Federal Strategic Plan to Reduce Health IT Disparities: Request for Comment
David Hunt, M.D., David Dietz and Dr. Garth Graham | August 24, 2011
Request for Comment: Federal Strategic Plan to Reduce Health IT Disparities
Working to ensure all Americans benefit from health IT is one of the principles guiding the development and execution of the federal health IT strategy. The Federal Health IT Strategic Plan that was released for public comment on March 25, 2011, states that we will strive to:
Support health information technology (heath IT) benefits for all. All Americans should have equal access to quality health care. This includes the benefits conferred by health IT.: The government will endeavor to assure that underserved and at-risk individuals enjoy these benefits to the same extent as all other citizens.
For the past few months, the Health IT Disparities Workgroup — comprised of staff from agencies of the U.S. Department of Health and Human Services (HHS): with strategic and operational programs in health IT and co-chaired by the Office of the National Coordinator for Health Information Technology (ONC) and the Office of Minority Health (OMH) — has led a focused effort to further define the federal government’s strategies and tactics to reduce health IT disparities within underserved communities. The result of this process will reflect our commitment to do more to reduce health IT disparities.
The Health IT Disparities Workgroup is developing a federal plan to reduce health IT disparities.: A draft set of strategies/tactics — aligned with the five goals of the Federal Health IT Strategic Plan — is included below: We hope you will assist us by providing comments on the following questions:
- What do you think of the draft strategies / tactics listed below?
- What specific activities would you like to see the federal government take on to reduce health IT disparities?
Health information technologies — such as electronic health records (EHRs), telemedicine, mobile health, and electronic disease registries — have been identified as effective means of helping to deliver safe, effective, affordable health care services; coordinate care across providers and clinical settings; and provide critical population data that may catalyze further policy and delivery system innovations.
The growing adoption and meaningful use of health IT is even more critical within the context of underserved communities. Within both rural and urban underserved communities, access to primary and specialty health care resources can be limited. This scarcity in many instances contributes to reduced quality of health care and of health outcomes for people residing in these communities. Within underserved communities, the use of health IT has demonstrated it can improve health outcomes, both from an individual and community-/system-wide perspective.
Federal planning efforts focused at reducing health disparities, including The National Stakeholder’s Strategy and the HHS Action Plan to Reduce Racial and Ethnic Health Disparities, highlight the proliferation of meaningful use of health IT within underserved communities as a critical objective. This draft set of strategies/tactics (see below) for the federal plan to reduce health IT disparities aims to ensure that underserved communities realize the full benefits of health IT.
Goals of the Federal Health IT Strategic Plan
Goal I: Achieve Adoption and Information Exchange through Meaningful Use of Health IT
- Accelerate adoption of EHRs
- Facilitate information exchange to support meaningful use of EHRs
- Support health IT adoption and information exchange for public health and populations with unique needs
- Future HHS grant programs focusing upon the provision of EHRs, use of telemedicine/telehealth, mobile health, or services to enable the purchase and use of health IT should emphasize the importance and, whenever feasible, work toward optimizing the program’s total number of providers who practice within medically underserved areas (MUAs) as defined by the Health Resources and Services Administration (HRSA).
- Recognize vendors who work extensively within underserved communities, as well as examine the concept of a “Public-Private Digital Parity Partnership,” wherein health IT vendors will pledge to work with a specific number of providers who practice within MUAs (as defined by HRSA). In exchange for offering these providers reduced health IT product and service purchasing rates, vendors who participate in this program will have access to assistance with identifying eligible providers within the MUAs, and a letter of support for health IT adoption and use from the National Health Information Technology (NHIT) Collaborative and/or other appropriate health IT minority advocacy organizations.
- HHS will continue its collaboration with the U.S. Department of Agriculture (USDA). Specifically, the HHS Secretary’s Rural Health IT Task Force, especially HRSA and ONC, will continue to work with the (USDA) Rural Development, in accordance with the 2011 Memorandum of Understanding, to ensure that rural health care providers can use USDA grants and loans to support the acquisition of health IT infrastructure.:
- HHS OPDIVS/STAFFDIVS will work collaboratively with the HHS OMH, as well as ONC’s Health Information Technology Resource Center (HITRC), to highlight practical, effective methods to achieve adoption and meaningful use of health IT by providers within underserved communities. These practical, effective methods will be published annually on a site and/or reference to be determined.: :
- HHS will collaborate with workforce training programs to implement marketing and communication campaigns reaching underserved communities. The campaign elements will highlight reduced tuition through grants to qualified health care personnel within underserved communities that participate in community college or university health IT training programs. Health IT workforce training programs will also be made available to students who attend minority serving institutions, such as Hispanic Serving Institutions, Tribal Colleges and Universities, and Historically Black Colleges and Universities.
- Work closely with White House Initiatives on Asian Americans and Pacific Islanders, Hispanic Excellence, and Historically Black Colleges and Universities to disseminate information on the meaningful use of health IT.
