Monday, May 20, 2013

Are Information Technologies (IT)  the Only Path to Innovation and a Better Health System?

Ask the right question to get the right answer.

Peter F. Drucker (1909-2005)

This morning I asked myself: Are computers and their information applications the only key to health care innovation? 

My answer was:  No, but as Archimedes might say if he were alive today, computers and their apps are the main lever lifting the health care world.   

Yes, but they are not the only lever,  As an article  “Almost Human “in today’s  New York Times’ Arts & Leisure  section says of electronic manipulation, “It’s an infinity of nuance, in the shuffles and the grooves.  Those things are impossible to create with machines.” 

It’s  impossible for computers to create, virtually or otherwise,  all the nuances, the shuffles and the grooves, of the human experiences and encounters of health care.

On May 11 I reviewed the book Innovation with Information Technologies in Health Care.   I sent the review to Lyle Berkowitz, MD,  co-editor with Chris McCarthy of Kaiser Permanente.  

Lyle  responded with this email, which said in part.


Wow- you always amaze me with your brilliant and thoughtful way of summarizing what can sometimes be a complex issue!

Thanks so much for taking the time to read the book and write a review… if you don't mind, I made a few minor edits below to make sure your readers knew that in addition to EHRs, we look at Telehealth and some other HIT tools as well.. I also included a few links to

And thanks again for being such an inspiration in healthcare overall - your book on Innovation was one of the first books I bought when I started my innovation journey, and I think it will remain relevant for years to come!

I've talked to you before about the ILN, which is the consortium of now over 30 healthcare organizations looking to use innovation and design theory.

Best, Lyle


This week Lyle called.   He tactfully suggested my review focused too much on EHRs and their various manifestations in Part I of the book, but not enough on Part II,  how telemedicine can better connect patients with their caregivers, and Part III,  how innovators are using the EHR and telemedicine to combine technologies, spaces, and workflow to create superior experiences and better results.

Part II explores the worlds of telemedicine -  televisits, teleconsults, telemonitoring, and teletranslations through innovations developed at Partners Healthcare, Group Health, the Veterans Health administration,  Indiana’s Memorial  Health System, and the Californian HealthCare Foundation. 

Of Part II, the two co-editors comment, “You should exit this section wondering , imagining , and scheming on what products and services can be broken from  the tyranny of four clinical walls to build interactions that are easier, smarter, and more responsive to clinicians and patients?”

Part III, ends with this, “We conclude with a trip down the Rabbit Hole:  The Gamification of HealthCare. It is safe to say that none of us know exactly where the rabbit hole will take us, but the exploration of games and game mechanics is getting big.  The wellness space is flooded with gadgets, gizmos, and apps that are quantifying just about everything and increasing the motivations and the ability of individual and even of groups to be healthier. Gaming is helping the sick and injured to heal, increasing chemotherapy compliance with kids with cancer, and is distracting third-degree burn victims during painful dermabrasion.  It is indeed an whole new world.”

A brand new world it is, indeed.  Berkowitz,  McCarthy, and their 40 authors tell it well.  But it‘s important to point out  that computer generated  and driven algorithms featuring  Big Data,  on-the-spot information,  comparative outcomes, pay-for-performance, coordinated care, telemedicine,  virtual simulations,  process analysis, and  artificial intelligence are not the only routes to a better  health system.  

Most clinical judgments will remain outside the computer box.  Common sense,  healthier  patient lifestyles,  improvement of personal interactions between patients and doctors,   new physician practice models,  intuitive observations and decisions,   reading body languages, and the Art of Medicine will continue to play pivotal roles.

In the course of our conversation,  Dr. Berkowitz informed me his hospital, Northwestern Memorial in  Chicago,  was the biggest health system in Chicago. The hospital system will  soon have 150 salaried physicians under its wing,   Berkowitz  will be responsible for helping these physicians initiate innovations to  meet the requirements  of health reform and  to improve and facilitate patient care. 

Of Obamacare,  he  commented, “It has to  work in Chicago, Obama’s hometown, or  the whole system may collapse.” I am not so sure of that.  Bottom-up incremental reform might just work as well and for a lot less money. In any event.,  he favored  federal  health reform, but he also thought  private sector innovation  was critical  for success. He looked in wonderment and awe at information technologies’ potentials  to transform the health care world into a better place.

A closing note:  “Down the Rabbit Hole,” for those of you not in the know,  is a metaphor for adventure into the unknown ,  as  in Alice's Adventures in Wonderland.  For physician innovators, this book is an adventure Down the Rabbit Hole of  innovative  information technologies.

Tweet: “Innovation with Information Technologies in Health Care” is a new book that explores the current and future worlds of health care.

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