Tag Archives: health disparities

2022 or the 1950s? 

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February started with news that was both disturbing and disappointing to see in 2022. But unfortunately, not a surprise considering the long history of racism and white supremacy in this country. News programs the first few days of Black History Month covered bomb threats at many HBCU campuses, the Florida Anti-Woke Act, book banning, a neo-Nazi group protesting in front of Brigham and Women’s Hospital in Boston, and another police shooting of a young black man, Amir Locke, in Minneapolis.

It makes one wonder if this is 2022 or the 1950s. Are we moving forward or backward?

When I touch on political subjects in my blog posts, I try to weave a healthcare perspective into it. The best I can do given these discouraging news stories is to reinforce that it takes each one of us to make change and create the kind of world we want to live in, work in and raise our families in.

As Rev. Dr. Martin Luther King, Jr. said, “The arc of the moral universe is long, but it bends towards justice”. Yes, but only if we pull it towards justice. So, what can you or I do to pull it?

I applaud Boston Children’s Hospital where I served as interim CIO last year for requiring “Bystander to Upstander” training for all employees as part of the health system’s commitment to diversity, equity, and inclusion. This program raised awareness of microaggressions in everyday life and provided simple tools for each of us to use to move from being a bystander when we see and hear something to being willing to call it out.

I applaud the CHIME Diversity and Inclusion committee which I am a member of for their continued work to raise awareness amongst CHIME and CHIME Foundation members and AEHIS, AEHIA and AEHIT members. The newest offering, “DEI Dialogues”, kicks off this Friday 2/25 from 12-1PM ET. DEI Dialogues will be a dynamic series of virtual conversations around identity, belonging, equity and inclusion with a different lens of focus each month. The focus of the first one is Black History Month. Cletis Earle, SVP and CIO at Penn State Health, and Dr. Andrea Hendricks, Senior Executive Director & Chief Diversity, Equity, and Inclusion Officer at Cerner, will moderate the discussion. For more information on CHIME Diversity and Inclusion and to register for the first DEI Dialogues, click here.

When it comes to understanding our own biases and working to end racism, we are each on our own journey of self-awareness and action. Together we can be the change and move forward not backward.

Resources and Related Posts:

Here’s the story behind Black History Month – and why it’s celebrated in February

How Sharing Our Stories Builds Inclusion

One year later – an increased focus on diversity, equity and inclusion

At the intersection of racism and healthcare

We got our shot!

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My husband and I got our first dose vaccine shot on Saturday. And yes, there is a sense of relief to be at this point a year after it all started.

March 5, 2020 feels like the last normal day for me. I had lunch in a restaurant with my daughter who is an NP at a Boston hospital. I was anxiously waiting to hear that HIMSS20 would be cancelled and wondered what they were waiting for. I discussed the risks of going with my daughter. I decided during that conversation not to go even if they held it (I got the cancellation notice as we were leaving the restaurant). I asked her about the Coronavirus from a clinical perspective. She said we’re “f’d” and projected 100,000 cases in the U.S. by April 1st. We now know it was to be far worse.

As a frontline healthcare worker, she was fully vaccinated by early January. Two weeks ago, she helped about fifteen of her husband’s 65 years and older family members and their friends navigate the somewhat confusing multiple websites in Massachusetts to schedule first dose appointments.

Here is my Rhode Island story. The vaccination site was a junior high in our town. Overall, it was a smooth process. When we pulled into the parking lot there was a sign that said wait in your car until 5 minutes before your appointment to avoid people crowding at the door. Our town Mayor was there working – that was a pleasant surprise. He took temperatures and asked initial screening questions at the door. I greeted him and commented on the fact that he was working – his somewhat joking reply was, “I have to earn my keep”.

Next, we went to the “check in” table. We gave them our IDs and they looked us up on the list of people scheduled for an appointment that day. The list was in no sort order, so it took a while. We then moved into the gymnasium where there were about eight vaccine stations. Firefighters and EMTs gave the actual shots. My husband was considered to have moderate risk of a reaction, so his PCP advised him to stay for 30-minute observation. When he shared that information, a physician was called over to ask him a few questions before he got the shot.

With information on how to sign up for the CDC’s v-safe app (after vaccination health checker), and our vaccination cards in hand we went to the observation area with many seats set up socially distanced. There were several people wandering around the area offering to help you make your second appointment or you could just use the QR code they provided on posters visible on the backs of the chair in front of you to sign up for 4 weeks out.

