Staff on RWJF's Pioneer Portfolio evaluated all of the ideas submitted to the Disruptive Innovations in Health and Health Care competition and selected 11 entrants to compete for grant funding, if they so choose. Many you will recognize as finalists and winners, while others were included because they represented a pioneering effort.

Entrants invited to submit proposals directly to RWJF will be asked to demonstrate how foundation funding could be used to further the development of the work represented in their respective Changemakers entries -- either through demonstration, scale and/or replication. The total amount of grants made under this phase will not exceed $5 million.

All of us at RWJF continue to be inspired by the ideas and energy contributed to this competition, and we're grateful for your participation.

The 11 entrants invited to compete for RWJF funding include:

• Project ECHO: Knowledge Networks for the Treatment of Complex Diseases in Remote, Rural, Underserved Communities -- University of New Mexico Health Sciences Center
• Family Coaching Clinics: A New Model of Preventive Mental Health Care -- UCLA Semel Institute Global Center for Children and Families
• Instant Birth Control -- Planned Parenthood of the Columbia Willamette
• Develop a universal technology framework for registries focused on capturing outcomes data for cardiovascular disease -- American College of Cardiology
• Clinical Research Information Exchange -- CRIX International
• Health Futures Markets -- New York University
• Respira!: An Extremely Affordable Device for Better Asthma Care -- Stanford University Design School/School of Medicine
• The EpiSurveyor Project: Lowering the Barriers and Raising the Bar for Data Collection -- The Datadyne Group
• Space age medical care for use on Earth -- Henry Ford Hospital
• Rethinking What a Health Insurance Package Can Be -- Working Today-Freelancers Union
• Get Outta My Face: Generation FIT -- Get Outta MY Face

"For more information on entrants invited to submit proposals to RWJF's Pioneer Portfolio, please visit www.rwjf.org/pioneer after November 1, 2007."

Hi, Just wondering if there had been any more news on this. I checked the website as suggested but
did not see any news on the Disruptive Innovation competition after the winners were announced.

Thanks!
Tara

If it's an "American Idol" style contest that helps change the world and elicit great ideas, than so be it. I'd like to see more women with access to birth control because it's available online. This program will get my vote. And, if it receives more funding because of a contest, great. It's a new world. However, it is a new world with great technology, and it should be far easier to vote! I don't see your average person taking the time to go through the registration and voting process.

I'd be curious to hear a discussion of the following (from a blog entry by Adam Huttler),

Adam Huttler Blog Entry

in which he discusses the new trend in funding through online contests. Huttler writes:

"I think contests are incredibly cool. Ever since the famous longitude prize of 1714, they've proven to be an extremely efficient, cost-effective, and democratic way of solving thorny problems. This has been demonstrated more recently through efforts like the Ansari X Prize and even the Netflix Prize. Contests like these spark enormous outputs of creative energy from disparate sources that might not otherwise make an investment in the challenge at hand.

What I'm not crazy about, though, is when contest designers are so keen to embrace the populist spirit that they agree to select winners based primarily or solely on how many votes they get. This is like the American Idol version of grant making and it has a similar likelihood of elevating unoffensive middlebrow mediocrity over genuine innovation."

I don't know Mr Huttler. I'm just curious to hear what the changemakers community thinks about his observations.

The New York Times featured the Disruptive Innovations in Health competition on Tuesday June 26. The article highlighted the innovative approach of Changemakers online collaborative competitions. “It’s a different tool we think we can use,” said Nancy Barrand, a senior program officer at Robert Wood Johnson. “It helps us reach a different audience and gain access to ideas and information much more quickly.” Robert Wood Johnson Foundation’s interest in finding innovations that would be eligible for an additional pool of US$5 million was also mentioned. Read the full story here

I believe technology has and will continue to play a distinct role in bringing about change within the healthcare industry. As people are increasingly turning to virtual solutions and e-business, the healtcare industry now has an opportunity to make a long lasting impact on the way people receive, learn and act upon health information and solutions. Getting information out to the masses is in most cases is only a click away and with proper management and marketing, the effect of programs, e-learning and communication can revolutionize healthcare and make it more accessible for consumers. This in turn will bridge the gaps between patients and providers.

