One of America’s greatest assets is its incredible diversity. Today, one in five people in this country age five and older speak a language other than English at home. The U.S. Hispanic population has reached 50.5 million, accounting for more than half of the population increase since 2000.
Most of us recognize that the country’s rich diversity is a tremendous asset, but not as many realize there is another side to the story. From 2003 to 2005, an African American child with asthma was seven times more likely to die from it than a white child. Nearly half of Spanish-speaking Hispanics reported having trouble communicating with their doctors, and one in five Spanish-speaking Latinos reported not seeking medical care because of language barriers. Variations in disease prevalence or health outcomes are known as health disparities; making sure that we address systematic barriers contributing to health disparities is one of the biggest challenges facing our health care system.
Passage of the HITECH Act in 2009 made many people hopeful that its explicit goal to reduce health disparities would close the gap between our ideals and reality. Electronic health records (EHRs) would not only launch our health care system into the 21st century, but ensure that the needs of the nation’s underserved and marginalized populations are better identified and met.
Despite this mandate, not enough progress has been made in making the system work better for all Americans. But we can do something about it now.
This week, the Consumer Partnership for eHealth (CPeH) positioned the country to take a giant leap forward when we released our Health Disparities Action Plan. In it, we offer three action-oriented prescriptions for our ailing health care system.
First, we need to improve how EHRs collect and organize patient demographic data. Right now, for example, EHRs aren’t designed to distinguish between ethnic subgroups like Chinese, Indian, or Vietnamese; instead, everyone gets counted as “Asian.” Here’s the problem: these groups have vastly different health profiles. Twenty-two percent of Korean adults versus 7 percent of Chinese adults are smokers. Asian Indian adults are nearly three times more likely to have diabetes than Japanese-Americans, but are less likely to have hypertension. If we have unique health risks, shouldn’t our doctors know about them? In the same vein, doctors need to be able to identify disparities within their own practices. But when the data get grouped together and averaged, variations are obscured. That’s why collecting and using more granular demographic data is essential. We can’t fix the problem unless we know what it is.
Second, we should use health information technology (IT) to open lines of communication between patients and doctors. Most of us know what it’s like when doctors talk about a particular health condition or course of treatment and we get lost in what they’re saying or recommending. Sometimes doctors forget that patients aren’t fluent in “medicalese,” and sometimes patients don’t want to admit their confusion. What if, after the appointment, we could go online and access our health information and treatment recommendations written in plain language, without all of the medical jargon? Now consider how much more difficult it is to decipher clinical information if your English skills are limited. Imagine being able to log on and see your health record in your language of choice. For more than 25 million Americans with limited English proficiency, this could be a momentous option. With health IT, we can ensure that all consumers are able to access their health information and communicate with doctors in their preferred language. If we don’t, much will continue to be lost in translation.
Third, we need to leverage technology to connect all the people who can play a role in enhancing health outcomes. How healthy we are isn’t just about what happens in the doctor’s office: personal, social, economic, and environmental factors must also be considered. Even with the best pulmonologist in the country, a child with asthma will keep coming back to the hospital unless someone figures out what’s triggering his attacks. What if doctors, with the click of a computer mouse, could automatically connect patients to all of the community-based organizations that can help? For a child with asthma, that could mean having a nurse and local legal services agency work together to identify and address environmental triggers in his apartment, like old carpets or moldy bathroom walls. If we do a better job of communicating, coordinating and planning care, we can reduce health disparities and improve the quality and affordability of health care for everyone.
There is perhaps no more immediate opportunity to reduce health disparities than through the “meaningful use” EHR Incentive Program. The CPeH Action Plan builds on a year-long review of scientific literature and collaboration with experts on disparities and health IT, and identifies a strategic, achievable roadmap to enhance health equity. We have the chance now to build the infrastructure for electronic health information exchange so that it works for all consumers. It is an opportunity we cannot afford to waste.