healthcare disparities

1
Informatics Role in Decreasing Healthcare
Disparities

• Georgienne Gordon
• Barbara Harris
• Elke Houser
• Melissa Hurt

2
Healthcare Disparities
Healthcare disparities are the differences in
treatment of a disease process, quality, access,
outcome of healthcare within a specific race,
ethnicity or socioeconomic group.

• Contributing Factors
• Medically underserved communities
• Economic Challenges
• Individuals with Disabilities
• Personal Behaviours
• Culture
• Education
• Language

3
Information Technology and Healthcare

• The mission of merging Information Technology
  and healthcare was designed to promote patient
  safety, improve the quality, accessibility and
  continuity of patient care by the collection,
  integration and analysis of data

4
Health Information Technology for Providers

• Electronic Health Record (EHR)
• The electronic health record is the collection of
  health information pertaining to an individual.
  The record contains medical history, medications
  and allergies, laboratory and diagnostic studies,
  immunizations and billing information. The
  importance of this record is the capability of
  being shared different facilities for continuity
  of care and in emergencies.
• Computerized Provider Order Entry (CPOE)
• The order entry system allows orders to be
  entered directly by the healthcare providers.
  The goal is to promote and improve quality of
  care and patient safety by eliminating illegible
  handwriting and transcription errors. The system
  checks for order accuracy, speeds the
  implementation of ordered diagnostic test and
  treatment modalities.

5
Health Information Technology for Providers
(continued)

• Telemedicine
• Telemedicine is the use of technology to consult,
  provide and expedite health care services to
  distant facilities. Diagnostic studies, x-rays,
  and EKG can be transmitted to remote testing
  facility for interpretation. Having the
  capability of telemedicine improves patients
  outcome by early detection, treatment and consult
  if warranted
• E-prescribing
• Allows the provider to enter a prescription
  electronically to the patients pharmacy. It
  ensures that the medication has been ordered for
  the patient. The pharmacist and provider have
  the ability to communicate regarding patients
  medication and allergies.
• Electronic Radiology Systems
• A provider can schedule diagnostic tests,
  generate client instructions and preparation
  procedures. The systems can included order
  entry, scheduling, transcription of results, and
  file room management.

6
EHR adoption rate for Medical Offices
7
Health Information Technology for Consumers

• Personal Health Record (PHR)
• The patient-oriented focus within the healthcare
  arena has been on the role of the personal health
  record. PHRs are internet-based tools which
  enables the patient to access, input, change or
  coordinate and control their health information.
  

8
Health Information Technology for Consumers
(continued)

• Consumer Health Informatics (CHI)
• Consumer health informatics is the use of
  internet-based and electronic resources to
  educate and improve medical outcomes and
  healthcare decision making for patients,
  caregivers and consumers. The consumer has the
  capability to retrieve information and
  recommendations regarding diseases, medications
  and treatments.

9
Health Information Technology for Consumers
(continued)

• Social Media
• The Social media is an emerging potent resource
  among healthcare consumers. Advanced technology
  allows people to interact socially online. 2004
  was the introduction of Web 2.0, this upgrade to
  the internet increased the level or intensity of
  user interaction with the technology.

10
Health Information Technology Barriers

• Technology Gaps
• Lack of Insurance
• Data Collection

11
Technology gaps

• Exist among communities of color, immigrants,
  those who do not speak English well
• According to APIAHF, CPEHN, Consumers Union
  NCLR (2013) 55 of Latino and 58 of African
  American households have home internet connection
  as compared to 75 of White households.

12
Technology Gaps

• If they dont have internet access at home, they
  may consider using a public computer such as at
  the public library but my worry about the
  security of their information on a public
  computer.
• If they do use a public computer to access
  information, the websites being used my not be
  user friendly for those populations.

13
Lack of Insurance

• This is a barrier for the poor, immigrants,
  communities of color and those who do not speak
  English well.
• These populations often do not seek medical
  attention as often because they do not have
  insurance.
• When they do they end up going from doctor to
  doctor with medical records getting left at each
  place and not having a complete record anywhere.
• They may seek medical attention at the emergency
  room when the public health office where they
  normally are seen is closed. This produces two
  sets of records because the medical record does
  not follow them from place to place.

