Patient IT disparities hurt everyone's health

There's yet more evidence that health IT isn't meeting its Triple Aim of better care, efficiency and improved population health--and in some ways is making things worse.  

First we had expectations that electronic health records, with their clinical decision support, checklists and other tools, were going to improve patient care and safety. While some of that is true, we know that EHRs are inadvertently causing potential or actual patient harm through design issues and user error.

Efficiency also has been a mixed bag. For every study that shows that health IT and EHRs can avoid duplicative tests and reduce costs, there seems to be another that shows that the current lack of interoperability is hindering these efforts.

And now we have a new study that says health IT may "perversely" be adversely affecting population health because it is widening disparities among patient populations.

The study, published this month in the Clinical Journal of the American Society of Nephrology, appears to have originally been focused on portal use and blood pressure control. The researchers found that those results were not statistically significant.

But they did find that at-risk populations were much less likely to take advantage of the portal that connected them to their renal provider. Overall, 39 percent of the patients studied used the portal for myriad reasons, such as accessing lab results, changing appointments, reviewing medical information and requesting medical advice.

However, there were big disparities in the types of patients who accessed the portal. Medicaid patients were 47 percent less likely than commercially insured patients to use the portal; African Americans were 50 percent less likely than non-African Americans; and 80-year-olds were 71 percent less likely than 40-year-olds. Patients with lower household incomes also were less likely to access the portal.

An accompanying editorial noted that "the study shows that portals could perversely widen existing disparities in care by advantaging those who are already at an advantage, while not helping the disadvantaged."

The researchers did not try to guess why there were such disparities in access of the portal by underserved populations. They did recommend that future research should examine barriers to the use of health IT by more vulnerable patients and how to address them.

And therein lies the rub.

I'm not a health IT researcher, but it's pretty obvious why the disparities exist. For instance, an 80-year-old patient is going to be less savvy about using a computer and accessing a physician's portal than one who is 40 years old. A patient on Medicaid or with a lower household income may have less access to the Internet and may be less health-literate--and perhaps is more focused on daily living issues.

But it's less obvious how to narrow the disparity. Ramp up patient engagement for these more at-risk patients? Change portal design to better fit their needs? Show them how to use the portal before they leave their providers' facilities? Expand the availability of free Wi-Fi? Address the underlying socioeconomic issues?

Unfortunately this problem, which has been identified in other studies, is not limited to the concern that the underserved will receive less or inferior healthcare.   

It's that these disparities can hinder the improvement of everyone's health, not just the underserved. If vulnerable populations are not engaged in their health, it can affect efforts to, say, track an outbreak of food poisoning or eradicate a disease.  

This goal of the Triple Aim is not more important than the other two. But it seems to be getting short shrift. Health IT disparities affect more than the "vulnerable" patient populations, and it certainly needs more of our attention. - Marla (@MarlaHirsch and @FierceHealthIT)