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Now or Later


The October 19 edition of iHealthBeat is reporting that National Coordinator for Health IT David Blumenthal and HHS Deputy Assistant Secretary for Minority Health Garth Graham have asked health IT vendors for their help in preventing a "digital divide" involving health care providers who serve minority communities. Blumenthal and Graham called on these vendors to make sure they target such health care providers in their marketing and sales campaigns.

They cited National Ambulatory Medical Care Survey data, which show low adoption rates of electronic health records (EHRs) among health care providers who serve primarily Hispanic patients who are uninsured or enrolled in Medicaid. Blumenthal and Graham wrote that the data show that 'EHR adoption rates among providers of uninsured non-Hispanic black patients are lower than for providers of privately insured non-Hispanic white patients.''  They added that the Office of the National Coordinator for Health IT and regional extension centers need to cooperate and 'focus substantial efforts on these priority populations.'

While it is true that efforts must be taken to avoid creating or exacerbating health care disparities, with the rollout and adoption of EHRs, it will take far more than marketing to prevent these potential digital disparities.

Part of the reason health care disparities exist is that we have generally employed a 'one-size-fits-all' approach to health care. It is a system-focused rather than a patient-focused approach to health care delivery. We may be about to make the same mistakes if we assume a one-size-fits-all approach to EHRs.

In order to build useable, safe and effective EHRs it is imperative to know the users.

Minority and safety net providers have unique needs and perspectives for which current EHRs are poorly designed. As EHRs increasingly include Personal Health Records (PHRs) and are designed to function as tools to provide decision support for patients, EHR/PHR designers will have to do a better job of understanding the unique needs and perspectives of special populations including racial and ethnic minorities, seniors and disabled populations. Involving end-users in the design, testing and certification process of these tools is critical.

As more and more care gets driven out of the hospital into homes and communities, in our efforts to reduce health care and insurance costs, health care outcomes will increasingly be affected by factors in patients' homes and communities that historically have been ignored by the traditional health care system. Factors that affect usability and accessibility will need to be considered when developing EHRs.

We are at a critical time in the transformation of our health care system. We can enhance outcomes and improve patients' engagement in their health by making the investments that are needed to design emerging EHR systems to meet the needs of diverse populations of patients and providers now or we can pay the ever-increasing price of poor health outcomes, premature death, disability and health insurance costs for everyone'later.

More Blog Posts by Chris Gibbons

author bio

Chris Gibbons, MD, MPH, is the associate director of the Johns Hopkins Urban Health Institute, the director of the Johns Hopkins Center for Community Health, and holds faculty appointments at the Johns Hopkins Schools of Medicine and Public Health. Dr. Gibbons is the Chair of CFAH's Board of Trustees. He blogs on the Healthcare Disparities Solutions Blog, a blog about healthIT innovation for disparities solutions. Want to read more from Dr. Gibbons? Subscribe to the RSS feed.

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Health Information Technology   Chris Gibbons   Communicate with your Doctors   Minority Health and Health Disparities   Inside Healthcare  

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