The notion of disruptive innovation was popularized by Clayton Christensen [1, 2], and is described as change, usually technological, that causes upheaval of an entire industry sector. We have seen plenty of disruptive innovations in the modern digital era, as the marketplace for products such as books, newspapers, photography, banking, and travel has undergone profound change. Who takes pictures using film or regularly walks into a bank anymore? Who does not spend at least part of their reading time doing so on electronic devices, increasingly those held in the hand, such as smartphones or tablets?
There is a certain irony for those of us who work in academic biomedical and health informatics. On the one hand, we are immersed in the technologies that have caused so much disruptive innovation, i.e., computers, the Internet, and the World Wide Web. On the other hand, those of us in academic informatics apply our work at the intersection of two fields that may be the lone remaining holdouts for disruptive innovation, namely healthcare and education.
We can debate in another post whether disruptive innovation will ever come to healthcare. There are some signs, but I am not holding my breath. Recent developments in higher education, however, potentially portend profound change coming. Being in higher education for a livelihood, I naturally have great interest in the consequences of disruptive innovation within it.
This potential disruptive innovation in higher education comes in the form of what some call massive open online courses (MOOCs). This area has received a great deal of attention lately with the foray of some of the leading US universities into this area, namely Stanford, Harvard, and Massachusetts Institute of Technology (MIT). It has garnered attention in the popular media [3-6].
As most readers of this blog know, I have great enthusiasm for online learning. A good deal of my work in the last decade has focused on the fusion of educational technology with biomedical and health informatics [7-10]. However, the result has mostly been education based on the traditional model of the professor teaching and interacting with a relatively modest number of students.
MOOCs change the calculus of online learning in a much more profound way. Stanford computer science professors Andrew Ng and Daphne Koller have been at the forefront, adapting and delivering their courses to massive audiences [4, 6]. They are part of a new technology venture led by Stanford and including several other big-name US universities called Coursera. Not to be left out, Harvard and Massachusetts Institute of Technology have also launched a similar initiative.
Despite their high profiles, these are not the first such initiatives to disseminate high-quality higher education content via the Web. Two other initiatives, Udacity and the Khan Academy, have been doing this for several years. Resources like the University of Pittsburgh Epidemiology Supercourse have been in existence even longer.
Will these MOOCs lead to disruption in higher education? The cynic in me notes that Ng and Koller are not changing the core Stanford product, where a small number of highly smart students pay a substantial amount of money in the form of Stanford tuition for the privilege of being on the Palo Alto campus and getting a degree from Stanford. I also note that these courses are mostly basic courses, and not the more advanced knowledge that might help someone apply this information. The content is "open" in the sense of being available to anyone, but not in the "wiki" sense of being improved upon in a massive way.
But the optimist in me with the goal of spreading knowledge via technology cannot help but be impressed at the uptake and reach of these courses. I certainly enjoy the global interaction I have through the various educational activities in which I take part in on the Internet. Even Facebook can sometimes be a platform for disseminating knowledge and doing what I enjoy most as an educator, which is getting people to both delve into deeper layers of fact as well as apply them in larger contexts and intellectually principled ways.
As is often the case, the ultimate reality will likely fall somewhere in the middle. Clearly the Web provides an unprecedented vehicle for knowledge dissemination. But education is so much more than a student absorbing knowledge. There is also the in-depth application of that knowledge for real-world purposes. I cannot help but wonder, for example, whether the Coursera natural language processing (NLP) course will enable a student to be able to implement a system that can detail with all the nuances of the narrative text generated by clinicians in the electronic health record. One thing that clinical informatics has taught us is the lack of predictability of technological interventions in healthcare settings.
Of course we have shown to our satisfaction at Oregon Health & Science University (OHSU) that pretty much all types of learning can be delivered online. But we have also learned that an education involves more than learning. Early on in our foray into distance learning, I was struck how we had developed, without deliberately trying to do so, a virtual community. When students join our program, they not only get access to our courses, but also our faculty, their student colleagues, and our connections to the larger informatics world, including our connections to industry. Even the staff in our office provide a conduit for their new journey into careers and other activities in the field.
But I am also, in a sense, part of this MOOC world, due to the Office of the National Coordinator for Health IT (ONC) Curriculum Project that has absorbed a great deal of my professional time, effort, and passion over the last couple years. All of this potential for disruptive innovation of informatics education therefore comes at a time of critical juncture for our field. We have been fortunate to have, for the first time in the history of our field, substantial federal investment, not only in the form of subsidized education for students, but also in the development of the ONC curricular materials. The verdict is still out on what impact the curricular materials will have on informatics education and training in the long run. But with the ARRA funding for them winding down, we are at a critical juncture in finding ways to sustain them (if we believe they are important) once the grant for them ends at the end of 2012.
In conclusion, I view the potential for disruptive innovation in higher education as a challenge and an opportunity. While I am not worried it will make my world dissipate like camera film or bank tellers, I do know the ride will be bumpy. But in the end, I am confident that education will be improved and possibly more cost-effective. I am also confident of the continued role I will play in advising students and others about directions and opportunities for our field. And if things ever do settle down, we can move on to the real challenge for disruptive innovation, which is the healthcare industry!
 Christensen, C. (1997). The Innovator's Dilemma: When New Technologies Cause Great Firms to Fail. Boston, MA. Harvard Business School Press.
 Christensen, C. (2012). Disruptive Innovation, in Soegaard, M. and Dam, R., eds. Encyclopedia of Human-Computer Interaction. Aarhus, Denmark. The Interaction-Design.org Foundation. http://www.interaction-design.org/encyclopedia/disruptive_innovation.html.
 Lewin, T. (2012). Instruction for Masses Knocks Down Campus Walls. New York Times. March 4, 2012. http://www.nytimes.com/2012/03/05/education/moocs-large-courses-open-to-all-topple-campus-walls.html.
 Markoff, J. (2012). Online Education Venture Lures Cash Infusion and Deals With 5 Top Universities. New York Times. April 18, 2012. http://www.nytimes.com/2012/04/18/technology/coursera-plans-to-announce-university-partners-for-online-classes.html.
 Brooks, D. (2012). The Campus Tsunami. New York Times. May 3, 2012. http://www.nytimes.com/2012/05/04/opinion/brooks-the-campus-tsunami.html.
 Friedman, T. (2012). Come the Revolution. New York Times. May 15, 2012. http://www.nytimes.com/2012/05/16/opinion/friedman-come-the-revolution.html.
 Hersh, W., Junium, K., et al. (2001). Implementation and evaluation of a medical informatics distance education program. Journal of the American Medical Informatics Association, 8: 570-584.
 Hersh, W. and Williamson, J. (2007). Educating 10,000 informaticians by 2010: the AMIA 10×10 program. International Journal of Medical Informatics, 76: 377-382.
 Hersh, W. (2007). The full spectrum of biomedical informatics education at Oregon Health & Science University. Methods of Information in Medicine, 46: 80-83.
 Hersh, W. (2010). The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics, 1: 197-212.