Subjects: Health IT
In the 12 years since our government acknowledged we had a problem with racial disparities in health care, we’ve made significant progress in reducing them. Steep declines in the prevalence of cigarette smoking among African Americans have narrowed the gap in lung cancer death rates between them and whites, for example. Inner city kids have better food choices at school. The 3-decade rise in obesity rates, steepest among minorities, has leveled off.
Still, racial disparities persist across the widest possible range of health services and disease states in our country. The racial gap in colorectal cancer mortality has widened since the 1980s. Overall cancer death rates are 24% higher among African Americans. Sixteen percent of African American adults and 17% of Hispanic adults report their health to be fair or poor, whereas only 10% of white American adults say that. The number of African Americans and Hispanics who report having access to a primary care physician is 30-50% lower than white folks who have one.
How can EMRs Help?
Many studies that rely on EMRs for data collection or care coordination have shown them to have great potential as tools that can reduce racial disparities in health care. For example, a 2009 study showed that post-market surveillance using patient data stored in an EMR could have detected cardiovascular complications from the diabetes drug, Avandia much faster than traditional methods. That’s a plus because African Americans and Hispanics are disproportionately affected by diabetes. Another study showed that patient data from EMRs could identify patients at high risk for domestic abuse, which is more common in some minority populations. A third study showed that EMRs improved care coordination for patients with kidney failure, a condition that disproportionately affects African Americans.
Some of the Federal government’s Meaningful Use criteria may also reduce these disparities, once they fully take effect. The requirement that providers use clinical decision support tools embedded within EMRs holds promise in this regard. CDS tools whose development was underwritten by the Agency for Healthcare Research and Quality incorporate care management strategies designed specifically for minority populations, for example. In addition, Meaningful Use also requires providers to record patient demographic information in the EMR, and this development will likely increase the research value of the patient data contained in these systems.
But There is a Problem
Unfortunately, the National Ambulatory Medical Care Survey suggests that EMR adoption rates are lower among providers who serve minority populations. A study by Jha and colleagues confirmed these findings and also demonstrated that hospitals which served Hispanic and African American patients provided lower quality care. However, among the disproportionate-share hospitals that did use EMRs in Jha’s study, the quality gap disappeared. Jha’s group concluded that EMRs helped mitigate quality issues in hospitals where poor people and minorities received care. Read the rest of this entry »