Health Information Technology: Addressing Health Disparity by Improving Quality, Increasing Access, and Developing Workforce

Health Information Technology: Addressing Health Disparity by Improving Quality, Increasing Access, and Developing Workforce Ricardo Custodio, MD, MPH (bio), Anna M. Gard, MSN, FNP-BC (bio), and Garth Graham, MD, MPH (bio) Evidence of racial and ethnic health disparities associated with socioeconomic differences is remarkably consistent across chronic illnesses and health care services. In 1985, the U.S. Dept. of Health and Human Services released the Secretary's Task Force on Black and Minority Health.1 This report was one of the first federal documents to highlight disparities in health and health care between the majority and racial and ethnic minority populations. Subsequent research demonstrates an increased burden of disease for our vulnerable homeless, impoverished rural, migrant, and public housing communities, which suffer greater morbidity and mortality than the general population.2 Health care reform efforts targeted toward these diverse underserved populations must capitalize on advances in health information technology (IT) and best practices. Health IT is a vital tool in achieving the goals of health care reform to increase health care access, improve care delivery systems, engage in culturally competent outreach and education, and enhance workforce development and training. The first national survey of federally funded community health centers shows that although 26% reported some electronic health record (EHR) capacity and 13% have the minimal set of EHR functionalities, the centers serving the most poor and uninsured patients were less likely to have a functional EHR system.3 Community health centers, free clinics and other safety net organizations aim to deliver evidence-based, patient-centered, culturally competent, efficient, high quality health care to underserved populations. Electronic health records can help the health delivery system achieve those goals. [End Page 301] The National Health IT Collaborative for the Underserved* was launched to ensure that health systems serving vulnerable populations are not lagging behind as health information technologies are developed and implemented. The vision for this collaborative is an interconnected public and private health system where all consumers have access to high quality, affordable care and to the information and technology resources required to maximize their health care services. The Health IT Collaborative has engaged more than 100 partners who are committed to one of four workgroups: Education and Outreach, Workforce Training, Advocacy and Policy, and Finance and Sustainability. The Association of Clinicians for the Underserved is most actively engaged in the Health IT (HIT) Workforce Training and Development Workgroup. Quality Improvement Electronic health records have a positive impact on quality of care, patient safety, and system delivery. Clinical decision support within the EHR system prompts clinicians on evidence-based recommended diagnostic and screening tests and immunizations for both primary prevention and chronic disease mangagement. This fosters equitable treatment for diverse populations by eliminating any potential racial or ethnic bias from the health care provider that might affect clinical judgment. Medication errors and adverse drug effects are reduced as the system displays recommended dosages and highlights drug interactions, allergies, and contraindications. The medication module provides formulary and cost information as well as generic alternatives to prescribed medication, which reduces cost for patient and insurer. Patients affected by medication recalls can be identified and notified quickly and easily through simple reporting methods, eliminating labor intensive paper chart reviews. Electronic health records serve as a centralized medical record available remotely to clinicians from multiple clinic sites, affiliated hospitals, or on call, which helps to minimize medical errors and duplication of efforts. The reporting function of the EHR enables performance monitoring for continuous quality improvement initiatives. Quality measures for prevention, risk factor screening, and chronic disease management are identified and evaluated to provide support for practice interventions and outreach initiatives. An electronic health record that includes documentation of demographics, including race and ethnicity, risk factor assessments, and preventive and chronic disease management decision support, enables the clinician to manage more effectively the complex health care needs of our vulnerable populations. [End Page 302] Education and Outreach Access to accurate organized data provides opportunites to perform targeted education and outreach services. Culturally appropriate health literacy education materials are embedded in many EHR systems and can be printed during patient visits. Clinicians can graph a patient's blood pressure measurement or weight for visual tracking of...