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Dr. Astril Webb:
Good morning everyone, we are about to begin. We are sorry we are just a couple of minutes
later. One of our presenters is on her way, she’s not here yet, but we will in the interest
of time, to make sure that you get maximum information out of our distinguished plenary
speakers, we will begin. So, welcome, I should say officially welcome to the second day for
our National Conference for Health in Public Housing. We hope that you’ve been enjoying
the sessions so far, yesterday, have we been enjoying the sessions so far? Alright, wonderful.
So yesterday we had the honor of having some really wonderful speakers, Dr. Marsha Brand,
Captain Henry Lopez, Congresswoman Donna Edwards, and Dr. Jim Hunt. Well today we have just
as wonderful a line-up of plenary speakers for you today, so we’re really enthusiastic
and excited about the information they are going to share with you as grantees. We have
had some wonderful workshops yesterday, we will continue doing those today, to provide
you that training and technical assistance that you need. I do want to make one or two,
three announcements. First of all, I want to remind you that our vendors and sponsors
were apart of this year, this year’s success, so we really want to encourage you to visit
with them. A couple of them have programs and services that can help you, and some of
them are actually attached, to some revenue streams, potentially for your health centers.
So please stop by and speak to them as well, the work that you’re doing is so important,
and we are going to link every type of resource you can leverage in order to make sure you
remain successful and continue to provide affordable access of quality care for residents
in public housing. So please take advantage of that as well. For those of you who are
members of this year’s Clinical Quality Working Group and Strategic Plan Committee
at twelve o’clock we have a meeting in the board room. So you already know who you are,
so please head to the board room at 12:00. We must end promptly at one so that you can
all get to your sessions as scheduled. And then, today, lunch is on your own so we hope
that, if you’re planning to eat here in the hotel that you considered making your
reservations, as there are going to be a lot of requests today. We want to make sure that
you’re able to eat during that hour session, before today’s workshop sessions. So I know
it’s raining a little bit outside there but there are a couple of areas in the walk,
you know, just outside as well. Alexandria is a healthy walk-friendly community. So we
really ask you to take advantage of that as well.
So I don’t think we have anymore announcements at this time. I am really, really honored
to have our plenary speakers again this morning. They’re all distinguished and after they
share what they have with you, you’ll understand that as well. I do want to recognize our HRSA
project officer, Captain Henry Lopez, with HRSA leadership. They are the ones who support
this corporate agreement to provide this training and technical assistance for you. So again
thank you, and the NAM staff, I do everyday have to thank them for their hard work and
efforts. So I’m going to turn it over to this morning’s moderator, and this is Ms.
Zara Marsellian, who is the CEO of La Maestra, one of our proud awardee recipients again
for the H. Jack Geiger Award. So I’m now going to turn over this morning’s session
to her. Thank you.
Dr. Marseilian: Thank you very much Dr. Webb. This is quite an, quite an honor. This is
the first time I’ve served as moderator, so your patience please. Of course I could
stand up here all day and talk about the health center, but I know I’m not going to do that.
Yea, ok, well, our first speaker is Kathleen O’Leary. Kathleen O’Leary is Deputy Chief
of Women’s Program of the National Institute of Mental Health, and she leads the women’s
team of scientists, which reviews and administers grants on women’s mental health research
at the National Institutes of Health. Her work involves studying adolescent mothers
and their infants, borderline personality disorders. She’s the supervisor of staff
working with patients with schizophrenia and as a supervisor of the Patient Screening and
Human Subject’s Protections Team. Her journal publications include studies on adolescent
pregnancy and depression and book chapters on neuropsychological testing and personality
disorders patients. She works closely with the NIH Office of Research on Women’s Health,
as well as the Department Health and Human Services’ Office of Women’s Health Initiatives
that include perinatal mental health, sex differences research, health disparities,
the mental health issues of women serving in the military and the mental health effects
of violence.
So here, we’re going to welcome Ms. Kathleen O’Leary. Thank you.
Ms. O’Leary: Thank you. It’s a pleasure to be here and I appreciate the invitation
from Dr. Webb. I usually address mental health researchers and practitioners, so this is
a very lovely change of pace for me. I’m going to give you a quick overview about some
mental health issues in general, and for women in particular. And I hope you will come away
with a clearer idea of why this all matters. So quick background, I work for the National
Institutes of Mental Health, which is one of the 27 health NIH institutes and centers,
and we fund neuroscience research. Our mission, you can read up there, is pretty straightforward.
So we actually focus on funding the research, other agencies, such as HRSA and SAMHSA, focus
more on the implementation of evidence-based practice. We actually try to discover and,
and publish information about the evidence-based practices and other agencies. We do some training
of health care practitioners, mostly of researchers, and the other agencies, HRSA and SAMHSA, actually
do more of the training. Sorry I just lost my place. And I’m focusing today on women’s
mental health because that’s the area which I am currently working and what I know best
at the moment.
There’s no artificial barrier between the body and the brain. Mental health and mental
illness have systemic effects. So that’s why we say, there’s no health without mental
health. And we’re focusing on women because women are generally the gatekeepers for the
family’s health; they make most of the healthcare decisions in a family. Women usually care
for an ill family member and make those decisions, maternal health strongly affects the developing
child’s health, which there’s been much, much research about this, and pregnancy provides
an opportunity for clinics and health care practitioners to have an entrée into a family
and provide guidance to women and families.
So how common are mental disorders? They are really, really common. This is a one year,
this slide shows 2008, one year: more than 4% of Americans in any given year have a serious
mental illness. It’s actually estimated that close to 1/3 of Americans in their lifetime
will experience a diagnosable mental illness, most of which are not treated. Women are more
likely to get certain disorders and women are more likely to get mental health disorders,
in general. They are common, they are debilitating and they are often chronic. Now this slide
is from the WHO, World Health Organization, and at the WHO they tend to focus on the burden
of disease, which means number of years lost to disability or death. This is actually all
about women, the lighter line, the lighter line is low to middle income countries and
the darker line are developed countries. And you can see at the very top of the list, of
disease burden are unipolar depressive disease disorders, in other words major depression.
And this causes more disability, and health burden than ***/AIDS, tuberculosis, and as
a matter of fact, I don’t know how well this is publicized but depression is the leading
cause of disability world-wide. Besides causing disability, mental health disorders can also
lead to death, as we all know, suicide rates are not dropping in this country. And the
mental disorder with the highest mortality is eating disorders.
So returning to this slide again, we could easily spend an hour on the current research
that seeks to understand why there are differences between the sexes in the occurrence of mental
disorders, and among the races. As you can see on the slide, African Americans actually
have lower rates of serious mental illness as do Asians, and these are all in this country.
And Whites and peoples of mixed rates have highs, now these are averages again. These
are huge epidemiological studies, so this may or may not pertain to any individual.
