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csanders

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May 8, 2013 8:07 pm

If diverse and underserved patients are to gain meaningful access to, and meaningfully use, their electronic health information, that health information must be available in “human readable AND useable formats”, including appropriate health literacy and numeracy levels, languages in addition to English, and formats appropriate for individuals with visual impairments and physical disabilities. The principle of using and making available multiple formats and channels for all electronic communication of health information must be a standard requirement for all patient-facing heath IT. For example, electronic copies of clinical summaries, care coordination documents, and discharge summaries will not be accessible or meaningful without alternate and multiple formats. Sending appointment reminders… more »

…by email in English to individuals who do not speak English as a primary language, or do not have low- or no-cost internet access will be ineffective. If these requirements are not explicit, then the implementation of health IT will only INCREASE disparities experienced by diverse and underserved patients and communities.

ONC should also work with other federal agencies such as the Federal Communications Commission to address and reduce digital divide issues (including the availability and cost of internet and broadband access, and data costs for mobile/smart phones) for racial and ethnic minorities, limited English proficient individuals, seniors, those living in rural areas, and individuals with disabilities.
-California Pan-Ethnic Health Network

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May 8, 2013 8:09 pm

Health IT cannot be accessed or used without appropriate electronic communications technologies, including email, texting, telephonic interactive voice response technologies, telehealth, remote electronic monitoring tools, etc. For example, a limited English proficient individual will not be able to schedule a medical appointment or request a prescription refill online if the patient website/portal and instructions are only in English. The principle of using and making available multiple formats and channels for all electronic communications must be a standard requirement for all patient-facing heath IT. All electronic health information must be available in “human readable AND useable formats”, including appropriate health literacy and numeracy levels, languages in addition to English,… more »

…and formats appropriate for individuals with visual impairments and physical disabilities. If these requirements are not explicit, then the implementation of health IT will only INCREASE disparities experienced by diverse and underserved patients and communities.
-California Pan-Ethnic Health Network « less
May 8, 2013 8:09 pm

While ONC is to be commended for its activities to raise awareness and educate health consumers about the benefits of health IT, much more outreach and education is needed in diverse and underserved communities, especially among racial and ethnic minorities, limited English proficient individuals, seniors, those living in rural areas, and individuals with disabilities. Many of these populations have experienced historical barriers to high quality health care and have legitimate issues of mistrust of both health care providers (who often excluded them or discriminated against them in the provision of care) and the federal government. Tailored and community-based outreach, education, and engagement with these populations is essential to achieving the full potential of health IT to support the improved health of all Americans.
-California Pan-Ethnic Health Network

May 8, 2013 8:11 pm

There is increasing awareness of the importance of the social determinants of health in improving one’s health status and the health of a population. While it is not realistic or feasible for an electronic health record (EHR) to document structured data that would address some of the social determinants of health, EHRs could and should document a comprehensive health assessment (including social and cultural factors) and contain up-to-date, locally relevant community resources list. In addition, there could be stronger linkages between these two elements, such as requiring those community resource lists to identify, and providers to make referrals to, supportive and emergency housing options for homeless individuals when homelessness is identified in a health assessment.

Similarly,… more »

…the primary language data now collected in EHRs is vastly under-utilized. That data should alert the provider to the need for language assistance in all encounters (including referrals and follow-up) and translations for all written communications.
- California Pan-Ethnic Health Network « less
May 8, 2013 8:12 pm

There are almost no tools to support shared decision-making that are culturally and linguistically appropriate. At most, some tools have been translated into Spanish but are not available in any other languages. Since shared decision-making also requires consideration of cultural beliefs, attitudes, and norms about health and health care, it is especially vital that the tools are not simply translated from English but address the specific cultural factors relevant to diverse and underserved populations. ONC can partner with and encourage OMH, AHRQ, NIH, and the Patient-Centered Outcomes Research Institute to prioritize and fund the development and validation of shared decision-making support tools that are culturally and linguistically appropriate for diverse and underserved populations.
-California Pan-Ethnic Health Network

May 8, 2013 8:13 pm

Health IT has the potential of decreasing disparities if appropriately leveraged. For example, data demonstrates that African Americans and Latinos access the internet through their mobile phones at higher rates than other populations. Accordingly, health IT directed at, or for use by, African Americans and Latinos should use text messaging and mobile applications as much as websites and email. Similarly, there are online and mobile applications that are readily available and used in many languages other than English. If these online and mobile communications and information technologies are not used for heath IT, then the digital divide and disparities will only INCREASE rather than decrease.

If health information can be accessed and used by diverse and underserved populations who experience… more »

…the greatest health disparities, then they can be more informed, engaged, and empowered health consumers that become activated and more proactive partners in their own health care plan, and maintenance or improvement of their own health status.

Finally, at a population and public/community health level, having more data and health information about a population can identify specific local disparities and prioritize interventions to reduce those disparities. However, it is essential that demographic information about patient race, ethnicity, language and other factors such as disability status, sexual orientation, and gender identity continue to be collected AND all quality data be stratified by each of those demographic characteristics to identify and reduce disparities. In terms of race and ethnicity, further granular disaggregation, as recommended by the Office of Minority Health under its Affordable Care Act section 4302 standards, and further recommended by the Institute of Medicine in its 2009 report “Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement” should be implemented through health IT, including all ONC-certified EHRs and all health information exchanges.
-California Pan-Ethnic Health Network « less

May 8, 2013 8:15 pm

Many new health care delivery models such as the patient-centered medical home and accountable care organizations rely on the platform of health IT. If the digital divide and access barriers for diverse and underserved populations are not addressed and reduced, then the continued implementation of these models will only INCREASE disparities in health care and health. At the same time, the “safety net” hospitals, physicians, community health centers, pharmacists, labs, and other health care providers for these diverse and underserved populations often have the least capacity and resources to implement health IT and are among the slowest adopters of health IT. As these new health care delivery models continue to be implemented, it is vital that ONC and its federal partners continue to… more »

…monitor, and provide financial and technical assistance support, for the actual adoption of health IT by these safety net providers.
-California Pan-Ethnic Health Network « less
May 8, 2013 8:16 pm

Health IT has the potential to vastly expand data available for health services research and quality improvement by making available more comprehensive, real-time, population-level and community-level clinical data available for analyses. Aggregation of data from all local providers in a geographic service area is possible with health information exchange capacities. In order for health IT to enable research and inform clinical practice improvement that reduces disparities, all quality data must be stratified by patient race, ethnicity, language and other factors such as disability status, sexual orientation, and gender identity. These demographic data elements must continue to be included in any aggregation of the data from multiple providers and sources. In terms of race and ethnicity,… more »

…further granular disaggregation, as recommended by the Office of Minority Health under its Affordable Care Act section 4302 standards, and further recommended by the Institute of Medicine in its 2009 report “Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement” should be implemented through health IT, including all ONC-certified EHRs and all health information exchanges.
-California Pan-Ethnic Health Network « less