Health Care Disparities
Connected for Health
The Potential of Health
Information and Communications
Technologies to Reduce Health
Care Disparities
In today’s technology-filled world, we have become dependent on the Internet for everything from doing any research (“Google it”), making travel and restaurant reservations, paying our bills, managing our investments, finding recipes for dinner, making charitable and political contributions, all types of shopping, and on and on. And we communicate primarily by e-mail and text messages, and chat using instant messages, much more than by phone, or the mail.
Unfortunately, U.S. health care delivery systems have been slow to embrace information and communication technologies. Physicians’ offices are filled
with …show more content…
paper medical records stuffed into folders bursting from file cabinets; prescriptions are written by physicians (with notoriously poor penmanship) in Latin on a small piece of paper for us to carry to a pharmacist; and when we are discharged from the hospital, we are given a copy (which may be blurry) of handwritten “instructions” on a wordy form telling us how to take care of surgical wounds, a listing of medications, and when we should see our doctor for follow-up. If we want to talk to our doctor outside of office hours, we usually have to go through an answering service, which then sends a message to the doctor through a pager (remember those?), who then, you hope, calls you back.
The tools of information and communication technologies will be brought crashing into the world of
U.S. health care thanks to a little-known section of the 2009 economic stimulus bill called the Health
Information Technology for Economic and Clinical Health (HITECH) Act. As part of the economic stimulus legislation, $29 billion will be invested over
A Publication of the National Civic League
BY IGNATIUS BAU
the next five to ten years to bring U.S. medicine into the digital age.
Under the HITECH Act, every hospital in the United
States will be eligible for a minimum of $2 million— and many millions more for larger hospitals—to buy and use “electronic health records.” Similarly, physicians will be eligible for payments ranging from
$44,000 to $63,000 to begin to use such health records. And, more critically, the federal government will condition all these investments on the ability of all these electronic health records to be shared, or “interoperable,” through local, regional, state, and, eventually, a national “health information exchange.” The “big hairy audacious goal” is for all physicians and hospitals to be using electronic health records by 2015.
The requirements for the HITECH payments have become a platform for demonstration programs and other activities that support health care quality improvement and cost reductions in the national health care reform legislation, the Patient Protection and Affordable Care Act. For example, the required functions of the electronic health records have been aligned to requirements for emerging models of health care delivery improvement, including “patient-centered medical homes,” a term for health care providers who emphasize partnerships between patients and their physicians, and accountable care organizations.
The federal government is spending $2 billion of the HITECH investments to support health information technology planning in every state. It involves technical assistance for hospitals, physicians, and
c 2011 Wiley Periodicals, Inc.
Published online in Wiley Online Library (wileyonlinelibrary.com)
National Civic Review • DOI: 10.1002/ncr.20064 • Fall 2011
15
community health centers; training of a new health information technology workforce (creating tens of thousands of new jobs nationwide); innovation and research; and evaluation. The other $27 billion will go to software developers, computer companies, Internet service providers, and other U.S. businesses that will be selling, installing, maintaining, and providing customer support for all those electronic health record and health information exchange technologies being bought by hospitals, physicians, and community health centers. (All of these investments will sustain and create tens of thousands of more jobs—yes, this really was an economic stimulus and a way to improve health care delivery.)
The widespread use of health and communications technologies has the potential to engage patients and health consumers in their own self-care—and even to mobilize entire communities in radical new ways. Today we think of our “health information” as mysterious, unpronounceable diagnoses, unreadable lab results, or a complex list of medications with different brand and generic names. In an information and communications technology–enabled world of health care, that health information will be accessible and available to patients, their families, and their caregivers in multiple formats and in the languages they speak. We will be able to use that information to become more informed about our health, to ask more and better questions of our health care providers, to better understand our treatment options and our medications, and, ultimately, to take greater responsibility for our health and wellbeing, in partnership with our health care providers, families, and caregivers.
Social media and social networking will enable us to find fellow patients for peer support, information, and engagement.
Moreover, social media and social networking will enable us to find fellow patients for peer support, information, and engagement. Self-monitoring and home monitoring devices, from simple pedometers to digital weight scales, to blood pressure and glucose monitors, will allow us as patients, and our health care providers, to better monitor our health
16
National Civic Review
status and progress on goals such as increased physical activity or weight loss.
Barcodes that give us calorie, fat, and other data will help us make healthier food choices, both in the supermarket and in restaurants. The Institute of Medicine recently issued a report on the potential impact of health information technology: [There is a] need for the establishment of a “new norm” around engaging patients and the population in health (theirs and that of the population) through the use of the digital infrastructure. Basic to this “re-norming” is a deepened appreciation by patient and the general population for the personal and public benefits that are likely to occur, as well as a strong measure of confidence in the security of the system and their records as they are used for new insights [p. 30].
