October 25, 2019 Advisory Board's take: Why many innovative ideas never make it past the drawing board

Cleveland Clinic on Wednesday released its annual list of the top 10 medical innovations the health system predicts will "transform health care" in 2020.

These 8 clinical innovations are coming soon (and could transform health care)

The list was chosen by a panel of Cleveland Clinic scientists and physicians led by Cleveland Clinic's Chief Wellness Officer Michael Roizen. To compile the list, the panel selected innovations that they predict will "significantly transform the medical field and improve care for patients at Cleveland Clinic and throughout the world," according to Roizen.

The top innovation

The panel predicts that a dual-acting osteoporosis drug will be the most important innovation of 2020.

In April, FDA approved a dual-acting drug called romosozumab that helps prevent additional bone fractures among postmenopausal patients with osteoporosis and among osteoporosis patients who are intolerant to other therapies. The drug works by inhibiting the protein sclerostin, which blocks bone formation.

However, Hylton Joffe, director of FDA's Center for Drug Evaluation and Research's Division of Bone, Reproductive and Urologic Products, noted that could increase the risk of cardiovascular death. As such, he said that "it's important to carefully select patients for this therapy."

The other selected innovations, listed in order of predicted impact, are:

2. Expanded use of minimally invasive mitral valve surgery

About 10% of patients over age 75 have a defective mitral valve. Expanding approval to a minimally invasive valve repair device could help patients whose symptoms failed to respond to other therapies, the Cleveland Clinic team said.

3. First medication for treatment of transthyretin amyloid cardiomyopathy

FDA this year approved tafamidis, the first-ever medication for treatment of ATTR-CM, a potentially fatal, underdiagnosed cardiovascular disorder in which amyloid proteins stiffen the walls of the heart's left ventricle. FDA's approval of tafamidis marks "the first-ever medication for treatment of this increasingly recognized condition," according to the Cleveland Clinic team.

4. Therapy to reduce effect of peanut allergies

A new oral immunotherapy medication could gradually build tolerance to peanut exposure among people with severe peanut allergies, protecting the patients against the effects of an allergy attack.

5. Closed-loop spinal cord stimulation to treat chronic pain

Spinal cord stimulation, a common treatment for chronic pain, can often lead to unsatisfactory outcomes due to overstimulation or subtherapeutic events. But closed-loop spinal cord stimulation improves communication between the implanted device and the spinal cord, resulting in more relief from pain and fewer complications.

6. Biologics in orthopedic repair.

The body can take months or years to recover from orthopedic surgery, the Cleveland Clinic team noted, but the advent of biologics in the field can help reduce recovery from these procedures. Biologics, the team wrote, "have the power to replace or harness the body's own power and promote healing."

7. Antibiotic-embedded envelopes for infection prevention

Antibiotic-embedded envelopes encase themselves around cardiac devices, helping to prevent potentially life-threatening infections and complications among the 1.5 million patients who receive implantable cardiac electronic devices each year.

8. Bempedoic acid to lower cholesterol in statin intolerant patients

Most U.S. adults with high cholesterol manage the condition with statins, but statins can cause bad side effects, such as muscle pain. Bempedoic acid can serve as an alternative treatment for the condition without the side effects, the team noted.

9. Poly-ADP ribose polymerase inhibitors for maintenance therapy in ovarian cancer

Poly-ADP or PARP inhibitors are "one of the most recent important advances [in] ovarian cancer treatment," according to Cleveland Clinic. The inhibitors "block repair of damaged DNA in tumor cells," which can increase cell death in tumors. The inhibitors, which are undergoing large-scale trials, have improved progression-free survival, the Cleveland Clinic team noted.

10. Diabetes drugs to treat heart failure

Researchers are exploring using SGLT2 inhibitors, which are commonly used to treat Type 2 diabetes, to treat heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure (Drees, Becker's Health IT & CIO Report10/23; Brooks, Medscape, 4/9; Roth, HealthLeaders Media, 10/24).

Advisory Board's take

Rachel Woods, Senior Consultant, Medical Group Strategy Council

Many health systems are investing in innovative technologies and products in hopes of setting themselves apart from their competitors—but all too often, their seemingly revolutionary ideas never make it off the drawing board.

Why not? We've studied how dozens of health systems and medical groups approach innovation, and we've discovered that successful innovators embrace four key principles.

  1. Innovation is not the same as invention. Successful leaders avoid being distracted by the promise of a particularly exciting technology. Rather, they focus on the business problem that they hope to solve through innovation.
  2. Innovation without implementation will fail every time. Most leaders focus on coming up with an A+ idea, but even the best ideas will fail if they aren't matched with A+ execution. Leaders should prioritize the innovations best positioned to meet their strategic goals, even if that means focusing on only one innovation at a time.
  3. Physicians will be your best allies—or your worst critics. One of the biggest roadblocks to success is the ability to engage frontline physicians. Successful organizations establish a "physician visionary" to lead and advocate for innovation, collect early feedback from frontline physicians, and help leaders respond to ideas and concerns throughout rollout.
  4. Seamless physician workflow is non-negotiable. Physicians will resist solutions that require a change in their clinical behavior. At a minimum, innovation should avoid impeding physician workflow, and leaders should prioritize technologies that actually give physicians more patient-facing time.

As a health system leader, you might choose to pursue any of the innovations outlined by the Cleveland Clinic, or you might prefer to design their own new products. But either way, it's imperative to ground your innovations in an existing business challenge. Start by defining your goal. Then, engage physicians, and over-invest in implementation.

To learn more about key lessons for deploying disruptive technologies, download our new report on Attaining a First Mover Advantage Through Innovation. 

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Here are 8 clinical technologies that could transform health care delivery

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