Clinical innovation, innovation centers - Fixing Health Care from the Inside Out

In my last blog, August 13, “Physicians Moving Towards the Internet; Slowly but Not So Surely,” I expressed the opinion that health care will not be fixed from the “outside” – by IT experts or policy or management wonks outside of medicine who think their software solutions hold the key to improving care and will overcome unwilling, un-enabled, and un-incented doctors who resist change for their own personal gain rather than for the good of the system.

The counter-view is that physicians leaders and innovators may be able to fix the system from the “inside out” by creating solutions within the physician community that are workable, flexible, practical, and acceptable to doctors. One such physician leader is Lyle Berkowitz, MD, a practicing internist and the chief medical information officer for the 120 person Northwestern Memorial medical group in Chicago. Berkowitz, who has an educational background in biomedical engineering, head the recently formed nonprofit Szollosi Healthcare Innovation Program at Northwestern Memorial. He recently returned from a tour of leading health care innovation centers across America.

My connection with Berkowitz stems from an interview I conducted with him. The interview appears in the August 13 issue Health & Human Networks Most Wired Magazine (Richard L. Reece, MD, “Fixing Health Care from the Inside, Part One, www.hhnmostwired.com). Here are a few things that Berkowitz had to say.

• Health care must be re-engineered from the inside with doctors taking the lead to create a more efficient and effective system.

• We have plenty of doctors; we are just not deploying them well in ways to produce better and less costly care.

• Primary care doctors ought to be leaders and managers of medical teams, e.g., as proposed in medical home models.

• Primary care practitioners ought to delegate routine care – colds, urinary tract infections, and stable diabetes – to a variety of physician extenders using protocol, evidence-based, protocols.

• Physicians ought to restrict their patient one-on-one time to patients with serious or complicated diseases.

• The reimbursement system ought to changed to reward physicians who lead medical teams that handle large patient populations, who care of patients well, who show demonstrable outcomes; payments should not be based on how often they see patients.


• His model requires an EMR system that supports protocol-based care, population management, and delivery of virtual care via phone or the Web. Not every patient needs to be seen.

• Physicians ought to apply the same level of ingenuity and innovative thinking to creating new business models and transforming care processes that have to developing new devices and new drugs.


• Physicians ought to be open to new ideas, to be inspired by physician innovators with new thinking, to sharing those ideas with colleagues, and to participating in innovation centers springing up around the country.

Commentary on Part Two of the Berkowitz interview will appear in a future blog