The Technology Hype Cycle: Why bad things happen to good technologies

Robert_wachterFresh on the heels of my recent bar coding epiphany comes another “unintended consequences” article. It turns out that the whipsawing that accompanies the adoption of new technologies is completely foreseeable, the “Why doesn’t this thing work right?” phase is as predictable as the seasons.

Thanks to Dr. Mark Wheeler, Director of Clinical Informatics of PeaceHealth, for introducing me last week to the “Technology Hype Cycle” concept. The Cycle, originally described by the IT consulting firm Gartner, is comprised of an all-but-inevitable series of phases that technologies tend to traverse after they are introduced. The five phases are:

  • Technology Trigger – The initial launch; a new technology reaches public or press attention.
  • Peak of Inflated Expectations – A few successful applications of the technology (often by highly selected individuals or organizations) help catalyze unrealistic expectations, often aided and abetted by hype driven by word of mouth, the blogosphere, or vendor spin.
  • Trough of Disillusionment – Virtually no technology can live up to its initial PR. As negative experience mounts, the balloon is pricked and air rushes out. The press moves on to cover another “hotter” technology, like a moth flitting to the light (see Phase II).
  • Slope of Enlightenment – A few hardy individuals and organizations, seeing the technology’s true potential, begin experimenting with it unencumbered by inflated expectations. Assuming that the technology is worthwhile, they begin to see and demonstrate its value.
  • Plateau of Productivity – As more organizations ascend the “Slope of Enlightenment,” the benefits of the technology (which by now has improved from its initial clunky phase) become widely demonstrated and accepted. The height of the plateau, of course, depends on the quality of the technology and the size of its market.
  • You can chart the course of virtually any
    health information technology on the Hype Cycle curve. In the case of
    computerized provider order entry (CPOE), the trigger was the
    development of the technology in the 70s and 80s (the first CPOE system
    was implemented at El Camino Hospital during Nixon’s presidency). The
    Peak of Expectations was turbo-charged by the research in the 1990s by
    Bates demonstrating its value in one highly unusual organization
    (Brigham & Women’s Hospital), working with a homegrown system. The
    apogee was the endorsement of CPOE by the Leapfrog Group in 2002.

    My colleagues and I may have helped initiate the Trough – our 2001
    report on evidence-based safety practices gave CPOE a relatively low
    mark on “strength of the evidence,” leading to significant
    consternation (“you’re holding back implementation”) among some safety
    experts and advocates but opening the floodgates of skepticism. Further
    Trough-digging came from studies that identified all kinds of
    unexpected consequences from CPOE – culminating in the Mother of all
    Excavators, the paper by Han from Pittsburgh Children’s Hospital
    demonstrating that CPOE increased the mortality rate.

    As more and more organizations enjoy successful CPOE deployments, we
    are now trudging up the Slope of Enlightenment. And, with improving
    systems (some of today’s commercial systems aint half bad), we are
    probably about to scale the Plateau of Productivity.

    Bar Coding and Smart Pumps, being less well-established technologies in
    healthcare, are probably a phase or two behind. So expect
    ecstasy-agony-realism cycles for these technologies as well.

    The reason I find the Hype Cycle concept to be so illuminating is its
    explanatory power and predictive value. The Cycle allows one to
    pinpoint the stage of any technology at a given time (for an example,
    here’s Gartner’s 2006 report on Web-based technologies outside
    medicine). In the health care world, the thoughtful and prudent CIO or
    CMIO will use his or her knowledge of the Cycle to help prepare the
    organization for the trauma that is about to be visited upon it. For
    example, a hospital gearing up to implement CPOE or bar coding would be
    well advised to ready its troops to read about – and possibly
    experience – the Trough of Disillusionment. This nadir (“Whose idea was
    this damn thing anyway?”) is much easier to stomach when you know that
    the final, happier, phases are just around the bend.

    Of course, none of this is new. Even before there was a Technology Hype
    Cycle, implementing new technologies was not for the faint of heart.
    Consider this quote:

    “That it will ever come into general use, notwithstanding its value, is
    extremely doubtful because its beneficial application requires much
    time and gives a good bit of trouble, both to the patient and the

    Was the writer speaking of CPOE?
    Bar coding? Well, no. This is a quote from the 1834 London Times,
    referring to a new contraption called the stethoscope. You’ll be
    pleased to know that it eventually reached its Plateau of Productivity.

    Robert Wachter is widely regarded as a leading figure in the modern
    patient safety

    movement. Together with Dr. Lee Goldman, he coined the
    term “hospitalist” in an influential 1996 essay in The New England
    Journal of Medicine. His most recent book, Understanding Patient
    Safety, (McGraw-Hill, 2008) examines the factors that have contributed
    to what is often described as “an epidemic” facing American hospitals.
    His posts appear semi-regularly on THCB and on his own blog “Wachter’s World.”

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