eHealth Equity & The Triumph of the ACA
About 27 years ago, while working at a community health center in Oakland, CA, I had my first professional experiences with the vagaries of the U.S. healthcare system. These experiences set the course of my career as a healthcare advocate for the underserved, as well as an unabashed promoter, funder and practitioner of technology use to achieve health equity, or in short eHealth Equity. Let me explain.
The clinic where I worked has served the low-income, mostly monolingual Asian American community in Alameda County since the early 1970’s. During my eight year tenure there, I witnessed first hand the difficulties the most vulnerable uninsured and underinsured patients had managing their healthcare. The lack of access to primary care, little understanding of the Western healthcare delivery system, and barriers related to language and culture resulted in avoidable and sometimes tragic health outcomes.
The ongoing national dialogue spawned by the Supreme Court’s ruling on the Patient Protection and Affordability Care Act (ACA) has caused me to reflect on these past experiences. One of my most vivid and relevant memories is of Mrs. Huang (not her real name). Because she didn’t speak English, had no insurance and was a low-wage worker, Mrs. Huang’s only source of healthcare was our community healthcenter. One weekend after suffering excruciating pain in her abdomen area she went to the local hospital’s ER, where it was discovered an emergency procedure was necessary. The hospital had no access to her health records and wasn’t able to communicate effectively with her or her family before performing an emergency surgical procedure. Mrs. Huang had an ectopic pregnancy and woke up to find out that she lost a pregnancy she wasn’t aware she had, and possibly any future chance at motherhood. Hearing Mrs. Huang’s story had a profound effect on me because I was pregnant at the time.
While working at the clinic, I learned that the majority of our patients were uninsured or were subject to monthly fluctuations in health coverage; and that our health providers had to be clinicians, translators, social workers, case managers, and financial counselors all at the same time. There was a community health profile of our low-income, limited English speaking patients. When documented and analyzed, it helped us plan for the delivery of comprehensive primary care and prevention services, but did not prepare us, them, or the broader delivery system for acute episodes of illness or injury and their consequences.
My tenure at the clinic taught me three very important things: 1) how critical it was to ensure our most vulnerable have access to quality and affordable primary care, 2) the importance of patient level and population level data that allowed providers to address community health concerns and to implement effective prevention and care management programs, and 3) how inextricably intervowen technology and the delivery of effective, quality healthcare are. It was while I was Finance Director that the clinic made a decision to install a computerized billing and patient management information system. We simultaneously launched an effort to electronically capture and document our service area patient health profile to better track and analyze the health of our community. Ahead of our time, certainly. But, we thought that by doing this, we would catalyze change in how to better serve patients and the community using what we currently refer to as eHealth tools.
Mrs. Huang's case might sound extreme and, yes, and it was the mid-80’s. However, the unfortunate reality is that today’s healthcare system for patients like Mrs. Huang is not so much different than it was 30 years ago. Uninsured, elderly, limited English speaking, rural residents, and the urban poor have few to no alternatives for regular, coordinated healthcare, prevention services, or medical providers who can access accurate and complete electronic health records to manage their care.
Given the gross disparities in healthcare delivery based on racial, social, and economic lines, I am increasingly convinced of the importance of quality health data and information in the improvement of health status for the underserved. The role of technology in facilitating the collection and exchange of health data between providers and with their patients is possible today, unlike in 1985. ACA represents a huge opportunity for our country to take leaps and bounds toward building a more efficient, affordable and quality healthcare delivery system. As with the transformation that has occurred in every other industry in our global economy, technology is crucial to the change.
ACA set us on a path of improving healthcare quality and affordability by advancing the meaningful use of technology among providers and patients. The passing and implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act set the stage for the adoption of electronic medical records among community health providers who are more likely to serve the underserved. The financial incentives and technical support associated with the CMS EHR Incentive program set the stage for the development of electronic health information exchange between disparate providers and between providers, payors and patients. How can we expect accountability without maximizing technology?
As I continue to serve the community through my work with ZeroDivide, and as a Board Member of Dignity Health and The California Endowment, I am confronted with the needs of the underserved on a daily basis. I am reminded regularly of how important technology and the fluidity of health information are to the delivery of quality, affordable care. In the past year, ZeroDivide has developed a Community HealthIT Initiative that would promote strategies to empower patients and their providers utilizing the tools of technology to allow them together to meaningfully address healthcare needs — to achieve eHealth Equity and assure that there is no gap in the coordination between the patients’ home and community, the doctor’s office and the hospital setting. Thirty years later, the Mrs. Huang’s of our world should no longer worry about how and where to get care, or whether her limited English speaking ability will hinder making informed health decisions. She can be assured that both her doctor and the hospital, because of access to her electronic health record, have accurate information
The Supreme Court’s decision to uphold the law is a true reflection of our nation’s commitment to take care of all of its residents, and not just those that can afford it. Our vision of eHealth Equity is now more readily achievable. The time to transform healthcare delivery so that it meets the needs of all is overdue, and our effective and efficient use of the vast array of technical tools available to us will serve as our guidepost for change. We can take advantage of the Meaningful Use provisions in the ACA that incentivize the adoption of electronic health records, health information exchanges, web portals, and mobile apps for patient engagement to pro-actively manage their own health. Now we can confidently guide our communities and their providers to maximize the use of the Internet and social media to improve the health and wellbeing of women, children, seniors, the disabled, and the poor as surely as we use them to address economic and social issues. Momentum, and now policy, is indisputably on our side.