Advancing Health Equity in the Digital Age

Karen DeSalvoDuring National Minority Health Month, we acknowledge the potential for health information technology (health IT) – from electronic and personal health records to online communities to mobile applications – to transform health care and improve the health of racial and ethnic minorities.

Lack of access to quality, preventive health care, cultural and linguistic barriers, and limited patient-provider communication are factors that aggravate health disparities.

By increasing our investment in health IT policies and standards, we can help improve the quality of health care delivery and make it easier for patients and providers to communicate with each other – a huge step toward addressing the persistence of health disparities.

The Pew Research Center’s Internet & American Life Project External Links Disclaimer found in 2012  that African Americans and Latinos are more likely to own a mobile phone than whites and outpace whites in mobile app use, using their phones for a wider range of activities.

The study showed that African Americans and Latinos use their mobile phones more often to look for health information online. This has very important implications for personal management of health and interaction with the health care system.

However, barriers to widespread adoption of health IT remain.

For example, a 2014 consumer engagement report found that minorities were less likely to adopt online patient portals to access their health information than were non-Hispanic whites.

Additionally, limited financial capital and lack of systems that can communicate effectively with each other widen the digital divide between providers and other clinicians who provide health services to a significant number of minority communities.

At the U.S. Department of Health and Human Services (HHS), the Office of the National Coordinator for Health IT (ONC) and the HHS Office of Minority Health (OMH) are committed to reducing technology gaps across and between communities of color as a key action of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and ensuring that the new electronic tools can support access to quality care and promote equity for everyone.

This includes a targeted strategy focused on four core areas:

  1. Adoption of health IT in all communities;
  2. Improving patient care by creating culturally and linguistically appropriate eHealth tools;
  3. Facilitating secure exchange and confidentiality of patient data; and
  4. Patient-centered consumer engagement.

Last year, ONC, OMH and ZeroDivide convened a diverse group of stakeholders at the White House to discuss how to advance eHealth among the underserved and the role eHealth can play in achieving health equity. The discussion generated many ideas about increasing patient engagement using eHealth, identified opportunities to work collaboratively, and committed participants to taking action following the meeting.

The White House Summit on Achieving eHealth Equity was followed by a webinar during which participants continued the dialogue and proposed specific action steps that are included in the briefing document.

In 2009, HHS enacted the Health Information Technology and Clinical Health (HITECH) Act, which laid the foundation and groundwork for health IT adoption efforts for many healthcare professionals across the United States. Today, more than 70 percent of physicians and other healthcare clinicians practicing in medically underserved and health professional shortage areas are engaged in efforts to adopt health IT, thanks to the work of the Regional Extension Center program.

Adoption of technology is also laying the foundation for communities to participate in and test out new payment models for care:

Health IT is already helping to improve chronic disease management and care coordination for health care providers and their patients, allowing the development of targeted strategies focused on reducing chronic disease and other health issues that disproportionately impact communities of color.

It also has implications for prevention efforts. For example, heart disease is the leading cause of death across most racial and ethnic minority populations, accounting for 25 percent of all deaths, but many of the major risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, smoking and obesity are preventable.

The Millions Hearts Initiative is a national effort to prevent one million heart attacks and strokes by 2017.

This public-private partnership brings together communities, health systems, nonprofit organizations, federal agencies and private-sector partners from across the country to fight heart disease and stroke. At ONC, Health IT Fellows – physicians and staff who are using health IT as part of their everyday practice—are looking for specific ways to align the Million Hearts Initiative with technical assistance and provider outreach programs with the goal of increasing the number of healthcare professionals using technology to detect and control hypertension and other innovative strategies to engage in patient-centered care.

Through the interoperability and standards work at ONC, we are making sure patient information is secure and universally accessible to those who are authorized to see it when they need it. Making sure the appropriate technical standards and specifications are in place is critical to establishing a fully functional nationwide health IT ecosystem.

Ensuring that providers have the right information about the right patient at the right time is essential to advancing overall quality of care for everyone and improving health outcomes for the underserved.

Early experiences with health IT adoption demonstrate that technology can lower costs External Links Disclaimer by improving transition of care processes and enhancing a health care professional’s ability to serve their patients with precision, especially for minority communities. Hurricane Katrina is an example of this.