Here are a few scenarios of what will soon be the new norm in health care: r You will be able to make all your appointments online, choosing appointment times most convenient to you. r Physicians will replace their off-hours answering services with nurse advice phone services, so that most of the time, your questions can be answered over the phone (or the nurse can instruct you …show more content…
to go to the emergency room if needed). r Most physicians will be able (and willing) to communicate with you by e-mail (and eventually, text messages), so if you have a quick question, you can get an answer without having to make an appointment or go into the physician’s office.
When you do go to a physician’s office for an appointment, someone else in that office will “verify” that the contact, insurance, allergy, medication, and other data in the electronic health record is accurate rather than repeatedly asking you the same questions. Those other members of your “health care team” may even remind you about preventive screenings or prescription medication refills that are due or coming due, and assist you in making sure that you get those screenings and refills.
DOI: 10.1002/ncr
Fall 2011
At the conclusion of your appointment with your physician, she will print out for you a summary of the visit, an updated “care plan” with individually tailored goals for changes, any tailored patient education materials, and an updated medication list. This will help you know exactly what you need to do to take care of your own health before your next physician visit. All these materials also will be available electronically to you, your family, and caregivers. Any new prescriptions will be sent electronically to your predesignated local pharmacy, ready for you to pick up as soon as you can get there. Similarly, when you have to go to the hospital, it will be able to access and use the information already in your physician’s electronic health record, including your complete medical history, diagnoses, past surgeries and treatments, and current medications. After you leave the hospital, both a summary of the care you received at the hospital and your discharge instructions will be printed out for you and also available electronically to you, your family, and caregivers. Of course, your regular physician will automatically—and electronically—receive the summary of care and discharge instructions.
If you are a parent, the immunization records for your children will be stored in your child’s electronic health record, and you will be able to authorize any doctor, nurse, or school to access that record when needed. That record also will be reported (without identifying information) to public health departments to ensure better monitoring of overall immunization rates in a local community.
When there are outbreaks of the flu or more serious diseases, electronic health records from physicians and hospitals will automatically send diagnoses (again, without identifying information) to public health officials so that appropriate communitywide preventive and precautionary measures can be implemented.
While such future scenarios will benefit all patients and health care consumers, the use of health information and communications technologies could have even greater benefits for racial and ethnic minorities, individuals with lower health literacy, individuals with limited English proficiency, individuals with disabilities, and persons living in rural and
National Civic Review
other isolated geographic areas—populations that often experience the greatest disparities in health care and health status.
Here’s how: One of the functions of electronic health records will be to document vital demographic data in a standardized and routine way. Nothing in health care changes without data. If we don’t know how many African American patients with hypertension a physician is caring for, we won’t know if their hypertension is being controlled at the same rates as for other populations.
(Unfortunately, usually it isn’t.) If we don’t know how many patients coming to our hospital (or who live in our community and should be able to use our hospital services) speak
Vietnamese, we will never plan for Vietnamesespeaking health care providers or interpreters. If we don’t know which of our patients might benefit from large-print educational materials, we will keep handing out materials they can’t and won’t read.
In order to get the HITECH Act payments, hospitals and physicians will have to collect the race, ethnicity, and preferred language of more than 50 percent of their unique patients. With such data, their electronic health record systems will then be able to alert them when a patient speaks a language other than
English and that a bilingual health care provider or a health care interpreter is needed. Such languageassistance-needs data can be shared automatically with the pharmacist to ensure translated medication labels, instructions, and counseling. It also can be shared with labs and specialists so that
language assistance services are alerted and available. Patient education materials can be instantly tailored for each person because different versions, with different graphics, font sizes, and translations, will be stored and accessible electronically. Physician office visit summaries and hospital summaries of care and discharge documents can be tailored to appropriate literacy levels, with translations (or verbal interpretation services), and in accessible formats for persons with visual impairments or physical disabilities.
Another of the conditions for receiving HITECH payments is that physicians and hospitals analyze the information in their electronic health records and proactively find opportunities to improve health care quality and outcomes, such as screening rates or avoidable hospitalizations. The demographic data in
DOI: 10.1002/ncr
Fall 2011
17
[Health information technology] provides an opportunity for engaging populations not historically well served by the traditional health community. . . .The impact of facilitating patient and population contribution to, and control of, their health information has the potential to provide further insights into, and opportunities to address, disparities in underserved populations
[p.31].
those electronic health records can be used to identify and address health care disparities. For example, by routinely analyzing quality and health outcomes data by race, ethnicity, language, and other demographic variables, any disparities can be quickly identified for priority quality improvement efforts.
