Jacksonville University School of NursingInformation Management in HealthcareGroup 02 ProjectJune 9, 2013
I. Ability to Pay for Scarce Resources/Jennifer Dumakor Slides 6- 9 & 19II. Geographical location with limited access toClinical Specialists (remote and rural locations,war zones, etc.)/Mary Louise Dietrich Slides 11, 20-23III. Patient knowledge and education related tohealth and wellness (Medications, education,monitoring, etc.)/Sandra Anketell Slides 13, 24-25IV. Race/Ethnicity, Age, Religion, Sexual Orientation,and Gender/Shelia Varner Slides 15, 26V. Joint Participation All RemainingSlides
Healthcare Disparities are defined as “differences inhealth outcomes and their determinants between segments ofthe population, as defined bysocial, demographic, environmental, and geographicalattributes (Truman, Smith, Roy, Chen, Moonesinghe, Zhu, Crawford, andZaza, 2011, p. 3). As we now enter the world of Informatics, itis imperative for all of us to recognize the benefits afforded tous, related to reducing or eliminating such disparities.Informatics can provide a number of resources, services, andoptions for our patients impacted bysocial, demographic, economic, environmental andgeographical conditions. Informatics is the “equalizer” in thefight for healthcare equality.
How will Informatics impact Healthcare disparities relatedto: Ability to pay for scarce resources Geographical location with limited access to ClinicalSpecialists (remote and rural locations, war zones, etc.) Patient knowledge and education related to health andwellness (Medications, education, monitoring, etc.). Race/Ethnicity, Age, Religion, Sexual Orientation, and Gender
• The elderly• The disabled• Low income persons and/or those below thepoverty level• Those persons with limitededucation, skills, and/or knowledge• The disadvantaged
• Lack of ability to pay for healthcareinsurance and/or services• Discrimination related to socio-economicstatus and health status• Provider bias and ignorance related toinability to pay for services and/or perceivedlack of self-motivation, related to health andwellness• Inability to pay for transportation, to accesslarger institutions that have scarce resources.
• Resources are not available in rural orremote locations, such as: Specialists andclinicians, medical technology, medicalequipment, supplies, and telemedicine, etc.• Physical access may be limited, andpotentially dangerous, in areas that areimpacted by war, conflict, or physical andenvironmental disasters• Technological and physical access may belimited due to physical or politicalconstraints.• Lack of affordable transportation toclinics, physicians, and other healthcareproviders and resources
• Level of education attained by the patient• Availability of “special needs” educationalresources• Availability of medical and clinical resourcessuch as on-line, telephonic, printed, and on-site educational offerings and screenings• Lack of technology to support health andwellness education and training• Lack of clinical personnel toeducate, reinforce, and provide educationand workshops specific to health andwellness, as well as, related to specificdisease states inherent in the community orpopulation
“More than one-third of U.S. adults have trouble readingand understanding basic medical information” with 36% ofpatients, understanding at the basic to below basic levels.[Source: “The Health Literacy of America’s Adults: ResultsFrom the 2003 National Assessment of Adult Literacy,” U.S.Dept. of Education, National Center for EducationStatistics, September 2006 ]According to the Pew Internet and American Life Project, of3,014 adults interviewed on the phone, 59% have “gone onlinefor health information,” with 16% seeking support from“peers” (Fox, 2012).
• Lack of trust and understanding related tocultural, social, and religious practices• Lack of understanding related to newtechnology• Physical and mental limitations, such as:Mobility, vision, hand dexterity, and memory• Lack of resources related to translatedmaterials
• Overall poor health and lack of wellbeing• Evidence of chronic diseases such as:Diabetes, hypertension, obesity, arthritis, andother preventable health issues• A high level of stress that threatens the body’sability to ward off future disease and reduces theeffectiveness of the immune system• An increase in the cost of healthcare to deal withconditions that have progressed, due to aninability to treat such conditions in the earlystages, or to prevent such conditions in the firstplace
• A diminished workforce• Depression• Poverty and increased reliance on governmentalassistance• A decreased life expectancy rate• A high mortality rate
• Health Reform Activities-The Affordable Care Act , theAmerican Recovery And Reinvestment Act (2009), andMeaningful Use, focus on reducing healthcare disparitiesand setting national standards for performanceimprovement and positive patient outcomes.• Meaningful Use has set priorities as related to “patientengagement, reducing racial disparities, improvedefficiencies, increased safety, coordination of care, andmeasures to improve population health (Hebda &Czar, 2013, p. 280-281). These initiatives will electronicallymonitor, track, and trend patients, to determine necessaryresources and services for all patients, including theelderly, disabled and poor.