But today we’re really looking at women and sex differences. Now sex differences that
I’m talking about may not be quite as lively as the sex differences in other arenas, but
they’re important to know about. And you can see, I think I need to walk around to
do this. (I don’t really know if it’s going to reach). Anyway, the line, the bluish,
grayish line, if a disorder meets the line, it means it’s a one-to-one ratio, between
women and men. If it’s above the line, it’s greater in women, if it’s below its greater
in men.
And you can see, like the first and the third disorders, schizophrenia and bipolar equal
distribution among women and men. If you look at depression, it is almost twice as common
in women as in men. If you look further along the line, the one that is sort if the thick
one I believe, that is PTSD, which is almost five times as frequently occurring in women
as in men. The very tallest one is anorexia which is not surprising; we know it’s higher
in women than men, although it’s increasing in men. And the disorders that are more common
in men are attention deficit hyperactivity, drug and alcohol dependence, and antisocial
personality disorder.
So though we often talk a lot about depression because it’s sort of better understood and
more well known. The most frequently occurring mental disorders in the United States are
anxiety disorders. And again, these are the most recent huge epidemiological studies.
So, anxiety disorders include general anxiety, post-traumatic stress disorder (PTSD), social
phobia and other obsessive compulsive disorders. And PTSD is very interesting in terms of women,
because men are more likely to experience a trauma in their lifetimes, but women when
traumatized are more likely to develop PTSD. And researchers are devoting a lot of time
and effort to examining why this is true. As a social worker, I try to bring neuroscience
kind of down to a comprehensible level. And I can tell you that the male and female brains
are wired differently; neurocircuits in the brain, when they are exposed to fear and anxiety,
operate differently in men and women. And all of this is mediated by hormones in terms
of development of these disorders. Also some very recent findings within the last year,
have shown that some women have a greater genetic risk. We’re actually doing a lot
of supporting research on genetics of these disorders. There’s also the nature of the
trauma itself. And there are theorist who believe, and researchers who believe that
because women are more likely to be exposed to *** trauma, either as children or as
adults that that resonates differently, physically as well as emotionally, and can make, can
lead to higher risk for subsequent disorders developing when traumatized again. For instance,
if a woman has had a childhood, has had childhood *** abuse, and is in the military and is
exposed to combat, she is probably more likely to develop PTSD than a male soldier.
So as I was saying, biology matters in terms of the differences. As we try to understand
the development and course of mental disorders, biology matters, social experience matters,
and the environment matters. So we don’t know a lot about neurotoxins and exposure
to neurotoxins and how they affect brain functioning, and health in general, as well as mental health.
We do know that poverty is an environmental factor, and living in poverty is an environmental
factor that leads to greater disease. And we do know that chronic stress leads to greater
disease. This has all been very well studied, and there is research actually, breast cancer
research, that shows that living in a dangerous neighborhood, and feeling isolated increased
risk for breast cancer among urban women. And this is apart from, this is controlling
from the accessibility to care. So these two issues separately, these two factors separately
can lead to a worse health outcome. Its also the highest rates of post-partum depression
have been found in an urban, low-income African American group of women.
More information about why women are more at risk. Women are the orangey line, men are
the blue. If you look along from the bottom, boys and girls equally likely to develop depression,
and all of a sudden puberty hits. The female rate goes up dramatically and stays up for
most of the lifetime. You can see kind of another jump upwards probably around the time
of perimenopause or post menopause. And this slide doesn’t show it because it ends at
54 but the two lines actually converge among seniors, in male and female. Actually, unfortunately,
depression goes up in males and goes down in females. Unfortunately for the males, good
for the women, but.
So I put this slide in here because some of you may know about the Army STARRS study.
It is a very high powered, unique study, collaboration between the US Army and the National Institute
of Mental Health, trying to quickly determine what are the causes of some of the really
mental health crisis in our active duty military in our deployed soldiers who and our returning
veterans. And what can be about it quickly to identify those at risk. So again, something
we can talk about all day or you can look it up, Army STARRS, S-T-A-R-S-S, it’s about
risk and resilience. And an important thing in terms of women, which is what I’m focusing
on today, is that there still is not enough women, serving in the active duty military
to be sort of statistically viable. And certainly in any of the small proportions serving in
combat, however, women are being oversampled in this study so we will end up with very
useful information about what leads to depression and PTSD and the cause and the factors and
correlations for women in the military in particular.
SAMHSA which is Substance Abuse Mental Health Services Agency does more of the implementation
of health care along with HRSA and other agencies. So one of the things is that I really appreciate
about SAMHSA is they are focusing on trauma informed care, they are training practitioners,
they are publicizing it and I can’t overestimate how important this is in terms of health care.
Somewhere on their website you can find the slides that there’s a really massive children’s
study that’s been done that’s a progressive study that shows that exposure to trauma as
a child leads to higher rates of tobacco, higher alcohol and drug abuse, higher rate
of homelessness. And it’s really pretty easy to ask as a clinician, have you experienced
something terrible or something frightening in your life to find out that in answers to
that can determine all kinds of high-risk disorders.
So as I said, mental disorders affect more than the brain. These are clippings from a
number of different sources that show maternal distress, rates and risks of childhood asthma,
depressed moms, kids are at higher risk of injury, actually children of depressed moms
are at higher risk for a lot of things. And it’s not just moms who are depressed but
moms who have anxiety disorders too and men are now being studied. And so obviously the
paternal influence matters also but the early childhood environment provided by parents
is very important as you all should know, better than I do I’m sure. Depression is
linked to bone loss in younger women. Here’s a recent press release from SAMHSA that basically
says, adults who have mental illness, and remember, you, if it’s one out of three
in a lifetime, this is someone in your family, these are people that you know, and are probably
undetected and untreated. But you are living among people who have mental illnesses.
So if you have mental illness, you’re more likely to have high blood pressure, asthma,
diabetes, heart disease, and stroke. And research has also shown that health outcomes are better
if the mental health disorder is treated in utilization of other health care declines
if mental health is treated. This is an older slide; it always shocks me every time I see
it though because it’s about death rates. And in the months after a heart attack, comparing
people with depression, green line, people without depression, so its pretty dramatic.
I mentioned the links between depression and osteoporosis in women, there’s a graphic
illustration. Again this has been known in sciences for quite sometime.
Services: services are a compelling issue in which you are all about today, and you
are more experts in this than I am, but although we need more trained medical practitioners,
it’s really clear that screening for mental health disorders is going to really have to
take place, also in primary care settings. And hopefully when the Affordable Care Act
is fully implemented in your medical homes, that is going to help in that effort. So people,
patients’ are resistant to seeing mental health professionals, as you probably already
well know, or people would be getting more treatment most likely. And practitioners are
often hesitant, non-mental health practitioners, are hesitant to screen because if you don’t
know who to refer to, you don’t want to ask the question. And this is really the sticky
issue, I think in mental health services today. Screening can only be effective if there are
referral groups within a healthcare system and within a community and much more work
needs to be done in this. We’re doing research on efforts to engage women and men in treatment,
capacity building, access to care. You all know that the type of health care system,
and who pays the bills, is the key to service delivery. You might realize that I haven’t
mentioned the need for more treatment research at this point, and certainly we need better
treatments, but we have treatments that work, we absolutely have treatments that work in
mental health we have cognitive behavior therapy for depression, for anxiety disorders, it’s
been shown over and over that it works. It’s called talk therapy, CBT, it’s very effective;
we have medications that are effective. Sometimes someone has to try more than one medication
to found out what the best medication is but medications and therapy together work great,
or either of them works by themselves. So we have the treatments the key for mental
health is getting people into treatment. And people don’t have to start with an M.D.