The one cautionary element in addressing health disparities is the reality of a continuing digital divide, the lack of access to certain technologies, primarily because of income and geographic barriers but also barriers due to age, language, and disability.
Yet health information and communications actually can bridge this digital divide if a principle of
“multiple formats, multiple channels, and multiple users” is applied.
Research by John Horrigan on wireless Internet use shows that some groups that have historically experienced the greatest disparities—namely African
Americans and Latinos—actually are accessing the
Internet through their mobile phones at a higher rate than other populations. If an electronic health record system is appropriately programmed to send out phone, e-mail, and text messages, the message may in fact be more effective when delivered to a mobile phone. Similarly, medication lists or interactive medication reminders available through mobile phones may be a more effective way to communicate with patients than other interventions. There already are some innovative uses of “mobile health” technologies among low-income pregnant women,
Spanish-speaking migrant workers, and homeless and at-risk youth.
The Institute of Medicine noted in its recent report on health information technology:
18
National Civic Review
The imminent and rapid implementation of health information and communications technologies in health care delivery systems throughout the United
States is the beginning of a radical transformation in health care. The technology-driven changes will fundamentally change our expectations and experiences as patients and health care consumers. These health information and communications technologies also will create tremendous opportunities for increased individual and civic engagement in our own personal health and in the health of our families and communities. References
Horrigan, J. “Wireless Internet Use.” Washington, D.C.: Pew
Research Center, 2009. http://www.pewinternet.org/Reports/
2009/12-Wireless-Internet-Use.aspx.
Institute of Medicine. Digital Infrastructure for the Learning
Health System. Washington, D.C.: National Academies Press,
2010.
Ignatius Bau is an independent health policy consultant who has served on expert advisory panels for the federal Office of
National Coordinator for Health Information Technology,
Office of Minority Health, Centers for Disease Control and
Prevention, and Institute of Medicine.
DOI: 10.1002/ncr
Fall 2011
Copyright of National Civic Review is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder 's express written permission. However, users may print, download, or email articles for individual use.
The Potential of Health
Information and Communications
Technologies to Reduce Health
Care Disparities
In today’s technology-filled world, we have become dependent on the Internet for everything from doing any research (“Google it”), making travel and restaurant reservations, paying our bills, managing our investments, finding recipes for dinner, making charitable and political contributions, all types of shopping, and on and on. And we communicate primarily by e-mail and text messages, and chat using instant messages, much more than by phone, or the mail.
Unfortunately, U.S. health care delivery systems have been slow to embrace information and communication technologies. Physicians’ offices are filled
with …show more content…
paper medical records stuffed into folders bursting from file cabinets; prescriptions are written by physicians (with notoriously poor penmanship) in Latin on a small piece of paper for us to carry to a pharmacist; and when we are discharged from the hospital, we are given a copy (which may be blurry) of handwritten “instructions” on a wordy form telling us how to take care of surgical wounds, a listing of medications, and when we should see our doctor for follow-up. If we want to talk to our doctor outside of office hours, we usually have to go through an answering service, which then sends a message to the doctor through a pager (remember those?), who then, you hope, calls you back.
The tools of information and communication technologies will be brought crashing into the world of
U.S. health care thanks to a little-known section of the 2009 economic stimulus bill called the Health
Information Technology for Economic and Clinical Health (HITECH) Act. As part of the economic stimulus legislation, $29 billion will be invested over
A Publication of the National Civic League
BY IGNATIUS BAU
the next five to ten years to bring U.S. medicine into the digital age.
Under the HITECH Act, every hospital in the United
States will be eligible for a minimum of $2 million— and many millions more for larger hospitals—to buy and use “electronic health records.” Similarly, physicians will be eligible for payments ranging from
$44,000 to $63,000 to begin to use such health records. And, more critically, the federal government will condition all these investments on the ability of all these electronic health records to be shared, or “interoperable,” through local, regional, state, and, eventually, a national “health information exchange.” The “big hairy audacious goal” is for all physicians and hospitals to be using electronic health records by 2015.
The requirements for the HITECH payments have become a platform for demonstration programs and other activities that support health care quality improvement and cost reductions in the national health care reform legislation, the Patient Protection and Affordable Care Act. For example, the required functions of the electronic health records have been aligned to requirements for emerging models of health care delivery improvement, including “patient-centered medical homes,” a term for health care providers who emphasize partnerships between patients and their physicians, and accountable care organizations.
