MIT Sloan Health Systems Initiative

Leveraging Technology in Healthcare Delivery: Overcoming Adoption Barriers

On February 29, 2024, Joanna Brownstein led an HSI lunchtime seminar on overcoming adoption barriers to leveraging technology in healthcare. Brownstein brings a unique perspective, combining a Sloan MBA with a Masters in Social Work. She focused on barriers and drivers to stakeholder adoption, using behavioral health as a case study.

Brownstein shared her framework to understand barriers to the adoption of tech-enabled clinical care and how they shift over time. Her framework of those barriers for entrepreneurs is as effective in 2024 as it was in 2008. She presents a way of thinking that uncovers critical strategic points to guide an organization entering a new market.

Brownstein’s framework consists of four types of obstacles. They are:

Market readiness: refers to the structural pieces that need to be in place, including the culture, the regulatory environment, and the technology underpinning.

Operational readiness: focuses on the organization and its culture of willingness and ability to adopt a new method or tool.

Business model: refers to both to a clear buyer within an organization and the new method or tool’s usefulness to the organization at that moment.

Product market fit: refers to the tool or method’s ability to meet a tangible urgent. It also requires consideration of the possible ancillary effects of the new implementation, which may impact another part of the organization negatively.

Brownstein views these categories in a pyramid with business model as the base and then the following three in the above order. Generally, an entrepreneur has more influence to affect the barriers at the top of the pyramid. That is, one probably can’t easily move regulatory obstacles, but may have more success addressing the characteristics of the intervention so that it solves a real problem.

Brownstein presented the case study of behavioral health technology evolution to illuminate how the barriers to implementation may shift over time.

She started with 2008 when it was still early days for apps and those that were available were fairly primitive. Cell phone adoption is high, but these are not smartphones with cameras and video. Computers are starting to be introduced into mental health clinics, but they are likely to be a shared resource.

Culturally there was a “huge stigma” around mental health. People shied away from using their meager behavioral health insurance benefits for fear that their employer might find out and judge them negatively. Privacy and data security were in their infancy.

At this point, Brownstein explained the barriers in all four categories are all pretty high. There is not much an entrepreneur can do, at least in the short term, about regulatory or hardware supply issues. The best bet for influencing a potential buyer is to focus on privacy and security concerns. If an entrepreneur can both simply and persuasively allay a prospect’s concerns about the new tool’s susceptibility to malware attacks, they may be able to convince a buyer that the new tool will address an urgent challenge without a high risk of a security breach. The success of this approach hinges on the entrepreneur thoroughly understanding the organization’s challenge and being able to express their pitch in language that is understandable to the prospect.

Brownstein contrasts 2008 with 2020. Approximately 80% of the population carry a smart phone. People are carrying a supercomputer in their pocket that tracks much of what they do. There is also much less stigma about discussing and treating mental health.

Electronic Health Record technology adoption is very high, with industry consolidation around EPIC and Cerner. Providers are more adept with technology and have much easier access to computers at work compared to just 12 years prior.

There are regulatory pathways for digital tools to be rolled out to the market and validated. Some of the regulations are a bit vague and can be open to interpretation; this area is a work in progress.

Overall, there was a significant cultural, technological and regulatory shift in a relatively short period of time. Some of these changes were accelerated over the next three or four years because of the pandemic. Not all of those changes are permanent, however. Waivers and funds that made some shifts possible are being rolled back or disappearing.

To wrap up her talk, Brownstein returned to the four categories to discuss 2024 and beyond.

Market readiness: cultural barriers continue to be overcome, regulatory landscape is evolving with positive signs and technology is ubiquitous. At the same time, the economy is uncertain and healthcare investors are more circumspect.

Operational readiness: provider burnout and shortages are both a major obstacle and an opportunity for innovation. However, related to the market readiness challenge, health systems are also scaling back on investment.

Business model: entrepreneurs and solution providers will need to demonstrate value using compelling data. At the end of a pilot project, entrepreneurs need to be able to prove they can add value to the person in the organization who is authorized to write a check.

Product-market fit: the market is less interested in point solutions that are meant to be dropped into a current workflow to address only one challenge. These will be difficult to sell. Entrepreneurs should explore partnerships so they can approach a potential buyer with an end-to-end solution.

Brownstein’s talk was not so much about the mechanics of overcoming barriers as it was providing a framework to analyze the market, environment and a new tool’s potential attractiveness to buyers. This thoughtful lens is just as useful now as it was in 2008, and will likely be a useful framework in the future as well. By considering many possible influence points, an entrepreneur can best present their innovation in a way that may allay a buyer’s objections and appeal to their most urgent needs.