Study: Racial disparities must be overcome with health IT
The U.S. healthcare system is not well designed to provide equitable care, as evidenced by the prevalence of disparities in care by race, ethnicity, language and social status, according to a study in the October issue of The Joint Commission Journal on Quality and Patient Safety. “As the United States invests in the design and implementation of health IT, consideration must be given to the impact that these innovations have on the quality and cost of healthcare for all patients, including those who experience disparities,” wrote the study authors.
Racial and ethnic disparities in healthcare have been consistently documented in the diagnoses, treatment and outcomes of many common clinical conditions, wrote Lenny Lopez, MD, MPH, assistant in health policy at Mongan Institute for Health Policy, Massachusetts General Hospital in Boston, and colleagues.
The authors noted that despite a generally low level of implementation, there have been demonstrated improvements in quality of care and patient safety, adding that the careful design and implementation of health IT also have the potential to eliminate disparities. Lopez and colleagues stated that examples of improvement have been noted in the reduction of medical errors, increased adherence to clinical guidelines and protocols and enhanced adherence to preventive measures in the hospital setting.
According to the authors, to truly make the greatest difference, health IT systems need to be designed with components that focus on the identification and elimination of disparities from the start and tailored to the needs of diverse populations.
There are numerous root causes for disparities including limited race/ethnicity data collection, limited patient language data collection, lack of linkage to linguistically appropriate services, lack of trust in the medical system and limited English proficiency on the patient’s side, according to the authors.
Lopez and colleagues offered several recommendations regarding the healthcare system, provider and patient factors can help healthcare organizations address disparities as they adopt, expand and tailor their health IT systems. In terms of healthcare system factors, organizations should:
“Development of a health IT infrastructure should address disparities in care from the start,” the authors concluded. “Health IT alone will not eliminate disparities, but as we harness its full potential to improve quality, we should ensure that disparities are not simply an afterthought for health IT. Only a thoughtfully designed and implemented health IT system will be capable of improving health care quality for all—and in the process address disparities in healthcare.”
In an accompanying editorial, Adil H. Haider, MD, MPH, and Peter J. Pronovost, MD, PhD from Johns Hopkins University School of Medicine in Baltimore, wrote that disparities in healthcare are a complex problem with contributing factors found both within and beyond the healthcare system. “It is time that healthcare confronts the factors that it [can] control."
They noted that the place to start is making disparities in quality by race, ethnicity and primary language transparent, a task that can be accomplished by Lopez et al’s recommendation of automation and standardization of the collection of this data.
“As health IT is adopted and expanded at healthcare organizations throughout the U.S., Lopez and colleagues’ five recommendations offer a comprehensive approach to using health IT to identify disparities and tailor culturally competent quality improvement initiatives,” they concluded.
Racial and ethnic disparities in healthcare have been consistently documented in the diagnoses, treatment and outcomes of many common clinical conditions, wrote Lenny Lopez, MD, MPH, assistant in health policy at Mongan Institute for Health Policy, Massachusetts General Hospital in Boston, and colleagues.
The authors noted that despite a generally low level of implementation, there have been demonstrated improvements in quality of care and patient safety, adding that the careful design and implementation of health IT also have the potential to eliminate disparities. Lopez and colleagues stated that examples of improvement have been noted in the reduction of medical errors, increased adherence to clinical guidelines and protocols and enhanced adherence to preventive measures in the hospital setting.
According to the authors, to truly make the greatest difference, health IT systems need to be designed with components that focus on the identification and elimination of disparities from the start and tailored to the needs of diverse populations.
There are numerous root causes for disparities including limited race/ethnicity data collection, limited patient language data collection, lack of linkage to linguistically appropriate services, lack of trust in the medical system and limited English proficiency on the patient’s side, according to the authors.
Lopez and colleagues offered several recommendations regarding the healthcare system, provider and patient factors can help healthcare organizations address disparities as they adopt, expand and tailor their health IT systems. In terms of healthcare system factors, organizations should:
- Automate and standardize the collection of race/ethnicity and language data;
- Prioritize the use of the data for identifying disparities and tailoring improvement efforts;
- Focus health IT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients;
- Develop focused computerized clinical decision support systems for clinical areas with significant disparities; and
- Include input from racial/ethnic minorities and those with limited English proficiency in developing patient health IT tools to address the digital divide.
“Development of a health IT infrastructure should address disparities in care from the start,” the authors concluded. “Health IT alone will not eliminate disparities, but as we harness its full potential to improve quality, we should ensure that disparities are not simply an afterthought for health IT. Only a thoughtfully designed and implemented health IT system will be capable of improving health care quality for all—and in the process address disparities in healthcare.”
In an accompanying editorial, Adil H. Haider, MD, MPH, and Peter J. Pronovost, MD, PhD from Johns Hopkins University School of Medicine in Baltimore, wrote that disparities in healthcare are a complex problem with contributing factors found both within and beyond the healthcare system. “It is time that healthcare confronts the factors that it [can] control."
They noted that the place to start is making disparities in quality by race, ethnicity and primary language transparent, a task that can be accomplished by Lopez et al’s recommendation of automation and standardization of the collection of this data.
“As health IT is adopted and expanded at healthcare organizations throughout the U.S., Lopez and colleagues’ five recommendations offer a comprehensive approach to using health IT to identify disparities and tailor culturally competent quality improvement initiatives,” they concluded.