reducing risks of hit induced health care disparities

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INFO731-900-201015 ORG & SOC ISSUE HLTHCARE INFO NOVEMBER 16, 2010

Reducing Risks of HIT Induced Health Care Disparities

Joel [email protected]

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Reducing Risk of HIT Induced Health Care Disparities

• HIT is seen as enabler of health care transformation

• ARRA/HITECH intended to spur adoption of HIT

• Actual costs & benefits not well known– Providers– Underserved populations

• Policy may exacerbate/induce disparities

Introduction

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• Medically Underserved Populations– Economic, cultural, linguistic barriers to care

• Medically Underserved areas• Health Professional Shortage Areas

• More than the uninsured (44.8M): 160M• Likely to have poorer health care, health

Who are the underserved?

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• Small practices• 25% of physicians in solo practice• 60% of physicians in groups of 9 or less

– 17% of visits by low-income/uninsured• Community Health Centers

– 56% of visits by low-income/uninsured• Outpatient departments of hospitals

– 40% of visits by low-income/uninsured

Who cares for underserved?

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Who cares for underserved?

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Office-based physicians: EMR adoption

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EMR adoption lags for smaller practices

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• Benefits accrue to payers, expense to provider

• Reduced transcription, higher coding• Costly , >25% more than expected

– KP HC: $285K/provider– Initial $44-54K/p , Install $22K /p, $7,500/p

• Computing ROI complex, sensitive to many factors

Benefits and costs of HIT

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• Lack of skilled personnel• Higher per provider costs• Questions about incentives & support• Limited choices for solutions• Lack of applicable data to inform projects

Small practices & CHCs: Issues

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• Primary care as locus of system change• Clinical decision support to reduce

disparities in care• New modalities of care

– Email, PHRs, Chronic disease management– Telemedicine

Opportunities for HIT

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• Meaningful use definitions & timeline– Revise for small & rural practices– Provide roadmap, extend timeline

• Infrastructure investment & Support• Broaden the scope of HIT use

– Decision support– Coordination of care

• Reform payment & delivery

Reducing risks of disparities

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• HIT must occur with a culture of change• Current HIT is inadequate• Current policy may be counterproductive• Policies need to

– Accommodate actual conditions– Be better aligned with desired outcomes

• Need for more research

Concluding summary

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Selected ReferencesBernstein, W. S., Pfister, H., R., & Ingargiola, S. R. (2010, June 2010). HITECH Revisited. Manett Health Solutions report funded by the California Health Foundation, Colorado Health Foundation, and the United Hospital Fund. Retrieved online

Chen, C., Garrido, T., Chock, D., Okawa, G., & Liang, L. (2009). The Kaiser Permanente electronic health record: Transforming and streamlining modalities of care. Health Affairs , 28 (2), 323-333.

Hasselman, D. (2010a, September). Leveraging Medicaid to encourage HIT adoption and strengthen primary care (Presentation given that the 2010 Medicaid Managed Care Congress. Retrieved online

Heyman, J. (2010, March). Health IT and solo practice,: A love-hate relationship. Journal of Law, Medicine, & Ethics, 38, 14-16.

Jha, A. K., DesRoches, C. M., Shields, A. E., Miralles, P. D., Zheng, J., Rosenbaum, S., & Campbell, E. G. (2009). Evidence of an emerging digital divide among hospitals that care for the poor. Health Affairs, 28(6), W1160-w1170.

Mechanic, D. (2008). Rethinking medical professionalism,: The role of information technology and practice innovations. The Milbank Quarterly, 86(2), 327-358.

http://www.manatt.com/uploadedFiles/News_and_Events/Newsletters/HealthLaw@Manatt/HITECH%20Revisited_Final%20May%2031,%202010.pdf

http://www.chcs.org/usr_doc/HasselmanMCCongress.pdf

reducing risks of hit induced health care disparities

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