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eHealth Equity Summit

eHealth Equity Summit

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Published by: iggybau on Apr 30, 2013
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White House Summit on Achieving eHealth Equity: Summary
| 1
White House Summit on Achieving eHealth Equity
|April 2013
Introduction: eHealth and Health Equity
In 2011, the U.S. Department o Health and Human Ser- vices (HHS) released two reports that urther highlight theimportance o using health I to address health disparitiesamong underserved communities.
highlight how health I can improve care quality and health outcomes within these communities.echnology can be tailored to “meet people where they are”and thereore is a powerul tool in actually helping to achieveequity in health care. Despite concerns about the digitaldivide, a recent study ound that age, education, and incomelevels are not accurate indicators o patients’ willingness toadopt an electronic health (eHealth) tool, such as a personalhealth record.
Still, other studies demonstrate disparitiesin the adoption o such tools related to actors such as race,ethnicity, education, income, age, literacy, disabilities,geography, and others.
2, 3
 In February 2013, the U.S. Department o Health andHuman Services Oce o the National Coordinator orHealth Inormation echnology (ONC), Oce o Minority Health (OMH), and ZeroDivide convened a diverse groupo stakeholders at the White House to discuss how toadvance eHealth among the underserved and the roleeHealth can play in achieving health equity.Specically, the summit objectives were to:1. Establish an understanding o the current use o eHealth,as well as barriers to use o eHealth technologies among underserved and minority populations.2. Identiy “community champions” and “bright spots” thathave demonstrated successul engagement o underserved patients and their amily caregivers in the use o eHealthto improve access to health care, acilitate care coordina-tion, and improve sel-management o health conditions.3. Identiy opportunities or ONC, OMH, and its Federal partners to collaborate with industry and community leaders and grassroots organizations to prioritize severalstrategies that will promote patient engagement viaeHealth while addressing barriers to eHealth equity.In a roundtable ormat with active discussion, attendeesshared ideas about increasing patient engagement using eHealth, identied opportunities to work collaboratively,and committed to taking individual action ollowing themeeting. Te White House Summit on Achieving eHealthEquity was ollowed by a webinar during which participantscontinued the dialogue and proposed specic action stepsthat are included in this brieng document.
Dening the Underserved
During the summit, participants discussed how the term “underserved” has evolved over time and that there is acommon understanding that there is a need to clearly dene the population i we are to create solutions that meet theirneeds. Te participants discussed how racial and ethnic minorities are traditionally dened as “underserved,” but theterm has broadened to include seniors, the disabled, youth, Lesbian/Gay/Bisexual/ransgender community, and theincarcerated. In addition to health and healthcare considerations, “underserved” communities may also include thoseacing nancial barriers, socioeconomic challenges, environmental hazards, or lack o access to natural resources such asclean water.
White House Summit on Achieving eHealth Equity: Summary
| 2
Current Use of eHealth and Ongoing Barriers Among Underserved andMinority Populations
We have seen tremendous advances in medicine and technology but the challenge is to reach everyone.We want to see opportunity for all people. There’s no better time, especially with an administration thatrecognizes the importance of prevention and wellness, and that eliminating health disparities is fundamental for us to become a healthier nation in which everyone has the opportunity to reach their full potential for health.
Dr. J. Nadine GraciaAssistant Secretary, Ofce o Minority HealthU.S. Department o Health and Human Services
In order to maximize the time together, participants completed a pre-summit survey and worked to dene eHealth equity,and to better understand the current landscape o eHealth use in the context o health disparities. Te group also exploredcurrent barriers to eHealth use and eHealth equity among underserved populations. Tese discussions are summarized below.
op barriers to adoption o health inormation technology identifed in pre-meeting survey (n=32).
Rural versus Urban Challenges
Te barriers aced by underserved rural populations and those aced by inner-city populations may be more similar than they rst appear. Noted one participant: “Even though one size doesn’t t all, it is possible that once we address the undamentalissue o access it will serve multiple populations. Te question we need to ask is not how do we keep rom bringing everyonedown, but how do we bring everyone up to the same level? How do we engage, educate, and keep in touch with individuals,even when they are not seeking healthcare? echnology can help with that.”
Lack of Outcomes Research
Research to this point has ocused primarily on the impact o health I on underserved communities in terms o access.More research is needed to examine how health I has aected health outcomes among underserved populations. Electronichealth records can enable researchers to more easily examine outcomes or specic populations.
White House Summit on Achieving eHealth Equity: Summary
| 3
Patient Engagement
Some see technology as a panacea, like the medical specialist who observed: “We use technology not just or inormationgathering and sharing, but or engagement.” But as others noted, the trend towards greater patient engagement is not reach-ing everyone. As one participant articulated: “A lot o patients who are not in that traditionally underserved category aretaking the lessons they’ve learned outside o healthcare to close the gap between being paternalistically led by providers tobeing engaged partners in their health. Yet that gap could get larger because one o the barriers [or underserved populations]is education.”
Cultural Competence and Literacy
In many cases, literal language translation o material is the sole eort made towards meeting diering cultural and linguisticneeds. Broader denitions o language and culture are needed, paired with approaches to communications and outreach thatare easily customizable at the local level to meet local needs.
Access to Technology
Overall access to technology remains a serious concern among underserved populations, but this issue is more complex thanit may rst appear. For example, some underserved populations have high levels o access to sophisticated mobile technology,but may not have access to eHealth services optimized or those technologies.
Successes, Needs, and Opportunities
ONC’s goal is to improve health and health care for all through the use of information technology. Wehave the opportunity and possibility with health information technology to tackle some of the mostdifcult problems by making visible what is often invisible in healthcare.
Dr. Farzad MostashariNational Coordinator, Ofce o the National Coordinator or Health ITU.S. Department o Health and Human Services
Moderators and participants brought several current examples to demonstrate the potential o eHealth to address healthequity issues.Deputy Assistant Secretary or Minority Health, Dr. J. Nadine Gracia noted the success o electronic health records(EHR) within Federally qualied community health centers, and also described an “app challenge” launched by HHS as part o its eorts to reduce cancer among women o color.Dr. Mostashari, the National Coordinator, described the success o the Regional Extension Center (REC) program’seorts to target providers in underserved communities. Providers working with an REC were 2.3 times more likely toachieve meaningul use than providers that were not working with an REC.Another participant shared their experience developing an online portal about diabetes geared towards Arican Ameri-cans and their ndings that eighth graders using the portal were able to use the inormation to educate their amilies andmembers o their wider community.Te roundtable discussions yielded additional specic needs and opportunities, summarized below.
Demonstrate Effectiveness
More rigorous studies are needed to document the eectiveness or ineectiveness o eHealth tools. Demand or this research will only increase as patients, providers, hospital systems, and regulatory agencies attempt to use eHealth to improve peror-mance, which is increasingly tied to payment

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