Now or Later

The October 19th edition of iHealthBeat is reporting that National Coordinator for Health IT David Blumenthal and Garth Graham -- HHS deputy assistant secretary for minority health -- asked health IT vendors for their help in preventing a "digital divide" involving health care providers who serve minority communities. Blumenthal and Graham called on vendors to make sure they target such health care providers in their marketing and sales campaigns They cited National Ambulatory Medical Care Survey data, which show low adoption rates of electronic health records among health care providers who serve primarily Hispanic patients who are uninsured or enrolled in Medicaid. In addition, Blumenthal and Graham wrote the data show that "EHR adoption rates among providers of uninsured non-Hispanic black patients are lower than for providers of privately insured non-Hispanic white patients." In addition Blumenthal and Graham also wrote that the Office of the National Coordinator for Health IT and regional extension centers need to cooperate and "focus substantial efforts on these priority populations"
While it is true that efforts must be taken to avoid creating or exacerbating healthcare disparities with the role out and adoption of Electronic Health Records (EHRs), it will take far more that marketing to prevent these potential digital disparities. Part of the reason we now have healthcare disparities is because we have generally employed a “one size fits all” approach to health care. It is a very healthcare system focused rather than patient focused approach to healthcare delivery. We may be about to make the same mistakes if we assume a “one size fits all” approach to EHRs. In order to build useable, safe and effective EHRs it is imperative to know the users. Minority and safety net providers have unique needs and perspectives for which current EHRs are poorly designed. In addition as EHRs increasingly include PHRs and are designed to function as tools to provide decision support for patients, EHR/PHR designers will have to do a better job of understanding the unique needs and perspectives of special populations including, racial and ethnic minorities, seniors and disabled populations. Involving end users in the design, testing and certification process of these tools is critical. As more and more care gets driven out of the hospital into homes and communities, in our efforts to reduce healthcare and insurance costs, healthcare outcomes will increasingly be impacted by factors in the homes and communities of the patients that historically have been ignored by the traditional healthcare system. As such home and community factors which impact the useability and accessibility of EHRs will need to be considered. We are at a critical time in the transformation of our healthcare system when we can enhance outcomes and improve patient engagement in their health by making the investments that are needed to design emerging EHR systems to meet the needs of diverse populations of patients and providers now or we can pay the ever increasing price of poor health outcomes, premature death, disability and health insurance costs for everyone…later.