Electronic health records and health disparities: Can one help us solve the other?
“There are risks and costs to a program of action. But they are far less than the long-range risks and costs of comfortable inaction.”
John F. Kennedy
In the last several years, the gaps in racial and ethnic health care and health outcomes have been widely reported. However, these reports are using data that’s tells only one part of the story. A recent Institute of Medicine Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality report emphasizes that inadequate data on race, ethnicity, and language lowers the likelihood of effective actions to address health disparities. Increased diversity in our population requires more thoughtful use of data to monitor disparities and target public health programs.
Collecting uniform racial and ethnicity data can help us do this.
While this is not the only solution, it will help us to link collected data to quality measures. That will allow health advocates to effectively create and target projects to reduce inequalities where we find them.
One important piece in this equation is electronic health records (EHRs). EHRs used in a meaningful way can be an effective tool to enhance health quality and close health gaps. EHR systems can help clinicians make more informed decisions and diagnoses. For instance, in some systems, there are prompts that guide doctors on evidence-based recommended diagnostic and screening tests and immunizations for primary prevention and chronic disease management among specific populations. EHR’s can help advance fair treatment for populations of color by eliminating potential racial or ethnic bias from the health care provider that may affect clinical judgment. EHRs may also provide the capability for providers to analyze population health data that will allow providers to pinpoint underserved communities on which to focus quality improvement efforts.
True, health information technology (HIT) holds the potential to improve the quality, safety, and equity of health care; but it also has the potential to unintentionally increase disparities. HIT is a vital tool in achieving two of the chief goals of health care reform: increased health care access and improved health care delivery systems. The populations at risk for increased disparities are the very populations that are disproportionately served by safety-net providers that are often unaffiliated with health care systems. Providers falling into this category would include solo practices, rural practices and those providers who mostly serve the uninsured and those on Medicaid. There are numerous up-front and on-going costs associated with the transition to an EHR system and these providers are less likely to be able to afford HIT or to have the supports necessary to implement and maintain them.
As with all technology, there are benefits and risks associated with the widespread adoption of EHR technology in our health care system. A system that provides physicians with “decision support” tools, such as clinical guidelines and checks for drug interactions, and generates printed post-visit summaries for patients, is a good thing. But if clinicians who predominantly serve populations where health disparities already exist cannot afford to take part in this brave new electronic world, and we create an additional digital divide: we have done ourselves and those populations a disservice by once again allowing the health care system to move forward without them.
For providers and health care systems that can afford to switch to EHRs and maintain them, the EHRs have the potential to facilitate communication between patients and their health care providers. This also can give patients on-line access to test results, prescription refills and patient education information. But if not thoughtfully implemented, HIT could make a bad problem worse. If health literacy, the patient’s preferred language, and access to needed technology and technical support for providers are not addressed, we could unintentionally increase the impact that health disparities currently have on our health care system.
The transitions taking place in our health care system are exciting ones that offer the promise of better care, better outcomes, and better communication between patients and clinicians. All members of our society deserve the opportunity to see that promise fulfilled in their lives. Today, we’re at the beginning of that journey of making that happen. Where the journey leads, however, will require the input and insights of all of us.
The opinions and views expressed in this blog and/or comments are those of the author(s) and do not reflect any position of the Center or the University.
