Designing IT for diversity: A problem that already has a solution

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"We should be building language access for patients and, frankly, providers, too... We have the opportunity to do it right the first time. We really should be further along on that than we are."

With the release of ONC's final Health IT Strategic Plan for 2015-2020, the industry has a roadmap to guide future developments to address the ills of the current information technology ecosystem.

The plan outlines four key goals with the overarching vision of using health IT to improve the health and well-being of individuals and communities. Perhaps the biggest departure from previous drafts of the five-year strategic plan is the goal to advance person-centered and self-managed health.

Mark Savage, director of health IT policy and programs with the National Partnership for Women & Families, says this focus on the individual represents a pivot in the ONC's mindset that likely stemmed from comments on previous drafts of the strategic plan.

"[Previously] it was organized around selecting data, sharing data and using data. One of the global reactions [to the draft] was, 'Where is the person?'" Mr. Savage says. "Now, it's advancing person-centered, self-managed health versus data-centered health."

When placing the person at the center of care, the healthcare industry needs to take into account all facets of that individual, which includes far more than just a clinical history. These so-called social determinants of health include elements like socioeconomic status, employment status and education levels.

Another one, which Mr. Savage says doesn't receive the attention it needs, is language and literacy. Not only is this barrier unaddressed, but the current landscape builds language obstacles directly into the system. Electronic records and health IT software often only interface in English, which means even if patients have access to patient portals and the like, they may not be able to use the resources if English is not their native language.

Hospitals and health systems are making efforts to put the patient in the center of care, but there still exists one slight degree of separation between patient engagement and patient-centered care if patients are unable to access this information, not for lack of access or connectivity — though that certainly can be an issue — but because too few vendors and stakeholders recognize demographically diverse patient populations.

Mr. Savage saw this play out in another industry, too. He worked in California at a time when banks began building ATMs. Although significant numbers of Californians spoke languages other than English, the ATMs were programmed in English. Mr. Savage says they had to restart the project and rebuild the entire system to factor in different languages.

"It was obvious from the beginning there were at least a handful of common languages that should have been accommodated," he says.

It's obvious because this information is readily available. According to 2014 U.S. Census Bureau data, 43.7 percent of Californians speak a language other than English at home. Twenty-seven percent of Californians were not born in this country.

"We have the census reports. We know about diversity. We're just not designing and building for it," Mr. Savage says.

The same applies for healthcare. Hospitals and health systems know the demographics of their patient populations, so project developers should be able to address these barriers from the get go.

In December 2014, the National Partnership for Women & Families released survey findings discussing how consumers use health IT. The survey found patients who were able to access health information online were more inclined to improve their health.

What's more, minority populations tended to want access to online resources more than the white population. While 78 percent of Hispanic adults said having online access to health information increases their desire to do something about their health, just 55 percent of non-Hispanic whites said the same. Additionally, Asian Americans were among the most likely population to say they want to access their personal health information on a mobile device.

To be fair, race does not necessarily directly correlate with language. However, 2011 data from the Census Bureau indicates 60.6 million people ages five and older spoke a language other than English at home, which is 21 percent of the population.

"We should be building language access for patients and, frankly, providers, too," Mr. Savage says. "We have the opportunity to do it right the first time. We really should be further along on that than we are."

The epicenter of patient-centered care requires designing a healthcare system around what patients need, not only what physicians need.

"Thinking about these things ahead of time and designing and building for diversity so we aren't building in barriers and instead are building in solutions is probably the best thing we could do overall to get the system where it needs to be," Mr. Savage says.

More articles on health IT:

25 quotes that show just how fed up physicians are with EHRs
U.K. hospital chief executives resign amidst $300M Epic rollout
25 hospitals with innovation centers

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