Social workers provide the majority of outpatient mental health in this country; ministers,
pastoral counselors are very good at providing counseling an entree into mental health, nurses,
there all kinds of people out there providing mental health counseling, whatever they call
it. And clinicians in primary care can also ask
some simple questions like have you had a change in mood or behavior in the last couple
of months. Have you, are you, do you find yourself worried more so that it interferes
with your life, are you concerned about any member of your family that has issues around
these. Some of that is openness to asking questions as well as having a referral rate.
As I mentioned a couple of minutes ago, pregnancy provides an entrée to health care. We spend
a lot of time focusing on mental health postpartum, we say perinatal because we know that most
postpartum depression begins during pregnancy. And we’re doing, funding a lot of research
on depression and anxiety. We have a great video on our website: a very brave young woman
who has participated in research and has spoken, very movingly, of her experience with postpartum
depression and how it affected her parenting and how she’s better now.
This is actually a HRSA brochure that we have linked to on our website. HRSA does a lot
of screening for postpartum depression in their Healthy Start Centers. HRSA also screens
for domestic violence. And for years we’ve been taught that the greatest risk factor
for postpartum depression is a previous history of depression, new research shows that the
greatest risk factor for postpartum depression is recent history of domestic violence. So
it’s important to know. And this is not sort of spread, this awareness is not spread
into the mental health, or the health communities yet, I don’t think.
Ok, resources: they’re really all on the web. If you scroll down below all of this,
so it’s NIMH.NIH.GOV. If you scroll down, you’ll come to all of our videos, we have
a lot of videos, they’re on YouTube. You have to hit more a couple of times to get
to the postpartum depression one that I mentioned. SAMHSA, again focuses more on the provision
of services, they have, they have an effective practices database that you can get to from
here and they also have a therapist locator that we link to through our site and HRSA
also links to from their site. It’s not perfect but it’s a beginning.
And I just put this womenshealth.com, also great resource for women’s health and women’s
mental health. That’s really our umbrella mother agency. And thank you very much, there’s
my contact if you needed to email me for anything, we don’t have time for questions, we’ll
see: olearyk@mail.nih.gov. Thank you. Moderator: Thank you so much Kathleen. I think
these studies are absolutely imperative for us, that are at the community-based level
in trying to develop innovative programs for our diverse cultures that are so, you know,
affected like everybody else with mental health issues. Now our next speaker is Marcia Thomas-Brown.
Ms. Marcia Thomas-Brown has extensive and accomplished experience in health care operations
spanning major segments of the health care continuum, including: long-term care, acute
care, outpatient and rehabilitative services, managed care with a focus on chronic disease
management and prevention, community education and outreach and business development. Currently,
Ms. Thomas-Brown serves as the chief operation officer for the National Health IT Collaborative
for the Underserved. And she is a graduate of George Washington University, she holds
a Masters in Health Services Administration and the Wharton School of Business Leonard
Davis Health Institute of Economic Executive Leadership Training Program, University of
Pennsylvania, in addition she is a licensed Nursing Home Administrator and a certified
Medical Technologist. So we welcome Marcia Thomas-Brown.
Marcia Thomas-Brown: Good morning. Good morning. Alright. How many providers do we have in
the audience today? Staff supporting physician practice? I, I was asked to talk about the
implementation of electronic health records and to be able to give you some information
about why providers need to do this. And that, they’re very specific reasons why providers
need to do this. But my approach today, after being in the field for two years, is to be
more focused on boots on the ground is what we call it, action-oriented, and give you
a specific example of what we’re doing out there. “We” meaning the Office of the
National Coordinator, the Office of Minority Health, and NHIT, what we’re doing out there
to support providers in underserved communities to adopt EHR. The approach that we took in
this particular case is trying to meet the challenge, the financial challenge that providers
have in adopting EHR. The incentive is there if you are able to adopt EHR and reach meaningful
use. And so our approach was to try to help providers get to that point. One of the things
that we, you know, we found out is that the adoption of EHR in all communities but specifically
in underserved communities is a process. It is for the most part a learning process. It’s
a process that must contain trust within those that are participating in the adoption. It
must be a process that is consistent, in terms of what you are doing and how you are doing
it. It’s a process that must be flexible. There’s not one practice that is equal to
another practice, even though they may be owned by the same person or same organization.
And so today, I can always reference the specifics as to why you should adopt, but I’m here
today to let you know that we understand the difficulties in adopting and that they are
resources out there that can help you adopt. So with that in mind, here we go. The National
Health IT Collaborative for the Underserved was began in 2008 when a group of leaders
form some Health Institute Research and Education and other partners realized that the whole
issue of implementing HIT was a wonderful endeavor. However, after attending a HIMS
meeting, they also realized that underserved communities and communities of color were
not at the table when this process was taking place. And so they decided that they needed
an organization that would be able to work closely with underserved communities to ensure
that they benefit from health information technology as a whole, not just EHR, but health
information technology. And this is where NHIT was founded. And again our focus is primarily
to empower consumers to use technology, to better manage their health. We promote HIT
adoption by providers in underserved communities; we spent a whole lot of our time doing that
over the past three years, foster creation of HIT workforce and facilitate funding for
HIT implementation which is what we’re going to talk about.
Also we work very closely with all the federal agencies, the private sector, advocates, stakeholders,
everyone, because as a collaborative that’s exactly what we do. We bring everyone to the
table and collaborate and try to resolve the problem. So I’m glad to see that HRSA is
here because that’s one of our favorite agencies, that support our collaborative and
our work in the field. As I said, when this started in terms of EHR adoption, the letter
went out from then head of ONC, Dr. Bloomingthaw and the head of OMH, Dr. Garth Grant. They’re
no longer with us, but they started this process and pretty much what they said was the federal
government had invested billions of dollars in implementing this process. The process
of adopting EHR, the process of supporting providers, primary care providers, in reaching
meaningful use and being able to collect incentive dollars so they can continue this process.
However, they realized that was not enough, we needed more resources to be able to get
this done, to bring 100,000 providers to adopt EHR0 by the end of 2014. This letter went
out to the vendors, and pretty much said, we need help, we’re here to show you how
you can benefit from your, a return on investment in underserved communities. And we want to
talk to you and be creative as to how you can help us.
