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Quality Update - Health care quality issues for Minnesota's health care leaders

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Technology in Support of Equity

Susan Severson
Susan Severson, MPH, Vice
President, Health Information
Technology, Stratis Health

As a health care outreach worker in Duluth two decades ago, I would have gladly traded in my hefty three-ring binder thick with dog-eared pages of community-based organizations and other trusted contacts for a searchable, sortable laptop app to address health care and social determinant needs. Today, online cloud services—like Aunt Bertha, Healthify, and NowPow—are powered by detailed, up-to-date resource databases. These tools allow outreach workers, care coordinators and others to make appropriate referrals faster for clients. These tools offer functionality that tracks whether clients and organizations were successfully connected to address the individual's needs.

Technology can be an incredible aid for health care organizations to advance equitable care if implemented properly. Stratis Health believes the Institute for Healthcare Improvement's (IHI) Framework for Health Care Organizations to Achieve Health Equity is a powerful approach for driving equitable quality improvement. Across the framework's cores areas, from making health equity a strategic priority to decreasing institutional racism, technology can play a supporting role.

IHI Framework for Health Care Organizations to Achieve Health Equity

Electronic health record (EHR) systems should be used to identify, communicate, and track gaps in care. Quality of care data needs to be parsed by race, ethnicity, language, and other criteria to unmask hidden gaps. Overall high screening rates for colorectal cancer for some clinics can become unacceptably low when looked at exclusively for African Americans. A gap revealed is ready for examination to understand and address the issues.

When one revealed gap becomes two, then three or more, they drive the need to make equity a strategic priority. Health care leaders use this evidence to make a business case grounded in their mission of patient care and to reflect the cost of unequal care. BlueCross BlueShield Minnesota published the 2018 report The Cost of Health Inequities in Minnesota showing that in our state alone, the cost of inequity is $2.2 billion.

When organizations become agile and can tap into their EHRs for detailed analyses of disparities data and provide high-level dashboards reflecting progress on disparate care, beyond what is reported to MN Community Measurement, we'll have made significant progress in integrating equity into quality improvement.

Data on disparities gives leaders the ability to paint the picture of uneven outcomes and care, and motivate others throughout the organization to seek improvement. Data makes an undeniable case for the culture change needed to reduce institutional racism. It enables people to make better data-driven business and care decisions. Culture change can be augmented by standardized assessments (administered electronically for efficiency, of course!) that help organizations evaluate their current focus on health equity and improvement efforts. From this look at their internal landscape, leaders can unfold their strategic priorities.

Predictive analytics software allows organizations to identify patients at risk for a health crisis before one happens. Care coordinators are using data dashboards from these technology tools on a daily basis to carry out interventions that maintain a person's health and avoid inappropriate utilization, setting the stage for the right care, at the right time, in the right place.

Patient engagement tools, like portals and open clinical notes, allow patients to access their health information and share with their social supports. Patients can better understand their health issues and shape their preferred approach to care in ways that are appropriate to their cultural values and beliefs, and support systems.

Virtual care delivery is filling the gap more and more in the service of equitable care, bringing care to where people need it. For rural care disparities, telehealth provides care in the absence of nearby specialists, allowing more patients to stay in their communities. Telehealth is rapidly being adopted for the delivery of mental health services. In-person medical interpreters are becoming more challenging to find so remote interpreter services fill the communication need.

The varied collection of emerging technology supports is needed to move health care organizations along the path of providing more equitable care. Stratis Health can guide the way.