On March 10th I had the distinct privilege of presenting to the ONC Health IT Advisory Committee at their meeting titled “Health Equity by Design.” The presentation highlighted five areas of focus for Health IT in reducing health disparities: health equity data collection, actionable analysis of the data, integration of healthcare and social service providers, the special role that Health Information Exchanges (HIEs) can play, and access to healthcare and technology.
Under the maxim that “you can’t manage what you can’t measure,” reducing health disparities begins with the standardized collection of health equity data. The COVID-19 pandemic has brought to light dramatic gaps in even the simplest health equity data collection. For instance, at the first peak of the pandemic only 24 states had reported the race and ethnicity of people who died from COVID-19, and during the first month of vaccine distribution, these data were missing for almost half of the doses delivered even though it was required.
The Gravity Project is a good example of how we can expand standardized data sets in order to systematically capture critical information about social determinants of health (SDOH) and other demographic data needed to inform actions intended to achieve health equity. As these data are captured, implementation of a clear privacy framework will be critical to building trust with currently underserved populations. Even as we work to expand a health equity database, it will be important to evolve requirements for capture of clinical data so as to minimize the burden of data collection on practicing clinicians. A rapid movement away from specific clinical metrics to patient-reported outcomes could go a long way toward reducing administrative burden on providers even as it drives a deeper understanding of health disparities.
Once adequate data is available, it must be compared to clinical and health outcomes data to identify disparities. NextGen Healthcare and other Health IT vendors offer many tools for analyzing demographic and other health equity data alongside health conditions and outcomes.Common analyses include geospatial comparisons (to “map” health disparities in a community), location vs location comparisons and benchmarking, quality improvement project before and after analyses, risk stratification, and predictive analytics.
Within individual practices, FQHCs/CHCs, healthcare organizations or health systems, there are many “actions” that may be taken based on these analyses. Examples of this include: patient outreach, distribution of services to match geographic need, development of quality improvement and variance reduction programs, alerts and reminders at the point of care, and care coordination activities. These analyses and response activities are the primary means by which health inequalities are identified and improved.
3—Integration of social services
Health inequity must be tackled by many different parts of the healthcare and social services systems, making the ability to share data among these entities essential. Recent increased focus on health IT interoperability has certainly improved the industry’s capabilities for data exchange, and while challenges remain it appears that an era of innovation, leveraging the availability of health data, is on the horizon. ONC has created an interoperable ecosystem for EHRs for healthcare providers, and now it is time to ensure that social service agencies are included in that ecosystem.
4—The unique role of Health Information Exchanges
Health Information Exchanges (HIEs) have a critical role to play in the healthcare ecosystem, particularly in the understanding and promotion of health equity. Although many were not originally conceived in this way, they have begun to play an important role connecting healthcare provider organizations with social services providers. In a sense, they have become health data “utilities”, like electricity or internet, connecting data collectors with data consumers such as food banks or local agencies because they provide the network’s “last mile” to the latter. Given that making everyone’s data available and sharable is an important step in addressing health inequity, HIEs are well-positioned to do this in many regions. Additionally, like other networks, their value increases with the number of connections, so they have a natural incentive to connect to as many agencies and providers as possible and a disincentive against rent-seeking behavior.
5—Access to healthcare and technology
While Health IT, data standards, and interoperability are important tools in pursuit of Health Equity, it’s important to remember that many health disparities result directly from lack of access—access to healthcare, to resources and services, and to technology and the internet.
We’ve all seen the rapid adoption of telemedicine by both providers and patients in the face of the COVID-19 pandemic. That said, it will require purposeful focus on access to care for the underserved, rather than convenience for the privileged, in order for virtual services to reduce rather than exacerbate health disparities. In this vein, ensuring broadband and smart devices are available in underserved communities is a critical first step.
The future and Health Equity by Design
Technology has a key role to play in a future without health disparities. Much like modern software applications automatically track and analyze users’ actions, the healthcare system of the future will gather a robust set of health equity data in an unobtrusive fashion and aggregate and report it for analysis while protecting privacy. The data will be used both by providers at the point of care in minimally-biased algorithms and clinical decision support tools as well as easily shared amongst providers of care and social services via APIs, point-to-point messages, local and regional HIEs, and nationwide interoperability networks. Creation of a longitudinal patient records will be unhindered by patient mismatches or varying transport standards, maximizing efficiency of care delivery and minimizing wasteful duplication. Finally, nationwide broadband and readily available devices for virtual care will remove access barriers and make high-quality care available to all, helping to create a world where everyone can reach his or her full health potential.
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