Applying Observations from Technological Transformations in Complex Adaptive Systems to Inform Health Policy on Technology Adoption Andrew B. Phillips, RN, MPhil1, Jacqueline Merrill, RN, MPH, DNSc1 1 Columbia University School of Nursing, New York, NY, USA Abstract Many complex markets such as banking and manufacturing have benefited significantly from technology adoption. Each of these complex markets experienced increased efficiency, quality, security, and customer involvement as a result of technology transformation in their industry. Healthcare has not benefited to the same extent. We provide initial findings from a policy analysis of complex markets and the features of these transformations that can influence health technology adoption and acceptance. Introduction The United States spends more per capita on health care than any other industrialized country, but has inferior healthcare outcomes1. Recent legislative efforts to address this issue all contain a significant emphasis on improving the use of health information technology. Policy makers strongly believe that these technologies will improve the efficiency and quality of healthcare and provide the framework for new creative healthcare delivery models2. However, technology adoption and acceptance, while improving, remains sub optimal. Over 10 years ago, the Institute of Medicine in their report, “Crossing the Quality Chasm,” suggests that the healthcare market leverage the lessons from systems engineering and technology in other markets, including the examination of health care systems as complex adaptive systems3. Despite these recommendations, there have been few studies evaluating the technical transformations in other markets as they apply to the technological changes needed to improve healthcare delivery today. Banking, the Internet, telecommunications and manufacturing have all benefited from efficiencies created by new technologies. Each of these markets represents a complex adaptive system from which a transformation emerged from the actions of its participants. We present initial findings from a policy analysis of the transformations that took place in these other complex markets and provide initial recommendations on the strategies and policies that can be applied to healthcare delivery and technology acceptance. Complex Adaptive System Framework and Policy Analysis Change in complex markets is not linear and is often unpredictable, making traditional policy analysis inefficient in predicting change. By viewing the healthcare system as a complex adaptive system (CAS) we are better able to evaluate policy options and improve decision making around health technology adoption. CAS theory suggests that despite a common vision, change emerges in reaction to multiple influencers. This concept of emergence is central to our evaluation of other markets and development of recommendations on future health policy. We will show how emergence has effected technology transformation and identify the potential influencers and facilitators of change as they relate to health policy. Discussion Evaluating how change occurred during technology transformation in other complex markets strengthens traditional policy analysis. Applying the lens and framework offered by the theory of complex adaptive systems results in an improved examination of current and future healthcare policy. Initial findings from this approach already suggest the enhanced role of the consumer in the adoption and acceptance of technology. Acknowledgements Andrew B. Phillips is supported by the National Institute for Nursing Research (T32NR007969) References 1. 2. 3.

Davis, K., Schoen, C., & Stremikis, K. (2010). Mirror, Mirror on the Wall How the Performance of the U.S. Health Care System Compares Internationally - 2010 Update: The Commonwealth Fund. Blumenthal, D. (2009). Stimulating the adoption of health information technology. W V Med J, 105(3), 28-29. Institute of Medicine. (2001). Crosing the Quality Chasm: A New Health System for the 21st Century.