Ashley Tabeling
Founder and COO
Project PCOS
http://www.projectpcos.org

Greeting to all!!

Nancy Barrand (RWJ) says in her "Welcome Letter": The competition is intended to offer you the opportunity to showcase your "ideas"! and your work."

This could be interpreted to suggest that actual implementation of a planned disruptive innovation which has not yet occurred, and is in its formative and partnership-building stages, would be eligibile applicants.

In the write-up on "What is a Disruptive Innovation (May3,2007), which references the sentinel work of Clayton Christensen, the very last paragraph says "This competition seeks to identify those changes that are examples of or "have the potential" to become disruptive innovations in health and health care".

The project FAQ, howver, says: Who is eligible to submit an innovation entry? The Second "bullet" says eligibles "are beyond the stage of idea, concept, or research, and, at a minimum, are at the demonstration stage and indicate success."

Finally, the application itself asks questions related to actual service delivery provided and outcomes, which assumes "service delivery and innovation is already underway".

Simply stated, we really cannot tell if we are eligible to apply for this spectacular funding opportunity. We can only hope the competetion is open to those in organizing and planning phases, in areas that fit the Disruptive Innovation concept "spot-on", and which would be ready for implementation by the time any RWJ award mighht be made.

Bruce M. Brock, Ph.D., MPH
Ann Arbor, MI 48103
734-662-1067

Quickly...RWJF's Pioneer Portfolio supports a program called Project HealthDesign that funds 9 interdisciplinary teams to design and test next-generation personal health record systems. They are taking a uniquely user-centered approach to designing tools and applications that will run in concert with consumers' PHRs to help them improve their health and manage their care. End users -- whether they be parents and school administrators trying to coordinate the care of a child with cystic fybrosis, elderly people struggling to manage complex medication regimens, or diabetics seeking better tools to manage their disease within the everyday flows of their lives -- inform every stage of the design and prototyping process. The PHR tools and applications they develop may be powerfully disruptive...indeed, we hope so. A short overview publication of the program and the grantees is available at http://www.projecthealthdesign.org/media/file/phd-about.pdf.

Along the same lines, a blog called eCareManagement just issued an interesting post on how Google is looking to own the market space for next-generation personal health records. It's a bit long but a good read, and there is a section devoted to the disruptive potential of Google's vision. Read on at http://e-caremanagement.com/connecting-the-dotsgoogle-health-promises-to-create-and-dominate-next-generation-phrs/.

Susan Promislo, Communications Officer
Pioneer Portfolio, Robert Wood Johnson Foundation

Dear CM Community -- We've fielded a few questions from potential entrants around submitting proprietary technology in a transparent, open-sourcing competition like Changemakers. As these questions raise issues that are especially relevant to this competition, and the health field in general, sharing this anecdote might be useful for our community:

"I am very interested in entering the competition, but to do so, I would have to reveal details of a proprietary technology in order to really capture the disruptive nature of my innovation. I'm concerned about giving away some of these details in a transparent competition process."

My first thoughts when fielding these inquiries: Is this paradox? Can you combine proprietary technology with an open-sourcing model in way that truly leads to effective, social impact? Not exactly helpful answers to start. So what is helpful, why should you enter?

Yes, you should enter the competition, and provide as much detail as possible in order to help us understand your disruptive innovation. Not only will you gain visability among a community of innovators and investors, but its an opportunity to position your initiative as a leader in the field. Otherwise, how else will people know you value of your innovation if you don't position yourself as such? We don't need the biochemical blueprint of your formula, per se, but we do need to know how it works, what it does, and why its disruptive. That's why our criteria starts with disruptive innovation, but also includes social impact and sustainability.

So how is this useful for the applicant, again? Visibility; exposure to a community of innovators, enthusiasts, investors, and thought leaders. For most, the profile and opportunity to present a blueprint of innovation to this community is enough; for others, the feedback and collaboration is important; and for others, like those with potentially disruptive, proprietary innovation, its a way to position yourself, publicly through Changemakers, as the first-mover/leader/originator.