- Effectively communicate to minority and underserved advocacy organizations, HBCUs, and health IT training programs in general the benefits and importance of achieving meaningful use, particularly the importance of health IT’s potential to reduce care disparities for underserved populations.
- Partner with the National Medical Association , National Hispanic Medical Association , National Council of Asian & Pacific Islander Physicians , and other minority health care provider advocacy organizations to facilitate meaningful use continuing education: training programs.
- Through the State HIE Program identify providers and communities where exchange may not be possible and provide strategic plans for enabling exchange capabilities coordinated with State Medicaid Health Plans to leverage federal resources to specifically meet the needs of underserved communities.
- Work closely with the Federal Communications Commission (FCC) to ensure that relevant FCC programs support the Administration’s health IT objectives. For example, continue the HHS Secretary’s Rural Health IT Task Force’s ongoing efforts to ensure that relevant FCC programs (e.g., the Rural Health Care Support Mechanism, the Connect America Fund) support the Administration’s health IT objectives.
- Provide leadership for health IT and data collection, tracking, and analysis of stratification of quality measures by race and ethnicity data as mandated in the Affordable Care Act.
Goal 2: Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT
- Support more sophisticated uses of EHRs and other health IT to improve health system performance
- Better manage care, efficiency, and population health through EHR-generated reporting measures
- Demonstrate health IT-enabled reform of payment structures, clinical practices, and population health management
- Support new approaches to the use of health IT in research, public and population health, and national health security
- OPDIVS/STAFFDIVS will identify quality, efficiency, and population health measures relevant to underserved communities, providers within these communities, including measures directly related to the adoption/meaningful use of health IT. These measures will be calculated on data stored on a distributed (interagency, shared-access) database, with the measure results made publicly available at appropriate levels of analysis (e.g., provider- and community-specific). The Health IT Disparities Workgroup will consult the HHS Data Council and work closely with AHRQ to select metrics correlating with adoption and meaningful use of health IT within underserved communities for purposes of publication in the annual AHRQ Health care Disparities Report.
- Align future HHS and non-HHS (VA, DoD, etc.) health IT and payment reform pilots and demonstrations/initiatives to include communities designated as MUAs.
Goal 3: Inspire Confidence and Trust in Health IT
- Protect confidentiality, integrity, and availability of health information
- Inform individuals of their rights and increase transparency regarding the uses of protected health information
- Improve safety and effectiveness of health IT
Objectives A, B, & C
- Engage provider and patient advocacy groups to create and disseminate multi-lingual information to increase both providers’ and consumers’ understanding of how Health Insurance Portability and Accountability Act (HIPAA) and other laws and regulations are implemented to protect their private, confidential, and sensitive information.
- Communicate to both consumer and provider advocacy groups representative of minorities that data is collected, used, and stored using safe, trustworthy technology, policies, and practices.
Goal 4: Empower Individuals with Health IT to Improve Their Health and the Health Care System
- Engage individuals with health IT
- Accelerate individual and caregiver access to their electronic health information in a format they can use and reuse
- Integrate patient-generated health information and consumer health IT with clinical applications to support patient-centered care
- Determine if the Culturally and Linguistically Appropriate Services (CLAS) Act and its National Standards must be adapted to encompass health messages delivered via mobile devices, and effect such adaptation if needed.
- Educate consumers about the availability and value to them of personal health records (PHRs), cellular/mhealth, and other types of ehealth or consumer health IT applications. Funding OPDVIS/STAFFDIVS will include IHS, OMH, and other agencies. Interagency, interdisciplinary teams of experts will develop the program announcement(s) and participate in application review(s), ensuring adequate inclusion of providers and consumers within underserved communities.
- Determine appropriate literacy levels and use innovative strategies to convey health IT information effectively at those literacy levels and in consumers’ preferred languages.
- Prioritize the engagement of minority patient advocacy organizations as a two-way mechanism to inform inclusive strategies across health IT initiatives as well as identifying possible new initiatives.
- Locate and communicate best practices of consumer and caregiver access in the context of underserved communities; showcase nationally “community champions” of effective patient engagement and patient-centric health care.
Goal V: Achieve Rapid Learning and Technological Advancement
- Lead the creation of a learning health system to support quality, research, and public and population health
- Broaden the capacity of health IT through innovation and research
Objectives A & B
- Current HHS Comparative Effectiveness Research objectives will be linked, when applicable, to HHS health IT grants and programmatic outcomes.
- In developing strategies to advance and measure progress toward the National Quality Strategy, HHS will utilize EHR-based clinical quality datasets that include language, race, and ethnicity information.
- ONC and OMH will create a charter for the HHS Health IT Disparities Workgroup, and this group will meet quarterly to update progress towards the strategic plan’s objectives.
- The Workgroup will create an annual federal conference where HHS and other (e.g., VA, DoD) agencies will share and develop information and evidence of effective practices for federal supporting widespread achievement of meaningful use of health IT within underserved communities. To promote efficiency, this conference will be integrated or coincide with an existing HHS-supported national conference (e.g. AHRQ or ONC annual grantee meetings) already regularly attended by key participants.:
We want to hear from you. Please submit your comments below.