Now, that was then, 2010, it’s now 2012, I just did a presentation with Dr. Hunt, head
of ONC provider adoption program. This is actually his slide. And, you know, the good
news is that we’re moving forward, the bad news is we are not moving forward at the rate
that we should. So when you look at the primary care provider adoption, 2010, 30%, whoopee,
small practice, less than 10 providers, which is where our focus is, we’re looking at
21% at this point in time. Now that’s one of the issues we have in terms of exactly
how many providers in underserved communities have adopted and I’m pleased to say that
after talking to Dr. Hunt, that actual information will be released shortly, they have been doing
some research and doing some surveys, so very shortly, we’ll be able to know exactly where
we stand as it relates to providers in underserved communities. That information is coming, but
the bottom line is that what’s going to happen is that will give us more specific
information geographically as to what the issues are. But we already know that we’re
behind in this process. Now when Dr. Bloomingthaw and Dr. Garth Gram
said, ‘we know we need help’, they asked the collaborative to also look at why providers
in underserved communities the rate of adoption was lower than the general provider community.
And so we actually went out into, three communities in 2010 and one in 2011, and did some research
and actually came up with an education and outreach program called High Touch. One of
the first things we found out is that providers didn’t know and still do not know about
EHR adoption, about meaningful use, about the benefits, you know, why do we need to
do this. They still do not know to the extent that they need to. And the reason we need
to do this is real simple: this is a matter of survival.
Yes. If you get an EHR it will help you improve care, care coordination, you know, your billing
will improve, but it’s a matter of survival. Because if we do not adopt, what’s going
to happen is that we will be left behind. At the same time that we are going through
this process of EHR adoption, government agencies are moving forward with new models of care,
medical models of care, such as accountable cure organizations, and medical hopes. We
all excited about it. One of the requirements in order to be able to participant in one
of those models of care is that you must have a way of electronically transmitting and sharing
information. So when you look at the list of, when you go on cms.gov, and you go into
meaningful use, the only reason that you need to do this, even though its stressful, you
need to do it, but you also need to do it because of your ability to survive in the
health care arena so you can continue to deliver care. Providers said to me, in the bad times,
‘get out of my office because I’m going to retire and I don’t want to do this, and
I’m not going to do this. It doesn’t matter to me.’ If you’re going to retire and
you plan to sell your practice, it will matter, unless you plan to give it away. The first
question will be asked is ‘do you have electronic health records?’, from perspective buyers,
partners, because it is a must. I know we’re thinking about it, but we need
to speed up the thinking and really get active in terms of looking at the resources that
are available to be able to do this. Hi-Touch is really bottom line. We work with regional
extension centers, we work with the community who identify a community, we go into community.
We do what’s called an environmental scan, which means we take into account issues relating
to that specific community as it relates to health care, the medical model that’s been
used in that community, the leaders of that community, the expectations. Because what
that tell us is what kind of education outreach we need to do to be effective in that community.
Doing webinar is a wonderful thing, I do them also, but what we’re finding is really,
in our communities, and with the challenges that our providers meet on a daily basis,
the most effective way to educate and inform those providers is by touching them. I have
been to, I am luckily enough, I have been to dances, I have been to golf courses, I
have been to shopping centers, I have been shopping with physicians, because that’s
the only time I had to speak to those physicians. And that’s what needs to be done, you can
get them in large meetings, and give them the meal, and, but that’s just the beginning.
You have to touch them. So in 2010, we went into three communities,
California, Florida and Georgia, and we applied the HI-Touch. We did our research, we did
the environmental scan. We get to know that community to the point that we figure out
what’s the most effective way to communicate with those providers. It could be, we developed
a call center, the first call system that we had in those different organizations. That
was very successful so they asked us to move on to the actual vendor supported program
which started in 2011. And for the first time, a vendor came to the table and say I hear
you, and I studied this and obviously there’s a return on investment for my organization,
and which is, you know, logically why they do this. I mean yeah, they love you they love
me, they want quality care, but they’re companies, they have investors. And they need
to understand what’s in it for them. This particular company, Quest Diagnostics, came
to the table and said we studied this, we think there’s a return for investment and
we want to partner with the Office of Minority Health and with the collaborative and donate
70 licenses in the Houston area to providers, so that they can adopt EHR. This program started
in, officially in April, we actually won the ground in July and ended December 31, 2011.
In order to qualify, and I’ll tell you why Houston. In order for you to qualify for the
program, the practice already has to have some form of electronic billing. We knew we
had issues with new communities in broad band adoption, or lack of access, but that was
not really our focus at this time. We wanted communities that already had internet, some
form of internet access. The practice should not have had an EHR over the past six months
prior to this program. It must serve an underserved community and again we selected a Latino community.
And again, I’ll tell you why. And be a small practice. We were not interested, even though
in underserved communities we were not interested in the large hospital system. Because even
though they have challenges, our focus was really go to the, for lack of a better expression,
the lowest of the lowest in terms of resources and be able to bring this program to the table.
They should be able to qualify to receive meaningful use incentives. And consistent
with federal law, the provider had to share 15% of the cost of that software, and the
vendor 85%. So, the provider ended up paying on an annual basis for the first two years,
$2000 to get a certified EHR. These are just some of the partners that agreed
to work with us on this project. We worked with the Regional Extension Center in Houston,
Golf Coast, HIMSS Latino community, the Office of Minority Health and of course Medic Success,
which is one of our partners and Quest Diagnostics. Why the Latino community? A lot of numbers,
you know, yea the, Houston, TX, has the second largest Latino community in the country. In
Houston, 50% of the population is Latino. And we have a growing rate of, in terms of
the Latino community, and so, statistically, it made sense, because it allowed us to go
into a community and quickly focus on a large number of providers to be able to implement
this program. But there’s another reality. When I talk about return on investment, and
that reality was that the vendor said, this is a community we would like to penetrate.
We would like to expand our market in that community, that’s where return on investment,
comes in. And so if we can come up with criteria, that meet the underserved requirements, and
benefit us, that’s where the partnership comes in, then we do business. So we selected
Houston. In addition to that we had a lot of support
from the mayor of Houston and from stakeholders in the Houston community because the collaborative
already had built a network in that community. These are just some of the facts that I mentioned.
We actually used the MUA standard for medically underserved communities that is defined by
HHS. So we wanted to be real specific and consistent in how we identify underserved
communities. And also we used zip codes to be able to identify those communities. This
particular slide, because I really want to get to the findings and the recommendations.
This particular slide actually, again, talks about the HI-Touch process. And, you know,
identify focus community, in this case it was Houston. Last year we did it in three
states and that was not just limited to the Latino community that was all underserved.
