Focused ultrasound and metrics of diffusion of disruptive medical innovation

Abstract

Innovation, as a concept in healthcare, has broad implications ranging from diagnosis to treatment of disease. The advent of new surgical modalities and medical devices continues to refine and reshape the provision of care for millions of patients across the world. Despite the tangible promise of such innovation, there remains a dearth of frameworks to understand how and how much progress has been made, particularly with regard to early-stage, non-invasive therapeutic technologies that have the potential to transform the treatment of medical disorders. A chief example of this is provided by MR-guided Focused Ultrasound. To the best of our knowledge, there are no prior reviews of the factors affecting adoption and diffusion of MRguided Focused Ultrasound as a proxy for disruptive medical technologies. The purpose of this review is to provide a comprehensive set of metrics to measure the factors affecting the rate of adoption and diffusion of these medical technologies with special focus on MR-guided Focused Ultrasound, Gamma Knife radiosurgery, and the da Vinci system. The authors review background information and literature regarding innovation in medical technology, and what constitutes disruptive innovation in the medical field. Metrics of adoption and diffusion are evaluated and applied to MR-guided Focused Ultrasound. Gamma Knife radiosurgery and the da Vinci system provide reasonable proxy technologies to understand the factors affecting the adoption and diffusion of MR-guided Focused Ultrasound. With a more comprehensive set of metrics to measure the rate of uptake and use of disruptive technology, we might move towards a better understanding of the limitations of new and potentially beneficial therapeutic modalities. OBJECTIVETo the best of our knowledge, there are no prior reviews of the factors affecting adoption and diffusion of MR-guided Focused Ultrasound as a proxy for disruptive medical technologies. The purpose of this review is to provide a comprehensive set of metrics to measure the factors affecting the rate of adoption and diffusion of these medical technologies with special focus on MR-guided Focused Ultrasound (FUS), Gamma Knife radiosurgery, and the da Vinci system. DESIGNThe authors review background information and literature regarding innovation in medical technology, and what constitutes disruptive innovation in healthcare. Metrics of adoption and diffusion of proxy innovative medical technologies are evaluated. The growth of MR-guided FUS is discussed with a new set of metrics to understand the rate of uptake and use of disruptive technology.

A systematic literature review of definitions and classification systems for radiotherapy innovation: A first step towards building a value-based assessment tool for radiation oncology

“…Out of the 25 selected publications, 15 'original' classification systems were extracted. [4,5,14,[24][25][26][27][28][29][30][31][32][33][34] (see Table 1 for an overview of all publications). These 15 classification systems were divided in two main groups (see Tables 3 and 4), based on appraisal of the difference between categories as described by the authors.…”

“…These 15 classification systems were divided in two main groups (see Tables 3 and 4), based on appraisal of the difference between categories as described by the authors. The first group, including 11 classification systems [5,[24][25][26][27][28][30][31][32][33][34] (Table 3), categorised innovations according to the perceived magnitude of innovation. The second group, containing the 4 remaining classification systems [4,14,29,34] (Table 4), categorised the innovations according to their radiotherapy-specific characteristics.…”

“…Of the 11 classification systems identified, nearly all are binary classifications with a 'minor' and a 'major' group, labelled in various ways. [5,[24][25][26][27][28][30][31][32][33][34] The exception is the system from Swart et al, discerning three categories: 'small', 'medium' and 'large' innovations. [16].…”

“…[24] Lastly, there is one system based on (impact on) the business model, described by Pomeraniec et al This system discerns between sustaining or disruptive innovations, where the latter transforms existing paradigms of competition. [31]. Four out of 15 classification systems categorise innovations based on radiotherapy-specific characteristics, such as the type of radiation equipment, mode of delivery, or radiobiological property of the intervention.…”

“…Different aspects were identified, based on information extracted from the selected publications, and can be found in the first columns. The following aspects for categorisation are indicated: (expected) impact on the patient; difference or comparison with a standard of care or standard practice; capital or human resources required; training or additional skills of staff required; expected impact on business model such as competition [5,15,[24][25][26][27][28][30][31][32]34].…”