Fresh on the heels of my recent bar coding epiphany comes another “unintended consequences” article. It turns out that the whipsawing that accompanies the adoption of new technologies is completely foreseeable, the “Why doesn’t this thing work right?” phase is as predictable as the seasons.
Thanks to Dr. Mark Wheeler, Director of Clinical Informatics of PeaceHealth, for introducing me last week to the “Technology Hype Cycle” concept. The Cycle, originally described by the IT consulting firm Gartner, is comprised of an all-but-inevitable series of phases that technologies tend to traverse after they are introduced. The five phases are:
You can chart the course of virtually any
health information technology on the Hype Cycle curve. In the case of
computerized provider order entry (CPOE), the trigger was the
development of the technology in the 70s and 80s (the first CPOE system
was implemented at El Camino Hospital during Nixon’s presidency). The
Peak of Expectations was turbo-charged by the research in the 1990s by
Bates demonstrating its value in one highly unusual organization
(Brigham & Women’s Hospital), working with a homegrown system. The
apogee was the endorsement of CPOE by the Leapfrog Group in 2002.
My colleagues and I may have helped initiate the Trough – our 2001
report on evidence-based safety practices gave CPOE a relatively low
mark on “strength of the evidence,” leading to significant
consternation (“you’re holding back implementation”) among some safety
experts and advocates but opening the floodgates of skepticism. Further
Trough-digging came from studies that identified all kinds of
unexpected consequences from CPOE – culminating in the Mother of all
Excavators, the paper by Han from Pittsburgh Children’s Hospital
demonstrating that CPOE increased the mortality rate.
As more and more organizations enjoy successful CPOE deployments, we
are now trudging up the Slope of Enlightenment. And, with improving
systems (some of today’s commercial systems aint half bad), we are
probably about to scale the Plateau of Productivity.
Bar Coding and Smart Pumps, being less well-established technologies in
healthcare, are probably a phase or two behind. So expect
ecstasy-agony-realism cycles for these technologies as well.
The reason I find the Hype Cycle concept to be so illuminating is its
explanatory power and predictive value. The Cycle allows one to
pinpoint the stage of any technology at a given time (for an example,
here’s Gartner’s 2006 report on Web-based technologies outside
medicine). In the health care world, the thoughtful and prudent CIO or
CMIO will use his or her knowledge of the Cycle to help prepare the
organization for the trauma that is about to be visited upon it. For
example, a hospital gearing up to implement CPOE or bar coding would be
well advised to ready its troops to read about – and possibly
experience – the Trough of Disillusionment. This nadir (“Whose idea was
this damn thing anyway?”) is much easier to stomach when you know that
the final, happier, phases are just around the bend.
Of course, none of this is new. Even before there was a Technology Hype
Cycle, implementing new technologies was not for the faint of heart.
Consider this quote:
“That it will ever come into general use, notwithstanding its value, is
extremely doubtful because its beneficial application requires much
time and gives a good bit of trouble, both to the patient and the
practitioner.”
Was the writer speaking of CPOE?
Bar coding? Well, no. This is a quote from the 1834 London Times,
referring to a new contraption called the stethoscope. You’ll be
pleased to know that it eventually reached its Plateau of Productivity.
Robert Wachter is widely regarded as a leading figure in the modern
patient safety
movement. Together with Dr. Lee Goldman, he coined the
term "hospitalist" in an influential 1996 essay in The New England
Journal of Medicine. His most recent book, Understanding Patient
Safety, (McGraw-Hill, 2008) examines the factors that have contributed
to what is often described as "an epidemic" facing American hospitals.
His posts appear semi-regularly on THCB and on his own blog "Wachter’s World."
Categories: Uncategorized
Professor Wachter, thanks for this interesting observation of the Hype Cycle – which probably is applicable to CPOE as you describe. If so it’s a particularly interesting example because it is such a long episode. Though often under ten years duration end-to-end, Hype Cycles can sometimes run to 20 years or more. Customer Relationship Management is a good example. Occasionally we see 2 or three sequential cycles in the same topic, over a multi-decade period.
Tim Gee correctly points out that Geoffrey Moore’s excellent work helps sellers of a technology or innovation to ‘Cross the Chasm’. However our Hype Cycle research does in fact address how the buyer / adopter can drive out of the trough of disillusionment – by addressing 4 key time-to-value gaps.
Gartner publishes several healthcare technology market hype cycles each year.
Another useful model for market adoption is Geoffrey Moore’s Crossing the Chasm. While the Gartner Hype Cycle is good for observing technology adoption, it does nothing to facilitate adoption or getting out of the trough of disillusionment (what Moore calls the “chasm”). Moore’s model provides the conceptual framework for figuring out how to, you know, get people to really buy your fancy new stuff.
Sounds about right to me, and I especially like the existential terminology.
“The Trough of Disillusionment” sounds pretty wrenching! I think we can all relate; that phase sometimes results in violent acts against inanimate objects…
Hmmm… What an appropriate reading for everyone so excited about this whole Health 2.0 thing.
Where is that “market” now? Sure seems like at the “peak of inflated expectations”. How long before it falls into abyss? To quote the post: “as negative experience mounts” and to add my comment “when people get tired of pouring money down the drain”.
By the way here is a “revised version of the hype cycle”. Some markets quickly skip disillusionment and some never come back from the dead. Take your guesses what will trend where and WHY.
Enjoy: The new hype cycle