“It’s a great time to be a CIO.”
Since March of 2020, healthcare has gone through arguably the most dramatic period of change in the history of modern medicine. Care was reinvented as alternate sites were rapidly created to accommodate surges of patients, and digital technology adoption rates soared to new heights. And behind the scenes, IT teams worked around the clock to provide much-needed support for frontline care providers and patients.
And yet, in spite of all that — or perhaps because of it — there’s nowhere else Ray Lowe wants to be. “With our thought leadership and partnerships, we can think through how to solve many complex problems,” he said during a recent interview.
Part of that is a willingness to honestly assess strategies, and pivot if necessary — something his team did in the early days of Covid-19 when it became clear that web-based training for telehealth wasn’t the best method for all physicians. And so Epic training teams were sent out to provide hands-on instruction, and centers of excellence were created to help extend these best practices across the organization.
During the discussion, Lowe talked about the challenges AltaMed has faced in rolling out virtual visits — particularly for those in underserved communities; the “modernization effort” the organization has been going through since 2018; why collaborating with other C-suite leaders is so critical; and what he expects to see in the next few years.
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- Every organization faced challenges during Covid, but for AltaMed, going from 3,000 visits per day to almost zero “was a significant shift.”
- Through its partnership with AT&T, AltaMed was able to use retail stores to provide the connectivity and power to run Covid clinics and “find a way to make them work seamlessly.”
- The pandemic has caused leaders to take a new approach to vendor relationships, focusing less on transactions and more on outcomes. “It was a leap of faith for many of them.”
- Although telehealth adoption has been critical in helping patients continue to receive care, it’s not a blanket solution. “There’s a real digital divide out there in the underserved in the low-income areas where broadband is not as ubiquitous or as available.”
Q&A with Ray Lowe, Part 1
Lowe: Good morning, I’m Ray Lowe, senior vice president and CIO at AltaMed Health Services in Los Angeles, California. AltaMed Health Services is the largest FQHC in the country. We primarily serve multi-ethnic, underserved and low-income patients. We serve over 300,000 patients in our community, primarily in East Los Angeles and Orange County. Our patients are many of the essential workers who have been affected so critically during the Covid pandemic.
We provide primary care services, pediatric services, women health, HIV-AIDS services, and elder care programs.
AltaMed started in 1969 as the East L.A. Barrio Free Clinic; at that time there was no healthcare in the East Los Angeles area. We’ve grown to have over 50 sites, with more one million visits a year.
Gamble: Every organization was impacted in different ways by Covid. Can you talk about how AltaMed was affected, and how your strategy changed?
Lowe: When the pandemic hit in March, it was a significant shift. Like many other healthcare systems, people stopped showing up in our clinics. When you’re providing primary care services and you go from having over 3,000 visits a day to almost zero, the company has to turn on a dime to support not only our patients and providers, but also our corporate functions.
During March, we actually moved 1,000 people to remote. Prior to the time period, working remotely was more of a convenience; maybe 100 did it. We had to push many departments and corporate functions to be remote. We relied heavily on our Cisco WebEx platform to enable distance meetings and facilitate collaboration, whereas before we did much more of our meetings in person.
For our patients, we had to shift to telephonic visits; then in April, we shifted to televideo visits so that we could provide care. The additional challenge for AltaMed is that we serve a multi-lingual and a low-income population, and we were now introducing new technologies to them that had not been used. We’re and Epic shop and we like to have our care go through the MyChart or the MyAltaMed portal. This is a real change moment when you think about the patient population that can now start receiving their care on their mobile device.
Gamble: Right. There’s a lot to unpack because there was so much that needed to be done in the first few weeks. Can you talk about how things unfolded and what had to be done from an IT perspective?
Lowe: The landscape was actually very dynamic. When this started back in March, the federal government was looking more at large hospital systems and payers. Community health centers like us were later in the game in terms of how funding and care should be provided.
At AltaMed, we had to prepare in order to provide that care. My team met daily for two or three weeks. We rallied around our medical director of infection control, and so we knew how to react to the virus and what was required. We pushed about a hundred folks from our patient contact center and our nurse center to work remotely. We set up 11 Covid-19 drive-thru clinics in parking lots adjacent to the facilities, and one in an empty lot provided to us by the city of Los Angeles where we provided drive-through testing to more than 250 patients in a day. At one point during the April time period, we actually provided over 11 percent of all testing in the Los Angeles County area.
We had an infrastructure Epic team focused on modification of the EMR that met daily. We were incorporating new technology and we needed to figure out how we were going to do things on these video visits. It was a sweeping uplift across the organization, and we had to wrap all of that up within the proper security framework to make sure no HIPAA violations or breaches would happen as well.
Gamble: How did AltaMed address the challenges with access and ensuring people were able to log into the portal to receive care?
Lowe: It’s interesting. We actually went live with Epic in August of 2019, so we were pretty new to it. We were on the new foundation build and we actually implemented Epic in 10 months. The first year of implementing a new EMR is about learning and stabilizing. Fast forward five months, we were in a pandemic and the Epic team had to respond in a way that we could most fast and move our providers to tablets. We had four stops in our Covid clinics. The first was to verify the patient. The second was to take some vitals, and the next two were to do the testing and release the patient, making sure they were doing well.
