Episode 05: Dr. Lyle Berkowitz – Chief Executive Officer – Automated Patient Care, Virtual Health Categories and Innovation, How to Solve Problems, and Emotional Decision-Making
Summary
In this episode, we welcome Dr. Lyle Berkowitz, Chief Executive Officer of Back9 Healthcare Consulting, to share incredible insight on virtual health.
Berkowitz discusses his vision for virtual health, the importance of automating patient care to allow clinicians to practice at the peak of their license, the different categories and motivators of virtual health, how to get better at problem-solving and process improvement, and understanding how emotions influence decision-making, especially in personal health.
Berkowitz’s insight is valuable for anyone interacting with the healthcare system, and he paints a picture of a better future utilizing virtual health.
Show Notes
Patient Care Should be Automated
In 2013, Berkowitz published a blog post that outlines his vision for telehealth in 2025. He discusses how close we are to that vision in 2020 and points out a theme that stays consistent through the whole episode: routine, repeatable workflows in doctors’ work and patient care should be automated.
Compared to many industries, healthcare has been resistant to automated care forcing our physicians to continue doing paperwork instead of practicing at the peak of their license. This causes an access-to-physicians problem for patients who either aren’t getting the evidence-based care they need or are wasting time on unnecessary office visits. Some parts of a doctor’s workflow have made progress in automation, such as drug refills, but haven’t been widely adopted yet.
The Three Categories of Virtual Health
There are many names for telehealth, but Berkowitz prefers the term “virtual health,” which encompasses any care that is non-face-to-face. He divides virtual health into three categories: synchronous, asynchronous, and autonomous.
Synchronous is what we typically think of when telehealth comes to mind – a direct patient-to-clinician or clinician-to-clinician interaction through means of technology. Asynchronous is when there is some type of delay between the interaction – messaging, email, app communication, etc. – but the clinician is still involved. Autonomous removes the clinician and is driven by AI or automated technology that empowers self-service by the patient. These currently appear primarily in the form of chatbots, chronic disease management, and remote monitoring.
The Three R’s of Telehealth
With a staggering rise in telehealth visits during the pandemic, one may wonder if it’s sustainable or if humans will naturally try to avoid virtual health. Berkowitz shares the 3 R’s that drive telehealth adaptation (or not): reimbursement, regulatory changes, and regularity.
Healthcare providers are now being reimbursed for a telehealth visit as an office visit, which is an important step, but asynchronous and autonomous care are still not incentivized through reimbursement like they should be. There have also been recent regulatory changes at the federal and state levels producing a positive outcome on virtual health. And perhaps most important is regularity, which is the frequency and preference of virtual health by both doctors and patients. In his conversations and studies, Berkowitz assumes it’s going to decrease from pandemic levels but has accelerated our comfortability with a hybrid approach to patient care.
How to Virtualize Non-Primary Care
Berkowitz shares ways that types of care such as physical therapy, nutrition, and mental health are virtualized. He specifically shares examples of the ways that access to virtual mental health care result in improved mental health outcomes. There’s a great example of a study in the 60’s from Warner Slack that showed that computers were better at providing non-judgmental feedback than people, so patients were more likely to share details during computerized interviews. Even in the 20’s, Fritz Kahn imagined the doctor of the future behind a computerized panel. Humans are great at creative, complex, problem-solving but not always great at tasks that require consistency.
Cultivating the Skill of Problem-Solving
Berkowitz’s background was originally in biomedical engineering, which drives him to always consider how to solve problems and make processes simpler. In reference to his book, The Healing Edge, he believes a key to solving problems is not asking the end user or frontline worker (in his example, doctors) what the solution is, but to watch and listen to better understand the problem. The assigned leader or project manager should solve the problem for the doctors, not the other way around. The final – and hardest – step is implementing innovation, which human nature is always resistant to.
How Emotion Influences Decision-Making
The conversation ends with Berkowitz sharing the importance of understanding the role of emotion in decision-making. Especially in healthcare, non-compliance can almost always be traced back to an emotion or belief-driving behavior. His work with the Northwestern Memorial’s Innovation Group studied emotional decision-making in diabetic patients and found ways to incentivize behavior change. Berkowitz argues we should respect patients as human beings who are intelligent and self-reliant, simply needing education with evidence to influence decision-making.
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Closing
Humans in Healthcare is produced by Shearwater Health in Nashville, TN, and hosted by Chief Marketing Officer, Nathan King.