'A great leveling of the playing field': How Dr. Richard Berger built orthopedics' 'BEST' telehealth service

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Richard Berger, MD, created a telehealth program for total joint replacement patients. He calls it Berger's Elective Surgical and Telemedicine Experience, or BEST, and the concept was conceived long before COVID-19 accelerated the use of telehealth.

Dr. Berger, of Chicago-based Midwest Orthopaedics at Rush, spoke with Becker's about building the service and his outlook for telemedicine in orthopedics.

Note: This conversation was edited for length and clarity.

Question: Tell me more about the development of the BEST platform and any obstacles you encountered.

Dr. Richard Berger: I have a unique practice in that a lot of patients have come to see me from far away, but for the past 15 years, half of my patients either take an airplane to come see me or take a very, very, very long car ride to come see me. I wanted to make things easier for the patients, and I've done that in a number of different ways. First, developing minimally invasive surgery so they have a quicker recovery and then outpatient surgery, which enables them to get back to work and do things easier. The next logical step was answering, "How can I make it easier for patients?"

Years before this, we've tried to develop a telephone version of consultations. We open this up to selected patients. First it was famous patients who lived far away, and then we started doing it with some more patients. Then we said, "Well, let's use modern technology. Why are we doing this on the phone?" We started doing that and we were doing this on a small number of patients — about 5 percent of patients. Just before COVID-19 hit, I was talking with my staff and said, "We need to really make this more and have it available to more of our patients." Since COVID-19 we've been doing this more and more, and we've opened it up to everyone with a much better and more refined way of doing this.

We really have two extremes. One extreme is you want to make an appointment to come see me and you feel comfortable with me. You come and have the surgery and then you come back to the office to follow up. There's the other extreme where you feel comfortable. I can diagnose you over the phone 99 percent of the time because you already have your X-rays. I can watch you walk, and I can talk to you. If all you need is pills, I can call it into your pharmacy. You can walk around the corner and get it or even have your pharmacy delivered.

Q: What was the biggest thing you had to refine when developing this?

RB: The biggest thing I think, like any new technology, is getting buy-in and getting your staff to feel comfortable with it. The second biggest thing or the biggest thing that I've learned from this is that just like anything, there's not one way of doing anything. There's multiple ways of doing it, and each patient wants something a little different. Customizing it has been the biggest thing that we've learned is important, that we've learned how to do. And then also using this in a different way and not just not just using it to assess their hip or their knee and decide whether they use surgery or not. But really looking at the patient as a whole. There's so much that goes on with personal interactions that if you don't have that personal interaction, you now have to start to consciously think about which is a good thing, not a bad thing, because now you have to make up for the fact that you don't have all of these other nonverbal cues that you normally get. So you tend to talk more and you tend to talk more specific. You tend to have a longer interaction. And I think all of those things make it better for the patient.

Q: How have the initial patient outcomes and feedback you have had with this program been so far?

RB: The feedback has been just wonderful. We're really tailoring this to what the patient's wants are. So it just makes it easier. If you live in Chicago and you want world-class hip and knee replacement, it's easy to come to see me. But if you live in Montana, you know, it's hard. But now this is a great leveling of the playing field. You can come to see someone like me if you live across town, across the state, across the country, across the world, and you don't have to have your own private plane.

Q: What aspects of telehealth still need to grow in orthopedics as a whole?

RB: I think the technology we have available to us right now is far outstripping our ability to use it. We have so many things available to us. All we have to do is start adopting them more. We now offer this to everyone, and more than 50 percent of my patients now take some advantage of it.

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