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,

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

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

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

This post originally appeared in the HealthIT Buzz Blog

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water filtration systemlawyerdoctorElliot BarryEd ConnorsFadesola Adetosoye Recent comment authors
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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… Read more »

Elliot Barry

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.

Ed Connors

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,… Read more »

Fadesola Adetosoye

We will be addressing the use of technologies to engage communities of color via a webinar on April 24th. Participants will have the opportunity to hear from Drs. Nadine Gracia and Karen DeSalvo.

Register here:

Leslie Kernisan, MD MPH

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… Read more »

Claudio Teri

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… Read more »

Dr. Val

Granpappy – the disconnect is breathtaking.

Granpappy Yokum
Granpappy Yokum

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?


Cell phones, the great equalizer…


Worked in “The Wire.” Disposable ones, at that.

Granpappy Yokum
Granpappy Yokum

And look at how healthy they all were.

Dr. Val

Bird – exactly: “one great app away from solving the healthcare crisis.” Meanwhile, back in the trenches, physicians note that electronic medical records systems are ground zero for the deterioration of patient care:


@ bird, do you have a link to that MU study?


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.


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… Read more »