Innovation can free up doctors for patient care, connection

BOSTON—“If we use technology correctly and efficiently, doctors are going to have time to take care of everybody,” said Lyle Berkowitz, MD, associate chief medical officer of innovation at Northwestern Memorial Hospital in Chicago, delivering the keynote address of the 2014 AMDIS Fall Symposium.

Computers won’t replace doctors, he said, because they can’t focus on caring. They can, however, automate easier tasks so “we can get to a point where doctors can get back to caring and connection.”

Berkowitz said in the future doctors will see fewer patients but takes care of more patients as part of a larger care team—in a “really high value, high quality way.”

Innovation can help U.S. healthcare get to that point, he said. Innovation involves three “Es”: explore, experiment and expand. Innovators should observe and investigate to understand what’s out there, then try out pilots or prototypes. Start wide and narrow down the focus, he said, to decide what to try and why.

Berkowitz said we could have much more usable EMRs today had developers focused on human-centered design thinking, or creating around the end user. “That seems self-evident but it often is not the case.” He said you can optimize a product around how users want or need to use the product rather than forcing users to change their behavior to accommodate the product.

Going forward, healthcare needs to focus on how “we use IT to improve the patient and provider experience. Had we focused on this before, we would have very different EMRs today.”

Berkowitz cited a project that sought to improve outcomes for poorly controlled diabetics using video ethnography. The clinicians visited patients in their homes and conducted interviews on camera to try to better understand why they didn’t comply with their medications and treatments. “There’s never been a more illuminating two hours in my life,” he said of the experience.

The problem has always been defined as one of poor compliance on the part of patients. What if, he posed, “we put the blame not on the patient but on us?”

The clinicians learned that the patients understood diabetes and potential complications. But, they felt fine so they thought their physicians were overreacting. That changed the clinicians’ mindsets. Rather than using posters that focus on the effects of diabetes, they came up with a simple number system represented with green, yellow and red. They also changed how they communicated with their patients. “I no longer get overly alarmed if their glucose is 422. I let them know it’s an issue to address and ask how I can help.” They’ve seen improvements including a decrease in the number of patients A1Cs over 8.

Healthcare organizations can borrow from others but have to make it their own, Berkowitz said. “Take away the essence and make it work for your organization.”

People and process are more important than the IT, he said. He noted several provider organizations that used relatively simple technology to help people improve care quality.

Berkowitz also advised that “it’s okay to start small—little bets can equal big wins.” At his own organization, he created a small program that involved lending iPads to patients. It took him more than six months to get the program approved and people said the devices would get broken or stolen. He countered by saying they wouldn’t know that until they tried it. It also let the organization get some experience before implementing a bigger program.

Patients checked out the five iPads for a few hours or a few days. They loved them, Berkowitz reported, using them for a variety of purposes with the No. 1 use being videoconferencing.

None were stolen or broken. The nurse champion had to figure out how to clean the devices and the organization learned other valuable lessons from the experience. For example, they found that their network was sorely lacking for videoconferencing. They were able to improve that to handle a larger volume. “It’s okay to start small. You can learn a lot,” he said.

Berkowitz recommended that healthcare organizations find champions with passion and knowledge. Also, “listen to and observe the front line. Your organization has much of the knowledge you need. Just talk to them.”

Make it easy to do the right thing, he said. If you start with the human-centered design component, “you’re invariably going to get adoption and benefits.”