Alameda Health System

Mark Amey

A strange thing happened on the way to dealing with COVID-19…

We learned that you can’t fight a new pandemic with old thinking and reluctant action —particularly those grounded in low expectations of our consumers and maybe even racism.

As an IT leader, I’ve shepherded Alameda Health System’s deployment of its electronic health record. Before the implementation, we were asked, “is it the right time? Will our population of vulnerable, homeless and low-income families be able to take advantage of its technology?”

Interestingly, when implementing electronic health records at other systems that served a more “sophisticated” population, those questions were never asked.

We know that there are disparities in health care. The most devastating may be a disparity in expectations.

If we fail to give disadvantaged populations the information, tools, and resources to better manage their health, we doom them to poor health outcomes – and ultimately – to a premature demise. COVID-19 reaffirmed that people of color suffering from social determinants of health and limited access to care are killed by COVID-19 at a disproportionate rate.

The need to protect patients and staff from exposure to the coronavirus forced us to overcome prejudice and implicit bias. Lengthy pondering about a faraway vision of more excellent connectivity and alternative methods of care delivery were replaced by immediate action. In a matter of weeks, if not days, we rallied to create telemedicine visits to maintain primary care appointments and other services. We stopped asking if we should. The question was, what if we don’t?

The answer was that more black and brown people, particularly those from low-income communities that depend upon safety net systems for care, would be placed at higher risk if required to come to facilities for care. Many of our patients suffer from limited access to transportation, and some take hour-long bus rides to arrive at our clinics. Can you imagine a patient risking exposure to COVID-19 on mass transportation as we urge folks to practice social distancing for a primary care check-up?

Some still asked if our patients would need help to become more computer literate.

My wonderful 70-something mother is fighting cancer. She adores her provider, but to “see” her involves a two-hour car ride, plus an exhausting 1/8 a mile hike once parked because she can’t afford the expensive parking near the provider’s practice. That reality changes when we offer telehealth.

We embraced technology sooner than we would have otherwise and made our technology simple by going to where the consumer is. Within days of CDC’s social distancing guidance, we put the wheels in motion to raise fully-operational isolation tents, created a work from home environment for hundreds – and thousands, if needed. We created an electronic dashboard to allow us real-time visibility into our COVID patients and trends by race, ethnicity, and zip code sooner so we can flatten disparities more quickly than not.

We stood up a telehealth program, enhanced our culture of safety – and we did it all without compromise to the quality of care. We customized the technology for the patients. Within a few weeks, we doubled/tripled the number of remote visits. Our patients have loved it, and the system is better off for it.

Battling COVID-19 showed me that gaps in our expectations fuel pandemics and allow them to spread like wildfire through populations we under-serve, under-mind, and under-resource. Technology shared broadly, can be a bridge that helps close a sizable gap in access to care and disparities in outcomes.

I am humbled. Never before did I imagine that the very thing I’ve built my life and career – can serve as a bridge that helps close a sizeable gap in access to care and disparities in outcomes.

COVID-19 provided a wake-call. It’s up to us to remove our bias and get out of technology’s way.