Posted tagged ‘health disparity’

Digital divide for electronic health records worth investigating, researcher says

November 15, 2017

Photo by mcmurryjulie

Over the past several years, most hospitals have adopted electronic health records — a digital version of a patient’s medical chart that can contain information from all clinicians involved in a patient’s care. The goal is to provide better, more coordinated care through EHRs, although they are also increasingly cited as a source of physician burnout.

But there may be another problem with the implementation of EHR systems: although EHR adoption is widespread, the use of the records varies at different hospitals. According to a recent presentation at the 2017 American Medical Informatics Association’s annual meeting, hospitals with fewer resources are less likely to use the advanced functionality of EHRs for measuring performance and engaging patients.

The University of Michigan researchers analyzed data from almost 3000 medical-surgical acute care hospitals in the United States, based on the 2008 to 2015 American Hospital Association Annual and IT Supplement surveys.

First, they evaluated which hospitals have adopted “basic” verses “comprehensive” EHR functions. They found larger, urban hospitals participating in payment reforms were far more likely to use a comprehensive system than small, rural and safety-net hospitals — creating a digital “use” divide of EHRs.

Next, the researchers analyzed questions newly available on the 2015 Supplement to further assess hospital use of EHRs for 10 performance measurement and patient engagement functions. Over all hospitals, the most commonly adopted performance measurement functions were used to monitor patient safety and create dashboards of individual provider performance. Similarly, the most common patient engagement function allowed patients to view data online and download it.

However, critical access hospitals overall were less likely to have adopted eight or more of the ten EHR functions of either category.

The conference speaker Julie Adler-Milstein, PhD, was an associate professor at the University of Michigan during this research and is now at the University of California, San Francisco Medical Center. She said she is concerned about this emerging divide because these advanced EHR functions are essential for improving hospital performance. “We do need to consider what we can be doing to help safety-net hospitals make sure that they are able to continue their adoption trajectory and invest in some of these more substantive and important capabilities,” said Adler-Milstein in a recent news piece.

Specifically, the authors recommended in the abstract that policymakers drive greater EHR adoption using direct funding for health IT and indirect incentives to promote value-based payment and delivery models. They concluded, “Policymakers may need to consider specific actions to target safety-net hospitals, which could include funding as well as technical assistance with implementation.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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How to improve care for LGBT patients

October 18, 2017

No one facing health concerns should have to worry about receiving inequitable care because of their sexual orientation or gender identity. But studies and surveys show that many lesbian, gay, bisexual and transgender individuals experience discrimination by healthcare providers — including clinicians who refuse to provide needed care, refuse to touch them or use excessive precautions, are disrespectful or simply blame them for their health status.

Fortunately, healthcare providers can improve clinical care of their LGBT patients by taking proactive steps, as outlined in a recent viewpoint in JAMA. In particular, Alexia Torke, MD, and Jennifer Carnahan, MD, professors of medicine at the Indiana University Center for Aging Research, focus in the paper on how to optimize care for older LGBT adults, who are the first generation to be more open about their sexual orientation or gender identity.

The authors recommend that clinicians use inclusive language, such as using a patient’s preferred name and pronoun and asking about a spouse or partner regarding marital status. Forms disclosing sex should also include options for transgender patients, such as “male-to-female,” they say.

In addition, they recommend that physicians learn about the medical concerns specific to LGBT patients, such as hormone treatment and gender affirming surgery for transgender individuals. They also state that screening and diagnosis for medical conditions should be based on a person’s anatomy rather than their gender identity, giving the example that a female-to-male transgender patient is at risk of gynecologic cancers if he has not had a hysterectomy.

Torke and Carnahan also indicate that clinicians should better understand the unequal treatment that many sexual and gender minority patients face, which can have financial, social and health consequences. For instance, these individuals may not have access to health insurance due to employment discrimination or as an unrecognized spouse.

They also recommend that LGBT-friendly clinicians register as a “safe physician” with organizations like the Gay and Lesbian Medical Association.

A key to improving care for these patients is training, according to the authors and other experts. So the Human Rights Campaign has established best practices for health care organizations and provides free online training for healthcare providers.

The campaign also evaluates the implementation of these best practices and publishes an annual report. In the 2017 report, almost 600 healthcare facilities participated in the related survey and more than 900 non-participating hospitals were also researched. Happily, over 300 of the participating facilities were rated as a “leader in LGBTQ healthcare equality” with a score of 100 — including Stanford Health Care.

The authors conclude in the paper:

“Although lesbian, gay, bisexual, and transgender older adults face barriers to good health and health care, clinicians can take proactive steps to improve the care they deliver. These steps include education about prior discrimination and major health needs, as well as policies that ensure respect for the individual patients and equal treatment in all health care settings.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Local knowledge key to building healthier communities

October 9, 2017

Photo by Chris Waits

Your zip code is just a number meant to guide mail delivery, but studies show that it predicts your lifespan better than your genetic code. For instance, the average life expectancy in New Orleans varies by as much as 25 years in communities only a few miles apart.

This health disparity is driving health care providers, researchers, urban planners and community members to work together to build healthier, more equitable communities — addressing the key factors that determine health and well-being outside the clinic.

““It’s not enough to ask how we can build healthier, happier and greener communities without first addressing the real inequalities that are impacting the design of our cities,” said Antwi Akom, PhD, an associate professor of environmental sociology, public health and STEM education at San Francisco State University, at Stanford Medicine X earlier this month.

However, this design movement depends on access to reliable data, which led the Obama administration to launch The Opportunity Project to “unleash the power of data and technology to expand economic opportunity in communities nationwide.” The project released 12 smartphone apps to provide easy access to governmental data on housing, transportation, schools, neighborhood amenities and other critical community resources.

One of these apps, called Streetwyze, was developed by Akom and Aekta Shah, a PhD candidate at Stanford University, through the Institute for Economic, Educational and Environmental Design. Streetwyze is a mobile, mapping and SMS platform that collects real-time information about how people are experiencing cities and local services, so the data can be turned into actionable analytics.

“The real challenge of the 21st century health data revolution is how do you bridge this gap between official knowledge and local knowledge in ways that make the data more reliable, valuable, authentic and meaningful from the perspective of everyday people?” said Akom at Medicine X. “We think the missing link is real-time two-way communication with every day people so they can participate in the design solutions that meet their every day needs.”

Streetwyze harnesses local knowledge to address questions like: How walkable is my neighborhood? Where can I buy affordable healthy food? How safe is my local park?

For example, a map of East Oakland based on county and city business permits shows many grocery stores in the area. But the reality, according to Akom and Streetwyze, is that most of these supposed grocery stories are actually liquor or corner stores, where you can’t find fresh vegetables or food.

In addition to providing more reliable data to design healthier communities in the future, the Streetwyze data already plays a critical role for community members and some organizations. “Every community has assets,” said Shah. “The Streetwyze platform actually helps lift those up, so that communities can better share those resources and organize around those assets that already exist.”

At Stanford, Shah is using Streetwyze to research how this digital technology may impact youth self-esteem, civic engagement, environmental stewardship and more.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.


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