How informatics can help reduce healthcare disparities

1. Randy Cook, Robin Crowder, Carla Dalton

2. The Health Resources and Services
Administration defines health
disparities as "population-specific
differences in the presence of
disease, health outcomes, or
access to health care."

3.  Financial concerns
 Geographic
 Literacy
 Race
 Cultural
 Other reasons

4. The Center for Advancing Health reports that 19% of
adults postpone care for financial reasons such as lack
of insurance or inability to pay.
21% of adults postpone healthcare for nonfinancial
reasons.
• scheduling conflicts
• inability to get time off work
• lack of child care
• transportation difficulties
• long wait times to see a provider

5. 20% of Americans live in
rural areas while only
11% of physicians
practice there.

6.  Rural populations have
disproportionately more chronic
illnesses than urban residents.
 Healthcare is limited by poor
infrastructure and fewer practitioners.
◦ Less access to preventative medicine
◦ Limited availability of wellness
programs. (HHS 2011)

7.  Hispanics in the United States are more likely
to die from diabetes than non-Hispanic
Whites.
 African Americans, Native Americans and
Alaska Natives have higher infant mortality
rates than Whites.
 African Americans have higher death rates
from heart disease, cancer, HIV/AIDS and
homicide than Whites. (Blais & Hayes, 2011).

8. “Eliminating racial and ethnic
disparities in health will require
enhanced efforts at preventing
disease, promoting health and
delivering appropriate care.”
(OMHD, 2010).

9.  People with higher education and income
have lower rates of heart disease, diabetes,
obesity and infant mortality.
 People with higher education and income
seek preventive care more frequently than
people

10. Poor infrastructure
◦ Lack of reliable computing and storage
Cost
◦ Clinicians and administrators may fear budget
disasters and lost productivity
Interoperability
◦ Systems do not exchange data seamlessly
Computer illiteracy among clinicians
◦ Some clinicians are not comfortable with new
technology

11. “Informatics is the science
and art
of turning data into
information.”
(Hebda and Czar, 2013).

12. “An EHR is a digital version of
patient data found in traditional
paper records.” (Hebda and Czar,
2013). Ideally, the EHR contains a
running record of all healthcare
encounters.

13. Meaningful Use
Meaningful use (MU), in a health information
technology (HIT) context, defines the use of
electronic health records (EHR) and related
technology within a healthcare organization.

14. .
 Stage 1:
Meaningful use criteria focus on:
 Electronically capturing health information in a
standardized format
 Using that information to track key clinical
conditions
 Communicating that information for care
coordination processes
 Initiating the reporting of clinical quality
measures and public health information
 Using information to engage patients and their
families in their care

15.  Stage 2:
Meaningful use criteria focus on:
 More rigorous health information exchange
(HIE)
 Increased requirements for e-prescribing and
incorporating lab results
 Electronic transmission of patient care
summaries across multiple settings
 More patient-controlled data

16.  Stage 3:
Meaningful use criteria focus on:
 Improving quality, safety, and efficiency,
leading to improved health outcomes
 Decision support for national high-priority
conditions
 Patient access to self-management tools
 Access to comprehensive patient data
through patient-centered HIE
 Improving population health

17.  According to the ASTM E1384 Standard Guide
for Content and Structure of the Electronic
Health Record 1 the EHR serves all of the
functions of the traditional health record with
many advantages. Some of these advantages
include:
 a unified repository of healthcare information
 information that is accessible from multiple
sites
 more efficient communication between
healthcare providers

18.  cross-patient retrievals will provide statistics
needed by clinical, outcomes, and health
service researchers as well as administrators
and managers
 better defined policies and procedures to
improve healthcare practice
 a longitudinal health record that can be
developed more efficiently and effectively

19. Medicare and Medicaid EHR Incentive
Programs
The Medicare and Medicaid EHR Incentive
Programs will provide EHR incentive payments
to eligible professionals (EPs) and eligible
hospitals as they adopt, implement, upgrade,
or demonstrate meaningful use of certified
electronic health record (EHR) technology.

20. Safety , Quality, Efficiency, Education
 Guidelines
 Clinical reminders
 Bridging communication gaps
 Communication with consumer and other
providers
 Retrievable record
 Social networking
 Education

21. Agency for Healthcare Research and Quality (AHRQ)
Measure trends in effectiveness of care, patient
safety, timeliness of care, patient centeredness,
and efficiency of care.

23. ◦ Few disparities in quality of care related to race,
ethnicity, or income showed significant
improvement, although the number of disparities
that were getting smaller typically exceeded the
number of disparities that were getting larger.
◦ Disparities that were getting smaller include
differences between Hispanics and non-Hispanic
Whites in rates of admission for congestive heart
failure. Disparities that were getting larger
include differences between Blacks and Whites in
rates of advanced stage breast cancer.

25. The Affordable Care Act requires that all
federally funded health programs and
population surveys collect and report data
on race, ethnicity, sex, primary language,
and disability and supports use of data to
analyze and track health disparities

26.  The AMA has encouraged physicians to examine
their own practices to ensure equality in medical
care.
 The AMA has created a program on health
disparities to coordinate many of the AMA's
activities in science, ethics, and medical
education addressing the issue.
 The AMA has extensive AMA's Principles of
Medical Ethics, used to define ethical and
professional behavior for physicians.
 The AMA is involved in ongoing efforts to
increase the number of minority physicians so as
to reflect the diversity of the US population.

