Dr. Berkowitz is a quietly spoken unassuming bloke, yet his message rings loud in the ears of those who understand the serious situation healthcare systems face in the developed world. He serves as the Medical Director of Clinical Information Systems for the largest primary care group in the city of Chicago, he is the Program Director for the Szollosi Healthcare Innovation Program (SHIP), and the president of an independent healthcare IT strategy consulting firm. Dr. Berkowitz has researched and consulted in the field of medical informatics with a focus on creating tools and strategies to ensure physician and patient adoption of clinical information systems. He is an author, public speaker and a self confessed media junkie; he’s a physician advisor to the ABC Medical news Unit and works with a wide variety of movie, television, and theatrical productions in Chicago. He’s also a Dad with two kids: although where he finds time to do that job I’m not sure.

Lyle Berkowitz and other speakers at HIC ’08 were all singing from the same hymnsheet, we: that is you and I, can no longer expect all our visits to the Doctor to be face to face. A lot will be virtual, online, maybe to a nurse practitioner first, then if they reckon you are seriously ill, a face to face consultation. To complicate matters. Medicare with its rebates and payments systems will have to find innovative ways to cope with the changing world. “We are more similar than we are diverse; we all suffer from the same medical problems of cost, quality and access to care.

We have the same shortages of healthcare professionals, we don’t have enough money to fund healthcare. We all deal with the same pain, we need to develop and use new technologies to make the systems work more efficiently.”

Lyle’s mind works in interesting ways, not only does he have substantial formal medical qualifications as a specialist physician, he has an enquiring mind and an ability to think like an engineer. It’s classic left and right side brain activity.

 
“Technology is fine but in the end these are only tools, they need to add value, they need to do that by improving the health system, making it work better. It’s all about establishing where we are now, where do we want to be in ten years and how do we get there with the help of new technology.  In our relatively small Innovation Centre, with limited budgets, we ask ourselves, ‘what can we do that will improve healthcare delivery in our hometown of Chicago?'"

"We work in niche areas, ones where we can afford to develop technology that will solve local problems and also make out health system better. Then we can export that technology to the nation and beyond.  We have concentrated on outpatient care for those people who need a lot of attention, where right now, a lot of time, money and resources are spent on a small number of individuals. We know that a smart future will see an increased use of paramedical personnel, supported by information technology, delivering basic healthcare before medical specialists get involved. Doctors will have to let go of a lot of ‘stuff’ they do now and quite honestly nurses and others are much better at following protocols than many doctors. If we don’t do this, there will be worse medical shortages than there are now, it will be harder and harder to get to see a doctor, it will cost more, the rich will cope, the poor will suffer and many will die, earlier than they would have if cost effective treatment was available."

The worst example of that is already apparent in the USA with some medical specialists in Florida establishing VIP care clinics. Patients have to pay an annual retainer of $2000.00 per year just to be on the clinic’s books. They also pay fees when they access services. These doctors see fewer patients and keep their income high. They might see 200 patients a year instead of 2000. What happens to the other 1800 who cannot afford the retainer fee? They have to find doctors in an already overstretched system.

"The implications of this sort of change are scary for ordinary Americans," says Lyle. I asked him if politicians in the US understand the seriousness of the healthcare crisis? He said, “I don’t think so, they all say we need more doctors, but that isn’t the answer, it’s not the answer in Australia either. We have to change our payment systems; in Australia that means changing the way Medicare pays doctors, that will provoke another healthcare debate. Care does not mean a face-to-face consultation with a doctor every time you feel ill. You may need to see a nurse practitioner first, the consultation may be online, yet the practice still has to be paid even if it’s an online consultation or the appointment and treatment is with a nurse in the medical clinic.  If we don’t adopt new technology and change the way we deliver care, the system simply will not cope, we have to act now before the healthcare system goes into meltdown.”

-Mike Swinson