Dr. Oxiris Barbot, a pediatrician who will be Baltimore's health commissioner starting Monday, has an up-close understanding of many of the city's public health challenges.
"I think my experience growing up," she says of her childhood in New York City's infamous South Bronx projects, "gave me a broader perspective on how important health is in communities that may not have the same level of resources as other communities."
Baltimore is a prime example. The city fares worse than the rest of the state of Maryland and many parts of the country on almost every major health indicator, ranging from heart disease to asthma.
Barbot, a graduate of Yale University and the New Jersey Medical School, is especially concerned about workforce shortages in disadvantaged communities and regularly talks with medical, nursing and public health students in New York about alternative pathways to pursue a medical education.
Her resume includes stints with the National Health Service Corps and a community health center in Washington, D.C. For the past seven years, she was the medical director of New York City's Office of School Health, where she helped develop an electronic medical records system for the city's more than one million students. She hopes to do the same for Baltimore's schools. Her first day is August 23.
KHN's Jessica Marcy recently spoke with Barbot about her ambitious plans, which include steps to address some of the gaps detailed in Baltimore's first-ever Health Disparities Report Card. For instance, the infant mortality rate for African-Americans is nearly twice as large as for white people while the HIV/AIDS rate is more than 10 times higher for black women than for white women.
Here are edited excerpts of the interview:
Q: What do you think Baltimore's most pressing health issues are? What new programs or initiatives do you have planned?
A: It's a pivotal time in public health.The most pressing problems would include substance abuse, infant mortality, obesity and health care disparities. In many ways, the health issues that affect Baltimore are similar to [that of] other large urban areas. But there are certainly areas such as substance abuse where Baltimore is much more affected. the rate of infant mortality -- especially among African Americans -- is higher than in other large cities. That's certainly an area that I want to pay attention to and direct not only agency resources to but also partner with community organizations to work collaboratively to address . It's a multi-factorial issue and I don't know that we've been able to ascribe it to one particular [cause]. But, certainly social determinants of health play a large role in contributing to infant mortality, things such as poverty, access to care, educational attainment and beliefs around safe sleep practices.
I'm interested in reinforcing programs that have been developed to address these issues. [I want] to look for opportunities to introduce technology to help track what we are doing and to quickly evaluate the outcomes that we hope to see soon. One of the first things that my staff is working on is to give me an update of how we are currently using technology.
Q: Many people believe school health initiatives are an integral part of a city's overall public health strategy, but that approach can sometimes be controversial. What do you think?
A: School health care is a critical component of the safety net for children and a great opportunity to do chronic disease management. For example, the work that we've done [in New York] in regards to asthma is not only providing direct services like having kids have access to rescue medications in schools, but just as importantly, it's providing health education so that these kids learn self-management and how to ask for help.
What school health can offer by focusing on chronic illnesses is hopefully to make some inroads at reducing health care disparities by targeting children and their families directly but also just as - if not more - important by targeting their providers. For example, we've had a huge push to get kids who have persistent asthma on inhaled steroids because that's the gold standard of care.
Across the board, we've been able to attain levels of 76 to 80 percent of our kids with persistent asthma who have had inhaled steroid prescriptions prescribed, double the rate of three years earlier.
Q: In New York, the nation’s largest public school system, you implemented an electronic health record. HHS is pushing for the use of such records for everyone. Some doctors and hospitals argue that HHS's plans are unrealistic. What challenges do you foresee in the move to EMR?
A: The biggest challenge we faced [at first] was fear of the unknown. Our staff was afraid that the introduction of technology would increase their workload, that information would be lost and they wouldn't know how to integrate it into the existing systems. Our approach was really to go very slowly, to listen, to create opportunities where they would have input as to how the system would function, but to never sway from the underlying message which was "we will become automated, we will become less dependent on paper," to really focus on the benefits that we anticipated as a result of automation. It took awhile, three to four years before people starting trusting [the system.]
Q:How has New York's system benefited from having an electronic health record system?
A: Immensely. Previously, when a child would change schools, it would take a considerable amount of time for their medical records to follow them. In this new system, as soon as the child is electronically registered within the Department of Education, the nurse in that new school has instant access to the kid's medical record. You reduce the delays in accessing information. You reduce duplication in efforts. You can track the outreach that has been done for kids.
The second part of it is more on a population basis. I know that we have 40,000 kids with active asthma throughout the city. I know what schools they're in. I know the neighborhoods they're in. I can see what our staffing ratios are in those areas. I can then look at the performance within those schools and if we're not meeting our benchmarks, redirect staff efforts to say, "What's going on in these clusters of schools?"
Honestly, it's just been revolutionary.