And our engagement strategies are numerous, which I mentioned including, the call center
and access to partners, very, very important, local partners. First time I did this, I was
in California, I was very excited about this thing that I had created, HI-Touch, and so
we had this teaching, major conference and I thought that it’d be really nice if I
could get all the, the “big” folks out of Washington, DC, to come to California to
this conference and present, you know these people out here want to hear from those people
over there. And I was lucky enough that I had included a local group from the area,
to help me plan this conference, and they were so gracious, they didn’t want to tell
me, but finally said you know we don’t think this is going to work. Why? Because we’re
really not crazy about the government and on top of that we don’t think they know
enough about us to tell us anything. So if this is going to work you’re going to have
to go to the local community, find experts, which by the way do exist in local communities
and put this conference together. So it’s very important when you’re doing
this, it’s very important for you to understand, that this is not a, a Washington, DC issue,
this is a local issue. And so we did, we found the experts in those communities, we found
the support, we found the detractors in those communities, physicians came up and said you
all are out of your mind, you’re wasting your time, I don’t see why we’re doing
this, and this is why I don’t think this is important. Because you have to get a feel
for the community to be able to help the community. Now, this is the problem, and this is the
opportunity. The programs in 2010 were successful, and the one in Houston they were successful
because, from our standards in the collaborative, we were asked to go out, educate, inform,
engage and find providers that were prepared to adopt EHR. And, and we did that, and I
think there’s another slide coming and you’ll see that in the three states last year. We
were able to contact over 3000 providers and surveyed 800 and we referred to the REC, 200
providers. Two hundred providers that said I’m willing, I’m able, my staff is ready,
let’s go, let’s do this, we were so excited. And in Houston, same thing happened. We were
asked to provide 75, I believe we did 300, over 300 providers, we were very excited,
we met our goal. How many adopted? Hmmm, our program ended December 31, and the actual
adoption, in terms of the vendor moving forward and getting the provider on line, was not
75, as matter of fact, they’re still working on it. So our excitement, as an organization,
that we had created this educational program that was able to motivate providers was missing
something. And that’s what we have to keep in mind when, when we talk to physicians and
their practice; and we talk about what they should be doing and how they can do it. Since
we started this program in terms of results of this pilot in Houston, other vendors have
come to the table and said I figured out that I want to participate. AHIMA has a program
currently, AT&T also has a program, Emdeon also has a program, different states, because
they see the benefit of it. Program, somewhat similar to others, to ours, but the reality
is that it’s lacking, it’s lacking something that is holding us back.
So when we sat down, our team sat down and spoke with the vendor, in terms of, you know,
how we did all this work, we handed these providers over to you, not only the provider,
but the staff, which is another key in providers adopting EHR. What we realized is, I don’t
know why it’s not there because it’s here, but I’ll keep, it’s on this one, I’m
not sure what happened there. What we learned was that we need to understand the needs of
the local community and the political dynamics. Very, very important. Simple things, like
when we went to Houston, as I said I’m Latina, and so I walk into physician’s offices and
you know, it’s different when they realize you’re a Latina, however, they had a major
issue with me because I call and I refer to them as Latinos were in Houston, they wanted
to be known as Hispanos, Hispanic. So you’re sitting there going ‘what’s the big deal?’
It makes a difference, that’s what that environmental scan should take into account,
learn that community and learn what provider you’re dealing with and what’s important
to those providers. We talked about early engagement of collaborative
relationships with physician leaders, very important that you have a network that you
can support you, teach you, encourage you and actually help you do the work. Providers,
doctors, have this thing where they really like and respect the knowledge of other doctors,
so even though I have a lot in my head as it relates to the specifics of meaningful
use and what it means, you need to come up with a strategy depending on who you’re
speaking to another provider to make sure that you know you have a provider, that, that
is respected in that community to be able to deliver that message. So little nuances
like that and some of these findings apply also to the general provider community at
large. But for us, we found it really made a difference if we paid attention to our lessons
learned. Close collaboration with Quest Diagnostic,
one of the important things, because we thought they agreed to do this that everything was
okay. What we realized is that, it’s not just important that they do their thing and
we do our thing but that we have to do it together; a lot of meetings, a lot of discussions,
a lot of disagreements, lots of agreements, and, and the good news in this particular
case is that Quest really wanted to make this work. It’s not just a matter of finding
a vendor that says I want to sell EHR and I want to come into your community and identify
those doctors and give me a list and let me go and do what I do best but it’s really
finding an organization that are committed to that community, there’s a return on investment,
there also needs to be a serious commitment to work with our communities and our providers.
Long-term commitment to the process. This was the bottom line. And this is what, this
is what, this is what the collaborative and its partners still think is missing in this
process, so when providers are attempting to adopt. Those of you that are here that
say, I’m going to do this. And I’m going to work with the Regional Extension Center,
I’m going to work with my friend, I’m going to call the National Collaborative and
see how I get this done. What we realized was that was the beginning the education and
outreach was just the beginning. We need to have, somehow, a providing continual support
to providers as they go through that process. And I’m not talking about continued support
in terms of sending emails saying how you doing Joe; that’s part of it. But really
be able to give additional resources to those providers to be able to get this done. That’s
what was missing from the Houston project. We came, we worked, we educated, we delivered
and then we left. And we said provider-vendor, you guys work it out. The vendor tried to
work it out. But what we found out that in our community, the challenge is astronomical
for a provider, on a daily basis to do what they do, provide care, deal with the staff,
deal with compliance issues, deal with quality reporting, deal with the bad weather, deal
with everything and anything others have to deal with in their environment, in their environment,
which is different and then talk about now I’m going to talk to a vendor and do a workflow
analysis and get this thing started. They want to, they schedule a meeting with the
vendor and the vendor is walking in the door, can’t talk to you Joe. I have an emergency.
What’s your emergency? The bank just called, and I’m trying to see what I’m *** with
my payroll on Friday. That is reality. That’s what we’re trying to figure out now, how
can we lend a hand, how can we support providers. If there’s nothing else, can pick up the
phone and say Marcie I missed that meeting and I really need to get this done, can you
talk to the vendor for me and see if I can schedule something. Any and every type of
support is welcome and is needed and that’s where we’re missing the boat.
Our recommendations: we need to identify communities, stakeholders and create regional consortiums.
The reason I say that is because I get a lot of calls from other organizations and other
providers that say we want to do what you do, what you’re organization is doing, or
we need help. But the reality is that we need to have an organized method delivering that
help, the collaborative and not only the collaborative, even the federal government has a, have a
very large network nationally. But it’s not organized from the perspective of coming
up with a body that can assess in that particular region what’s needed, you know, can we develop
a volunteer service to do this, can we work with even small businesses within that community
that is willing to support those providers because they understand that if the provider
adopt I can get business out of this. I can come back and maybe be a part-time consultant
to their offices. I can come back and help them deal with developing marketing strategies
now that they have EHR. The small businesses in those communities understand that and we
work with them all the time that are saying, I’ll give you “in kind” but I’m hoping
to get something from this, but that’s not an organized system that exists, and it needs
to be organized. Holding monthly meetings to continue to educate providers as it relates
to meaningful use and the incentive program. It doesn’t have to be webinars but holding
meetings and continue to provide that information because what is happening is that now we’re
moving into stage two of meaningful use. And for the most part we are focusing on stage
two. So the webinars that you see today, and the information that is out there today is
not really focusing on the whole incentive program, EHR adoption. Things are moving and
we are here. And so we feel that they still needs to be that continued education offered
providers in our community, starting at the beginning, because the assumption is that
the federal government is moving in stage two, that we all are in stage two, we have
not even started. Identify and highlight success monthly, we
say monthly, it could be weekly, bi-monthly and by that I mean, all is not dark and all
is not gloom. We have providers in underserved communities that are doing an excellent job,
as it relates to adoption, implementation, and use of EHR. They’re really out there,
but we don’t know about them, we need to. Because it really makes it somewhat palatable.
