Compressing the Curve

Last week, we explored a few ideas surfaced by Dr. Atul Gawande in his New Yorker essay, ‘Why Doctors Hate Their Computers.’   I have one more thought on this subject, this one more mine than his.  At least I am not just ripping his stuff off today.  Is that progress?

Let’s go to our imaginary white board and let me draw the old venerable bell curve to as I rip off another guy’s idea.  So much for my progress.

Back in the early 90s, Geoff Moore wrote ‘Crossing the Chasm,’ a great book about how new technologies are adopted into the market.  You’ve probably heard it referenced somewhere.  Innovators are on the far left side of the adoption curve as they go first.  Then come Early Adopters as the technology starts to gain traction.  The fat part of the distribution curve includes the Early and Late Majorities.  Finally, the right tail brings us the Laggards, the last people to get with the program.

That summary is brilliant not because it reveals some deep mystery, but because it simply and accurately captures the way things are.

The history of many new technologies – electricity, fax machines, smart phones, complex business software – shows that movement through the curve takes time, as it should.  Every different market segment plays a valuable role in advancing the technology. 

Back to last Friday’s post, there is a time when we want a lot of mutation, a lot of variety, a lot of experiments.  But then, for a technology to progress as it should, we need the big majority to bring in the power of selection, killing off the bad ideas and reinforcing the good ones.  Often, this process takes 30-50 years.

Unless the government gets involved.  Like it did with the EMR.

So, we decided we needed our entire industry automated faster.  Whether it was driven by vision, the need to cut spending, or just a politically acceptable government handout doesn’t really matter.  It happened. We first dictated it, then we bribed. 

If adoption was the goal, it worked.  In the space of about seven years, we went from near zero EMR market penetration to near 100%.  Few technologies will ever rival that pace. $30 billion of subsidies helped.

And along the way, we screwed this up big time. 

Mandated software functionality killed off early stage variation at the time it was most needed.  Subsidized purchases, compressed into a very short time frame, took away the market’s critical selection process as bad solutions that should have died persisted like Zombies.

The optimistic view is that though we forced the Laggards into the technology way too fast, we’ll eventually get it right, though we’ll probably take the rest of the normal 30-50 years before we do so. 

The pessimistic view is this jacked up process so resulted in fundamental flaws that we’ll never get it right. 

We’ll check in around 2040 to see which is right.


twelve + 19 =


Tim Coan, ALN’s CEO, writes an insightful and witty blog once a week about a variety of topics relevant to independent physician practices.

Yes, I'd like to get Tim's blog.