Cerner Senior Vice President Dick Flanigan recently participated in a virtual College of Healthcare Information Management Executives (CHIME) roundtable with thought leaders from five U.S. healthcare organizations. This article, which provides highlights from the conversation, was originally published Feb. 18 on ChimeCentral.org.
The COVID-19 pandemic has highlighted racial inequities and the devastating impact on communities of color and marginalized citizens in our society. Healthcare leaders recognize that racial disparities contribute to a public health crisis that shortens lives and reduces quality of life. Unintentional bias in the selection of the data used to design digital technologies may be exacerbating problems of inequity. With efforts now under way to vaccinate people nationwide against COVID-19, it is important that populations that disproportionately have felt the brunt of the pandemic are not underserved.
To address those concerns and explore actions digital healthcare leaders can take to help close the disparities gap, five members of the College of Healthcare Information Management Executives (CHIME) joined Dick Flanigan, senior vice president of Cerner, in a virtual thought leadership roundtable. CHIME President and CEO Russell Branzell moderated. CHIME participants included:
- Chani Cordero, chief operating officer, Presidio of Monterey Health Services
- Adnan Hamid, vice president and CIO, Good Samaritan Hospital
- Shafiq Rab, MD, chief digital officer and CIO, Wellforce
- Jeffrey Sturman, senior vice president and CIO, Memorial Healthcare System
- William Walders, CIO, Health First
A Call to Action
An analysis released by the Centers for Disease Control and Prevention in December 2020 found that the rates of COVID-19 infection, hospitalization and death were higher for African American, Hispanic and Native American communities in the U.S. compared to other racial and ethnic groups. The agency cited “long-standing health and social inequities” for the disparities, noting that lack of access to quality jobs, housing, education, healthy environments and healthcare contribute to these gaps. Now, with vaccines being distributed nationwide, many question if those same groups will continue trending at a disadvantage.
Some digital healthcare leaders see the moment as a call to action, an opportunity to raise awareness about racial and ethnic disparities, examine health IT’s role as an unintentional contributor and create resources to eliminate inequities now and in the future. The question is, how to start and where to focus? Cerner’s Dick Flanigan offered context at the beginning to help frame the discussion and CHIME’s Russell Branzell led the questioning. Below is a highlight of the conversation.
DF: When we look at data, when we look at outcomes, we see big differences in how people of color are receiving services in the United States. Sometimes the algorithms or the care management approaches we have put together, while not intended, have led to reinforcing some of these disparities of care and access to care.
We began to ask the question, how could we work together to ensure that the systems we put in place, the data we collect, the algorithms we use, the interventions we evoke, don’t further perpetuate what we think is some less than desirable outcomes of the healthcare system.
CHIME is a really good place to have this discussion. When you think back to the Opioid Task Force that some of you participated in, we had a direct role to play. We could (use IT to help) change the prescribing habits and it worked. This one’s a little more insidious.
RB: This is the hypothesis: There’s a natural and historical bias in the systems we use. The data we both put in and the things we pull out of that are just as flawed. We don’t have a checklist against bias. Do you agree with that premise?
AH: One example that came to my mind was when I was at Henry Mayo (Henry Mayo Newhall Hospital). We were trying to figure out how to deal with patients who were transitioning from male to female and how to configure the systems to manage the preference for the patient. The systems only gave us male, female and maybe unknown. We were talking about patient satisfaction, patient centric and patient empowerment, but we had no way of trying to configure the system to adapt to those choices and those requirements. The systems are standard, which I get, but not flexible. I agree with that hypothesis, that systems need to do better.
CC: Sometimes when we look at the data and the metrics, we make assumptions and at times, beliefs are inherently false. I read about this study looking at high-risk patients for a care management program. You are correlating that maybe high-risk patients cost your organization more money because the cost of care means they need more services. But when you start peeling back the onion, you see that minority communities don’t necessarily go into the facility as often as other communities. As a result, the opportunity to manage chronic care for Black patients is overlooked. Oftentimes they had to be a lot sicker to be considered high risk. These types of considerations in algorithms are missed.
The part that makes it very difficult in healthcare, is that the social determinants of health are so squishy. It is very hard to narrow it down. If you have two people who look alike, sound alike, live in the same community, why are their health outcomes different? That is because we don’t think about the environmental factors or genetic factors that play a part. Until we are able to nail that down, we are always going to have a little bit of this disparity.
JS: In healthcare, usually that first point of contact is a registration or a scheduling person. Often, if I’m standing in front of them there is an assumption made about my background and they are not even necessarily asking me a question. Without asking the questions, we are making some really broad-based assumptions, which can be dangerous. I think systems can help facilitate this, but at the end of the day, some interaction and some relationship building needs to come into play to make it all happen better.
SR: When people talk about inequities, systemic racism and other things, we have to go through a very painful dialogue. A lot of talking has to happen for the healing to happen and to understand it. Once we understand it, then the systems will change. That awareness, that understanding, can only happen when we are willing to listen and try to understand the cultural background from where the person is coming from. The most important thing is to understand from the perspective and experience of the other person.
WW: (In roles in the U.S. Navy and Department of Defense) I had the great luxury of designing hospitals in Central America. What did we do? We took a United States model of a hospital, put it in Central America. What happened? Well, little did we know that when someone is sick in a Latin country, their entire family occupies the bedside with them and those rooms were no longer supportive and, frankly, couldn’t work. To Shafiq’s point, listening, understanding, learning, adapting. As we listen, we will change.
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