Can EHRs make healthcare disparities disappear?

There's probably not much debate over the issue that healthcare disparities exist nationwide--related to a variety of factors such as ethnicity, race, socioeconomic status, physical or cognitive disabilities, or language barriers. With these disparities come increased healthcare costs, premature illness, and increased death rates. But could electronic health records (EHRs) eventually prove to be the great equalizer--a way to eliminate disparities in providing healthcare?

Maybe, according to a new study published by the National Institute of Standards and Technology (NIST). Earlier this month, NIST published a report--Human Factors Guidance to Prevent Healthcare Disparities with the Adoption of EHRs--which declares that "wide adoption and Meaningful Use of EHR systems" by providers and patients could impact healthcare disparities.

Making this happen, however, will require a different way of thinking about EHRs. While the report notes that EHRs primarily are used by healthcare workers, patients still interact with these systems both directly--such as through shared use of a display in an exam room--and indirectly. For patients to obtain the intended benefits of this technology, EHR systems should display or deliver information in a way that is suitable for their needs and preferences, the report says.

Therefore, it is "vitally important" that EHR developers and healthcare organizations implement Meaningful Use requirements "in a way that supports the patients, populations, and communities that they serve," it adds.

Essentially, this means that EHRs should be designed to take account of the people who will end up actually using them. It opens the up discussion for EHR developers--and eventually healthcare organizations--to identify the many relevant patient user groups and their challenges to using EHRs. This includes EHR use when cross-cultural or communications barriers exist.

For instance, in some cultures, major decision making is considered an activity that requires input from family. However, informed consent and access to EHR information currently is constructed largely from the "Western perspective"--which focuses on single users and individual rights, the report notes.

This can include looking at the needs of the adult caregiver of a senior relative. In many families, adult children caring for elderly parents is becoming increasingly common. This may be even more likely among patients from disparity populations who may lack resources to provide alternate care arrangements for their aging relatives, NIST says.

The demands and stress on the caregiver--when combined with childrearing, homemaking and employment demands--may create human factors challenges for the safe and effective use of EHRs.

What this implies in the long run is that understanding how patients--from all walks of life--use EHRs to improve their healthcare may be just as critical as understanding how EHRs adapt to the clinical workflows in the hospital.

Without EHR design accommodations, current problems inevitably will lead to poorer EHR user experiences, limited EHR adoption among high-risk patients, and possibly even poorer health outcomes. To push outside these "digital disparities," EHR developers and users will need to think outside the IT box to meet the needs not only of providers, but of all kinds of patients, as well. - Janice