the United States.  Sophisticated new M.R.I. and CT machines can detect tiny tumors that once would have gone unnoticed, and doctors are ordering a lot more scans as a result.

When I talked this week to E. Stephen Amis Jr., the head of the radiology department at Montefiore Medical Center in the Bronx, he had just finished looking at some of the 700 images that had been produced by a single abdominal CT exam.  "We were just taking pictures of big, thick slabs of the body 20 years ago," Dr. Amis said.  "Now we’re taking thinner and thinner slices."

Economically, in other words, ra-(p. C6)diology has a lot in common with industries that are outsourcing jobs.  It has high labor costs, it’s growing rapidly and it’s portable.

Politically, though, radiology could not be more different.  Unlike software engineers, textile workers or credit card customer service employees, doctors have enough political power to erect trade barriers, and they have built some very effective ones.

To practice medicine in this country, doctors are generally required to have done their training here.  Otherwise, it is extremely difficult to be certified by a board of other doctors or be licensed by a state government.  The three radiologists Mr. Levy found in Bangalore did their residencies at Baylor, Yale and the University of Massachusetts before returning home to India.

"No profession I know of has as much power to self-regulate as doctors do," Mr. Levy said.

So even if the world’s most talented radiologist happened to have trained in India, there would be no test he could take to prove his mettle here.  It’s as if the law required cars sold here to have been made by the graduates of an American high school.

Much as the United Automobile Workers might love such a law, Americans would never tolerate it, because it would drive up the price of cars and keep us from enjoying innovations that happened to come from overseas.  But isn’t that precisely what health care protectionism does?  It keeps out competition.

 

For the full story, see:

Leonhardt, David.   "Political Clout in the Age of Outsourcing."  The New York Times  (Weds., April 19, 2006):  C1 & C4.

Seeing How Life Has Improved Since the Days of the Cowboys

cowboyPBS.jpg A cowboy on "Texas Ranch House."   Source of image:  the WSJ article cited below.

 

"Texas Ranch House" — circa 1867 — is the latest PBS experiment in transporting a group of people back to another era so we can watch them live and struggle the way our ancestors did.  (Part one of eight begins Monday, 8-9 p.m. ET, but check local listings.)  As with past series such as "Colonial House," everything — clothing, tools, food, housing and all-around deprivation — is authentic.  Once again, though, stuffing 21st-century mentalities into period costumes and situations is a tough fit. And once again, it’s the folks wearing the bodices that chafe the most.

The Western setting is fascinating for two reasons:  What seems familiar from movies and TV takes on fresh significance when there are real people — not pampered actors — trying to scratch out an existence on the frontier 24/7, with no plot to guide them.  There is also the fact, as one of the participants points out early on, that many of us exist today only because a forebear actually did make the real journey West and manage to survive there long enough to bear children.  What luck, we are reminded more than once during this series, that those ancestors were so different from contemporary Americans.

. . .

The trouble that threatens to sabotage the entire experiment develops in the widening gap between the cowboys and the Cooke family.  The first time one of the employees disses boss man Mr. Cooke, yelling "Don’t let your wife run your life," we react with disgust at the insult.  As one of the women in the household explains to the camera, all the cowboys "are sexist bastards."  Besides, instead of rising early to ride the range in search of mavericks for 10 hours, the cowboys — mostly young Americans plus one frisky British boarding-school boy playing the part of 19th-century remittance man — indulge in long naps during the 100-degree days and often wake up in the morning with hangovers after nights of hard drinking.

At some point, though, certain facts begin to sink in:  Mr. Cooke does have management shortcomings and Mrs. Cooke is far more involved in running the business side of the ranch than a frontier wife would have been.  The ladies, in general, don’t enjoy the roles or status that historical reality would dictate, and some act out in defiant, liberated ways.  A fatal flaw, if not the only one, for the success of the ranch enterprise.  In 1867, spending days making cornhusk dolls while the house filled with flies and vegetables rotted in the garden wasn’t an option for folks who wanted to stay alive.  And, like it or not, keeping the ranch hands happy, as obnoxious as they might be, was more important than maintaining marital bliss.

This being a made-for-television environment, no one perishes, but there are no happy endings here, either.  When one of the Cooke daughters says to the camera, "I feel lost and dazed and hurt," you feel genuinely sorry for her.  At the same time, it’s clearer than ever that emotional pampering, navel-gazing and gender warfare are modern luxuries.  Like it or not, if these had been features of daily life in the West 100 years ago, many of the people reading this would never have been born.

