HIT can create barriers for underserved populations

Report calls for ways to improve access, ease enrollment in public programs
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While health information technology has the potential to improve care, it also erect barriers to care for marginalized and underserved populations, according to a new paper from a coalition of advocacy organizations. The report was created collaboratively by the Asian & Pacific Islander American Health Forum, the California Pan-Ethnic Health Network, Consumers Union and The National Council of La Raza, a Hispanic civil rights and advocacy organization.

"HIT implementation must be done in a manner that responds to the needs of all populations to make sure that it enhances access, facilitates enrollment and improves quality in a way that does not exacerbate existing health disparities for the most marginalized and underserved," the report says.

Among the upsides to health IT: it can help those with literacy and language challenges more effectively communicate their health issues to provider. In turn, health information can be provided to them in the manner that suits them best--and that might be on paper.

But the digital age also poses challenges: Patients might come from families with mixed immigration status, with some members eligible for public programs and others not. These folks tend to be fearful of exposing their undocumented family members. For instance, an undocumented parent might be leery of enrolling a child in public programs such as Medicaid and the Children's Health Insurance Program.

Automated enrollment might exacerbate these fears and create additional barriers to enrollment by requiring unnecessary information during the application process, the report says.

Among the ways technology can help: Cell phones are rapidly becoming the communication method of choice among low-income populations, many of whom work multiple jobs and require more flexibility than a landline. The report points to services such as Text4baby, which provides text messages about newborn care and is available in Spanish, as a move in the right direction.

Among the report's recommendations:

  • Ensure that online applications only require information that is necessary to advance an application.
  • Design a web portal that takes into account differences in culture, language, and health literacy among its potential users.
  • Hospitals, providers and health plans should use demographic data, including race, ethnicity, and primary language to identify and address differences in utilization and health outcomes.

Researchers from the University of Central Florida in Orlando in a study published last fall found that age, income and education level were not factors in patients' willingness to adopt personal health records. This new report, though, points out that low-income patients may have barriers, such as lack of access to high-speed broadband, that prevent them from interacting with providers online.

FierceMobileHealthcare has written about smartphones' potential to reduce health disparities in America. Text4baby, which has more than 50,000 subscribers, was associated with positive changes among pregnant women in a study published at BMC Public Health. Its success has the U.S. Department of Health & Human Services looking for ways to best disseminate messages on the health of children ages 1 to 5 in similar program called Txt4Tots.

To learn more:
- find the report (.pdf)

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