The following are the opening remarks made by Dr. Lyle Berkowitz, Program Director for the Szollosi Healthcare Innovation Program, during his Keynote Presentation for the Health Informatics Annual Conference of the Health Informatics Society of Australia in Melbourne (August, 2008).

“Enabling the future for care delivery”

“We have reached the limits of what it is possible to achieve with computer technology”…So said Dr. John von Neumann in 1949.  Dr. von Neumann was a PhD – a well known mathematician and computer science expert. 

His words held a lot of weight…but he knew his limitations, and he followed up his prediction with a second sentence that some people forget to attribute to him.
His full quote was:  “We have reached the limits of what it is possible to achieve with computer technology…although one should be careful with such statements,
as they tend to sound pretty silly in 5 years”.

I am a primary care physician from the United States
And I think we have not even gotten close to realizing  what we can achieve in healthcare.

You’d think I’d be a bit more worried…as the US, and many other countries,
are struggling to balance Cost, Access and Quality of healthcare.

And yet I hold strongly to the belief that “In the middle of difficulty lies opportunity”
Both Albert Einstein and Winston Churchill said essentially the same thing
When faced with overwhelming odds.
Well, we know we have enough difficulty in healthcare….
So let’s explore the opportunity

I realize there is not one easy answer, but I do know that as new tools become increasingly available to us, both from within and from outside healthcare, we can and need to become more innovative.

In the past, innovation in health care has traditionally focused on devices and medications.  The result has been the growth of CT and MRI scans, implantable devices of all sorts, and an explosion of drugs for most every condition.  

But now we need to apply this same level of ingenuity and innovative thinking
to process improvement and software development.

We need to apply new ideas and technologies to solving the core problem we face –
How do we improve access AND quality while maintaining or lowering the cost of care?

We have the Internet and Cell phones.
We have Telemedicine and Web messaging.
We have smart devices that can monitor a patient’s movements throughout their house.
Surely we can bring these all together
And figure out a better way
To improve communications and coordination of care
That will make things easier for both patients and their physicians

Many reasonable and smart people will say it can’t be done,
At least not in a cost-effective manner.
But Dr. Neumann would tell you to wait a few more years
Before making any predictions
which limit what you can and can not do. 

Today, I will talk about innovation in healthcare…
First – We’ll review “What is Innovation” and
“Why it is so important for the future of healthcare”?

Second – I want to introduce a paradigm shift that explains the critical nature of IT in healthcare innovation

And finally,
I will share with you a success story about the birth of a new program in Chicago -
a program that brings together software development and process improvement.
A program focused exclusively on Healthcare Innovation.
And I hope to encourage everyone sitting here to think about how you can do the same in your own organizations.


Need for Change in Healthcare
Our present efforts
resemble a team of engineers
trying to break the sound barrier
by tinkering with a Model T Ford.
-    Institute of Medicine Report on Errors in Healthcare: Crossing the Chasm (2001)


Why Innovation
You cannot solve a problem using the thinking that got you there.
-    Albert Einstein


What is Innovation?
Converting knowledge into something valuable


Who should be involved?
Your providers of care…
Doctors, nurses, pharmacists, technicians and assistants of all sorts
And your patients – inpatient, outpatient, well patients, and sick patients
They all can provide value

When to Start
No better time than now

Healthcare Innovation in the US
In the first months of 2008,
I visited or spoke with “Healthcare Innovation Centers” across the United States

Lessons Learned
Create, Validate, Spread
 
Innovation + HIT: Paradigm Shift

Current Paradigm
Slow evolution of EMR Systems

Paradigm Shift
Focused Innovation: Niche Solutions for High Impact Situations


Creation of a Healthcare Innovation Program
SHIP Description
Mission
Vision

HOW
Combining Product Development with Process Improvement

Where is the Opportunity?
Look for the difficulties


Model for Success
Focus on pragmatic, real world solutions
Within the walls of an academic medical center
Need for Sponsorship!


Project 1: ExpectED
Focus on efficiency for doctors sending and receiving information
Proof of concept we could combine
Product Development with Process Improvement

 
Project 2: Inflection Navigator
60% of healthcare dollars are spent on 10% of patients
An inflection point in healthcare means things can go good or bad… over a short period of time. And an inflection point involves both clinical outcomes and the patient’s personal experience. In other words, a successful clinical outcome is important,
But can be discounted by a bad experience, such as delays in treatment, frustration with communication, etc…


Project 3: Patient Dashboard
I’m not a big fan of the PHR concept as much as actionable tools that help patients maneuver thru the healthcare system


Project 4: EMR of the future
Today’s EMR’s are built on a problematic paradigm. They are based on the paradigm of paper
And. they have been created to help a doctor document what he or she did when they should be designed to help a physician do their job. And, then documentation should simply a byproduct of their care

We plan to create prototypes of what the ideal EMR will look like and how it will act
We plan to explore gaming, business and other industries to take advantage of the computer’s power and make an interface that is both intuitive and functional

We plan to have fun with this one!


 
Resources

•    AHRQ Health Care Innovations Exchange
o    Agency for Healthcare Research & Quality
o    http://www.innovations.ahrq.gov
o    The Health Care Innovations Exchange is an AHRQ program designed to support health care professionals in sharing and adopting innovations that improve the delivery of care to patients. Explore this site to find innovative strategies and quality-related tools, learn how to improve your organization's ability to innovate and adopt new ideas, and interact with innovators and adopters.

•    Innovation-Driven Health Care: 34 Key Concepts for Transformation
o    By Richard L. Reece, MD

•    Innovation in Action (Guide for HC Professionals)
o    By Scott Endsley, MD (sendsleymd@aol.com)
o    Email him and he will email pre-publication copies


•    Centre for Health Innovation (Alfred Hospital, Melbourne)
o    http://www.healthinnovation.com.au
o    The Centre for Health Innovation was established to improve the safety and quality of health care by fostering collaborations between clinicians, scientists and technology developers.
o    Based at The Alfred Hospital in Melbourne, the Centre is a purpose-built training and technology testbed facility used by clinicians and industry to support professional development and the trialling of new technologies that can improve patient care.
o    Services provided at the Centre include:  Health Technology Innovation, Technology Evaluation, Technology Demonstration, Simulation Education, Consultancy, Research
o    Cathie Steele
 
Conclusion
You see things and you say, "Why?" But I dream things that never were and say, "Why not?"  
- George Bernard Shaw

I am always doing things I can't do, that's how I get to do them.  
- Pablo Picasso

Never believe that a few caring people can't change the world. For, indeed, that's all who ever have. 
-Margaret Mead

And so I hope I have accomplished my goal to encourage everyone sitting here to think about what you can do in your own organizations

Whether it be starting an Innovation Program or simply encouraging a colleague to think outside the box.
You can make a difference.