On August 26th, the Consumer Partnership for eHealth, a coalition of more than 50 consumer, patient and labor organizations published an evidence-based action plan for leveraging meaningful use stage 3 to reduce health disparities.
With EHR adoption moving past the tipping point the coalition feels this is the perfect opportunity to build an optimized health IT infrastructure that will reduce health care disparities resulting in a healthier population.
According to Debra L. Ness, National Partnership for Women & Families,
“it’s impossible to achieve better health outcomes and significantly reduce health care costs without tackling health disparities, which are a pervasive and costly problem. We have the chance to leverage Stage 3 of the Meaningful Use program to make significant progress in addressing disparities. We must not squander this opportunity. CPeH has created a bold, yet achievable, path forward for including criteria in Stage 3 that will begin to reduce disparities and, in doing so, help us achieve patient- and family-centered care, better outcomes, and lower costs for everyone.”
The action plan reflects what can be “realistically” achievable for Stage 3 based on the criteria proposed by the HIT Policy Committee in November 2012. Also identified is some critical criteria that might be too ambitious for Stage 3, but should be listed and incorporated as early as possible in future stages. The areas chosen in the action plan – data collection and use to identify disparities; language, literacy, and communication; and care coordination and planning – were chosen based on an extensive review of scientific literature.
The most immediate recommendations for MU Stage 3 & future stages that could begin to make the contribution to reducing health disparities include:
Data Collection & Use To Identify Disparities
EHRs should accommodate collection of more granular data on patients’ race, ethnicity, and language by using HHS standards rather than OMB standards, and moving toward the eventual approach recommended by the Institute of Medicine
EHRs should enable and incentivize new types of data collection, such as sexual orientation; gender identity; occupation and industry codes; and physical, behavioral, and cognitive disability
The population health dashboard should include views of patient populations across multiple disparity variables, even if certain objectives related to recording disparity variables are retired
Reported quality measures should be stratified by at least two disparity variables, with reduction in disparities demonstrated in at least one measure
EHRs should capture patient preferences with regard to sharing their health information for research purposes
Care summaries and plans should require recording of caregiver status and roles using DECAF standards (Direct care provision, Emotional support, Care coordination, Advocacy, and Financial) as appropriate 303
EHRs should incorporate data collection and real-time integration from home monitoring devices, including apps and smartphones
Patient-interfaces (such as texting and smartphone platforms, patient portals, patient reminders and secure messaging, etc.) should be able to accommodate patients’ linguistic, visual, hearing, and/or cognitive needs.
Language, Literacy, & Communication
All patient-facing information and decision support tools should be displayed in no higher than 6th-8th grade reading level, in patients’ preferred languages, and accessible to those with visual, hearing, cognitive, and communication impairments.
EHRs and online access for patients should incorporate automatic links translating medical jargon to contextual information accessible to patients and displayed in no higher than 6th-8th grade reading level, in patients’ preferred languages, and accessible to those with visual, hearing, cognitive, and communication impairments
V/D/T and Blue Button function should include information displayed in patients’ preferred languages and accessible to those with visual, hearing, cognitive, and communication impairments
Future Stages: EHRs should facilitate patient tutorials on use of systems (such as online access) with built-in explanations of individual functions and features (via hover box) and videos in patients’ preferred languages and accessible to those with visual, hearing, cognitive, and communication impairments
Care Coordination & Planning
Care plans should enable patient access and ability to contribute and correct health information (such as family health history, goals, chosen support individuals and networks, and advance directive content) to help manage their care and wellbeing.
EHRs should have capacity for real time clinical trial identification and eligibility checking
Blue Button functionality should be implemented for Medicaid and CHIP beneficiaries
Future Stages: EHRs should enable identification of community based programs/supports from which patients may benefit, including by accessing an automated directory of community resources
“This action plan presents a great opportunity to improve quality of care, enhance patient participation and understanding, and reduce health disparities nationwide through health information technology. It is important that we implement these recommendations so that the health disparities of today are not replicated in electronic health systems tomorrow.” Kathy Ko Chin, Asian & Pacific Islander Health Forum.