5 Questions For….Dr. Lyle Berkowitz

Dr. Lyle Berkowitz, associate chief medical officer of innovation for Northwestern Memorial Hospital, believes that failure leads to innovation. His book, Innovation with Information Technologies in Healthcare and organization, Szollosi Healthcare Innovation Program, offer proof that innovation must be nurtured and that it often occurs under surprising circumstances. Read below in this 5 Questions interview for his insights and advice on making healthcare organizations more in tune with innovation.

Intel: What are three simple things an organization can do to encourage innovation? Dr Lyle pic.jpg

Berkowitz: The key is to change the culture of the organization, which needs to be both top down and bottom up. From the top, the first step is to get executive buy-in that failures are a good thing. An innovation mantra is fail fast, fail often and fail cheap…you will always learn a lot! So many hospital executives are scared of any failures, but they need to be embraced to encourage people to try new things. Second, identify someone whose role is to find new innovations for piloting and to support innovators within your organization. Give this person a small budget so they can try new things without having to go through the usual budget bureaucracy, while also recognizing that their job is to move from concept to pilot to figure out if a bigger project is warranted. Finally, consider an X-prize or crowdsourcing exercise in which your whole organization is challenged to come up with an idea that can create significant value.  If you promise to split any cost savings with the winners, you will likely be shocked with how many good proposals you will get!

Intel: Your book, Innovation with Information Technology in Healthcare, collects stories from more than 20 organizations that have successfully created and implemented new health care information technology processes. What is the common denominator across all of these successes?

Berkowitz: Our book allows the innovators themselves to tell us what they did, why they did it, how they succeeded, lessons learned, and their plan for next steps. It's like a big cookbook of recipes on how to innovate, with sections on EMR Innovation, Telehealth Innovation, and Advanced Technology Innovation (e.g., analytics, portals, mobile, and gaming). Some commonalities include having a physician or other champion with a passion for fixing something that is not working well, the patience for multiple iterations, and the skills to start something small and then expand it once it starts succeeding. Additionally, many of the stories focus less on the technology, and more on the process, business model, and sometimes legal changes needed to realize the full power of the innovation.

One of my favorite stories in the book describes how UPMC addressed an issue involving a patient who came in for antibiotics, but had a severe allergic reaction to the latex gloves used by the IV team. Although she had a known latex allergy, the IV team was not aware of this because it was not part of their workflow. Instead of simply saying, "We can improve this process by making the IV team always check for latex allergy,” the executives decided to do a brainstorming session and used this example as a starting point for how they might rethink the whole process of care at their hospital. Someone came up with the wild idea of "What if the room was alive and knew who entered and what information they needed based on their role?” That idea became a prototype involving a monitor and computer system, which used RFID to identify who entered a room, and then displayed relevant information and allowed them to enter data. The team found that this improved both quality and efficiency, and they wound up creating a company to deploy these at their hospital and beyond. It represented the whole arc of innovation—problem to brainstorming to piloting to spreading. Other stories describe how an EMR’s built-in functionality can be used to support care coordination, preventive care and disease management, and early warning for adverse events. Telemedicine stories range from traditional doctor-patient video calls to electronic curbside consults to ePharmacists and Teletranslators. And, finally, there is a section describing the use of analytics, mobile, and gaming technologies applied to healthcare.

Intel: What healthcare technology do you use and like?

Berkowitz: From a personal and business perspective, I loved my smartphone from the second I got it. It's critical for me to keep in touch with my email as I juggle multiple roles and travel away from my office several times a week. However, with respect to clinical care, my technology needs are different. I need a large-screen computer. I use an electronic medical record system and a secure messaging system to keep in touch with patients. I access UpToDate for most clinical reference, and use Google in the exam room when I need to show a patient a picture or video to get a point across. We also have a nice touch-and-go authentication system, and more importantly, for security is a system that locks my computer when I open my exam room door to leave.

Intel: How do you see healthcare technology changing in the next three years?

Berkowitz: I think there will be two major changes for healthcare.  First, I think the EMR will become more of a platform and we will see "EMR Extender Companies" building apps that sit on top or alongside EMRs to improve efficiency and quality in a variety of workflows. A company I cofounded two years ago, healthfinch, focuses specifically on apps to improve physician productivity by helping to automate and delegate certain repeatable tasks away from doctors and toward their staff (e.g., medication renewal requests). Second, I think we will see consumer biometrics get increasingly small, cheap, easy, and ubiquitous. What will then be important is to have a way for physicians to "use" all this data. I envision a future where this ubiquitous health data flows into a cloud that contains the protocols to help promote wellness in all, maintain health in those with stable illnesses, and identify outliers who need to come in for review.

Intel: What is the Szollosi Healthcare Innovation Program? What changes are you trying to make within the healthcare system?

Berkowitz: The Szollosi Healthcare Innovation Program (SHIP) is a charitable endeavor with a mission to use creative thinking and diverse technologies to produce a better healthcare experience for patients, physicians, and others associated with their care. Our work on care coordination has been highlighted in the Harvard Business Review and by the Hope Street Group. Our work on "information visualization" was highlighted at the Mayo Clinic's Center for Innovation Transform Conference.

Two of our care coordination projects were selected for the AHRQ's Innovation Exchange:

ExpectED: Electronic Handoff Notes to the Emergency Room

The Inflection Navigator: Tale of an Easy and Effective Care Coordination System

The Szollosi Healthcare Innovation Program is trying to help spread the word on the use of innovation science in healthcare to help others think differently about how to address issues we face every day.

For more insights, follow @DrLyleMD on Twitter and read his book, Innovation with Information Technology in Healthcare.

What questions do you have?