The “Technology Hype Cycle”: Why Bad Things Happen to Good Technologies

Fresh 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 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 healthcare 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 practitioner.”

One of Laennec's original stethoscopesWas 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.

2 Responses to “The “Technology Hype Cycle”: Why Bad Things Happen to Good Technologies”

  1. menoalittle May 13, 2008 at 6:07 am #

    Bob,

    You have become as prolific as Dr. Pronovost and your contributions to the field of patient safety are exemplary.

    The Hype Cycle describes phases pertaining to technological advancements that are implemented or introduced. There is a fallacy of applying this concept to CPOE device technology because, rather than it being introduced or implemented, it is being politically forced upon the medical community by edicts from the Oval Office and our lawmakers who think of CPOE devices as typewriters.

    These fiats are reinforced by hospital administrators who have now found a way to bill $$$ for the ordered aspirin that is never used and repeatedly proclaim that they are not aware of compromised patient safety caused by CPOE devices. While you mentioned El Camino Hospital, it was omitted that El Camino Hospital, an early “voluntary” CPOE device user, changed devices a few years back and for $8 million (they needed more), bought a device with a flawed interface with the pharmacy resulting in patient endangerment and a state department of health investigation…but the CIO who departed at that time stated “all concerns are being addressed and to date no safety issues have been encountered” (of course).

    Being forced upon patients, doctors, and nurses based on political ideology and as a disruptor to the administration of medical care and therapy, these devices should raise our concern. Since the premise of forcing the use of these devices is based on improving patient safety, where are the outcome studies proving safety and efficacy?

    There needs to be an outcomes appraisal of these devices based on the scientific method and not “Hype Cycles”. Hope and prayer (and profits) that patients whose care is altered by these devices will be safer and have better outcomes does not replace science. Bad things may and should happen to ideologically good technologies for a reason.

    Best regards,

    Menoalittle

  2. menoalittle May 16, 2008 at 2:20 am #

    Bob,

    Your readers in the states may be interested in this news from across the pond published in E-HEALTH INSIDER. It is not clear where this failure fits on the Hype Cycle but it demonstrates that bad things deservedly happen to unproven technology, especially when lives depend on it.

    Best regards,

    Menoalittle

    Millennium fails again across Southern England
    15 May 2008 E-Health Insider
    Many NHS staff in the south were left unable to use the Cerner Millennium care record system last Wednesday morning, after the Fujitsu-provided system failed across the region for the second time in a month.
    As a result of problems with the centrally hosted system, that lasted an entire Wednesday morning, some staff had to switch to pen and paper while others either had no access or had to endure lengthy waits while logging in.
    Six of the eight trusts live with the system have confirmed to E-Health Insider that they experienced problems. The remaining two – Milton Keynes and Buckinghamshire – declined to respond to questions.
    For staff at some of the trusts – including Nuffield Orthopaedic Trust – it was the second failure in weeks.
    The unspecified failure occurred on Wednesday, 7 May, lasting between 8.00am and 1.00pm and caused increased log-in times for users across the region, with many having to try and access the patient administration system from different PC’s on-site.
    The incident follows a similar system failure three weeks ago when Millennium systems in Milton Keynes Hospitals NHS Trust; Nuffield Orthopaedic Centre NHS Trust; Buckinghamshire Hospitals NHS Trust and Buckinghamshire PCT went down and stayed down for an hour.
    Neither Fujitsu, local service provider to the programme, or Connecting for Health, the NHS agency delivering the National Programme for IT, were able to confirm the extent of the failure, but said they were aware of the problem and were investigating its cause.
    A Fujitsu spokesperson told EHI: “Fujitsu is aware that some issues were reported and is investigating these reports thoroughly.”
    Steve Finch, head of communications for the Southern Programme for IT, added: “I can confirm that on Wednesday 7 May it was reported that some staff experienced increased log in times and others were unable to log in. While the issue was reported by some trusts across the south of England, it did not affect every member of staff using the system.
    “The incident was closed on the same day and Fujitsu is investigating the cause of the issue to ensure any repeat of the same problem is avoided.”
    Trusts told EHI that as a result of the problems, some users had to work manually and those logged onto the system experienced slow processing speeds.
    According to Weston Area NHS Trust, the downtime affected the whole cluster, leaving some users unable to work on the system.
    A spokesperson for Weston Area Health NHS Trust added: “There was a problem with Cerner Millennium on Wednesday morning, 7 May, which was across the Southern Cluster and not solely at Weston. This meant that some users could not access Cerner and others experienced slow performance. Some areas of the hospital put alternative systems in place while the system was fixed. Everything was back to normal by lunchtime.”
    Reports of painfully slow performance and difficulties logging into the centrally-hosted system were also reported to EHI by three other trusts in the region using the R0 Cerner Millennium software.
    A Taunton and Somerset NHS Trust spokesperson said: “We did experience some problems with Cerner on Wednesday morning 7 May. This meant that some users could not access the system and others who could access experienced slow performance. Some areas of the hospital put alternative systems in place while the system was fixed. Everything was back to normal by 1.30pm”
    A Nuffield Orthopaedic Centre NHS Trust spokesperson added: “Cerner Millennium did go down at 07.50 hours on 7 May. Not all of our servers were affected and some users were able to continue using the CRS. Manual procedures were in place for those who were unable to connect to the system until the problem was resolved at 1.20pm.”
    Winchester and Eastleigh Healthcare NHS Trust said the problem affected only a small number of trust PCs, but those users had to find alternative systems to work from.
    A spokesperson said: “A problem with Cerner was detected and reported at 08.30 on Wednesday 7 May. It affected less than half of our PCs and some areas were completely unaffected. Patient care was not affected although the issue did cause some inconvenience while staff found other PCs to log on to. The problem was resolved by 13.00.”
    Such widespread problems with the LSP-provided CRS application occurring twice within a month is likely to raise concerns about the systems reliability and ability to be further scaled up to cope with further users.
    Bath is scheduled to be the next NHS trust in the South to go-live with Millennium, provided by Fujitsu. However a spokesperson for the trust told EHI no firm go-live date had yet been agreed.
    In a written answer to Parliament this week, health minister Ben Bradshaw, told Parliament the Fujitsu contract reset is still under negotiation.
    “The Department continues to negotiate constructively with Fujitsu on the company’s proposals to reset its supplier contract under the national programme for information technology,” he said.
    “Reset is a normal, repeatable, process, for contracts with a long lifetime to ensure that their ongoing delivery reflects progress to date, current priorities, and deployment plans for the future, and that they continue to support the evolving needs of the NHS. Reset also allows for the option of agreeing enhancements to existing services or functionality that does not effect a change in contract scope or risk allocation,” he added.

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