Feds target HIT for Disparities

Reducing Disparities in Health Care Quality in Underresourced Settings Using Health IT Strategies
In October 2009, the Agency for Health Research and Quality (AHRQ) convened a small group of researchers, policymakers, and experts in health IT and health care disparities. The goal was to inform AHRQ’s short- and long-term research and action strategies to reduce disparities while improving health care quality, with a specific focus on the potential for using health IT as a tool in underresourced health care delivery settings. Meeting the pressing needs for health care quality improvement within an increasingly diverse U.S. population will require clear strategies and close collaboration with private and public stakeholders
Among the participants were representatives from Federal agencies, a State rural health agency, health services researchers with expertise in quality improvement and disparities reduction, patient advocates, provider organizations representing potentially underresourced health care delivery settings (URS), employer groups, and other organizations. URS were loosely defined for purposes of the meeting and papers, but are generally considered to be settings that provide care for people who have insurance with low reimbursement rates or those who have no insurance, thus leading to a relatively low level of resources to make the required capital and human resource investments (http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hserta&part=A210093).
Participants identified three main areas of consideration for reducing disparities in URS through improved health IT infrastructure: Experts noted the importance of applying a multifaceted approach that recognizes and preserves cultural sensitivity. Participants emphasized the importance of thinking across providers, patients, and communities to develop health IT to connect and improve care for all three. Efforts to apply health IT to reducing disparities should focus on developing strategies or studies that encompass integration and collaboration across agencies as well as partnering with the private sector (e.g., foundations), especially considering medical home initiatives. Implementers should consider social determinants of health as an integral issue because many URS are an integral part of wider neighborhoods. Meeting participants suggested that research into using health IT to reduce disparities should be conducted with increased rigor using the lenses of patient-centeredness and health care provider teamwork. Participants also identified the following specific research needs: 1) Increasing patient empowerment using health IT. 2) Using tools that are already in place (e.g., New York City was provided as an example). 3) More testing of electronic medical records in URS serving priority populations. 4) Examining technology development and policy 5) Understanding what's needed for maintenance once the IT is in place. 6) Applying the business case. 7) Exploring the role of disease registries. Meeting participants identified the need for greater understanding in the following areas: A) How social and environmental contexts in URS and communities they serve affect effective implementation. B) How to assess the needs of solo, small, Medicaid, or uninsured dominant practices and providers in other URS. C) Identify how small, solo, and underresourced practice providers can use their networks to increase effective health IT implementation. D) How to assess the health care needs diverse patients who receive services in URS.
Participants stressed the need for designing health IT with the users in mind. The communication aspect of health IT development is becoming increasingly important in health care, since patients are being discharged from hospitals quickly after procedures. Patient or consumer characteristics and needs should drive the development of health IT, given its utility in helping the patient's family take over the care of the patients. Participants noted that health IT should be available, engaging, vivid, easy to use, informative, and affordable, particularly when managed care plans are able to absorb the cost. Participants recommended developing broader strategies (as well as health IT studies that address social networking sites such as Facebook™ and Twitter™ among consumers or patients) that also encompass disparities reduction and improving quality in nonmedical settings such as the home. Finally, valid and reliable measures of various patients' experiences with health-related communications are needed as well as studies on improving health IT incentives for provider-patient communications between visits. The goal of health IT should be to get doctors, patients, and organizations to "do the right thing".