PCL Experts: Dr. Jack Lewin, Chairman of the National Coalition on Healthcare, on COVID-19 & Healthcare's Future
Jack Lewin is the Chairman of the NATIONAL COALITION ON HEALTHCARE, a non-profit organization promoting comprehensive health system change. He’s previously served as the President and Chief Executive Officer of the Cardiovascular Research Foundation, CEO of the American College of Cardiology. Lewin also served as the Hawaii Director of Health between 1986-1994, overseeing 6,500 employees, 12 hospitals, and a billion-dollar budget. In 2011, Lewin was named as one of Modern Healthcare’s 100 Most Influential People in Healthcare. Nowadays, Lewin focuses his time on the future of healthcare, founding Lewin & Associates: a consulting firm focused on launching health start-ups to transform the sector.
VectorCare recently sat down with Lewin to chat about PATIENT CARE LOGISTICS, disaster management in the face of COVID-19, and the future of healthcare.
Some comments have been edited for brevity and clarity
You’re clearly spending most of your time right now helping with the nation’s response to COVID-19. What did we learn about disaster management during this pandemic?
Firstly, we are/were completely unprepared as a nation to handle the pandemic. We have a lot to learn, and we have a lot to prepare to prevent a recurrence. We need to make a much much greater investment in public health and prepare to ensure that the healthcare system is geared up and ready next time this happens. In terms of technology, we were woefully unprepared for testing and we still are. There’s work to be done.
In addition, it’s clear that the US needs to become far less dependent on foreign manufacturing to meet our own emerging needs. We expect this will become more clearly evident when we begin distributing a vaccine whenever it becomes available.
What are the main things that COVID-19 has changed about the healthcare system at scale?
Many healthcare practices have suffered due to COVID. Primary care practices have been extremely threatened by this pandemic, and many may not recover. Hospitals have also been seriously affected due to a lack of elective cases. The only party that has truly benefited are healthcare insurers, who are profiteering like wild due to patients not using services.
More broadly, the nation’s attitude toward healthcare has radically changed during the COVID pandemic. So many people who are frontline workers are at risk because of a lack of access to healthcare. These workers have had to go to work even when they’re sick, and have inadvertently spread the infection. These frontline workers are heroes, and should not be forced to work while sick. Many people are going to demand a different healthcare system very soon. We expect to see enormous public pressure for improvements in the healthcare system to address the glaring deficiencies we’ve experienced as a nation during this pandemic.
"Many people are going to demand a different healthcare system very soon. We expect to see enormous public pressure for improvements in the healthcare system to address the glaring deficiencies we’ve experienced as a nation during this pandemic."
Are there any positive changes or trends we’re seeing in the industry as a result of COVID?
COVID created a long-awaited approach to telemedicine, with no doubt. Telemedicine is in amazingly broad use and we will probably never go back to expecting in-person visits for at least 50% of all outpatient visits. We’re going to see a major shift in how primary care is delivered, with technology aiding visits to all kinds of physician specialists and triage services that don’t require an in-person visit. We can expect other types of delivery systems, like CVS and Walmart clinics, to fill the role that outpatient care used to.
How do you see technology improving patient care?
AI and analytics have begun to have a major impact in terms of using data to personalize care. We’re in the early stages here, but we’re using artificial intelligence, remote monitoring, and biomonitoring, to transform the healthcare system. In the future, if someone has a risk for atrial fibrillation they’re most certainly going to be monitored 24/7 with some kind of patch or other device. We’ll be monitoring many other things, including the time people spend out of bed, the amount of sleep people get, the monitoring of bio-signs for problems, daily weight, daily blood pressure, etc. We’ll be using technology to transform healthcare in many ways.
Parallel to that, there’s something that hugely concerns me. That is, that healthcare is increasingly turning into a system where nobody knows you. It’s a very alienating and lonely experience to be hospitalized today. No one knows you, and in fact people make mistakes because they don’t know you and don’t understand the little idiosyncrasies around your health that your personal physician might automatically understand after years of working with you.
The art of medicine has become downplayed. Physicians spend their time sitting with their backs to a patient, typing into an electronic health record. The art of medicine is rarely being taught: it’s an afterthought in medical education. As a result, we have an alienated patient population and a very unhappy, frustrated clinician population. As doctors, we didn’t sign up to enter information in a computer: we became clinicians in order to have relationships with patients. The decline of the art of medicine is an ominous sign, and we’re going to have to rethink the design of our healthcare system in the future to utilize technology to improve the level of empathy in healthcare.
"As doctors, we didn’t sign up to enter information in a computer: we became clinicians in order to have relationships with patients. The decline of the art of medicine is an ominous sign, and we’re going to have to rethink the design of our healthcare system in the future to utilize technology to improve the level of empathy in healthcare."
What’s the Future of Healthcare?
Well if you go all the way out to the distant future, the Starship Enterprise, we won’t need specialties or subspecialties. We’ll have a doctor and a nurse, and they’ll have amazing technology capable of diagnostic, analytic, surgical skills that humans don’t possess. In the distant future, we’ll have that. What that doctor and nurse will have, that technology doesn’t, is empathy, compassion, and the ability to communicate with another human being in a way that’s meaningful to both parties. So I think we’ll have a healthcare system that begins again to rely on empathy. In fact, maybe in the medical schools of the future students will be admitted based on some degree of intelligence, but also on some basis of their capacity for empathy and desire to truly communicate with people.
I think we will rely on technology more and more, as technology becomes more and more impressive. That’s going to create a need to rethink how humans fit into the healthcare system of tomorrow.
Want to read more from the Patient Care Logistics Journal? Check out our recent interview and resources from Shauna Shapiro, tackling mindfulness at work.