ONC 2015: Providers discuss barriers to population, public health efforts

While innovative technologies and data analytics sets currently help providers in their quest to improve population and public health management efforts, barriers persist for those who need care the most. At the Office of the National Coordinator for Health IT's annual meeting in the District of Columbia on Monday, a panel of providers discussed concerns about various barriers, in addition to providing updates about their progress.

For instance, John Mafi, a fellow in general internal medicine at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, talked about the progress of the OpenNotes program, both at his facility and others nationwide. Early takeaways from the program include that it bolsters patient medication adherence while better connecting doctors with their patients, generating more meaningful visits. However, Mafi noted, such tools often cater to wealthy and elite patients.

"In my opinion, that's probably one of the biggest challenges of this whole movement," Mafi said. "If you think about disparities in healthcare with regard to race, in particular, we've gotten somewhat better in terms of process measures like making sure patients have aspirin for myocardial infarction, but we have not improved in terms of the outcomes. Outcomes still remain poor for nonwhite populations, and this has to be--from the bottom all the way to the top--a priority."

Mafi said policies to incentivize narrowing health disparities, which currently don't exist, would go a long way toward improving that situation.

Meanwhile, Annie Fine, medical director of the reportable disease data analysis and informatics unit within the Bureau of Communicable Diseases at the New York City Department of Health and Mental Hygiene, spoke about the need for better access to basic demographic information within electronic health records to improve infectious disease efforts.

"We don't need the whole medical record," Fine said. "Just a few critical data points that would be standardized would help us be so much more effective. … This is really what the public expects. You saw with the Ebola outbreak, even though it wasn't very many cases, the expectation of the public about what we need to do" was high.

"I think the expectations need to go further in terms of other chronic infectious diseases, as well," Fine said. "We need to build those bridges to being able to get critical data points out of electronic medical records and link those data on a population basis."

Mafi added that what he really wants to see is the patient's voice more prominent in healthcare decision making. OpenNotes recently evolved to become an interactive program known as OurNotes, in which patients can contribute to their own medical data.

"We're finding very few things where one size fits all," Mafi said. "What's getting bigger are things that are preference sensitive."