Bringing Innovation Into Clinical Practice - The Missing Links

Of all the medical devices that General Electric (GE) brings into the market each year, a small hand - held electrocardiogram (ECG) called the Mac 400 is one of its top sellers and most stellar innovations for this year.  This device was actually developed by GE's R&D team in Bangalore, India.  It is exemplary simple and slick, low in cost and very easy to use by clinicians in the field.  The multiple buttons on other ECG units have been reduced to only four.  The printer is small and portable which allows for ticket like receipt print outs of patients medical data.  The unit is extremely portable, can fit in a small bag, runs on batteries and most importantly sells for $800 compared to a market average price of $2,000[1].  There seems to be a paradigm shift in medical technology towards complex and costly systems to simplicity and cost efficiencies due to the economies of scale that are needed to reach a vast patient population in a country like India or the U.S.  Increasing healthcare costs are forcing this trend and the rehabilitation industry should not be an exception.  Many times I've asked myself, why there seems to be such scarcity of product innovation in physical, occupation and speech therapy?  Paradoxically, I've been to a few university labs around the country and I'm startled at the level of innovation and research.  Why then are so many clinics, hospitals and rehabilitation centers across the country stuck in the horse and buggy days?   How come some of the wonderful innovations that are coming up at the university level are not making it into mainstream centers?  Perhaps we can learn something from GE's Mac 400 unit in order to answer these questions - in order for innovation to make it to the rehabilitation market place it must have three main components of which the Mac 400 has mastered: simplicity; ease of utilization and cost efficiency.  But just as important as these three pillars, in order for innovation to make it into the hand of a therapist, we need to close the gap between university level research and the private sector.  These may seem like some very obvious elements but somehow, all other fields in the healthcare industry seem to be way ahead of the innovation curve than us.

When it comes to innovation simplicity drives ease of utilization and lowers costs.  I've walked into a few university labs in the U.S. to look into certain patented products and I'm absolutely amazed at the level of complexity, ingenuity and pure genius that goes into certain inventions: robotic arms and legs; complex force platforms; exercise ergometers that can track VO2 max and lactic acid levels; exoskeletons for the upper and lower extremities of patients with severe neurologic dysfunction and prosthetic arms that are controlled through patient's own neural circuitry.  Why then are these incredible innovating ideas not making it into our clinics to help the patients that we are so dedicated to?   Off course we see a few exemptions to this rule.  University owned rehab centers sometimes benefit from the technology transfer and big name institutions with ample grant availability or big private budgets can afford to bring some of these innovations into their practices.  But we certainly don't see this level of technology transfer in your typical Dubuque, IA SNF therapy department or strip mall out patient PT clinic.  The level of complexity of these innovations can drive the cost of the product to such high levels that the vast majority of the typical therapy centers in the country (and for that matter the vast majority of patients) cannot afford to benefit from the technology.  Technology complexity does not only add cost to the product itself but also to the operations of therapy departments that always rely on very thin profit margins. Complex technology can be time consuming to apply into clinical practice.  For example, setting a patient up on a force platform to conduct a balance evaluation or balance activity can be a very time consuming task for a therapist who's already very strapped for time and has to meet certain efficiency criteria's at the workplace (i.e. number of patient treatments per day).  A therapist will not likely take 30 minutes of his / her time to set somebody up on a force platform when he or she can conduct a Time Up and Go Test or balance exercise in half that time (the only piece of innovation required for that is a gait belt at a cost of $5 with no difference in reimbursement!).  Furthermore, figuring out what buttons to press and how to exactly set up the force platform could be a very daunting task to therapists who by nature do not readily embrace technological changes.  The therapist's manager on the other hand may not enforce the use of the force platform since this particular therapist can bill and get reimbursed the same amount of money for regular therapeutic exercise techniques as he or she would with the use of a platform.  The end result is that most than likely this therapist will probably opt for a simpler way to measure balance and treat the patient and not use the force platform at all.  If this continues to happen across this department, the technology would be considered a poor investment for that department no matter how innovative and amazing it may be.

Many of the rehabilitation innovations that we see coming out of universities are simply not efficient in clinical practice because of their complexity of use and high cost structures.  As a result the private sector cannot offer a proper price point on these innovations which makes it extremely difficult to market and sell these products.  This is a sad reality because there are a myriad of new products and technologies that come out university research labs every year that indeed make it into various research journals but end up sitting and collecting dust in research labs across the country.  In order to avoid such waste of investments and leverage technology to the benefit of the vast majority of patients undergoing rehabilitation services the private sector must collaborate in R&D with universities to bring products and ideas into the market place.  This is not a new concept as many other healthcare companies such as GE collaborate with several universities around the world to bring products into the market.  Hence, the development of technologies that are simple, easy to use and cost effective can only be brought into the market place and implemented across the majority of therapy departments only if this collaboration exists.  The private sector (i.e. therapy companies, private hospitals, durable medical equipment firms, private equity investors, etc) can give extremely important feedback on the needs, use and marketability of products or concept innovations.  Valuable time would be saved in the part of researchers via solid feedback from private companies that precisely know the market needs of their customers at a much deeper level than the researchers do.  Durable medical equipment companies for example invest heavily in market research and customer surveys.  The constant communication and investigation of the end users of products (therapists and patients) allows the private sector to address two intricate questions: 1) what technologies are needed by therapists to address the needs of their patients OR improve their clinical efficiencies and 2) how therapists apply the technology in the context of their working environment and performance demands.   Without properly answering these two fundamental questions many innovations come out of university research labs just because the researcher thinks that his or her concept is a great idea.  But just because the researcher thinks that the concept is a big idea does not necessarily mean that the market thinks it's a great idea as well.  This problem of innovation for the sake of innovation is notorious in the IT industry.  Finally good ideas that come out of universities that are simple, inexpensive and easy to use often time do not make it to the clinician hands because the universities lack the proper distribution channels as well as  proper marketing, sales, supply chain and logistic strategies to effectively implement the innovation across the needed target segment.  Thus, the private sector collaboration with academia is crucial for developing proper business plans that will help universities attain the proper economies of scale needed to reach the vast rehabilitation industry market place and make technologies reach mainstream rehab centers across the country.

Perhaps there might come and age in the rehabilitation industry in where the majority of rehabilitation clinics across the country can measure postural sway for stroke patients using force platforms or improve the abnormal synergies of patients using robotic arm systems.  But until these technologies don't become simpler, easier to use and considerably cheaper we will not see patients reaping the rewards of new technologies.  Finally, until the private sector does not properly collaborate with academia, researchers will be flying blind in the labs, bringing products into the pipeline that although may be good for the patient may not be efficient and realistic for clinicians to use in clinical practice as we see it today.  The ultimate goal of innovation in the rehabilitation field is to have an impact at a clinical level.  Off course the advancement of our profession depends on properly conducted research and empirical evidence that allows us to properly answer clinical questions as well - a much needed area of research.  But if innovations and ideas don't make it into the market place, they run the risk of never leaving professional journals or research labs - and that's not doing any good to the patients that we serve.

[1] The Economist: First Break All the Rules: The Charms of Frugal Innovation.  April 17 - 23, 2010