IT: the great equalizer

Better care access across demographics
By Bernie Monegain
12:00 AM

The Commonwealth Fund published another one of its eye-opening reports recently. It was one of those scorecards the organization issues from time to time. This scorecard is a "first ever," and the results are grim.
Bottom line: Commonwealth researchers found that poor people in America - no matter what state they live in - have trouble getting care, and when they do access care, the disparity between what low-income patients and high-income patients experience is - as the report put it - "striking."
"The stark differences in healthcare access, quality and outcomes detailed in the report add up to substantial loss of lives and missed opportunities to improve health and quality of care," Commonwealth researchers conclude.
The first thing that came to mind was: Here's an opportunity for health information technology to really make a difference, to close the gap between the poor and the rich, to help provide excellent care. Information matters, and having information at care providers' fingertips, in a way that means something, is critical.
Though the IT systems are not yet ideal, they can likely serve up some meaningful data more quickly than rifling through a bunch of paper charts. My own doctor often gets frustrated with how long it takes her to get to the right place to find the piece of data she is looking for in my electronic medical record, but she does find it. And, the information appears to be all there - and accurate. Gone are the yellow post-it notes about to fall off a manila folder.
Dig a little deeper into the report, and you'll see that the authors assert that information technology can help close the gap between the haves and the have-nots. Shouldn't we all be among the haves, especially when it comes to healthcare?
That's part of what this arduous and long, winding road to meaningful use, accountable care, health information exchange, health insurance marketplaces, Blue Buttons and more, is all about. The goal may not be easy to achieve, but it's clear: Better care at less cost.
The role healthcare information technology could have in achieving those goals is implicit throughout the report, "Health Care in the Two Americas." On page 58, the authors speak to information technology explicitly.
"Information technology can also be leveraged to support clinicians and expand health system capacity by linking providers and patients in different ways, creating virtual health care teams and better communication," the authors write.
Sounds like they are talking about ACOs, mobile health and telemedicine.
"For example, several academic medical centers are addressing access challenges in rural communities with innovative programs designed to support the capacity of rural providers to deliver primary and specialty care. Many are using collaborative care models that electronically link rural physicians, nurses, and caregivers with urban specialists using tools like telemedicine, e-referrals and shared electronic records to address needs that might otherwise require a referral.
They highlight a project called ECHO in New Mexico that Healthcare IT News wrote about back in 2008.
The technology links primary care clinics in rural parts of the state, the Indian Health Service and state prisons with the University of New Mexico's School of Medicine in Albuquerque. Called Project ECHO, the pilot makes it possible for rural doctors to consult with specialists who can help them treat their patients, many of whom are poor and uninsured and often go untreated.
Project ECHO (ECHO stands for Extension for Community Care Outcomes) is but one example of how technology can help close care gaps. There are many such examples across the country. But, clearly, there are not enough.
We need more Project ECHOs throughout this disparate nation of ours.
The push to use IT to address care disparities is gaining momentum. In August, the Consumer Partnership for eHealth, which comprises more than 50 consumer, patient and labor organizations, published an action plan to make disparities a critical focus of Stage 3 meaningful use.
"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," said Debra L. Ness, president of National Partnership for Women & Families, one of the CPeH member organizations. "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."
David Blumenthal, MD, former national coordinator for health information technology, now president of the Commonwealth Fund, put it this way in the news release accompanying the Two Americas report.
"We are at an unprecedented moment in the history of our nation. We have the potential to raise the bar, unite the country, and realize the promise of a more equal opportunity to thrive by expanding health care coverage and innovating to find the most effective ways to deliver high-quality, safe care for everyone."
The work is demanding - and incremental. But each of us - patient, CIO, policymaker, writer, care provider, technologist, researcher, you name it - has a role to play, an obligation to meet.