Health Disparities and Health InformaticsThis is a featured page

Learning Objectives

From the wiki entry on health disparities and health informatics, readers will be able to…
· Increase their awareness of health disparities and why they exist.
· Recognize challenges that need to be overcome to eliminate health disparities.
· Identify how health disparities can be reduced or eliminated using health informatics according to leaders in the field.
· Access additional information to learn more about how health informatics and health disparities relate.
· Familiarize themselves with health promotion initiatives being made to eliminate health disparities.

Description of health disparities

Health disparities are differences that occur by gender, race and ethnicity, education level, income level, disability, geographic location, and/or sexual orientation (National Public Health Week, 2004). Healthy People 2010 has highlighted how health disparities can occur among various demographic groups1 and has identified ten leading health indicators where health disparities exist2. To name a few, health disparities include lack of physicians in rural areas, low health literacy, unequal treatment for minorities, and exposure to environmental risks. Race and ethnicity account for much of the disparities in public health. Minority populations in the United States have higher rates of chronic disease, higher mortality, and poorer health outcomes than whites. According to the National Clearinghouse for Alcohol & Drug Information (NCADI), socioeconomic factors (e.g., education, employment, and poverty), lifestyle behaviors (e.g., physical activity, alcohol intake, and tobacco use), social environment (e.g., educational and economic opportunities and neighborhood and work conditions), and access to clinical preventive services (e.g., cancer screening and vaccination) contribute to racial/ethnic health disparities (MMWR Weekly, 2004). The same article also states that the future of public health will be adversely affected because minorities will account for nearly 50% of the total U.S. population by 2050. Therefore, the current disproportions in health care and increasing minority population in the U.S. further confirms the need to address and eliminate health disparities.

Background

Office of Minority Health (OMH) was established in 1986 by the U.S. Department of Health and Human Services to improve and protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities. OMH maintains that to eliminate racial/ethnic disparities, enhanced efforts are required to prevent disease, promote health and deliver appropriate care. This will necessitate improved collection and use of standardized data to correctly identify all high-risk populations and monitor the effectiveness of health interventions targeting these groups. In addition, new knowledge about the determinants of disease, causes of health disparities, and effective interventions for prevention and treatment will need to be addressed. It will also require improving access to the benefits of society, including quality preventive and treatment services, as well as innovative ways of working in partnership with health care systems, State and local governments, tribal governments, academia, national and community-based organizations, and communities. Appleyard (2005) also emphasized the importance of researching the most effective way to provide health information as new technologies have made possible the use of genetic research to identify and ultimately lead to the treatment of disease. In its efforts to achieve its goal of eliminating health disparities, Healthy People 2010 constructed midcourse reviews, which are available3 to track revisions of objectives and progress made toward its goal of eliminating health disparities.

Practical tips and lessons learned

In some cases, the use of health informatics has been believed to increase health disparities. The Institute of Medicine report (2000) identified medical errors that may cause up to 98,000 deaths in hospitals and cost approximately $38 billion per year. Ash et al. (2005) published an article on unintended consequences of patient care information systems. The article highlighted medical errors made as a result of using technology in the clinical setting to supplement patient healthcare. For example, many health care providers complained about the interface not being user friendly, which ultimately led to wrong prescriptions being ordered or prescriptions ordered for the wrong patient. In another journal article on the related subject, Zhang et al. (2005) provided examples of failed efforts to incorporate health informatics in patient care. One being the Computerized Physician Order Entry (CPOE) project at Cedars-Sinai, which was terminated because physicians complained that entering and sending orders took longer than using paper systems.For underserved populations, improving access to health information will aid in eliminating health disparities. Many barriers exist to effectively deliver health information as an increase of information is being made available online. Socioeconomic accessibility or the digital divide continues to be a major problem to certain populations such as the elderly, certain race and ethnic groups, or individuals with low income and education (Appleyard, 2005). There are many web-based programs available to help improve health but if there is limited accessibility to this information, it still has little effect in the reduction of health disparities for populations who need it the most. According to statistics from National Telecommunications and Information Administration, high-risk populations are less likely to have access to the Internet (2002). An additional concern raised with using internet-based delivery of health information is the literacy level of the material since underserved populations usually have a low level of literacy. The National Library of Medicine (NLM) created audio news and conducted interviews to reach audiences via radio to raise awareness about their health information websites. In addition, they recorded the same message in Spanish to reach more consumers. Effectiveness of their efforts will be measured by the number of hits to their website before and after the radio spots. NLM has been instrumental in addressing health informatics barriers contributing to health disparities. NLM devised a strategy to improve health information access by health professionals, patients, families, community-based organizations, and the general public to information, with special emphasis on rural, minority, and other underserved populations. NLM believes that improved access to health information in MEDLINE, MedlinePlus4, ClinicalTrials.gov5, and the Library's other computerized databases will result in higher quality health care for the Nation's citizens. These strategies include:

