Health information technology remains an untapped opportunity with great promise for reducing disparities in healthcare delivery and outcomes in the clinical environment.
That’s the contention of 12 original research papers and five editorials and commentaries published in the June supplement to the journal Medical Care.
The supplement, supported with funding from the National Institute on Minority Health and Health Disparities, is based in part on presentations made at an NIMHD-funded workshop in collaboration with the National Science Foundation and the National Health IT Collaborative for the Underserved.
“Health IT tools such as EHRs, patient portals, patient-monitored health behaviors and clinical decision support (CDS) systems may yield population health benefits for underserved populations by enhancing patient engagement, improving implementation of clinical guidelines, promoting patient safety and reducing adverse outcomes,” according to an editorial by NIMHD Director Eliseo Pérez-Stable, MD, with NIMHD Health Scientist Administrator Beda Jean-Francois and NIMHD Chief of Staff Courtney Ferrell Aklin.
The authors contend that “EHRs should provide a platform for improved documentation of social determinants of health using standardized terminology and methods of ascertainment,” while the “availability of real-time actionable patient data, clinical care coordination and decision support enabled by health IT tools may also reduce disparities in quality of care for underserved populations.”
For example, an observational study published in the Medical Care June supplement shows how an EHR-based model—developed by researchers at Boston Medical Center—was able to gather social determinants of health information to screen primary care patients for unmet needs.
The model leverages a one-page screener that patients fill out in the waiting room before their appointment, and—based on that input—the EHR prompts providers to address any SDOH concerns raised by patients during the appointments.
“The potential is great in actually helping to decrease health disparities if it’s done correctly,” observes Courtney Ferrell Aklin, chief of staff at NIMHD. “The opportunity is there, but we need to make sure that we’re mindful of how we go about using healthcare IT and ensure that we are using it for the benefit of all.”
While African Americans and Latinos have a higher rate of use of mobile technology than their white counterparts, she notes that minorities lag behind when it comes to the use of patient portals in EHRs.
“As a result, we could see an increase in health disparities instead,” adds Aklin. “What we haven’t done is the research to have enough data to figure out how to mitigate those efforts.”
More research is needed to “investigate the potential unintended consequences of health technologies, such as identifying barriers that prevent the uptake and engagement with EHRs by medically underserved patients, develop effective approaches and models to deliver CDS in safety net clinical settings, and implement and evaluate the best models for the inclusion and utility of social determinants of health in order to advance health equity for racial and ethnic populations,” according to Aklin and her colleagues.