Apple and Android are famously known for two very different approaches to computing and innovation. Apple has tall castle walls and a moat surrounding its products and innovation strategy – no one can get through. Conversely, Android is open to one and all and encourages outsiders to innovate with its open operating system.

Health systems, hospitals and group practices must innovate to keep up with the fast-changing worlds of both healthcare and IT. And healthcare provider organizations on top of their game have innovation strategies in place to foster progress.

One question becomes: Does a healthcare organization keep its innovation methods close to the vest and closed like Apple or wide open to outside influences like Android?

Let’s take a look at the pros and cons of each approach.

Innovation the Android way

While different healthcare organizations have different approaches to innovation, open appears to be a popular route. New York’s Hospital for Special Surgery, for example, takes the Android path – wide open.

“As a mission-driven organization dedicated to advancing musculoskeletal health globally, we operate without the concern of competition often seen within more closed innovation models,” said Leonard Achan, RN, chief innovation officer at the Hospital for Special Surgery. “HSS is transitioning our business model and moving from a focus factory, as a single-service provider, a specialty hospital, to a knowledge factory.”

As a “knowledge factory,” the Hospital for Special Surgery is leveraging all of its intellectual property, know-how and clinical expertise as part of its evolution to caring for consumers, not just patients, before they even know they need the hospital. This means that its strategy includes not only “inside-out” innovations traditionally seen in academic medical centers – technology transfer – but also inviting the entrepreneurial community in to solve problems with the hospital that span across a consumer’s musculoskeletal lifecycle.

“These ‘outsiders’ then infuse HSS knowledge into their own ideas to create new products, companies and services that differentiate us and our offerings to the world,” Achan explained. “We would not be able to accomplish this if we had a closed model. Our longstanding appetite for experimentation and iterative learning in the clinical realm has transferred into our business development, commercialization and innovation practices.”

The hospital’s maturity in the field of musculoskeletal health as one of the leading experts in the field gives the hospital the confidence and “brand permission” to not worry about others executing ideas without the hospital, he added.

“While commercialization and shared economics are key drivers for our innovation strategy, we do not lose focus of our primary driving force for innovating , which is to get what HSS has to offer today on the upper east side of Manhattan to the rest of the world at scale without having to be at an arms distance to our patients or consumers,” he said.

Digging in the digital dirt

Like the Hospital for Special Surgery, Great Neck, New York-based health system Northwell Health maintains an Android-like open approach to innovation.

“Our strategy is definitely one of open collaboration – much the way advancements in the medical sciences have been made for centuries,” said Emily Kagan Trenchard, vice president of digital and innovation strategy at Northwell Health. “The possibilities of the digital age are being explored and developed in so many sectors, by more brilliant minds than any single company could ever hire alone.”

The wealth of that collective knowledge is what Northwell seeks to harness – bringing together ideas to germinate in what Northwell Chief Technology Officer Purna Prasad, MD, calls the health system’s “digital dirt.”

But there is a qualification to this open methodology.

“This is not to say that Northwell Health doesn’t also have a strong commitment to developing its own custom applications, algorithms and processes,” Trenchard said. “Innovation is a core pillar of our employee promise, and the brilliance of our workforce is a constant source of transformative ideas for our innovation pipeline.”

But to think that Northwell Health could innovate in seclusion, that it could lock itself in a room and still solve the complex and nuanced challenges of delivering care to the country’s largest metropolitan area, would be a hubris the health system could not afford, she added.

"Where possible, being open is much more cost-effective. With the closed devices, security threats are far more manageable."

Kris Wilson, Hilo Medical Center

Apple and Android: The case for a little bit of both

Kris Wilson, CIO at Hilo Medical Center, which has achieved the HIMSS Analytics Electronic Medical Record Maturity Model Stage 7, discusses specific projects and the medical center’s approach to using open and closed mobile devices in innovative uses of IT.