If you know me well, you know that I always have an eye out for process improvements. Continue reading →

Vaccine rollout – it takes a village, part 3

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Let’s start with the big picture and some good news. There are downward trends in the key COVID-19 indicators – the number of new COVID cases, hospitalizations, and deaths. But we know there is no good news in 3,000 deaths per day and nearly 500,000 deaths since the pandemic started a year ago.

In terms of the vaccine, there is good news at a macro level. According to the Bloomberg COVID tracker, 48 million doses have been given in the U.S. with an average of 1.62 million doses administered per day, 14.6 doses have been administered for every 100 people, and 70% of the shots delivered to states have been administered. (as of 2/11/21 at 6:25PM)

There are more examples of mass vaccination sites with thousands being vaccinated in a single day at stadiums around the country. UC Health in Denver is offering a playbook for mass vaccination sites to other health systems – best practice sharing is something we do very well in healthcare.

Dr. Anthony Fauci projects that by sometime in April, the vaccine will be available to anyone who wants it. That seems very optimistic considering many states are just now in mid-February beginning to vaccinate anyone over age 75. President Biden says there will be enough vaccine supply to vaccinate 300 million in the U.S. by the end of summer.

Access issues continue with a lot of confusion and frustration for those in qualified groups trying to make appointments either online or by phone.  It has become a family affair for many as younger family members try to help their elders figure out how to get vaccine appointments when there are multiple channels possible in their state or city and multiple different websites to go to. I applaud the various initiatives of software engineers in Massachusetts and New York who based on their own frustrating family experiences created a way for people to check availability of vaccine appointments. But we should not have to rely on such solutions. I would expect our government agencies to have made it simpler to begin with.

I just learned of another tool that notifies people via text message when there are leftover doses in their zip code so no dose goes to waste – Vaccination Standby  List. According to the website, their mission is  “to reduce COVID vaccine waste, reduce unnecessary lines and crowds at stores, reduce misinformation of leftovers, and allow as many people as possible to take advantage of any leftover doses”.

Disparities in vaccine distribution are real. We need more examples like the one in South Los Angeles where Dr. Jerry P. Abraham and the Kedren Community Health Center set up a walk-in site described in the Los Angeles Times article by Erika D. Smith on January 29, “Column: How a South L.A. doctor is beating the system and distributing vaccines equitably”. In Dr. Abraham’s interview on MSNBC’s Rachel Maddow Show on February 5, he said that he and his team are extremely solutions oriented and recognized that people with no car, no Internet access, and no email needed a workaround. Continue reading →

Vaccine rollout – it takes a village, part 2

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Last week’s blog post on vaccine rollout took longer than expected to write as I compiled multiple resources and articles to comment on and share. With the vaccine rollout as massive an undertaking as it is and so many stories (good and bad), I decided to do part 2 this week highlighting best practices, technology challenges, and health disparities.

Best Practices

Last week, I mentioned Atrium Health and their local partnership to do mass vaccination events. It was encouraging to see their update on vaccinating over 20,000 people had a special emphasis on underserved communities.  We need more focus on underserved communities – more on that in a bit.

Another health system doing drive thru vaccination clinics at scale is Memorial Hermann in the Houston area. They are getting calls from health systems across the U.S. asking for guidance on how to design similar large-scale vaccination events and are more than willing to share their blueprint for others to replicate according to Binita Patel, Vice President of Pharmacy Services for Memorial Hermann Health System. The location (NRG Park) and staffing (700 people including many volunteers) were key to their success.

We cannot forget that there are many people leery of the vaccine, sometimes referred to as “vaccine hesitancy”. Education and public health messaging campaigns will be key as the vaccine rollout continues over the next several months. Based on the Kaiser Family Foundation’s latest COVID-19 Vaccine Monitor report, there are key messages that resonate with people. They are listed in this short article from Becker’s Health IT : “8 most convincing messages to promote COVID-19 vaccines”.

Many health IT vendors pivoted their products and services to support COVID-19 over the past year. Vaccine scheduling is the latest focus area for vendors like Kyruus which shared best practices and insights from their customers in their recent blog: “Eight Best Practices for COVID-19 Vaccine Scheduling Online: Insights From Our Health System Customers”. A great transition to the next topic.

