Reaching People Where They Are with Health IT [Podcast]
As a country, we have at our disposal the kind of technology that can shift health care from beyond the four walls of a hospital, to reach ordinary people where they are.
When adopted uniformly by all communities, the benefits of this kind of health technology infrastructure are clear: improved quality of health care for all Americans, lower costs, enhanced care coordination among hospitals, doctors, labs and health care organizations, and ultimately the promotion, prevention and management of chronic illness.
In this episode, Fadesola Adetosoye – Public Affairs Manager, at the Office of the National Coordinator for Health IT (ONC) – explains what her organization is doing to support the promotion of such infrastructure, and how some of the barriers to health IT adoption can be eliminated.
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Q: What is the ONC, and what kinds of problems you are helping to solve in the health care system?
A: ONC is the federal office that oversees policies and programs to support the proliferation and adoption of health IT across the country. We are also working on standards to ensure interoperability between electronic health records across and health care systems, so that patients and providers can access any pertinent patient information at the point of care.
We were established in early 2000 as a policy shop providing recommendations to Congress on ways to incorporate health IT into health care legislation and oversight.
In 2009, as part of the American Recovery and Reinvestment Act, President Obama signed into law the Health information Technology Economic and Clinical Health Act (HITECH). The Act provided billions of dollars to support programs and provide financial incentives that would encourage the adoption of health IT in a way that lowers cost and saves lives for all Americans.
Q: Why is it important to engage communities of color in discussions pertaining to health equity and ehealth?
A: Health information technology (HIT) merges IT into the health care field, making it possible for providers to better manage patient care through secure use and sharing of health information.
Minority communities are often mobile, and disproportionately account for chronic diseases and ailments. So when we think about ehealth and health equity, it’s important to have communities of color participating at the table.
We can’t experience true health care transformation if we’re not engaging communities of color in the use of technology to better manage their care, e.g. via electronic health records and patient portals instead of paper records to maintain their medical information and history.
We also know that communities of color, own smartphones at higher rates than non-Hispanic whites. Pew research shows that African Americans and Latinos are using their smartphones to access online information related to health. They are also tracking other health related activities, e.g. weight management and physical activities.
Since we know that those types of activities are penetrating communities of color, it’s important that mobile health is part of the discussion as we think about how to incorporate health IT in these communities.
Q: What other technology opportunities exist, other than mobile to engage communities of color?
A: The Office of Minority Health at HHS is working on a couple of ways to leverage technology, especially culturally appropriate and linguistic tools related to minority populations.
We saw that in programs such as “Text for Baby,” SMS text messaging is a great way to leverage technology within communities of color. We know that communities of color like SMS text messaging. “Text for Baby” used text messaging as a way of sending medication reminders, alerts to increase pre-natal vitamins, and other pre-natal activity encouraging compliance among Latino mothers. We saw more than 100% in the compliance rate using this strategy.
“Text for Health” in Louisiana used SMS text messaging appointment reminders and other tips through SMS to improve chronic disease management. The program was specifically around the area of diabetes, which has a disproportionately higher prevalence among African American and Hispanic communities.
The more we can incorporate SMS-based technology into electronic health records, patient portals or some kind of app, it’s going to be important to develop a strategy that meets people where they are. SMS text messaging and use of mobile health apps are examples of ways to do that for communities of color.
Q: Do you think that strategies for patient engagement should be different for communities of color versus the one-size fits all strategy?
A: Certainly. Disparities exist in all formats. For communities of color, there is the issue of trust that does not necessarily exist between them and medical communities. It’s important to build a provider-patient coalition.
Providers need to think about incorporating t the 4 “C”s in building that coalition:
- Creating the relationship;
- Celebrating the relationship;
- Committing to the relationship;
- Connecting the relationship.
Health access is just one part of the equation when you look at overall health status. You also need to look at the other community resources that support the patient in other areas of their lives. Doing so will ensure a holistic approach to address a person’s health care status.
As we look at engagement strategies, it’s important to continue to engage persons of color and to look at health literacy and culturally appropriateness as tools and resources.
For example, you may have an African American that comes in and says he wants to talk about his “sugar,” and you may have a doctor from India that responds, “No, I want to talk about your diabetes.” We need to help both understand they are talking about the same thing.
We need to think about the types of language that providers and patients use, come to a consensus on what the regimen should be, and think about how to address the health concerns.
Q: What roles could federal and state governments or even national organizations play to promote health equity for all Americans?
A: Coordinating and convening. There are a lot of great things happening in the field that often happens in information silos.
One of the things that the ONC is committed to doing is playing that coordinating and convening role. Among the activities could include:
- Conducting a series of federal advisory committees;
- Hosting informal roundtables at our offices to increase awareness and education about the concerns and challenges facing the health care community, specifically as it relates to consumer engagement and disenfranchised populations;
- Looking at ways we can align ourselves with strategic partners around policies and regulations.
It’s important to look at using coordination and convening as an opportunity to promote health equity for all.
Q: What are some personal experiences that you or a loved one has had using technology within the health care setting?
A: I am actually a care giver for my mother, who immigrated to the U.S. in 1983 to pursue a higher education. She was a functioning adult when she came, but in 2008 was diagnosed with end-stage renal disease. That diagnosis is rather challenging and requires a lot of care coordination and transitions of care within health care settings and across various specialties.
I’ve taken to using mobile apps, specifically Microsoft HealthVault, to help manage some of the information required for my mother’s care. At the time of her diagnosis, her nephrologist was in D.C. and her primary care provider was in Maryland.
It was a challenge because her providers were in different health care organizations, and there wasn’t a good way to transfer health information across state lines. So I served as the health information exchange for my mother. I took to using the HealthVault application to store her health information.
I’ve also taken to using other types of applications to come up with, for example, kidney disease-friendly meals. Using such apps that show you how to make a creative meal for the renal population has been interesting.
I’d like to see some type of culturally appropriate or culturally sensitive app that offers some good meals or recipes for kidney patients.
Q: What do you think it will look like when we start having more consumers and privacy advocacy groups engaged and participating in problem solving of health IT issues?
A: It will look like having more consumer-related tracks in everything we do. The ONC will continue convening consumer organizations that will:
- Meet with the director of our Office of Consumer Ehealth.
- Be represented on our federal advisory committees.
We will also make a targeted effort to make sure that consumer advocacy groups are at the table when we’re having policy discussions related to health IT adoption in our communities.
It will also be interesting to look at the types of consumer groups, especially considering the need for diversity. Ensuring that we have diversification and having a reflection of the population groups at the table that we are trying to target will be very important. But how we go about that is yet to be seen.
Q: What are some of the things that either bug you or that you can brag on about the health care payment and delivery model?
A: The current health care payment and delivery model is fragmented. My mother’s situation is one example of that. At one point, she was in and out of the hospital 5 to 6 times within a 30 day period, often because she was discharged on an improper medication regimen. As a result, she had an adverse medical reaction. Or she was discharged improperly or prematurely.
That’s been my frustration, yet providers still get paid, despite those situations. As we look at a payment reform system that is shifting more on outcomes-based measures, we’ll see an improvement in that area.
I am proud of the work we’ve done so far to proliferate health IT adoption across the U.S.
If you look at the numbers from 2007 and 2008 related to adoption of basic EHRs into 2012 and 2013, that number has more than doubled.
Federal efforts to encourage health IT adoption and to incentivize providers to do so in a meaningful way are actually working. That’s something to be proud of.
Q: What is the best way to connect with you?
A: The best way to connect with me is @fadesolacares via Twitter, or here on ehealthequity.com, where I offer my thoughts fairly regularly each month.
Image Credit: iStockphoto