• The Health Resources and Services Administration definestelehealth as, “the use of technology to deliverhealthcare, health information, or health education at adistance (NCSL, n.d.). This technology, and its applicationto remote and rural locations, deliversinformation, services, and education to those that wouldotherwise not have such resources.• Telenursing can use technology to “deliver nursing care andconduct nursing practice,” for those with limited access toclinical services and advice (Schlachta-Fairfield, Elfrink, &Deickman, 2008, p. 558).• Other “tele” services are also available such as:Teleradiology , telemedicine, and telepharmacy (Schlachta-Fairfield, Elfrink, & Deickman, 2008, p. 558).
• The Health Resources and Services Administration definestelehealth as, “the use of technology to deliver healthcare,health information, or health education at a distance (NCSL,n.d.). This technology, and its application to remote andrural locations, delivers information, services, andeducation to those that would otherwise not have suchresources.• Telenursing can use technology to “deliver nursing care andconduct nursing practice,” for those with limited access toclinical services and advice (Schlachta-Fairfield, Elfrink, &Deickman, 2008, p. 558).• Other “tele” services are also available such as:Teleradiology , telemedicine, and telepharmacy (Schlachta-Fairfield, Elfrink, & Deickman, 2008, p. 558).
• Telerobotic surgery or Mobile Robotic Telesurgery(MRT), as it has been named, can provide a “surgical robotsystem in mobile settings and/or extreme environmentssuch as the battlefield or natural disaster areas withsurgeons operating wirelessly”(Lum, Rosen, King, Friedman, Donlin, Sankaranarayanan,Harnett, Huffman, Doarn, Broderick, & Hannaford, 2007, p.1).
• Healthcare Informatics can replace the traditionalinformational packets, group workshops and face-to-faceencounters, with a virtual classroom and/or remoteinteractions, for our patients.• Telehealth initiatives can provide “in-home caremanagement” via remote monitoring and data collection(Care Innovations, 2011-2013).• Smart phone applications can monitor a patient’s heartrhythm over the telephone (AliveCor, 2011-2013).• Systems are available to monitor medication occurrencesand events (AARDEX Group, n.d.)
• The Internet: The Internet is a great resource ofinformation. It is very accessible, even if you do nothave a computer of your own. Libraries and theworkplace may offer free use for Internet access.Sites may be geared to the specific needs of theclient, as related to: Culture, ethnicity, educationallevel, language, religion, just to name a few.• The Internet provides a forum with which to“network” with others that may have the samedisease or illness.• The Internet also provided information related tospecific diseases and illnesses, as well as, links tospecialists and clinical support.
• With advanced technology, a person with a physicaldisability, such as blindness, is able to utilize the technologythrough voice activation on computers.• In regards to lack of trust, Health Information Management(HIM) professionals can communicate safeguards to protectprivacy for various Personal Health Record (PHR) formats.HIM professionals are experts on privacy regulations andprocedures. HIM professionals can be active supporters indesigning PHR tools that are sensitive to low incomepopulations.Information technology can enable increased monitoring ofimportant clinical parameters among racial and ethnicminority patients. Patient sensor ("smart") technology canenable remote monitoring and direct delivery of patient data(Gibbons, 2011).
As healthcare professionals, it is up to us to help bridgethe gap related to healthcare disparities. There will be anumber of ways in which to narrow the gap: Healthcarereform legislation, technology, incentives, and education, toname just a few.Informatics provides us with a vehicle to transportinformation, services, education, remote technology, andtraining to those who have been without for so long. As welearn the advantages of informatics, we will be able todiscover new ways to address the disparities.As the focus becomes one of quality care, bestpractices, and positive patient outcomes, we must find waysto provide equal and efficient care for all of our patients.Affordable healthcare is one avenue on this journey.Informatics is the vehicle to help us reach our destination.