Injecting Equity into the eHealth Conversation
Recent publications have made this spring an exciting period for proponents of patient-centered eHealth tools. However, what is still missing is the inclusion of wider range of perspectives. There remains a need to recalibrate the dialogue surrounding eHealth tools to include the underserved.
An article by The Office of the National Coordinator for Health IT (ONC-IT) leadership, National Action Plan to Support Consumer e-Health, details the agency’s strategy to increase access and utilization of eHealth tools. Their efforts to improve access to electronic health records (EHRs) and other enterprise health information technology (HIT) are laudable, but they fail to mention specific efforts to target the barriers facing underserved patients anywhere in the strategy.
A recently released Agency for Healthcare Research and Quality (AHRQ) patient-centered care initiative highlights a number of patient-facing eHealth interventions. Many of these interventions are tailored personal health records (PHR) or patient portal solutions with secure messaging functionality that move us closer to empowering the patient with as much information as possible. However, precious few of the AHRQ-funded interventions deal directly with the unique needs of underserved populations.
The editorial Why the Nation Needs a Policy Push on Patient-Centered IT acknowledges the potential of consumer eHealth to address health disparities. But, the authors' policy framework focuses on the need for patient-centered care as a broad goal and lacks specific policies to ensure the underserved receive tools for engagement that meet their unique needs.
At the same time, the health care sector that is moving ever closer to a crystallized vision of how patient-centered eHealth tools and data platforms should empower and engage patients to take control of their healthcare and wellness. This is a vision of a world in which patients can download their EHRs and PHR data into applications of their choosing to track and monitor their health, or that of their loved ones.
One of the most real and recognized examples of this vision is the Veteran Administration’s innovative BlueButton and BlueButton+ systems. This is a precedent-setting approach that allows patients to download their PHR data in common formats, features an operating system that is open to app developers, and may be included as part of Meaningful Use Stage Three.
As exciting as innovations like BlueButton are, we must be careful of the risks of embracing a one-size-fits-all strategy that could leave behind vulnerable populations facing significant disparities in health outcomes and access to care. Such individuals face unique barriers in taking advantage of this brave new world—language proficiency, health literacy and technological literacy. Unique cultural barriers related to trust and sharing information about health and wellness may also serve as hindrances. Finally, the providers they visit and the insurance programs that cover them may not be well-positioned to make effective use of eHealth tools in partnership with patients.
At ZeroDivide, we are excited by projects that acknowledge the unique eHealth needs of underserved patients. Going forward the goal should be to include these critical design considerations when implementing large scale eHealth tools across health systems, rather than only in small pilot programs. The promise of eHealth lies in its customizability for all levels of literacy, disability, and cultural needs, but that customizability has to be built in from start. Let’s not forget that.