“Our solution is mixed,” Wilson said. “In situations where we do not interact with PHI on the device and it only needs Internet access, we have used Android devices. For devices internal to the network or where PHI is used as part of the workflow, we use Apple devices or Windows 10 Enterprise-based tablets.”

These healthcare organizations lean toward an Android-like open approach to innovation. So what are the benefits of being open?

“An open approach to innovation has really enabled us to draw upon the best ideas from all sectors,” said Trenchard of Northwell Health. “We’re lucky to have a very strong ventures team that is adept at crafting the various kinds of collaborations, so we don’t have to limit ourselves in the types of partnerships we pursue.”

This openness not only brings Northwell into conversations with fascinating companies just beginning to think about healthcare, but it has introduced new revenue opportunities that Northwell might not have otherwise considered, she added.

“But perhaps the best part of this strategic approach is how much it aligns with our mission – doing this work with like-minded organizations builds a shared sense of purpose and helps us channel energy and attention to the needs of our communities,” she said. “And when partners take that shared knowledge back into their own sectors, we’re not just innovating on behalf of those who come to Northwell, we’re transforming care delivery for the industry as a whole.”

The Hospital for Special Surgery’s organizational culture is built upon shared leadership, collaboration and solving problems by getting the smartest, most talented people in a room to innovate, Achan said.

“For our environment, these practices allow us to challenge each other every day and achieve more together,” he said. “We strive to continue to not only sustain our success, but to manage the tension between maintaining what currently works and experimenting to see what we are capable of. Being proprietary and operating in a closed environment will not allow the creative process to thrive. It will not allow the flexibility to establish an atmosphere that supports value innovation.”

The benefit of sharing and letting others in “de-risks” the hospital from feeling comfort with complacency, Achan said. The open innovation model helps the hospital learn about its own creativity, capabilities and possibilities while remaining humble enough to know that it does not have all the answers in-house and must collaborate with the community to truly improve healthcare for global consumers, he said.

"Being proprietary and operating in a closed environment will not allow the flexibility to establish an atmosphere that supports value innovation."

Leonard Achan, RN, Hospital for Special Surgery

Android approach has big benefits but challenges, too

At a micro level, the benefits of open versus closed are very clear.

“Where possible, being open is much more cost-effective,” said Wilson of Hilo Medical Center. “The devices are less expensive and we are able to provide devices to a large number of users without impact to the budget. With the closed devices, security threats are far more manageable. System security updates are released frequently, often making it easier to keep these devices up to date.”

But as one would expect, there are challenges to having an open approach to innovation. One cannot open their doors to the world and expect no issues to arise.

“Healthcare provider environments are not structured, staffed or equipped to drive open innovation models at scale and speed,” said Achan of the Hospital for Special Surgery. “We are limited by our own policies, procedures, practices and regulations that do not allow for frictionless creativity. Open innovation is often misunderstood as it requires creatives to execute strategies that are not common to hospital practices and procedures.”

It often cannot be put into a box that can be explained and this allows for models like these to be short-lived or not supported enough to thrive in environments, he added.

“Closed strategies can more easily be explained, tracked and quantified and may translate well in more traditional organizations,” Achan said. “These are the reasons many provider-based executives and leadership do not move in this direction, even if they think they are.”

One of the biggest challenges in taking an open approach to innovation is keeping one’s strategic focus, said Trenchard of Northwell Health.

“There are so many opportunities we could pursue and there are many talented people with big ideas on how to make healthcare better,” she explained. “Which ones should we pursue and why? What about those fantastic ideas that we simply don’t have the resources to develop at this time? How can we set them up to incubate without having them build products that don’t align with our core platform?”

Another challenge of the open model, she added, is the time it takes to set the right structure for collaboration.

“We’ve been lucky to have partners in our legal division who share our passion for this kind of work,” she said. “But it is a lot of time upfront to ensure that everyone feels comfortable with how the fruits of our creative labor will be shared.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com