“There has been much talk about the promise of health IT to reduce health disparities, but unfortunately little actual progress in federal health IT policy, and specifically the meaningful-use program, on this critical issue,” according to the plan.
Mark Savage, director of health IT policy and programs at the partnership, said within the HIT Policy Committee there is “a generalized acknowledgement” of the need to further address health disparities. The action plan contains a 31-page appendix linking its recommendations to add to or amend, by rule number, existing Stage 2 and proposed Stage 3 meaningful-use criteria.
“We wanted to do some of the heavy lifting for them,” Savage said.
The report noted that Stage 1 meaningful-use criteria for federal EHR incentive payments—and the soon-to-be activated Stage 2 criteria—“require providers to record a patient's demographic information and to generate at least one list of patients by specific condition” to target for the alleviation of disparities. “However, there is no requirement to view lists of patients by disparity variables such as race, ethnicity, language, gender identity, sexual orientation, socio-economic or disability status. Moreover, neither stage requires anything more to explicitly identify report, address and reduce health disparities.”
The report contains 14 elements the partnership suggests should be rolled into the State 3 criteria, plus three more to be “incorporated as early as possible in future stages.”
Many of them could benefit patients overall as well as those in the populations targeted for alleviation of health disparities. For example, the group recommends that Stage 3 criteria include a requirement that EHRs be able to collect and integrate in “real time” data from home-monitoring devices and mobile apps on smartphones. Others are more specific, such as targeting criteria for health dashboards on health IT systems that include “views of patient populations across multiple disparity variables.”
Development of Stage 3 criteria for the program is now underway by a workgroup of the Health Information Technology Policy Committee, an advisory panel created under the American Recovery and Reinvestment Act. Stage 2 criteria for those providers that have meet Stage 1 for two or more years go into effect Oct. 1 for hospitals, and Jan. 1, 2014, for physicians and other eligible professionals.
Savage said the partnership's recommendations have resulted in inclusions to the meaningful-use rules in both Stage 1 and Stage 2. “When this got launched, Stage 1 was about building the basis,” he said. “Even then, we were building in some things, such as demographic information with structured fields,” which included race, ethnicity and preferred language. That enabled data holders to query those populations against other items in the medical record, such as diagnoses or lab values.
“In Stage 2, we built in view, download and transmit,” Savage said, which will allow patients to obtain electronic copies of their entire medical record. The request for Stage 3, for example, includes a request for “more granular” demographics, he said.
The coalition, formed in 2005 and whose members include unions, the AARP, ACLU, and numerous other advocacy groups, is led by the not-for-profit National Partnership for Women & Families, which has had a representative on the HIT Policy Committee as a patient and consumer advocate since its inception in 2009.
“It's impossible to achieve better health outcomes and significantly reduce healthcare costs without tackling health disparities, which are a pervasive and costly problem,” partnership President Debra Ness said in a news release. “We have the chance to leverage Stage 3 of the meaningful use program to make significant progress in addressing disparities. We must not squander this opportunity.”
Follow Joseph Conn on Twitter: @MHJConn