· Improving the information infrastructure and communications capabilities of minority communities.
· Employing communication methods that are racially and culturally sensitive and appropriate.
· Increasing the scope of information products and services to include cultural, psychological, behavioral, social, gender-based
and environmental influences.
· Building partnerships with community-based and professional organizations.
· Strengthening the capacity of minority communities
· Improving the infrastructure at minority academic institutions

Advances in technology call for continual revision in objectives to most effectively eliminate health disparities. Continuing to tailor messages to various underserved populations will be key in disseminating health information to the public, which will lead to an increase in health literacy and prevention of disease. Progressive strides in health information delivery from health promotion initiatives such as Healthy People 2010 and NLM, the goal of eliminating health disparities can be attained or significantly improved.

References

Appleyard R. Disability Informatics in consumer Health Informatics. In: Lewis D, Eysenbach G, Kukafka R, Stavri PZ and Jimison HB, eds. Springer: New York, NY, 2005, p. 129-142.

Ash JS, Berg M, Coiera E. J Am Med Inform Assoc. 2004;11:104-112.

Institute of Medicine, Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.

MMWR Weekly. Health Disparities Experienced by Racial/Ethnic Minority Populations. 2004 Aug 27; 53(33): 755.NLM. Strategic Plan for Addressing Health Disparities 2004-2008. National Institutes of Health, Health and Human Services, Bethesda, MD.

National Public Health Week. Eliminating Health Disparities: Communities Moving from Statistics to Solutions Toolkit, 2004 Apr. NTIA. A nation online: how Americans are expanding their use of the Internet. In: Cooper KB, Victory NJ, eds. Washington, DC: US Department of Commerce, Economics and Statistics Administration, National Telecommunications and Information Administration, 2002, p. 92.

Zhang J, Patel VL, Johnson TR, and Turley JP (2005) Health Informatics and Medical Errors. Business Briefing: US Healthcare Strategies; 34-35.
External Links

Patricia Flatley Brennan, Ph.D.
University of Wisconsin-Madison
August 18, 2003 Presentation:
Using the Science of Informatics to Advance Health Disparities Research. http://www.son.washington.edu/centers/hdc/videos/CAHDR_Brennan_030818.ramhttp://www.healthdisparities.net/


natkinson
natkinson
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natkinson Poorly designed PHI 0 Dec 11 2006, 7:21 AM EST by natkinson
Thread started: Dec 11 2006, 7:21 AM EST  Watch
I liked the discussion about how poorly designed application can cause medical errors by the clinician or clinical staff. This points out, again, the importance of formative research and usability testing. Otherwise, people have the potential to use these applications incorrectly and not even realize it! If I had a primary concern for EHR systems, it is that the training required to use them correctly may not be done properly or systematically and lead to more errors rather than fewer.
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nsarpal Another Barrier to Accessing information 0 Dec 8 2006, 4:25 AM EST by nsarpal
Thread started: Dec 8 2006, 4:25 AM EST  Watch
I think another barrier, which goes along the ones that were listed in here, is the fact that a lot of times people don't know that this information is out there on the web. Even if people can gain access to a computer and internet, they might not know how to access webpages like MEDLINE, and even worse, they might not even know these websites exist. It was mentioned that the NLM has tried creating radio news bits and interviews to try to reach audiences, but how often are they run and oh which radio stations? I think it's great that they're doing something to get their name out there, but I think that more should be done in order to make sure these target audiences are being met. I know at UMD, whenever an undergrad class has to do a research paper, one class each semester is dedicated to going to the library and learning about all the different research options at the library. I think it would be helpful if something like this was created for public libraries. I think it would really help people who do not know much about the internet.
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