If you can look at something that you need to do that is difficult, and realize that
your brother and your sister have done it and that if you really, really stick to it,
you can do it as well. So you know, this is not never, never land, this is a process that
requires support from all of us, including the providers, and for us to see that there
is a tomorrow, that this does work. Clear, create a repository of local community vendors,
and we’re working on that, these are vendors that have come to the table and say, you know,
we want to participate, we want to do this, so if someone in X state calls and say we
have a group, a church, providers that are apart of XYZ religious organization, and they’ve
decided they want to do this, is there any vendor that would be interested in us that
we can make that referral to them. And also, we’re in the process also of putting this
together, but when we do we’ll be encouraging all to join the NHIT EHR Adoption Consortium.
And what were trying to what we will be doing, putting together resources that are available
to providers in those communities, the small businesses that I spoke of the advocate that
I spoke of, the stakeholders that I spoke of, putting it all together, but doing it
at a national level. Now we believe that would be successful in terms of being able to provide
resources to providers to help them adopt EHR, and the reason we have believe so is
because we have done it in a smaller scale and its worked. And we believe that if we
can expand this to a national level, that that would then support for the federal government
to the RECs, that are still trying to provide that support to be able to get this done.
Because again the key is to adopt EHR but to do it at a rate that is going to make a
difference. And right now our rate is not where it needs to be.
That’s the end of my presentation. When it comes to things in terms of why you should
adopt, as I said, cms.gov meaningful use will give you all the specifics: efficiency, effectiveness,
and all that is true, quality, cost, care management, safety issues, e-prescribing,
medication, all that is true, but the main reason is we don’t adopt we will be left
behind. We can’t afford that to happen. Thank you.
Moderator: Yea, what I think is really cool about the peer support that does really make
a difference, is taking providers that do face the same challenges every day and say
look, this is how we did it in our center, we face the same challenges that you do and
let me help you. We’re here, just call us. I know that would really work with us.
Now we’re on to our next speaker. Everybody awake? Okay. Dr. William P. Sawyer, is an
innovator, way ahead of his time. He has become an international expert in hand awareness.
Through four principles of hand awareness, he has created a multi-sensory primary prevention
program that once viewed is never forgotten. During his 26 years of practicing family medicine,
he has perfected these behavior modification techniques training strategies throughout
his patient population. So we’re here to welcome Dr. P. Sawyer.
Dr. Saywer: Good morning. How is everyone? Great, well I’m feeling after I heard Kathleen
and Marcie’s discussion. Feeling a little doom and gloom at times and I want you to
touch me so I feel better but I may. Solo practice family physician for twenty-six years
and as they’re telling me what I have to do, I’m happy to hear you say it is tough
everyday and now you’re asking me to do more. And very funny with all of you it’s
the right strategy to complete, it’s a process and how do we do it. And many docs in Cincinnati,
a bunch of us say, many who are private practice say, ‘show me the money’, I hate to say
it but that’s part of it because we can’t work harder or higher more staff for less.
So, together we can make a difference, so just hang together here. So a little bit of
house keeping first, so some of you have on your table a little plastic container that
you’re wondering what that is so somebody can sort of identify it and take a hand of
it and, it’s a little clicker. So I’ll tell you a little bit about this so you can’t
click it yet, so I mean just, some of you that are thinking about it we’ll get to
the end and so, we’ll see how we do. I’d like to say, thank you to Dr. Webb for
inviting me to talk here because when she contacted me, I thought okay, National Public
Housing Conference, ok, family doc, and I do still practice family, and I looked into
it and thought God this is the perfect marriage so to speak, not she and I but the conference.
Because it is. It blends everything together. It’s where you’ll take care of the patients
where they are, not where they should be down the street ten miles away in my office perhaps,
but at school, at the site, at the center, at the housing center, let’s do this. So
that’s the big picture, so thank you Dr. Webb for inviting me and others have asked
me why so… So what I would hope for all of you to take
home today is a life-changing behavior that will enable you to never again contract a
respiratory infection, flu/flu-like illness. Can you imagine that? Does anybody believe
that? Who doesn’t believe that? Oh okay, oh there’s a few doubters, we always like
that. It’s true. I’ll tell you it’s true, so stick with us. Your question also
is, how does a solo practice family physician in Cincinnati become an international expert
in infection prevention? You hear about infectious disease, ID docs, ID, that’s a process and
a discipline. But what’s this infection prevention? It’s a strategy to keep you
well and stay well. So what it does is it starts with somebody who has allergies, asthma,
spent time in the hospital when he was younger, becomes a solo doc and has children, and his
wife is his office manager. And when we had each of our children, they would come to the
office for the first year and would sleep in a box, and when they got up and were pulling
the charts, then we had to ship them off to daycare. And I was convinced they were not
going to fall into the cesspool of disease, and come home sick and go to the hospital,
so we have to do it different, so I gave the center four packets of baby wipes and I said
please wipe every infants hand in the area four times a day, just randomly. Oh my God,
anecdotally, they were healthier, the kids in that area were healthier. And so as time
went on in the mid-90s, built a, created a curriculum, built a costume and went to schools.
And the kids, years ago, and my son is now twenty-four, and they remember this. And I
thought, gee this is something that is tremendous. We need to keep this going.
So what we did was, in 1999, in Cincinnati, there’s a health improvement collaborative
and the first flu vaccine shortage. And they go, what are we going to do? And so Malcolm
Hancock, the health commissioner there goes, ‘Oh my God we need to do hand washing’,
so we said let’s create the first national hand washing awareness week. It’s the first
week of December, every year so everybody pay attention, and we had a program in coloring
posters and all, he was washing his hands in the bathroom, there was Henry doing it
with him, it was a great success. The next year, there’s more than enough vaccine and
they say ‘ah well maybe we don’t do this’, but I said, no you have to keep going, and
it was really successful. So, we’ve kept it going. And then ever since then we tried,
created a foundation in 2000, 19 took me a couple of years, but this is the right program,
everybody needs to do this. How can we take this to the world and so we could have gone
back in forth, whose going to lend a hand and carry this.