The use of mobile technology helped to meet the health needs of the community members External Links Disclaimer, especially minorities, as 75 percent of those affected by Katrina had access to a cell phone.

As we continue to push a national agenda to transform health care and advance health equity, we encourage communities and advocates to join the discussion. For a list of current initiatives and opportunities to engage with HHS around health IT and health care transformation, visitwww.healthit.gov.

To learn more about National Minority Health Month and what HHS is doing to reduce health disparities and to achieve health equity, visit www.minorityhealth.hhs.gov.

Prevention is Power!

Karen DeSalvo, MD, MPH, MSc. is the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. More information about the Office of the National Coordinator for Health IT and health information technology can be found at www.HealthIT.gov

J. Nadine Gracia, MD, MSCE  is the Deputy Assistant Secretary for Minority Health and the Director of the Office of Minority Health at the U.S. Department of Health and Human Services (HHS). More ingormation about the Office of Minority Health can be found at minorityhealth.hhs.gov

This post originally appeared in the HealthIT Buzz Blog

17 replies »

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  2. Gee, from what I recall about Katrina, NOBODY”S cell phone worked. For weeks.

    The interesting thing about this issue is that Charity Hospital in New Orleans was a leader in providing underserved populations with access to care. They did this by being low tech, instead of highi-tech. Charts were on paper. Doctors were not hamstrung by unwieldy, clunky, time-sucking EMR’s. You could look up labs on monochrome monitors. Massive numbers of patients were evaluated, processed, and treated in their clinics and ER.

    Sadly, the Charity Hospital ER (where it was not uncommon to see homeless patients sitting on gurneys, munching Burger King Whoppers and talking on their cell phones) went immediately without power during Katrina because some genius decided it was a good idea to put the generators in the BASEMENT of a hospital that is already 6 feet below sea level, even when there isn’t a hurricane. The hospital is now closed, a unique healthcare and teaching opportunity forever lost because of a “technological” mistake.

    Therefore, I’m skeptical of the premise that if we could just get a few more multi-million $$ government grants so that everyone in the “underserved” or “minority” populations can get a free I-pod to look at their MRI results, all our primary care access issues will be solved? I aint buyin it. Give me the old, low tech Charity, where x-ray files were kept under the patient’s stretcher, and I’ll beat you every time. At least we knew where to find that lost CXR if the “system” crashed.

  3. Health IT is helping to improve chronic disease management and care coordination for health care providers and their patients, allowing the development of targeted strategies focused on reducing chronic disease and other health issues that disproportionately impact communities of color.

  4. The fundamental problem is that research has shown that technology driven health strategies designed for mainstream populations fail to serve the needs of minorities because they do not take into account health beliefs, culture, and language in their implementations. In fact one could very well argue that, up to this point, advances in Health IT only serve to exacerbate Health Disparities among low income and vulnerable populations.

    Equally important is that for patient portals and similar health technologies to work they must specifically address the barriers to care often faced by these individuals. For example, language, transportation, literacy, fear, distrust, finance, and know-how.

    Our focus has been toward pairing a mobile health platform that serves as a both a virtual social worker and community navigator with a culturally competent implementation process. The method on which this implementation process was based was found to significantly increase access to care. It serves to increase inter-organizational collaboration and communication while aligning medical care with the social determinants of health.

    Ultimately, the value technology is in making access to health and social services easier for low digital and language literate populations.

  5. If you tell me that minorities are using cell phones more, are looking for health information often, but aren’t using patient portals, then the first thing I wonder is do these patient portals have mobile responsive design.

    Next is, if you correct for overall use & access to primary care services, how much less are minorities using patient portals?

    A separate, and more important issue, is what kinds of services and constructive healthcare exchanges are portals designed to facilitate. We are collectively scratching the surface on that front.

    I think it’s important to strive for zero divide. That said, right now we generally do a poor job of clinically collaborating even with those patients who have all the advantages (robust healthcare insurance, money to cover copays, internet access with the latest computers/smartphones, high literacy, etc).

