Advancing Health Equity in the Digital Age
Dr. Karen B. DeSalvo and J. Nadine Garcia, MD, MSCE | April 18, 2014
During 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 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:
- Adoption of health IT in all communities;
- Improving patient care by creating culturally and linguistically appropriate eHealth tools;
- Facilitating secure exchange and confidentiality of patient data; and
- 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 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 , 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, visit www.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!