The federal government is spending $2 billion of the HITECH investments to support health information technology planning in every state. It involves technical assistance for hospitals, physicians, and
c 2011 Wiley Periodicals, Inc.
Published online in Wiley Online Library (wileyonlinelibrary.com)
National Civic Review • DOI: 10.1002/ncr.20064 • Fall 2011
15
community health centers; training of a new health information technology workforce (creating tens of thousands of new jobs nationwide); innovation and research; and evaluation. The other $27 billion will go to software developers, computer companies, Internet service providers, and other U.S. businesses that will be selling, installing, maintaining, and providing customer support for all those electronic health record and health information exchange technologies being bought by hospitals, physicians, and community health centers. (All of these investments will sustain and create tens of thousands of more jobs—yes, this really was an economic stimulus and a way to improve health care delivery.)
The widespread use of health and communications technologies has the potential to engage patients and health consumers in their own self-care—and even to mobilize entire communities in radical new ways. Today we think of our “health information” as mysterious, unpronounceable diagnoses, unreadable lab results, or a complex list of medications with different brand and generic names. In an information and communications technology–enabled world of health care, that health information will be accessible and available to patients, their families, and their caregivers in multiple formats and in the languages they speak. We will be able to use that information to become more informed about our health, to ask more and better questions of our health care providers, to better understand our treatment options and our medications, and, ultimately, to take greater responsibility for our health and wellbeing, in partnership with our health care providers, families, and caregivers.
Social media and social networking will enable us to find fellow patients for peer support, information, and engagement.
Moreover, social media and social networking will enable us to find fellow patients for peer support, information, and engagement. Self-monitoring and home monitoring devices, from simple pedometers to digital weight scales, to blood pressure and glucose monitors, will allow us as patients, and our health care providers, to better monitor our health
16
National Civic Review
status and progress on goals such as increased physical activity or weight loss.
Barcodes that give us calorie, fat, and other data will help us make healthier food choices, both in the supermarket and in restaurants. The Institute of Medicine recently issued a report on the potential impact of health information technology: [There is a] need for the establishment of a “new norm” around engaging patients and the population in health (theirs and that of the population) through the use of the digital infrastructure. Basic to this “re-norming” is a deepened appreciation by patient and the general population for the personal and public benefits that are likely to occur, as well as a strong measure of confidence in the security of the system and their records as they are used for new insights [p. 30].
Here are a few scenarios of what will soon be the new norm in health care: r You will be able to make all your appointments online, choosing appointment times most convenient to you. r Physicians will replace their off-hours answering services with nurse advice phone services, so that most of the time, your questions can be answered over the phone (or the nurse can instruct you …show more content…
to go to the emergency room if needed). r Most physicians will be able (and willing) to communicate with you by e-mail (and eventually, text messages), so if you have a quick question, you can get an answer without having to make an appointment or go into the physician’s office.
When you do go to a physician’s office for an appointment, someone else in that office will “verify” that the contact, insurance, allergy, medication, and other data in the electronic health record is accurate rather than repeatedly asking you the same questions. Those other members of your “health care team” may even remind you about preventive screenings or prescription medication refills that are due or coming due, and assist you in making sure that you get those screenings and refills.
DOI: 10.1002/ncr
Fall 2011
At the conclusion of your appointment with your physician, she will print out for you a summary of the visit, an updated “care plan” with individually tailored goals for changes, any tailored patient education materials, and an updated medication list. This will help you know exactly what you need to do to take care of your own health before your next physician visit. All these materials also will be available electronically to you, your family, and caregivers. Any new prescriptions will be sent electronically to your predesignated local pharmacy, ready for you to pick up as soon as you can get there. Similarly, when you have to go to the hospital, it will be able to access and use the information already in your physician’s electronic health record, including your complete medical history, diagnoses, past surgeries and treatments, and current medications. After you leave the hospital, both a summary of the care you received at the hospital and your discharge instructions will be printed out for you and also available electronically to you, your family, and caregivers. Of course, your regular physician will automatically—and electronically—receive the summary of care and discharge instructions.
If you are a parent, the immunization records for your children will be stored in your child’s electronic health record, and you will be able to authorize any doctor, nurse, or school to access that record when needed. That record also will be reported (without identifying information) to public health departments to ensure better monitoring of overall immunization rates in a local community.
