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Health Innovation for the 99 Percent

Alicia Wilson

Executive Director, La Clínica del Pueblo

When Mr. Mejia came to his first appointment at our clinic, La Clínica del Pueblo, he told his doctor parts of his medical history. He had been hospitalized several years ago, he said, and they had informed Mr. Mejia that he had cancer. He was advised to get surgery, but did not do so, since he was uninsured.

Mr. Mejia did not speak English well, so he wasn’t sure he totally understood what the hospital doctors had said. He didn’t know exactly what his diagnosis was, but he was concerned that he might be very sick. He could not recall the name of the hospital. George Washington Hospital? Washington Hospital Center? Georgetown Hospital? They all sounded the same.

Our staff began sending records requests to all three hospitals, only to find that none of them had a record of Mr. Mejia. Then his doctor, Dr. Fernandez, began to order tests.

Between the hospital records search and the testing, weeks passed. While Dr. Fernandez found no evidence of cancer, thankfully, he was frustrated by the staff time and laboratory costs he could have avoided if he had better access to the hospitals’ electronic health records.

Meanwhile, each time Mr. Mejia came to an appointment over those weeks, he had to take the day off from work in order to catch two buses to make it here. His day off meant that he wasn’t going to earn anything that day to pay his rent and support his family back home in El Salvador.

When I hear stories like that – every day – I grow frustrated by the fragmented and disjointed healthcare system in the U.S., and by the promises of EHR interoperability that have not yet been realized. As Executive Director of La Clínica del Pueblo, I see such extraordinary potential in technology to provide better, more integrated and more holistic care. While I see already the benefits that an EHR has provided us in data analysis, quality improvement monitoring, and coordination of care internally, we struggle to invest sufficiently in the human resources necessary to really maximize the tool we are using. And beyond our clinic’s walls, we are hampered to provide a seamless continuum of care for patients who require multiple specialists, have recent hospitalizations or need home healthcare.

La Clínica del Pueblo is a nonprofit, comprehensive community health center that has primarily served the immigrant, Latino population in the D.C. Metro area for more than 30 years. Many of our patients are uninsured. Most are limited-English-proficient, are at or below the poverty level despite working long hours, have complex family situations straddling here and their home countries and have complicated medical histories.

Thus, for La Clínica, providing healthcare is much more than a simple doctor’s visit: we are a patient-centered medical home that integrates mental health and substance abuse services, social services, health education, promotores de salud (community health worker) support and more, all in order to ensure that patients have the tools they need to overcome barriers that prevent healthy living.

We at La Clínica also look beyond the care we can provide to address the structural issues that make our patients sick. We work to expand language access for anyone in the city who needs an interpreter in order to communicate clearly in a medical visit. We advocate for expanded health insurance coverage for immigrants (and everyone). We address homophobia and transphobia in order to tackle some of the root causes of HIV risk. We expand access to Spanish-language mental health services by piloting tele-psychiatry in community settings. We work to build partnerships to stitch together this fragmented and disjointed healthcare system. We recognize that your health is much more influenced by social and economic factors than it is by a doctor’s visit, and we must improve our patients’ health at a community level as well as at an individual level.

For me, as an administrator of a community-based nonprofit, I’m looking to technological innovations to support our staff to expand our impact, to enhance our efficiency and to better enable our patients to be active participants in their healthcare. I recognize, however, that we have to balance our budget, attract and retain high quality staff and navigate this rapidly changing healthcare environment. As a nonprofit, we need funding to support dedicated staff time to prepare, implement, maintain, and evaluate the new tools. Often, the latest, greatest idea, with lots of bells and whistles, will not be remotely practical for us to implement. We’re too busy hustling for grant funding, serving low-income patients and trying to stretch $1.25 of value out of every dollar we receive.

Our staff wear many hats but always put patient care first. Asking a nurse to juggle implementing new technology while also caring for her patients will always result in good patient outcomes, but little time spent on rolling out technology effectively. We also need time to develop our internal “champions” of change. These champions need space to learn, network, explore, and try out new tools so that they can truly determine if they will make a positive impact on care. Partnerships with health IT innovators require investments in the staffing to push those innovations into actual use.

After spending time at the 1776 Challenge festival this month, I came away with renewed awe for the creative and entrepreneurial spirit of health sector technology innovators. There is seemingly limitless opportunity to make practical, technology-based improvements to our fragmented system and to improve the overall health of our communities. While nonprofits may not be “angel investors,” we have the reach to rapidly deploy new technologies and demonstrate their impact—if we can invest in the human resources. I am inspired, for example, by how La Clínica’s staff can use social media to increase HIV testing, and how our patients trying out tele-mental health counseling and psychiatry are helping us push back the physical barriers to culturally-competent mental health care. There’s so much more that we could do.

For now, however, I’d like to see better EHR interoperability so that Dr. Fernandez can spend more time seeing patients and less time chasing down their records. And I’d like to see Mr. Mejia have all of the information he needs to care for his health.

Alicia Wilson

Executive Director, La Clínica del Pueblo

Alicia Wilson has a long history of working for social justice and equal access. Following her graduation from Swarthmore College with a BA in Religion and Sociology/Anthropology, she immersed herself…