 

For the full review, see:

Nancy deWolf  Smith.  "TV REVIEW; The West That Never Was."  The Wall Street Journal  (Fri., April 28, 2006):   W10.

Chernobyl Accident Cannot Occur In U.S. Type Reactors


Twenty years ago (April 25, 1986), the Chernobyl nuclear accident sent a plume of radiation into the air above Ukraine.  The word "Chernobyl" remains the most emotionally charged argument used by the opponents of nuclear energy.  But if examined carefully, the main lesson from Chernobyl may be that what happened there cannot occur in the better designed light water reactors used in the United States, and most of the rest of the world.  William Sweet, the author of the commentary below, has also authored Kicking the Carbon Habit:  Global Warming and the Case for Renewable and Nuclear Energy.

 

(p. A23) . . . , though it went unnoticed at the time and has been inadequately appreciated since, Chernobyl also cast into relief the positive features of the reactors used in the United States and most other advanced industrial countries.

The reactor at Chernobyl belonged to a class that was especially vulnerable to runaway reactions.  When operating at low power, if such reactors lost water, their reactivity could suddenly take off and very rapidly reach a threshold beyond which they could only explode.  Making matters worse, surprisingly little more pressure than normal in the machine’s water channels would lift its lid, snapping the vital control rods and fuel channels that entered the reactor’s core.

On the night of April 25, 1986, poorly trained and supervised plant operators conducted an ill-conceived experiment, putting the machine into the very state in which reactivity was most likely to spike.  Within a fraction of a second, the reactor went from being barely on to power levels many times higher than the maximum intended.

This kind of accident cannot happen in the so-called light water reactors used in the United States and most of Western Europe and Asia.  In these reactors, the water functions not only as a coolant but as a "moderator": self-sustaining nuclear chain reactions cannot take place in its absence.  This is a very useful passive safety feature.  If coolant runs low, there is still a danger of a core meltdown, because the fuel retains heat; but the reactor will have automatically and immediately turned itself off.

 

For the full commentary, see:

WILLIAM SWEET.  "The Nuclear Option."  The New York Times  (Weds., April 26, 2006):  A23.

 

The reference to Sweet’s related book is:

Sweet, William.  Kicking the Carbon Habit:  Global Warming and the Case for Renewable and Nuclear Energy.  Columbia University Press, 2006.


Source of book image:  http://www.amazon.com/gp/product/0231137109/sr=8-1/qid=1146071688/ref=sr_1_1/104-5668094-9083929?%5Fencoding=UTF8



Founder of Greenpeace Endorses New Nuclear Reactors


MoorePatrick.jpg   Patrick Moore, co-founder of Greenpeace.   Source of image:    http://www.nytimes.com/2006/04/25/us/25nuke.html?_r=1&oref=slogin

 

(p. A24) WASHINGTON, April 24 — The nuclear industry has hired Christie Whitman, the former administrator of the Environmental Protection Agency, and Patrick Moore, a co-founder of Greenpeace, the environmental organization, to lead a public relations campaign for new reactors.

Nuclear power is "environmentally friendly, affordable, clean, dependable and safe," Mrs. Whitman said at a news conference on Monday.  She said that as the E.P.A. leader for two and a half years, ending in June 2003, and as governor of New Jersey for seven years, she had promoted various means to reduce the emission of gases that cause global warming and pollution.

But Mrs. Whitman said that "none of them will have as great a positive impact on our environment as will increasing our ability to generate electricity from nuclear power."

. . .

Mr. Moore said he favored efficiency and renewable energy, but added that solar cells, which produce electricity from sunlight, were "being given too much emphasis and taking too much money."  A dollar spent on geothermal energy, he said, was "10 to 12 times more effective in reducing greenhouse emissions."

Mr. Moore is the director of a company that distributes geothermal systems in Canada.  He is also a supporter of what he called "sustainable forestry" because, he said, building with wood avoided the use of materials whose manufacture releases greenhouse gases, like steel and concrete.

Mr. Moore, who left Greenpeace in 1986, favors many technologies that some environmentalists oppose, including the genetic engineering of crops, and has referred to his former colleagues as "environmental extremists" and "anti-human."

. . .

Representatives of the United States Chamber of Commerce and the Teamsters also spoke in favor of new reactors.


For the full story, see:

MATTHEW L. WALD.  "Ex-Environmental Leaders Tout Nuclear Energy."  The New York Times (Tues., April 25, 2006): A24.