The term disruptive innovation was coined in the 1990s by Harvard Business School professor, Clayton Christensen, to describe technological innovations that transform current markets and quickly replace existing technology.1 A commonly cited example relates to the development of the automobile in the early 1900s. Clearly, the automobile represented a revolutionary technological advancement for transportation, but it remained a luxury good of limited use until Henry Ford began production of the Model-T in 1908. The Model-T was by no means a superior product to previously produced automobiles. But Ford's assembly line mass production methods allowed the car to be produced at a significantly less cost and suddenly the automobile was affordable to the masses. In this case, more efficient mass production techniques represented a disruptive innovation in the transportation market.

Technology innovation within healthcare has been extraordinary and has undoubtedly resulted in improved patient outcomes over time. However, examples of truly disruptive technologies in healthcare are uncommon. Essential qualities of disruptive technologies are that they need to be convenient, affordable and accessible in order to foster rapid adoption. Instead, most innovations in healthcare technology are considered sustaining innovations in that they represent step-wise improvements of existing technology, but are also more costly and complex. Recent examples include the use of positron emission tomography (PET)/CT, robotic assisted surgery or molecular targeted cancer therapies.

The need for evidence development is clearly one reason why disruptive innovations in healthcare are rare. Healthcare is relatively unique in this regard when compared with other sectors of technological innovation, such as automotive manufacturing or telecommunications. Decisions in healthcare use have high stakes that can impact patient's lives, and the associated costs are often borne by society as a whole rather than the individual. Stakeholders in healthcare therefore rely on methods of evidence-based medicine, health technology assessment …