mHealth Congress: Getting underserved communities up to health IT speed
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Providers from the Children’s National Medical Center in Washington, D.C., noticed that pediatric patients from certain areas of the city were less likely to have insurance, less likely to have a primary care provider and more likely to visit the emergency department. However, they didn’t necessarily require more emergency care than others.
Some of the problems these particular patients were presenting with “were so trite and simple that they didn’t need a doctor or nurse,” said David J. Mathison, MD, MBA, associate medical director of pediatric transport at the Children’s National and assistant professor at the George Washington University School of Medicine, which also is located in Washington, D.C. “The emergency room became a safety net where they went if they had a question or concern, particularly after hours.”
Most of the unnecessary visits were rooted in patients’ lack of medical knowledge, Mathison and his colleagues determined, so they began prescribing short educational videos targeted toward patients’ individual needs. “People who have asthma don’t want to know what asthma is,” Mathison said. “They want to know how to manage it.”
The videos are shot with mobile devices in mind and are generally around two minutes in length. While some panelists at the conference declared text-based initiatives better for reaching underserved communities, Mathison was unconvinced that underserved individuals didn’t have access to smartphones; a patient survey had found that 70 percent of respondents at least had a family member with a smartphone and 99 percent had an email account they checked at least once every two days.
Still in its infancy, the video prescription program seems to be producing results. About one-quarter of patients watched prescribed videos within 24 hours, patients generally reported high levels of satisfaction with the videos and emergency department visits appear to have dropped by half of a percent because of the program, which is a significant amount for an organization treating tens of thousands per year.
“For families, we are improving home care and population health; for providers we are improving service quality, education and operational efficiency; and for payers we may be reducing emergency department visits,” Mathison said.
While video prescriptions are helping in Washington, D.C., underserved communities nationwide are less likely to have access to digitized healthcare than others. Low income individuals and people of color are less likely to have a primary care provider using EHRs, according to Joyce M. Hunter, a founding member of the National Health Technology Collaborative for the Underserved (NHIT).
NHIT was formed to address this discrepancy and has since launched initiatives to bring health IT educational resources to providers in underserved communities and to connect them with regional extension centers. The organization has communicated with more than 3,000 providers since 2010. Some are receptive to the material and some aren’t, according to Hunter, but “our commitment is to leave no community behind.”