When there are outbreaks of the flu or more serious diseases, electronic health records from physicians and hospitals will automatically send diagnoses (again, without identifying information) to public health officials so that appropriate communitywide preventive and precautionary measures can be implemented.
While such future scenarios will benefit all patients and health care consumers, the use of health information and communications technologies could have even greater benefits for racial and ethnic minorities, individuals with lower health literacy, individuals with limited English proficiency, individuals with disabilities, and persons living in rural and
National Civic Review
other isolated geographic areas—populations that often experience the greatest disparities in health care and health status.
Here’s how: One of the functions of electronic health records will be to document vital demographic data in a standardized and routine way. Nothing in health care changes without data. If we don’t know how many African American patients with hypertension a physician is caring for, we won’t know if their hypertension is being controlled at the same rates as for other populations.
(Unfortunately, usually it isn’t.) If we don’t know how many patients coming to our hospital (or who live in our community and should be able to use our hospital services) speak
Vietnamese, we will never plan for Vietnamesespeaking health care providers or interpreters. If we don’t know which of our patients might benefit from large-print educational materials, we will keep handing out materials they can’t and won’t read.
In order to get the HITECH Act payments, hospitals and physicians will have to collect the race, ethnicity, and preferred language of more than 50 percent of their unique patients. With such data, their electronic health record systems will then be able to alert them when a patient speaks a language other than
English and that a bilingual health care provider or a health care interpreter is needed. Such languageassistance-needs data can be shared automatically with the pharmacist to ensure translated medication labels, instructions, and counseling. It also can be shared with labs and specialists so that
language assistance services are alerted and available. Patient education materials can be instantly tailored for each person because different versions, with different graphics, font sizes, and translations, will be stored and accessible electronically. Physician office visit summaries and hospital summaries of care and discharge documents can be tailored to appropriate literacy levels, with translations (or verbal interpretation services), and in accessible formats for persons with visual impairments or physical disabilities.
Another of the conditions for receiving HITECH payments is that physicians and hospitals analyze the information in their electronic health records and proactively find opportunities to improve health care quality and outcomes, such as screening rates or avoidable hospitalizations. The demographic data in
DOI: 10.1002/ncr
Fall 2011
17
[Health information technology] provides an opportunity for engaging populations not historically well served by the traditional health community. . . .The impact of facilitating patient and population contribution to, and control of, their health information has the potential to provide further insights into, and opportunities to address, disparities in underserved populations
[p.31].
those electronic health records can be used to identify and address health care disparities. For example, by routinely analyzing quality and health outcomes data by race, ethnicity, language, and other demographic variables, any disparities can be quickly identified for priority quality improvement efforts.
The one cautionary element in addressing health disparities is the reality of a continuing digital divide, the lack of access to certain technologies, primarily because of income and geographic barriers but also barriers due to age, language, and disability.
Yet health information and communications actually can bridge this digital divide if a principle of
“multiple formats, multiple channels, and multiple users” is applied.
Research by John Horrigan on wireless Internet use shows that some groups that have historically experienced the greatest disparities—namely African
Americans and Latinos—actually are accessing the
Internet through their mobile phones at a higher rate than other populations. If an electronic health record system is appropriately programmed to send out phone, e-mail, and text messages, the message may in fact be more effective when delivered to a mobile phone. Similarly, medication lists or interactive medication reminders available through mobile phones may be a more effective way to communicate with patients than other interventions. There already are some innovative uses of “mobile health” technologies among low-income pregnant women,
Spanish-speaking migrant workers, and homeless and at-risk youth.
The Institute of Medicine noted in its recent report on health information technology:
18
National Civic Review
The imminent and rapid implementation of health information and communications technologies in health care delivery systems throughout the United
States is the beginning of a radical transformation in health care. The technology-driven changes will fundamentally change our expectations and experiences as patients and health care consumers. These health information and communications technologies also will create tremendous opportunities for increased individual and civic engagement in our own personal health and in the health of our families and communities. References
Horrigan, J. “Wireless Internet Use.” Washington, D.C.: Pew
Research Center, 2009. http://www.pewinternet.org/Reports/
2009/12-Wireless-Internet-Use.aspx.
Institute of Medicine. Digital Infrastructure for the Learning
Health System. Washington, D.C.: National Academies Press,
2010.
Ignatius Bau is an independent health policy consultant who has served on expert advisory panels for the federal Office of
National Coordinator for Health Information Technology,
Office of Minority Health, Centers for Disease Control and
Prevention, and Institute of Medicine.
DOI: 10.1002/ncr
Fall 2011
Copyright of National Civic Review is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder 's express written permission. However, users may print, download, or email articles for individual use.