Dear Fellow Change Makers,

I would appreciate your thoughts on evidence-based medicine (EBM) and the healthcare community's information needs.

Prof. Christensen's theories of innovation show us how to recognize disruptive innovation opportunities. One telltale circumstance is when the 'consumer' is unable or unwilling to utilize all the functionality that a particular product offers. The product has 'overshot' the needs of the consumer. In the case of EBM, I believe the traditional information 'gold standard', the randomized-controlled trial, overshoots the needs of most physicians and patients.

There appears to be a long lag time between the publication of RCT results and the incorporation into medical practice. 17 years is the interval often bandied about. EBM attempts to rank and summarize relevant studies on a particular topic, in order to make research more accessible to the practitioner. However, it is questionable whether any impact on the lag time between research and practice has been made. Might we surmise that providers do not value peer-reviewed journal articles and EBM summaries, at least not along traditional performance dimensions? Could it be that these products overshoot provider needs?

Biomedical research holds the RCT in highest esteem. These trials often require large resource and time commitments, but yield the greatest statistical power. I believe a disruptive innovation in biomedical research would provide a trade-off of statistical power for quicker results. Ignoring, for the moment, the disconnect between population studies and individual application (paradox of the general vs the particular), we could provide 'good enough' information that improves upon under-served dimensions of performance.

If information technology were leveraged to collect information about practitioner treatments and patient outcomes, longitudinal studies cold be performed in near real-time. These analyzes would lack true randomization, but today's statistical tools could create controls from such data. Nor, would these studies be peer-reviewed, in the traditional sense, but would be 'peer-performed'. Provided in near real-time, practitioners could access useful information about various treatments.

This innovation is predicated upon a significant number of provider participating in a system that collects information about their treatments and their patients' outcomes. We plan to summarize such a system and submit it as an entry to Change Makers: Disruptive Innovation in Health. Beyond such a system, I would like to hear opinions about the concept. Could we trade-off statistical power for quick access to outcomes information? Are providers not using current research products? If not, why?

Your comments are appreciated.

Respectfully,

Benjamin D. Atkinson
President
Independence Health Center

Dear Dr. Hwang,

I believe that Current Procedure Terminology (CPT) codes are a product of the third-party payer system. Essentially, the codes exist to enable payment for discrete health care services. It seems to me that CPT codes represent an artificial taxonomy in health care. Are we stifling innovation by restricting the vocabulary around care? Could a poet practice his/her craft with only 1000 words?

Do you feel that more innovation would occur with less contrived nomenclature around care?

Thank you, in advance.

Respectfully,

Benjamin D. Atkinson
President
Independence Health Center

Hi there,

In preparing for this competition, folks at the Robert Wood Johnson Foundation and Changemakers did a good bit of thinking about what types of innovations in health and health care truly carry the banner of "disruptive." Not all do - many valuable quality improvement innovations or other novel approaches can not, or don't show potential to, disrupt incumbent health and health care services, technologies or delivery/business models.

I thought it might be helpful to share an e-mail exchange I had with competition judge Jason Hwang of Innosight, an M.D. and Harvard Business School Fellow who works extensively with Clayton Christensen, the originator of the disruptive innovation concept. It suggests that some key health-related innovations demonstrate many of the key characteristics of disruptive innovations but may not have fully completed the cycle, or amassed all the components, needed to truly disrupt how health and health care jobs get done for consumers. They may serve as early enablers of disruptive change to come -- such ideas are valuable and encouraged in this competition.

Thanks to Jason for generously sharing his thoughts and expertise. Hope this is helpful - we hope you'll build on this discussion with your comments and questions.

Susan Promislo, Communications Officer
Robert Wood Johnson Foundation
*****************************

From: Promislo, Susan
To: Jason Hwang
Subject: Question re: Changemakers DI competition

Dear Mr. Hwang,

We have been working on refining the competition mosaic that will provide a reference point for potential competitors' entries. We have no problem identifying solid examples of disruptive innovation on the health care side of the equation, but it has been more challenging to come up with examples in health or preventive services. At first we considered the idea of adding fluoride to public drinking water sources, but concluded that it didn't really disrupt or dislodge an existing industry or service delivery system.

