When Health IT Meets Innovation: Q&A With Dr. Lyle Berkowitz of Northwestern Memorial Hospital

The rapid proliferation of health information technology has resulted in healthcare organizations racing to adopt and implement IT systems to stay ahead of the curve. Some organizations, however, are taking their use of health IT a step further and are using technology in truly innovative ways to improve quality and cut costs.

Lyle Berkowitz, MD, the associate chief medical officer of innovation for Northwestern Memorial Hospital in Chicago, and Chris McCarthy, innovation specialist with Oakland, Calif.-based Kaiser Permanente collected some of the most successful stories of innovation in health IT and documented them in their book "Innovation With Information Technologies in Healthcare."  

Here, Dr. Berkowitz talks about the book, some of the most innovative uses of health IT that he has come across and why the healthcare industry needs to begin developing a culture of innovation.  

Question: What inspired you to write this book?

Dr. Berkowitz: I have been in the informatics space my whole career, and in 2007, I also started moving into the innovation space when I received philanthropic funding to start the Szollosi Healthcare Innovation Program at Northwestern [Memorial Healthcare]. I also became a member of the Innovation Learning Network, which now has about 30 organizational members. We meet twice a year and learn new innovation techniques and how to apply them to the healthcare setting. Through these meetings, I was able to learn more about the innovation process and meet a lot of amazing folks innovating across the nation. In 2010, I was approached to write a book about the intersection of innovation and IT in healthcare. I liked the concept as I felt that the healthcare industry was spending a lot of money on IT, but was not always great about using these tools for care innovation.  So I quickly asked Chris McCarthy to be my collaborator, and we decided to create a book which would highlight the learnings of others.  In other words, we wanted to provide case studies of organizations that would share the full arc of their innovation stories, from the beginning idea to the failures along the way to their ultimate success. We wanted to create a book which would educate and inspire people about how IT could be used in new and creative ways to improve quality, increase provider and patient satisfaction and lower costs as well as help readers figure out how they might do the same at their own organizations.

Q: Out of all the stories and examples of innovation in health IT in this book, which one stood out to you?

LB: The book divided into three sections: electronic medical records; telemedicine; and advanced technologies, such as analytics, dashboards and gaming technologies. In the first section there is a variety of stories about using EMRs to help automate and delegate various parts of care. It is fascinating to read how different organizations addressed this issue in different ways. In some cases, they were doing essentially the same thing but doing it in different ways, making it clear that there was no perfect way to do it. But when someone reads the chapters they will hopefully be able to get enough from multiple viewpoints to figure out how it might work in their own organization. In the telemedicine section, one of the important things we realized was that usually it was not the technology which was innovative; rather it was the innovative business models or regulatory changes which made the real difference. For example, Via Christi Health's use of a telepharmicist for their overnight shifts was a great use of telehealth, but the real trick was dealing with state laws and other regulatory issues to ensure they could utilize pharmacists from around the nation. It was a lot of work, but it made a profound difference in the quality of care they could deliver.

Q: What do you think will be the biggest takeaway from your book for readers?

LB: The best takeaway, I think, will be to understand that there is no perfect solution. The biggest mistake that people make is that they try and exactly replicate an innovation that was successful at another organization. My strong advice is to figure out the basic innovative concept which worked and then customize the surrounding parts to your own organization. Another important takeaway for innovations to succeed is that there needs to be both a top-down and a bottom-up approach. There needs to be leaders who understand the culture of innovation and are passionate about creating a culture which supports those ideals, and there needs to be people evolving it day after day from the bottom up to make it work.

Q: Given that IT in healthcare is not as advanced as IT in other industries, to what extent can we innovate within health IT right now?

LB: The number one innovation limitation we have in healthcare is incentive alignment. I think healthcare can and will be very innovative in IT, but our incentives are not well-aligned. We also need to be able to use physicians more efficiently in whatever reimbursement system we have, and IT can help with that. In every industry we see that IT is used to help with the repeatable, assembly line work, while the more complex work is handled by the higher level talent. For example, we don't go to the vice president of a bank to get a $200 cash withdrawal, we go to the ATM. Why don't we think similarly in healthcare?  The main reason is not the IT limitations as much as the fact that we don't get paid for automating our work.  But as we move from volume to value based reimbursement, using HIT to automate routine tasks should start happening quickly. Of course, there is a culture of being overly cautious in healthcare, and while we don't want to do away with that, we have to remember the important innovation mantra, which is "Fail fast, fail small and fail cheaply." We need more people in healthcare to be okay with trying new things and be okay with failing.

Q: Why is it important to look into health IT innovation now?

LB: Our healthcare system is not sustainable, and we certainly have to become more innovative. IT is a tool, but it is a really important and powerful tool that will help us spread innovation more efficiently and effectively. We need to think about how we can do things differently and how information technology can enable these changes in the safest, quickest and most cost-effective manner.

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