Innovation, Diffusion of Ideas, and the Medical Home

Early in my medical school education, I heard about the "science to service gap" , i.e. "it takes 13 years for proven medical improvements to become mainstream".  But after 20 years of clinical practice and 17 years of work with informatics, I consider it a truism.

During my medical informatics work, it has become more than a curiosity as to why the science to service gap exists.  About 5 years ago, I discovered a series of books that explain the Diffusion of Innovations by Everett Rogers who was a professor of communications.  It helped me to understand that there is a natural variation, a bell curve of sorts, for how any group adopts innovation.  Since negative news travels fastest, physicians often get a bad rap when it comes to adopting health information technology (HIT) due to the vocal nature of what Rogers called "laggards".  That is a complex topic for posts in the future. I would encourage anyone interested in innovation to read Rogers 2003 5th edition of Diffusion of Innovations as it includes many lessons learned during the 40 year period following his 1st edition in 1962.

I recently re-visited a web site which comprehensively documents the 18 year journey of a medical home practice that was formed in 1995 called SETMA.  The link to the SETMA site is a great example of how diffusion of innovation can happen within an organization with visionary leadership.  I had the pleasure of meeting Larry Holly, MD the founder of SETMA and I would encourage anyone interested in how to create a cultural framework for innovation to read his web site which is beyond comprehensive in its depth and breadth of information shared.

Believe it or not, in 2013, the medical home is still being questioned as a valid approach.  So perhaps the science to service gap for team work, process improvement, and user-centered design in health care is a bit longer than 13 years.  I am encouraged by the work being done in both my local medical community as well as at the national level -- American health care really needs the medical home innovations more than ever.