Because this was happening so fast, it hadn’t been thought through as we much as we would have liked. Different clinics were opening up, but we needed to find a way to make it work seamlessly. And there were other considerations. WOWs, for example, usually operate inside of a hospital. We had WOWs in the parking lot where there was no power source. We were also using iPads at the same.
In terms of the technology, there was not really an option to say we couldn’t do it. We had to figure it out. For example, from a network perspective, we had to put an access point next to the glass in the window so that the parking lot would have coverage through our corporate wireless.
Interestingly, when we opened the clinic in East Los Angeles, we partnered with AT&T and were able to donate their mobile retail stores. That provided the connectivity and power on this large city lot where there were no services available. With that kind of innovative thinking, you can look at how to do these things and segment them. By working with my leadership team and with our partners, we were able to come up with some very innovative solutions.
Gamble: And you only been on Epic since 2019, correct?
Lowe: Yes, since August of 2019. When you move forward to where we are today, we’re offering telephonic as well as televideo visits to our patients. We’ve incorporated language services so that if English is not your primary language, you’re able to bring in a translator.
We’ve also launched remote patient monitoring care for congestive heart failure so that we can keep our patients healthier at home. We’ve strongly embraced this mobile-first strategy for patient engagement as well by enabling folks to register for My AltaMed. We push out a link to them and they’re able to do real-scheduling. We’re moving very quickly to the digital edge in terms of what patient consumerism requires; and again, all of this has happened really in the last year.
Gamble: You said the first year on Epic is a lot of learning and stabilizing, and so I’m sure you were glad that was in place, otherwise you’d face even more challenges.
Lowe: Absolutely. In healthcare, a lot of organizations have technical debt. There’s going to be technical debt in any type of corporation you go into. But sometimes IT is treated as a cost center and the proper funding may or may not be there. I’ve been at AltaMed for three years. During that time period, I’ve been leading a modernization effort from a technology perspective. When I arrived here in January of 2018, there wasn’t even wireless in our clinics. If you fast forward to what we’re doing now, not only for our patients, but our providers, that delivery of care has been a wholesale transformation.
I got a little bit lucky in that we’re pretty far along our modernization path around there, and we have good partner relationships with Cisco, AT&T, Presidio, Epic, and other folks. The interesting part is how you introduce your video technologies; that’s where being on Epic and seeing what they have in their App Orchard as you’re doing product selection makes it easier, because you know it’s going to fit versus trying to do API development.
Gamble: You mentioned partnerships. One thing we’ve heard in recent conversations with CIOs is that their relationships with vendors had to change during the pandemic. What has your experience been like?
Lowe: I think you need to treat them as partners, not as vendors. I had some very strong asks of them. For instance, with AT&T, I needed to have a 10-gig circuit put up. The normal AT&T timeline would have been potentially 90 days to 6 months for these services, but they were able to put it up in two weeks for us.
With some of our hardware vendors, it was establishing ourselves as a high priority; they jumped up in the queue because we provide health services. But you have to have that forward thinking. We actually had to procure 700 laptops in one month to create a Genius Bar, where we brought in medical management and providers and educated them.
The other side of it is managing your VPN access. We use Duo, and so having that elasticity in those agreements so they were actually able to give us an accommodation, was very helpful. Nothing is free. But without partner support in that time period, it would have been very hard to move through this.
Gamble: It seems like vendors had to switch from selling mode to focusing more on helping or making adjustments.
Lowe: Yes. They had to move away from pure selling. To me, it’s really about understanding the business relationship and what’s the outcome. It was a leap of faith for many of them; I had some very strong asks. But when they understand why we were doing it and where we were going, they were actually very happy to help get us over the hump. Again, we were in a global pandemic; nobody knew what was going to happen. In March and April, everybody stayed home and was working remotely. Many companies were not ready to work remotely and they struggled through it.
On the healthcare side, everything needs to stay HIPAA compliant; we can’t expose PHI. For us, not only did we look at how to provide patient-centric care where they want and how they want it, we’re also looking at how we allow our providers to work from anywhere. We’re looking at how to convert a traditional exam room into one with a video conference capabilities so that the provider’s flow isn’t interrupted by making them change rooms or space, and they can continue their care.
Our providers see about 20 to 22 patients a day, which is a pretty high volume. How do we help our providers enjoy their practice and have some work-life balance during a pandemic? In the first couple of months, people weren’t coming to our clinics, just like they weren’t coming to hospitals. In the summer time we started our business pick up, but again, there was a lot of movement to the telehealth space. It’s being well adopted by our patient population.
But there is one area that still needs to be addressed. There is a real digital divide out there in the underserved in the low-income areas where broadband is not as ubiquitous or as available. We have essential workers who have to decide whether they’re going to pay their broadband bill or put food on their table.
You have all the SDoH aspects of how are you dealing with the social determinants of health in the inner city of Los Angeles so that people can provide and receive proper healthcare.