So, and it’s not about hand washing, this is the piece that became very obvious. It’s
not just hand washing, that’s one single event. It’s also about cross contamination,
hosp-, food service has taught us about this and in health care when you need to do better
so its awareness. So hand awareness is knowing where you hands are and what they are doing
at all times. Ok? Scientifically, it’s hand hygiene, respiratory etiquette and cross contamination
awareness. So what, during our program in the early 90s, we created the 4 principles
of hand awareness which are: wash your hands before you eat, two: do not cough or sneeze
into your hands, throw an elbow, and fourth is never put your fingers in your eyes, nose
and mouth, it’s the only portal of entry into the human body for all infectious disease:
respiratory and GI. Imagine that. Now who’s heard that, who’s been told that repetitively?
The mucous membranes of your eyes, nose and mouth are the only portal of entry into the
human body for all respiratory infections and GI. Nobody? Oh one person, ok great. Somebody,
has heard about it, fantastic. So we want you all to spread the word, not the germs
about this. So, why? You’re question why do we do this?
Because we are the petri dish that grow all seasonal illnesses and infections, and pandemics.
Imagine this: if we never grow these organisms, cook the pig, we’ll be fine. There’ll
be no more pandemic if we do this. So cook the pig, cook the bird, its okay. So what
we saw back in 2009, when there’s a pandemic fear, you know, ‘my gosh there’s no vaccine,
what’s going to happen?’ What everybody’s talking about, millions of people are going
to die, but what happened? But what happened? They were promoting hand washing, hand hygiene,
hand sanitizer, respiratory etiquette, do this, and they did say avoid touching your
eyes, nose and mouth. They didn’t say do not put your fingers in your eyes, nose and
mouth. And what happened, hardly any schools closed down that year. Incredible. But what
did happen? All the grocery stores, you couldn’t keep sanitizer, wipes, paper towels and soap
on the shelf, but they had tons of cough and cold medication—they couldn’t sell it.
People were healthier, my gosh it worked. This promotion of the true primary infection
prevention strategy worked. So what happens? The next year we have plenty
of vaccine, the pandemic risk is over, there’s hardly any promotion. So what are we doing?
What’s the right thing to do? Hospital acquired infections, oh my God, whose been to the hospital
recently to visit somebody or stay? No, anyone? What’s happening there? We doctors and nurses
are spreading disease around. C death is ravaging the hospital. So what are we doing? We’ve
got the tools. We’re just not doing it. So what we have to do, is do something different.
It’s called positive deviance. Now many of us were younger, if you recall that, you
were isolated, put to the side and nobody wanted to be around you so…Positive deviance
today is a great thing is health care. That’s what we’re trying to do, is change the behavior.
So positive deviance is act your way into a new way of thinking, instead of think you’re
way into a new way of acting. So there are, based on these four principles of hand awareness,
we have some tools. First one, wash your hands before they eat, you eat, and when they’re
dirty. So we have a nail brush, it’s the forgotten tool, it’s not only for the ICU
and the newborn unit, it used to be around 60 years ago, we’ve forgotten what’s under
these nails. So we say pass this on. The sniff test, for kids, we know what that is, for
college kids it means something else, so we don’t, that’s the college crowd now. Two
and three, respiratory etiquette, we want you to know when you cough and sneeze, what
happens when you cough and sneeze, ‘oh my god, there droplets that come out’, but
you go around, it’s amazing. Who knows that? Who coughs in their hands? Why would you do
that? You’re going to go shake somebodies hand and pass it on. Number four is cross
contamination awareness, how do you stop that? How do we do this? Look at the germs that
are on your hand, you have a black light, you’ve seen these. You can’t see them
so it’s a very hard habit to break. We can’t handcuff you. But we have a training device
which you can use, which is called the barrier method. We use barrier methods for other parts
too, but this one’s different, it’s for this head up here. So we want you to learn,
how many times you touch you’re “T-zone”. T-zone, did I say t-zone? What’s the T-zone?
Oh there you go, exactly. It’s the mucous membranes of the eyes, nose and mouth. That
visual aid, so we’re watching. So that brings me to this clicker. So when
you see some of your peers, presenters, and others today touch their T-zone, we want you
to (demonstrates clicker), click it. And my wife would say, don’t say this but click
it don’t lick it. Now, when this happens, people will start looking around and figure
out what happened. And they’ll say, you are going to spread the pandemic, they’re
causing the pandemic over there. So, please don’t’ do that because together we can
make a difference. So it’s the accountability that’s so critical for all of us. Again
in the hospital it’s the same thing. I’m waiting for them to shackle me, and when I
go into the room they’re going to say, you know, ‘alright, open up, take it off, this
is , you do it before you touch the patient. Alright, so I brought a special guest with
me today, to sort of help you take this message home. So we’re going to count to five maybe,
four. Henry is anybody coming out here? Hey, I don’t know. Two. Hey! Talk to the hand.
So Henry is happy to visit all of your sites, he’s a tremendous messenger and the ambassador.
So what it’ll do is it will change everybody’s behavior, it will change your behavior and
you don’t change it, and you can’t help anybody else. So thank you very much for helping
to spread the word, not the germs. Moderator: Thank you so much, Dr. Sawyer.
I think that woke us all up didn’t it? That’s great, thank you. Our next speaker is Ms.
Fredette West, she’s a steadfast leader in health policy and health advocacy. She’s
the chair of the Racial and Ethnic and Health Disparities Coalition and director of the
African American Health Alliance, both of which are committed to eliminating racial
and ethnic disparities in health and health care and improving access to quality health
care for all. Together, under Fredette West direction, REHDC and AAHA, which is, wait
a minute, we got it, it is the Racial and Ethnic Health Disparities Coalition and the
African American Health Alliance. Got it? Ok. So, together, they are a leading advocacy
organization and advancing minority health improvements and health reform. To that end
the Affordable Care Act law includes in some form all of the health reform provisions championed
by the African American Health Alliance and Racial the Ethnic Disparities Coalition. Fredette
West has remained at the center of countless health policy battle and accomplishments.
Here we have on April 24, 2012, Fredette was awarded the Lifetime Achievement and Health
Equity Award for outstanding efforts to improve access to for healthcare for emerging populations,
awarded by the Congressional Black Caucus Health Brain Trust and the National Minority
Quality Forum. So we’re proud to welcome Ms. Fredette West.
Fredette West: Good morning. And thank you all for being here. Because you all could
be somewhere else. And thanking God for having allowed us to come together, again. Because
He didn’t have to breathe into any one of us this morning, and He did and still is.
And some that were alive this morning, already gone and some will more even be gone tomorrow.