  6. This article highlights some intersting points that can be developed and can benefit the whole community. I strongly agree with 4 areas to focus our attention:
    1. Adoption of health IT in all communities;
    2. Improving patient care by creating culturally and linguistically appropriate eHealth tools;
    3. Facilitating secure exchange and confidentiality of patient data; and
    4. Patient-centered consumer engagement.
    And I agree with Dr. Val about deterioration of patient care (great article BTW).
    I also believe that “sustainable” (consider this term in a wider concept, not simply related to CO2 emissions) tools to reduce healthcare costs and optimize resources can be developed and will not request scientists to do so, only a radical change in our mindset.
    It is funny (not really) how almost everyone has a Facebook or Twitter account, but there is not a reknown website (not as much as the ones I mentioned) for patients to look for their health, check available doctors or useful information. Some websites offer some good services but you (patients or doctors) have to pay for it (unlike Fbk or Tw). Some are free but users have to see cheap advertising on them (not nice for user experience).
    No one so far is trying to follow the steps of the 2 social giants, offering a serious service at no cost, trying to attract VC investors for unicity and quality of service, level of engagement and viral growth.
    There are a lot of Healh IT excellent devices, apps and so on but there is a lack of coordination among them and a health aggregator.
    In addition to this, no one is seriously trying to develop such a project and implent it with a sustainable tool that gives back to the community not only a service but cash! (This to be honest has not been done by Fbk and Tw either).
    DrSocial is trying to close this gap and offers the following free services:
    1. Doctor reviews database. Reviews are all manually (this means there is a human being not an algorithm) verified applying a self developed reputation control protocol. Doctors should not fear the website, instead they can promote their business safely. Patients can benefit of an open database with quality content reviews and doctors’ availabilities.
    2. Patients can request health info: http://drsocial.org/forums/2781/ask-a-doctor-for-free-health-inf or check for news and articles and doctors can post their articles or comment and add knowledge.
    3. Every hospital or practice can request DrSocial admin to create free accounts for all emploees, therefore each doctor do not have to waste 1 minute of his/her time signing up (except for activating account link and change temporary password).
    4. Non-profit associations, research, hospitals (everyone aiming to improve the healthcare system somehow) can follow the Colon Cancer Alliance: http://www.ccalliance.org/help/shop_services.html and receive $1 for every sign up on the website. Sign ups form organic search are still donated to associations at the end of every month. This way the website donates money to healthcare instead of spending money for marketing, traffic and user acquisition.
    Is DrSocial a solution to all healthcare problems? Absolutely not, but it does analize the whole system from a different perspective.
    Is this an easy task? In theory yes, if everyone is understanding the importance of it. In reality the majority of people prefer to open an account on Facebook or Twitter for futile things and later on (when they need it) blame the healthcare system because services are not good enough.
    At the end of the day the most important message that DrSocial wants to spread is:
    “Do not ask yourself what the healthcare system can do better, instead ask yourself what YOU can do to make it better”

  7. Does anyone understand what Dr. DeSalvo is saying here?

    HIT is good for minorities, because minorities have cell phones, and cell phones make you healthier . . . or something like that?

  8. MU measures and CQMs (particularly the latter) are to a distressing degree what I call “Quadrant 3” activities — “urgent but not important.”

    I wish the feds would throw their considerable might behind comprehensive, usable standardized outcomes measures.

    It’s assumed that by documentably doing process items X, Y, Z, A, B, C, D, E, and F, the lagging indicators of better outcomes will eventually surface. But, unless we’re prepared to accurately measure them, how will we ever know?

    Do the beltway wonks even WANT to know? Have MU and CQMs become ends in themselves? Health improvement is what matters, not where Dr Bird ranks on some CMS spreadsheet table for certified EHR capture of “Smoking Status” or NQF 0004 etc.

    I’m not seeing a lot of coordinated work on objective outcomes measures across the board (and, yeah, in fairness, there is low-hanging fruit already out there like BMI, BP, lipids, a1c reductions, etc., though these too are proxies, with high transient variabilities).

    Outcomes measures are problematic in any event. In our policy ADHD world, we want wholly unrealistic Insta-Results (e.g., see Oregon “study”), or we flit on to the next mega “improvement” initiative.

  9. wow!!! we are just one great app away from solving the health care crisis. interesting take on health care crisis in light of the recent study that showed that meaningful use only improved 2 of the 7 quality metrics, made 2 of them worse and no change in the other 5.