Technology Challenges

I mentioned the Vaccine Access Management System (VAMS) in my post last week as a system provided by CDC to states and other organizations for pre-screening, registration, scheduling and tracking. Not surprisingly, a software solution developed quickly and made available for many different but similar situations and workflows has experienced problems as captured in this article from MIT Technology Review. I would hope the problems can be resolved so organizations using it do not have to switch systems midstream with vaccine rollout already in process and moving rapidly. Continue reading →

8 health experts to follow

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In past years, I’ve used the end of the year mark as a way to highlight my most read blogs of the year and encourage you to check them out if you missed them. But who cares about my most read blogs? Instead, I want to amplify the voices of health experts who have educated us throughout this pandemic and who will continue to for many months to come. If you aren’t already following them on social media or listening to their podcasts, I encourage you to do so. They are often interviewed on the major news programs.

Trusting the science, knowing the facts, and maintaining objectivity are critical for all of us to do our part and get safely to the other side of this pandemic.

Here are the experts I recommend you follow in alphabetical order:

Esther Choo, MD, MPH, Co-Founder, Equity Quotient, is an emergency physician and professor at the Oregon Health & Science University. She has been speaking from the front lines of the pandemic since the beginning. She did a podcast series called Doctors’s Log – A Covid-19 Journal in the early months of the pandemic. Twitter: @choo_ek

Laurie Garrett is a Pulitzer Prize winning science journalist and author of several books including “The Coming Plague: Newly Emerging Diseases in a World Out of Balance” and “Betrayal of Trust: The Collapse of Global Public Health”. In 2007, she did a TED talk “Lessons from the 1918 Flu”.  Twitter: @Laurie_Garrett

Ashish Jha, MD, MPH, is an internationally respected expert on pandemic response and preparedness. He recently left his position as faculty director of the Harvard Global Health Institute and became dean of the Brown University School of Public Health.  His recent interview on In the Bubble with Andy Slavitt, “The Next Three Stages of COVID-19”, is worth checking out. And as I just learned, he also has his own podcast series, “COVID: What Comes Next”. He is a frequent contributor on all the major news outlets. Twitter: @ashishkjha

Vivek Murthy, MD, MBA, has been nominated as the next U.S. Surgeon General, a role he also served in during the Obama Administration.  He is the co-chair of the Biden COVID Task Force. His recent interview on in the Bubble with Andy Slavitt, “Inside the Biden COVID Task Force”, is worth checking out. Twitter: @vivek_murthy

Michael Osterholm, MS, MPH, PhD, is the director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota and is a world-renowned epidemiologist who has spent his career investigating outbreaks. He is a member of the Biden COVID Task Force. Continue reading →

At the intersection of racism and healthcare

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It has been two weeks since George Floyd was murdered by police in Minneapolis. Since then, millions of people have joined protests in major cities and small rural towns around the world to make their voices heard. They have said enough is enough, racism must end and real change is needed.

When the protests end and our national focus begins to shift, we can not go back to business as usual. The statements of support and solidarity made by so many these past two weeks must turn into action.

At the local, state, and federal level we must hold our government leaders accountable for change and exercise our right to vote for those committed to change. With the focus on police brutality, we are beginning to hear some major cities announce planned changes in policing. New York Governor Andrew Cuomo has introduced his “Say Their Name” agenda to reform policing in New York state. House and Senate Democrats have introduced the Justice in Policing Act.

In recent days, we have seen many “white coat” rallies as well – White Coats for Black Lives. My social media feeds are filled with pictures and stories of hospital staff rallies – many of them organized by the residents. Brigham and Women’s Hospital in Boston, UMass Memorial in Worcester, Massachusetts, and Henry Ford Health System in Detroit were just a few of them. And these are hospitals who saw thousands of COVID-19 patients in recent months. Truly our healthcare heroes.

In 2014, after Michael Brown was shot by police in Ferguson, we saw similar support. Students at 70 medical schools around the country organized a national white coat die-in saying it was an “important time for medical institutions to respond to the violence and race-related trauma that affect our communities and the patients we serve”. They lay down for fifteen and a half minutes. Eleven minutes to represent the number of times that Eric Garner said “I can’t breathe” as he was in a choke hold by police in New York City and four and a half minutes to represent the four and a half hours that Michael Brown’s body lay in the street after being shot by a police officer. And yet here we are in 2020.

These hospital staff rallies along with the many statements of support from hospital and health system CEOs are an important show of support but we also need action and attention to health disparities. I want to share two heartfelt CEO statements that were the most impactful for me. They are from healthcare leaders I have worked with and greatly respect. Continue reading →