Doctors' digital divide could widen health care disparities

As the federal government strengthens its push for health information technology adoption among physicians, there is growing concern that the effort may increase health care disparities in minority communities by adding a digital divide to the mix.

Efforts are under way by the government and private and nonprofit sectors to help advance health IT adoption and funding in minority communities, which advocates say have been slower to take advantage of federal programs to bolster adoption of electronic medical record systems. If done right, experts say, disparities will not only be kept from widening, they have the potential to disappear.

Garth Graham, MD, MPH, deputy assistant secretary for minority health in the Office of Minority Health at the Dept. of Health and Human Services, said there is great potential for health IT to improve health care in the United States. "But that potential won't be realized if we don't implement this uniformly across the board in both underserved communities as well as the general communities," he said.

Michael Christopher Gibbons, MD, MPH, associate director of the Johns Hopkins Urban Health Institute in Baltimore, published a report in the winter 2011 edition of Perspectives in Health Information Management, the online journal published by the American Health Information Management Assn., that explored the potential for health IT to improve minority health care.

"Opportunities to address health care disparities through health IT at the health care system level are related to the potential of health IT to improve patient-centeredness, timeliness, efficiency and effectiveness of health care delivery," Dr. Gibbons wrote. "This is especially true among providers and patients delivering and receiving care within the nation's health care safety net system."

The article laid out "technical, practical and human challenges" to widespread adoption in those communities.

The barriers are similar to those in more affluent communities, especially the cost to physicians who install technology. But recent reports have shown that federal programs aimed at reducing those barriers, including the federal incentive program offering Medicare bonuses up to $44,000 and Medicaid bonuses up to nearly $64,000 for EMR use, may not be enough for physicians who serve poor minority communities. The federal government has acknowledged these concerns and called for grassroots efforts to help address them.

In October 2010, David Blumenthal, MD, national coordinator for health information technology, published a letter on the Office of the National Coordinator's website. In it, he cited analyses of the Centers for Disease Control and Prevention's 2005 and 2006 Ambulatory Medical Care reports that found EMR adoption rates in minority and large Medicaid population communities were much lower than mostly white communities and those predominately covered by private insurance. Dr. Blumenthal, who recently announced he was resigning as head of the ONC, said that despite the government's efforts since those numbers were released, EMR adoption rates remained low for practices serving poor and minority communities. He expressed concern that the incentive program would only exacerbate the disparities.

To help prevent a digital divide, the letter solicits help from the vendors and those heading the regional extension centers that assist small practices in selecting and implementing EMRs so the practices may qualify for incentive pay.

Dr. Graham said since Dr. Blumenthal's call for help, his office has helped coordinate several public-private collaborations aimed at outreach in minority communities. Many of these efforts have included regional extension centers, which recently got a funding boost from Dr. Blumenthal's office. RECs were set up to help physicians with health IT adoption.

The ONC announced in January that it was providing an additional $12.2 million to the RECs to continue funding them by 90% for four years instead of two. The RECs are responsible for the remaining 10% of funding. Dr. Graham said several vendors are also in discussions with the RECs to offer loan programs to the practices that come to them for help.

The Healthcare Information and Management Systems Society has been involved in the outreach.

The HIMSS Foundation's Institute for e-health Policy helped found the National Health IT Collaborative for the Underserved, a public-private partnership that includes the Dept. of Health and Human Services Office of Minority Health; the Summit Health Institute for Research and Education; and Apptis Inc., an IT service provider whose clients include several federal agencies. Dr. Graham said the group, formed in 2008, has started working with minority medical groups to host teach-ins and other educational programs aimed at educating underserved communities about the heath IT incentive programs. It is helping in recruitment efforts for the RECs serving those communities.

HIMSS also announced in January the launch of the HIMSS Latino Initiative aimed at advancing health IT adoption in Latino communities. Latinos are expected to account for 30% of the U.S. population by 2050.

Danny Vargas, president of VARCom Solutions, a public relations firm in Herndon, Va., was tapped to co-chair the work group along with Luis Belen, president and CEO of VWCGlobal, a marketing and consulting firm with offices in New Jersey and Florida.

Vargas, who spent 10 years in the telecom industry, said he saw firsthand how technology that was considered revolutionary would be adopted in some communities and then trickle down to those serving poorer or minority communities.

"My gut tells me that will hopefully be what we start to see happen from a health IT perspective," he said. "Having said that, there's still a lot of work that needs to be done to reach out to these communities and identify ways to educate and inform them."

But Vargas said he is concerned about whether that education will happen in enough time for those communities to take advantage of federal incentive programs. There's always a lag time, he said.

"I think that's why you see a number of entities that are starting to make a push today," he said. "They have been engaged for some time, but as the months fly by it becomes even more imperative to become even more proactive."