14
Data Collection

• Physicians offices and medical centers are just
  beginning to collect information on race,
  ethnicity, language and other demographic
  information (APIAHF et al, 2013) and store it in
  the patients chart.
• This information is important because knowing
  this information will help the medical staff
  provide more effective care for the patient.

15
Health Information Technology and Quality
Improvement

• American Recovery and Reinvestment Act of 2009
• Patient Protection and Affordable Care Act of
  2010
• Underlying causes of disparities

16
Recommendations for Organizations

• Automate and Standardize collection of race and
  ethnicity data
• Prioritization for identifying
• Focused HIT efforts to address fragmentation of
  care
• Development of focused clinical decision support
  systems
• Input from minorities and limited English to
  develop HIT tool

17
Electronics and HIT

• Wireless Technology
• Text messaging
• Email
• Automated reminders via above

18
Clinical Decision Support Systems

• Preventive Care
• Guideline adherence
• Electronic alerts, reminders or prompts for
  facilitation of provider decision making

19
First steps

• Infrastructure
• Quality and cost of care
• Design to address and eliminate from ground up

20
Improving Health Outcomes

• The ProviderThe goal of informatics technology
  in the healthcare field is to promote and improve
  patient safety. And that means patient safety for
  all. Health care providers now have the
  capability to retrieve and input data literally
  at the touch of a button with the use of PDA's
  and other mobile devices. The provider is able to
  provide safe and timely care through EHR,
  mhealth, telemedicine and e-medicine even while
  being away from the office. The application
  allows the provider to communicate through
  interpretation, written or verbal, for persons
  with language barriers. Applications are also
  available for consulting a physician for the
  patient who requires additional care. Any changes
  to care is transferred to the patient's EHR for
  updating.

21
Improving Health Outcomes

• The Consumer
• With the use of PDA's, computers and other mobile
  devices the consumer is able to receive
  information, education and recommendations
  regarding their disease process, medications and
  treatments. Through the translation application
  information can be readily transferred to the
  desired language. Like the provider this
  information can be available to the consumer with
  the touch of the finger. Any changes to care is
  transferred to the patient's EHR for updating.

22
References

• Asian Pacific Islander American Health Forum,
  California Pan-Ethnic Health Network, Consumers
  Union, National Council of La Raza. (February 24,
  2013). Equity in the digital age How health
  information technologies can reduce disparities.
  Retrieved from http//www.cpehn.org.
• Gibbons, M. (2011) Use of health information
  technology among racial and ethnic underserved
  communities, Perspectives in Health Information
  Management, Winter 2011. Retrieved from Pubmed
  Central, website http//www.ncbi.nm.nih.gov.ju.i
  dm.oclc.org/pmc/artices/pmc30358301
• Hebda, T. And Czar , P. (2013). Handbook of
  Informatics for Nurses and Healthcare
  Professionals (5th edition). Upper Saddle River,
  NJ. Pearson.
• Hsiao, C., Jha, A., King, J., Patel, V.,
  Furakawa, m. and Mostashari, F. (2013), Office
  based physicians are responding to incentives and
  assistance by adopting and using electronic
  health records, Health Affairs, August 2013 32
  1470-1477 , doi10.1377/hlthaff.2013.0323
• Lopez, M.D., M.P.H., L., Green, M.D., M.P.H., A.
  R., Tan-McGrory, M.S.P.H., M.B.A., A., King,
  M.D., M.P.H., R., Betancourt, M.D., M.P.H., J.
  R. (2011, October). Bridging the digital divide
  in health care The role of health information
  technology in addressing racial and ethnic
  disparities. The Joint Commission Journal on
  Quality and Patient Safety, 10, 437-445.
• What is Telemedicine?(2013)
• http//www.news-medical.net/health/What
  -is-Telemedicine.aspx