Convened by the Kaiser Permanente Institute for Health Policy in co-sponsorship with the Agency for Healthcare Research and Quality (AHRQ) and AMIA, the association for informatics professionals
The Roundtable convenes a broad group of stakeholders representing community health centers, health systems, health plans, clinicians and other medical professionals, and consumers to:
- consider delivery-system perspectives on disparities concerns related to health IT;
- prioritize potential public policy and organizational practice changes that might decrease disparities in HIT deployment and use; and
- identify relevant research priorities for the health sector.
Health information technology (HIT) holds the potential to improve the quality and safety of health care but it also has the potential to unintentionally increase disparities in health and health care. There are a variety of sociocultural, economic, human factors, and environmental issues at play with HIT that could lead to differential benefits across populations that therefore increase rather than reduce disparities. For example, the benefits of HIT may disproportionately accrue to individuals and populations cared for by health care organizations that are best positioned to implement and use new technologies. Meanwhile, a digital divide persists among older adults, racial and ethnic minorities, physically disabled, poor, and those with limited English proficiency. In addition, the usability considerations for groups considered "at risk" for disparities are often overlooked by the vendors and suppliers of HIT.
The objectives of this roundtable discussion will be to consider delivery system perspectives on disparities concerns related to health IT and to prioritize potential public policy, organizational practice change and research opportunities. The following subtopics will be explored:
- HIT Benefits Disproportionately Accrue (providers) — Populations that experience health disparities are served disproportionately by under-resourced providers that are often disenfranchised from larger integrated systems. These "have-not" health care providers are less likely to be able to afford HIT systems (e.g., EMRs, PHRs, home health devices) or to have the support necessary to successfully implement and maintain them. The widened gap between the quality of care available to patients whose providers are able to access advanced technologies and those whose providers are unable to take advantage of them will actually increase disparities in health and health care.
- HIT Benefits Disproportionately Accrue (consumer populations) — Health IT has the potential to facilitate communication between "at-risk" populations and their health care providers, but it also has the potential to exacerbate disparities if consumer language, health literacy, technical literacy, and access to needed technology and technical support are not addressed. Internet or broadband access—enablers of consumer HIT —is lower among older adults, minorities, physically disabled and poor. Health IT places high demands on health literacy and technical literacy for health care consumers. Furthermore, HIT applications are often designed without consideration of the needs and characteristics of diverse user groups.
- Medicaid Expansion — The Patient Protection and Affordable Care Act (PPACA) will expand Medicaid to nearly all individuals under age 65 with incomes up to 133 percent of the federal poverty line which will extend coverage to large numbers of the nation’s uninsured population. The newly eligible Medicaid recipients are a diverse group that includes many low-income, minority and chronically ill individuals for whom public and private coverage is unavailable or inaccessible. In anticipation of the influx of new Medicaid enrollees, health plans and health systems need to carefully consider how HIT can improve or exacerbate disparities.
- A background issue brief that highlights the relevant concerns will be prepared and distributed to participants in advance of the roundtable to inform the discussion.
- A synthesis document for peer-reviewed publication consideration that summarizes the major points of discussion and highlights recommended actions.