Having given it a bit more thought, we were wondering whether the nicotine patch or gum could be considered a health disruptive innovation. Such products provide consumers with a needed tobacco cessation aid, over the counter, without a medical professional needing to be involved.

If you have a moment, it would be most helpful to get your feedback on this possibility.
______________________________

From: Hwang, Jason
To: Susan Promislo
Subject: RE: Question re: Changemakers DI competition

Hi Susan,

What we’ve discovered is that disruptive innovation often occurs in 2 steps. First, there is a technological enabler – a discovery or invention that converts what was previously expensive and complicated work into affordable and simple tasks. The second step is an innovative business model that incorporates this rules-based work in a way that capitalizes on its advantages.

In healthcare, we have found that technological enablers are plentiful. The pace of science continues to offer us new ways to transform the work of medical professionals and institutions. What is often lacking, however, are the business models that successfully implement these enablers in ways that are successful and sustainable. Admittedly, there are characteristics inherent to the healthcare system which make this second step much more difficult to accomplish than in other industries. However, I believe this is where your competition’s evaluative process should focus.

The two examples you mention can both be described as enablers of disruptive innovation. The discovery of fluoride as a preventive agent enabled society to treat people much earlier in the process of cavity formation. Many more people could now “self-treat” rather than depend upon the skill of high-cost dentists once caries occurred. Likewise, as you mention, nicotine cessation devices enable a similar transformation of work, shifting the work from medical professionals to patients themselves.

I believe what has led to some confusion is the different business models which have incorporated these enablers. The government saw such great value in fluoride that it found it necessary to add it to the water supply. Not surprisingly, this sort of intervention is not uncommon in healthcare. However, had the government not stepped in, private industry would have needed to find a way to deliver fluoride in a cost-effective manner to as many people as possible. The addition of fluoride to toothpaste, for example, probably would have been followed by other innovations were it not for the government’s intervention. While government intervention can be a good thing, you can also see where it might stunt innovation and “trap” the system in an existing model.

The nicotine cessation products serve a similar preventive need. However, in this case business model innovation is still at work, since there is no universal mandate for smokers to use these products. Therefore, companies needed to find a way to deliver their products in a convenient form, and developed patches and gum which could appeal to reluctant consumers. Likewise, I imagine a need to promote consumer education, deliver value (for the growing number who do not have insurance), and develop associations with behavioral and addiction counseling centers. I don’t believe we have found a model that is very successful in delivering on these latter areas, and I hope this is where innovation continues to develop in order to really capture the promise of such technology.

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Folks here might be interested in checking out some of the health projects that were submitted to the NetSquared competition -- see http://tinyurl.com/29b87n
Some of these are more health-centered than others, but they provide some useful examples/inspiration of how people are using technology as a tool for disruptive innovation.

The United Methodist Church Kansas West Conference and the University of Kansas Department of Medicine Wichita have collaborated on Self-Care workshop development and on promoting self-care in the congregation.

Locally in Salina Kansas the University United Methodist Church, the Salina Commission on Aging and The Kansas Wesleyan University Department of Nursing have collaborated to make Fitness and Whole Health Assessments and planning available to the community.

