To jumpstart progress in leveraging federal health information technology (IT) policy to reduce health disparities, the Consumer Partnership for eHealth (CPeH) today released a plan for addressing disparities in Stage 3 of the Electronic Health Record (“Meaningful Use”) Incentive Program and beyond. CPeH is a nationwide coalition of more than 50 consumer, patient and labor organizations.
The result of a year-long review of scientific literature and collaboration with experts on disparities and health IT, the Disparities Action Plan focuses on data collection and use to identify disparities; language, literacy and communication; and care coordination and planning. The plan would integrate disparities reduction with the other criteria in Stage 3 to improve the identification and understanding of health disparities while improving health outcomes. CPeH has submitted the plan to the Health IT Policy Committee, with a request that the committee consider and act on its recommendations.
“It’s impossible to achieve better health outcomes and significantly reduce health care costs without tackling health disparities, which are a pervasive and costly problem,” said National Partnership for Women & Families President Debra L. Ness. “We have the chance to leverage Stage 3 of the Meaningful Use program to make significant progress in addressing disparities. We must not squander this opportunity. CPeH has created a bold, yet achievable, path forward for including criteria in Stage 3 that will begin to reduce disparities and, in doing so, help us achieve patient- and family-centered care, better outcomes, and lower costs for everyone.”
The Joint Center for Political and Economic Studies reports that, from 2003 to 2006, the combined costs of health disparities and premature death in the United States were $1.24 trillion. The costs associated with health disparities will only increase as the country becomes more diverse. The Census Bureau reported last year that the majority of children under age one in the United States are now minorities.
“Every American deserves an equal chance at a full, healthy life,” Ness added. “We need policymakers to recognize that health IT offers a way to give every American that chance.”
“This Action Plan presents a great opportunity to improve quality of care, enhance patient participation and understanding, and reduce health disparities nationwide through health information technology,” said Kathy Ko Chin, President & CEO of the Asian & Pacific Islander American Health Forum. “It is important that we implement these recommendations so that the health disparities of today are not replicated in electronic health systems tomorrow.”
The Action Plan details how improved data collection and use can help doctors and hospitals identify disparities in health and health care and better understand how to reduce them. At present, the Meaningful Use program requires only a basic level of race, ethnicity, and gender data collection based on standards created by the Office and Management and Budget. The Action Plan recommends transitioning to the more rigorous data collection standards designed by the Department of Health and Human Services (HHS), similar to what the Census uses, to help providers better recognize, track, understand and address disparities and expand data collection to include disability status, sexual orientation and gender identity.
“According to the Institute of Medicine, collecting sexual orientation and gender identity data in electronic health records (EHRs) is crucial to understanding and addressing the health disparities that affect the lesbian, gay, bisexual, and transgender (LGBT) population,” said Kellan Baker, associate director, Center for American Progress. “The Disparities Action Plan is a key step in turning that recommendation into action to finally end the culture of ‘don’t ask, don’t tell’ for LGBT people in our health care system.
The Disparities Action Plan also:
- Recommends that EHRs have the ability to stratify patients’ specific conditions by variables such as race, ethnicity, language, gender identity, sexual orientation, socio-economic status, and disability status. This would allow providers to identify important patterns – for example, whether Hispanic or African-American patients experience a higher rate of a health condition than non-Hispanic White patients.
- Recommends greater use of patient data collected and shared through devices such as smartphones. Enabling EHRs to collect data from mobile health applications provides an important point of access to underserved communities.
- Emphasizes the need to ensure that electronic health information is effectively communicated to patients, so they are better able to utilize its benefits, including better understanding their plans for care, improving communication with providers, and providing feedback on their care experiences. Health IT should be accessible in the languages patients speak and be presented in plain language for patients with low literacy and in ways that accommodate patients with disabilities.
A final set of recommendations in the Disparities Action Plan addresses using health IT to better coordinate care and develop care plans. As health care has advanced and the number of individuals living with chronic conditions has increased, the need for better care coordination and planning has grown. Health IT can enable multiple providers to connect, facilitating better communication with patients, families, and other care team members. Health IT should also be used to improve information sharing and automate connections between patients, health care providers, and community-based organizations, the plan says, enabling improved care coordination and health outcomes.
“The National Health Law Program (NHeLP) views the Disparities Action Plan as a health IT guide to improving the health quality of low-income populations, communities of color, women, individuals with limited English proficiency, and other underserved communities,” said Deborah A. Reid, senior attorney, NHeLP. “The Disparities Action Plan serves as the link that connects the mission of the HITECH Act and the Electronic Health Record Incentive Program with existing laws, HHS strategies, and advocacy efforts that support health equity.”
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The Disparities Action Plan is available here.