So we need to talk about and move in the urgency of now. It’s always good to see the public
health centers represented. And I’m going to ask everybody to take a moment to stand,
and stretch. Because you’ve been seated for awhile. Public health Service too. Ok,
and let’s take a…oh, I see one stretching, two, three, four. That even makes me feel
good. So I will too, I will too. Thank you Dear Lord for allowing all us to be here,
to be able to stand and stretch to whatever extent we can, because we don’t even have
to be able to do that. And pleased to see the hand that came through. So if you’d
have a seat please. But look at how, how much power we have when we all move together. You
all don’t know me. Yet you stood for me and you stretched. That you have lent me your
trust, through Dr. Webb and others. What I’m going to talk you a little bit
about today is community organizing and how important that is. Notice how some got up
and some didn’t, so when I said, ‘ok, let’s all of us get up’, then more got
up. That’s all that community organizing is about. Look at the hand that was just presented
to you, what did the hand really do? It stood up, it stood up. And you’ll remember it
because it stood up. Had the doctor just walked away, left this conference and without that
hand, you’re going to remember that hand. Had that air not gone up in it and it had
remained silent, you wouldn’t remember that hand. You’re just, that doctor had a click,
but a click for what, what did it do? But that hand reminds you to wash your hands and
how important that is. So again, I want to talk to you a little bit about community organizing
and the urgency of now. Not just because it’s an election year, but period. That hand, and
each of you when you stood up, didn’t ask you, I didn’t ask any of you if you were
a democrat, republican, or independent, but you stood up collectively. And that’s all
it takes within community organizing, is for all of us to work together. Realize the power
that each and every one of you have, at your finger tips that really goes unused. Silence
and fear will take us out of here. Not too far from here, just metro stops away, you’re
looking at a Congress that is in recess. Recess from what? What have they been doing but gutting
programs right and left? How much can that take? But they can only do that gutting, because
its no longer cutting, cuts gone, it’s gutting now. When you look at an office, like the
Office of Minority Health, whose budget is $55 million dollars, and a proposed cut for
15, proposed cut for cutting $15 million, whose going to stand up for that if we don’t,
and people that benefit from that office. Whose going to stand up for those that fund
Dr. Webb’s programs and all the others. I see you have on the agenda, Congressman
Daniel Davis. I think about all that he has done in community health centers.
Community health centers are a big winner in health reform. But they won’t just stay
there if we don’t stand up for them. Silence and fear does kill. I know we’re working
on an executive order. I won’t go into the details of that; person called me who is a
colleague from years back, and said to me that, ‘Well, Fredette, I don’t have a
fight with you, because I don’t have any bone in this fight for this executive order.’
And I thought about it and I said, ‘No, I don’t either, my children are grown, and
then I thought about it further, and said oh yes you do. You’re still on the service
so you got a bone in this fight because this executive order’s about children. So it
doesn’t matter if your children are yet to be born, if they’re young children or
old children, you got a bone in this fight. And you all have a stake in the fight that’s
only a few metro stops from here, but those cuts and community service’s block grants
will go away forever if you remain silent. And when budgets are gutted or cut to the
extent that they’re bare bones, and no longer carry out their policies effectively, people
should be in enough worry. We’re talking about quality of life programs. Medicare,
Medicaid, would be nothing like they currently are. Totally rearranged in such a way that
they would only carry their titles. We got to mean more to each other than just that.
So silence does kill, fear does kill, and I don’t know how much time I have left because
you told me time was tight. So I don’t know how tight it is, is it up? Is your time up?
Okay, and my five minutes, mind you they gave them to me. I want to share them with you.
Tell me if you can, and if you are committed, what will you do when you leave here? Because
there’s no point, and I’m not trying to mess up your program, but there’s no point
in being here, if you’re not going to go back and do something. Otherwise you just
came and sat and had in-house leave, and in-house leave is too expensive. I don’t want to
say GSA, but in-house leave is too expensive, way too expensive. So what is it you’re
going to do when you leave here. And I heard Marcia talk about ONC, look at the billions
of dollars ONC got, I’m going to, come on give me a break, hold them accountable. You
can’t expect docs to do overnight with a few dimes and a few quarters. Hold them accountable.
Hold the agencies accountable. Monitor what they do, you’re paying taxes. And honestly,
you need to pay more taxes, all of us do. We can’t keep, these programs don’t run
off air. Revenues are what run our government. Government is not bad, government is good.
Look at the people who were once poor, somebody depended on some form of government service
to help get them over. And now we’re talking about do away with all of it. And we’re
talking about new poor. Again give me a break and give people a break. Let people keep their
dignity, at least their dignity in tact. We’re at the end of the month, beginning of a new
month. New unemployment figures will come out. We can guess where they’ll be double
digit unemployment still. Again, give people a break. Help them, help somebody. But again,
my minute is going to be gone, at least three people tell me what you’re going to do when
you go home. I don’t care what three, somebody stand up. Thank you.
Audience member #1: The first thing I want to do go to the local health centers to find
out if they’re utilizing the electronic records system and to see why or why not they
are using it. I’m also going to the hill tomorrow to talk to some of the assistants
about health care and the importance of health care for public housing residents. I work
with public housing residents 24/7 implementing programs to help public housing residents,
so I’m bringing this information back to them as well.
Great, I need too more. Somebody stand up, you already stood and stretched…one.
Audience member #2: We’ve got to create more jobs for people in the communities we
serve. We can do it, we just need effort and focus.
Stand please. Can you yell it out? Audience member #3. Yes. I’m going to go
back to Philadelphia and convene a meeting of my partners who are in the health care
field and staff who are frontline staff on
the health issues and talk about what was learned from this conference my colleagues
and I. Good. Very Good.
Audience member # 3 continues: Come up with some low-cost, quick to implement ideas that
we can start immediately to get off the ground.
Good, very good. Very good. And notice that the backdrop against all of this are continued
threats to dismantling the Affordable Care Act law. And when you say Affordable Care
Act, go on and add “law” to the phrase. Because it’s still too many people that
don’t realize that it is the law. And that you have rights under that law. And if for
any reason, that law is repealed, don’t expect anybody else to lay their political
lifeline blood on the table to try to get it again. So if we lose it, it’s because
we gave it away. Thank you so very much, please keep me and my family in your prayers and
we’ll do the same. And thanks again. By that I meant, the same for you.
Moderator: Thank you so much Fredette. I think definitely, we are all advocates in our community,
and here we have the opportunity to go and advocate here in DC for the rights of our
population and the right of health care. And we have to take this opportunity and go for
it tomorrow. Ok. Great. Thank you so much.
Dr. Webb: Thank you. Thank you very much to all of our panelists. Didn’t they do a tremendous
job sharing some information today? Thank you so much. And I would like to thank Zara,
she did a phenomenal job moderating. Thank you again.
Audience member: Can I just get her name? The one’s name again. She’s not in the
program. Ms. Fredette West, and we will have all the
information revised, everything uploaded on our website. So you can also have access as
well. So we know we ran a little into your break, but I think this was really, really
important for you to hear, and it was worth waiting the few minutes. So we’re going
to break now and then try and get to your workshops as soon as you can. We have a lot
more for you to enjoy for the rest of the day, so thank you again everyone.
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