Patients are treated as slabs of meat because the current modality of mainstream medical care itself is one that views the body as one would view a broken car or computer. If a part breaks down, the "solution" is almost always to remove or replace that part. This would, of course, be the end-result after a standard course of medical drugs prescribed to alleviate/reduce the so-called "abnormal condition" (symptoms) fails to cure the problem. How can a cure be possible if there is no earnest interest or investigation as to the symptom's true cause(s)? There lacks a severe acknowledgement of the importance of addressing the whole person as a physical, mental, and spiritual being. (The term, "spiritual", here simply implies that a person's religious, or lack thereof, beliefs can be an important factor in the healing process.) Visit most M.D.'s and you will be seen for only a few minutes, prescribed a drug, and sent on your way. Is it any surprise that the mainstream medical community has such a poor track record of curing anyone? Is it any surprise that cancer, diabetes, obesity, stroke, and heart disease are continuing to rise? Is it any surprise that iatrogenic (doctor-induced) deaths is the number one killer in the U.S.? Unless the cause of the disease is a deficiency of a certain drug, I don't foresee any success in the use of medical drugs in curing anything. Even the much applauded antibiotic drugs don't cure anything but simply kill bacteria (all bacteria indiscriminantly). Where is the question of why there was even such a serious infection there in the first place? Now this does not mean drugs don't have a useful role in acute/trauma/emergency care (which only comprises about 5% of medical cases). But such use of drugs is brief and, at the time, deemed necessary in a life and death situation. For the more knowledgable, it is well known that powerful herbs can replace even these potent emergency-use drugs; but who/what clinic would be brave enough to stand against the FDA and mainstream censorship to commit to such a grand experiment, despite the fact that the use of herbs would create a substantial savings in cost (not to mention, greatly reduce the potential for adverse medical side effects, and increase the rate and speed of recovery)? Should other nations follow America's relatively new, non-traditional lead which has a very poor track record of success, or should America be following other nations' more traditional lead which has a successful track record spanning even thousands of years? As I see it, there are too many doctors, and not enough healers.

World Bank has development competitions (development marketplace I think it is called) It looks like they have something that closes on the 15th of this month.
http://web.worldbank.org/WBSITE/EXTERNAL/OPPORTUNITIES/GRANTS/DEVMARKETPLACE/0,,menuPK:180652~pagePK:180657~piPK:180651~theSitePK:205098,00.html

Having been hospitalized 48 times in the last 9 years, been a part of hospital procedures on the average of 15 to 20 times a year, it infuriates me that no one listens or ever requests feedback from the consumers of one of the largest "businesses" around. Even if you are greeted courteously by the registration staff, the doctors, technicans, sometimes the nurses (though not as often) most often treat you like a slab of meat or a disease at best, almost never as a living, breathing, feeling human being. There needs to be some way to insist on rating patient treatment, publicizing that information and rewarding those medical establishments that 1) acknowledge the plight of persons with disease and pain, 2) take steps to understand/accomodate human feelings in a medical environment, 3) excel at making the experience humanistic and sensitive to those who seek healing. I'm sure there are other areas of concern/social environmentalism, I'm just glad to learn there is an organization that is even looking into the problem. I would love to be involved in any way that can improve the contact of human to human in the medical establishments.

Numanaste'

If I understand correctly, 55% of US budget of nearly 3 trillion $ is now spent on pensions and health, a % that has doubled in under one generation

Basically I would be interested in seeing the following questions posted anywhere, do you have ideas of where?

1.1 Who to trust worldwide on affordable healthcare initiatives
Looking around the world, the cost of healthcare seems both to vary astonishingly but also to be ever increasing- WHO anywhere in the world do you trust most in terms of experimenting openly with health initiatives aimed at serving health for all but turning round the overall system so costs start spiralling down instead of up?

1.2 Who to be guided on on health's costs by among social entrepreneurs?
The omidyar co-sponsored changemakers had 1 health for all competition http://proxied.changemakers.net/journal/300603/health.cfm

and one upcoming this year http://www.changemakers.net/en-us/competition/disruptive

where else can we look for social entrepreneurs reducing healthcare costs?

example of a place where we are raising the question is omidyar community http://www.omidyar.net/group/community-general/news/1669/

example of a space we will try and post some replies: http://up200.tv/_wsn/page8.html

chris macrae, changemakers.info worldcitizen.tv

Health care is a field long associated with innovation, whether it is the practice of medicine or invention of equipment to improve the quality of life. Despite the history of innovation, the field of health is increasingly in need of innovations that are based on the clients’ voice, innovations that positively disrupt current practices for the better. This collaborative competition will surface these innovations and invites you to participate by entering your solutions and joining this discussion that will help us identify and act upon effective strategies. We want to know what disruptive health innovations are you launching. What disruptive health innovations do you need?