27.  The AMA's House of Delegates reaffirmed our
commitment to minority health care by making
the elimination of racial and ethnic health
disparities an issue of high priority.
 The AMA is partnering with the AMA Foundation
to help physicians become aware of and
appropriately manage low health literacy among
patients.
 Educating Physicians on Controversies in Health
(EpoCH) is a series of brief informational Web
streaming programs—developed by the AMA—
targeting primary care physicians.

28.  Examples of successes
 Affordable Care Act
 American Medical Association commitment
 AHRQ focus & data element changes
 Enabled Research
 Community Ministries of Rockville (CMR)
 Mobil Medical Care (MobileMed)
 Primary Care Coalition (PCC)
 World Wide Assistance (WWA)
 Regional Minority Prevention Network - George Washing
Cancer Institute (GWCI)
 ProstateNet
 Health Disparity Conference

29. Quality Improvement strategies, better
outcomes
 Integration of fragmented fields
 Forging public and private partnerships
 Prevention
 Necessary educational and training tools
 Partnering with communities
Utilizing community organizations

30. Summary and Conclusion
 Researchers have found that some populations,
including certain racial and ethnic groups, limited
English proficient persons, people with
disabilities, and the elderly, are
disproportionately affected by barriers which
prevent or decrease access to healthcare
services. In addition, there are measurable
differences in the use of healthcare services and
the quality of healthcare services received among
various population groups.

31.  We need to improve access to care, reduce
disparities, and accelerate the pace of quality
improvement, especially in the areas of
preventive care and safety.
 More data are needed to assess progress in
care coordination and efficiency. Information
needs to be shared with partners who have
the skills and commitment to change health
care.

32.  Building on data stakeholders can design and
target strategies and clinical interventions to
ensure that all patients receive the high-
quality care needed to make their lives better.

33.  Agency for Healthcare Research and Quality (AHRQ) found at
http://www.ahrq.gov/research/findings/nhqrdr/nhqr12/highlights.html
 Andrulis DP, Siddiqui NJ, Purtle JP, et al. Patient Protection and Affordable Care Act of
2010: advancing health equity for racially and ethnically diverse populations.
Washington, DC: Joint Center for Political and Economic Studies; 2010. Available at:
http://www.jointcenter.org/research/patient-protection-and-affordable-care-act-of-
2010-advancing-health-equity-for-racially-and .
 HHS action plan to reduce racial and ethnic health disparities. Washington, DC: U.S.
Department of Health and Human Services; 2011. Available at:
http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285.
 Office of Minority Health. Explanation of data standards for race, ethnicity, sex, primary
language, and disability. Washington, D.C.: U.S. Department of Health and Human
Services; 2011, Available at:
http://minorityhealth.hhs.gov/templates/content.aspx?ID=9228&lvl=2&lvlID.
 U.S. Department of Health and Human Services. 2012 annual progress report to
Congress: national strategy for quality improvement in health care. Washington, DC:
HHS; 2012. Available at:
http://www.ahrq.gov/workingforquality/nqs/nqs2012annlrpt.pdf [Plugin Software Help].
 http://healthinformatics.wikispaces.com/Health+disparity
 http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-
health-disparities.page

34. Khan, K. (2011, August 19). Americans face barriers to health care beyond cost. Retrieved
from http://www.cfah.org/hbns/2011/americans-face-barriers-to-health-care-beyond-
cost
Fiscella, K., & Williams, D. (2004). Health disparities based on socioeconomic inequities:
Implications for urban health care. Academic Medicine, 79(12), 1139-1147. Retrieved from
http://journals.lww.com/academicmedicine/Fulltext/2004/12000/Health_Disparities_Base
d_on_Socioeconomic.4.aspx
U.S. Department of Health and Human Services, Office of the National Coordinator for Health
Information Technology. (2011). Federal health information technology strategic plan.
Retrieved from website: http://www.healthit.gov/sites/default/files/utility/final-federal-
health-it-strategic-plan-0911.pdf
DeBenedette, V. (2013, July 23). Unemployment linked to reduced use of preventive health
care. Retrieved from http://www.cfah.org/hbns/2013/unemployment-linked-to-reduced-
use-of-preventive-healthcare
Blais, K., & Hayes, J. (2011). Professional nursing practice: Concepts and perspectives. (6th
ed., p. 122). Upper Saddle River, NJ: Pearson.

35.  U.S. Department of Health and Human Services. 2011 policy brief: Reducing health
disparities in rural America: Key provisions in the affordable care act; Washington, DC:
HHS; 2011. Available at:
http://www.hrsa.gov/advisorycommittees/rural/publications/healthdisparities.pdf
 Office of Minority Health & Health Disparities. 2010.
http://www.cdc.gov/omhd/About/disparities.htm
 "Mom's Son I" by Janne Nummela
http://freemusicarchive.org/music/Janne_Nummela/Kosmoskalevala/05_janne_nummel
a_-_mom_s_son_i