Informatics and healthcare disparities 2014


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How informatics can help reduce healthcare disparities

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Informatics and healthcare disparities 2014

  1. 1. Randy Cook, Robin Crowder, Carla Dalton
  2. 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. 3.  Financial concerns  Geographic  Literacy  Race  Cultural  Other reasons
  4. 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. 5. 20% of Americans live in rural areas while only 11% of physicians practice there.
  6. 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. 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. 8. “Eliminating racial and ethnic disparities in health will require enhanced efforts at preventing disease, promoting health and delivering appropriate care.” (OMHD, 2010).
  9. 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. 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. 11. “Informatics is the science and art of turning data into information.” (Hebda and Czar, 2013).
  12. 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. 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. 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. 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. 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. 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. 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. 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. 20. Safety , Quality, Efficiency, Education  Guidelines  Clinical reminders  Bridging communication gaps  Communication with consumer and other providers  Retrievable record  Social networking  Education
  21. 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.
  22. 22. ◦ 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.
  23. 23. 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
  24. 24.  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.
  25. 25.  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.
  26. 26.  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
  27. 27. 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
  28. 28. 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.
  29. 29.  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.
  30. 30.  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.
  31. 31.  Agency for Healthcare Research and Quality (AHRQ) found at  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: 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:  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:  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: [Plugin Software Help].  
  32. 32. Khan, K. (2011, August 19). Americans face barriers to health care beyond cost. Retrieved from 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 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: health-it-strategic-plan-0911.pdf DeBenedette, V. (2013, July 23). Unemployment linked to reduced use of preventive health care. Retrieved from use-of-preventive-healthcare Blais, K., & Hayes, J. (2011). Professional nursing practice: Concepts and perspectives. (6th ed., p. 122). Upper Saddle River, NJ: Pearson.
  33. 33.  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:  Office of Minority Health & Health Disparities. 2010.  "Mom's Son I" by Janne Nummela a_-_mom_s_son_i