Diversity extends beyond race, gender and ethnicity.
It includes age, sexual orientation, and different cultural and religious backgrounds.
It includes the chronically ill, unemployed individuals and those with unstable housing.
As such, health care needs might to go beyond the obvious and not be limited to the doctor’s office.
Expanded use of information technology has helped improve outcomes for these populations, but are there unmet gaps still?
Panelists examined the benefits and challenges of healthcare IT, particularly for smaller health care providers serving diverse communities, on the Health Law Section Annual Meeting webinar, “Diversity in Health Care, Including Using EHRs to Improve the Health of Diverse Populations.”
IT and diverse populations
Veda M. Collmer, Esq. (WebPT, Inc.) said that effective healthcare delivery accounts for a 360-degree perspective of the patient.
“Use of information technology helped advance providers’ ability to focus on non-medical factors with the triple aim goals of improving the patient experience, improving population health and reducing health care cost,” said Collmer.
A key component of the shift from volume to value-based care has the been the widespread use of electronic health records (EHR), which began in academic settings. Now, they are used in all settings from hospitals and clinics to nursing homes, but it has not been easy nor inexpensive.
“Adoption of effective use of electronic health records and health IT requires financial resources, technology resources, providers training and connections with other health IT systems,” said Collmer. “Providers must use the resources in the right way. More policies are needed to provide financial support and tech support or physician practices and ambulatory centers serving vulnerable populations to maintain interoperability systems.”
There have been federal and state laws promoting electronic health records and IT adoption, such as the The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, to promote the adoption and meaningful use of health information technology.
She noted that smaller practices, particularly those that tailor to vulnerable populations, could not financially afford the electronic health records. There were limited to no incentive programs for EHR adoption and technical support for other providers serving vulnerable populations, such as social workers, behavioral health and occupational therapists.
Collmer said that there are still many policy gaps for value-based care using electronic health information in practices that treat diverse populations. More policies are needed to provide financial support for proper IT training, as well as policies that mandate data sharing and privacy practices.
According to Dr. Homer Venters, M.D. (New York University College of Global Public Health), who travels across the country to assess jails and facilities, there are three principles to protecting the health of those in the justice system: quality, accountability and population health.
In correctional facilities and immigration detention centers, he said “There is actually very little measurement of quality and very little measurement of whether or not what is supposed to happen really happens.”
“The way that correctional health facilities are designed and operated are really wanting and have a grossly deficient standard of care and use,” said Venters.
Most health systems in jails, he explained, are part of a security service. “The health service in a jail works for the sheriff. The health service in a prison works for the prison commissioner. ICE detention reports to ICE.”
There is not a real value placed on transparency, said Venters. “Electronic medical records (EMR) implementation isn’t detailed the way it is in the community. That is critical to quality.”
Likewise, he said, that there is not a great demand for more transparency. “To the contrary, transparency is viewed as a threat to litigation.”
Venters said the EMR was the most potent way to think about population health, in terms of risks and safety. “It is a toll that allowed us to advance human rights.”
These records provided a better look at the relationship between solitary confinement and suicide and self-harm in jails. They showed that those in solitary confinement were seven times more likely to harm themselves.
“I have always viewed these tools as integral to not just providing better care but to documenting the health risks that these systems confer to the people that pass through them,” said Venters.
But the best system in the world won’t matter without buy-in from the community.
“If you have better information systems, but the sheriff in the county jail doesn’t care about addressing the problem, then it doesn’t get addressed,” said Venters. “It doesn’t help people at all.”
Venters remained optimistic. “I think we have a shot to make the technological innovation result in better health outcomes.”
Other panelists were Thomas Moore (Healthix, Inc.) and moderator Lillian P. Mosley (Community Service Society of New York).