Health Information Technology and Disparities in Quality of Care

Sequist, Thomas D.

doi:10.1007/s11606-011-1812-8

Cited by 16 publications

(11 citation statements)

References 10 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Much of the prior literature related to patient portals and low-income populations has focused on the barriers posed by the digital divide; that is, the fact that many vulnerable populations lack the digital access, capacity, and interest to use a portal [ 14 - 28 ]. However, prior national studies suggest that the racial/ethnic and socioeconomic digital divide is shrinking, and that there are no racial/ethnic differences among people accessing the internet via mobile phones (about 60% of US adults) [ 28 , 29 ].…”

Section: Introduction: a Patient Portal Arrives To The Safety Netmentioning

confidence: 99%

Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

Casillas¹,

Abhat²,

Moreno³

et al. 2020

J Med Internet Res

View full text Add to dashboard Cite

Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.

show abstract

Section: Introduction: a Patient Portal Arrives To The Safety Netmentioning

confidence: 99%

Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

Casillas¹,

Abhat²,

Moreno³

et al. 2020

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…The discussion regarding health technology in diverse populations has been limited to the explanation offered by the digital divide-that vulnerable populations will not have access to, or be able to use, digital technology. [26][27][28][29][30][31][32][33][34][35][36][37] Though gaps in portal use are partially due to structural barriers like access to and knowledge of the Internet, and familiarity with Internet-connected devices (computers, tablets, or smartphones), [29][30][31][32][33][34][35][68][69][70] emerging research suggests that the factors driving differences in portal use among diverse patients go beyond technological access or literacy. 40 Recent studies suggest that physician validation of the portal, repeated education about the portal's tools, and use of a patient portal by friends or family are important, 57,[71][72][73] and these points were all brought up by patients in our study.…”

Section: Discussionmentioning

confidence: 99%

“…As echoed by some of the patients in these focus groups, bilingual support interventions to increase patient portal registration and use in the safety net are in high demand, but have not been developed and evaluated for these populations, especially for patients who are LEP. 13,15,26,49,67 Based on this formative work, the LAC DHS is also developing tailored Spanish-speaking instructional content for patient registration and use in the efforts mentioned previously. [58][59][60] Among the limitations of this study are small sample size and generalizability to other safety net healthcare systems or other persons who speak languages other than English or Spanish.…”

Section: Discussionmentioning

confidence: 99%

“…This divide is also observed among those with lower income, older age, less educational attainment, rural residence, and low health literacy. [26][27][28][29][30][31][32][33][34][35][36] Given the previous, there is valid concern that health technologies, like the patient portal, exacerbate existing racial or ethnic and socioeconomic healthcare disparities-only to "yield further advantages for the already advantaged," as stated in the "Inverse Care Law" argument. 37 The Los Angeles County Department of Health Services (LAC DHS), the second-largest health safety net system in the nation, launched its English-Spanish patient portal in March 2015-one of the few bilingual portal interfaces in the nation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net

Casillas

Perez-Aguilar

Abhat

et al. 2019

Journal of the American Medical Informatics Association

View full text Add to dashboard Cite

Objectives Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets—health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems—including those who are limited English proficient (LEP). Materials and Methods The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. Results Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants’ discussion centered around 3 major thematic narratives: (1) participants’ awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. Conclusions Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.

show abstract

“…At the same time, benefits from such new technologies and associated solutions are in general likely to accrue to those who have access to and good understanding of those technologies. Early evidence does indicate that the benefits from health care technological innovations preferentially accrue to users from privileged socioeconomic backgrounds and those with higher levels of e-health literacy (i.e., the ability to use digital technologies to find relevant health information and apply the knowledge gained to improve health or address a health issue) [5][6][7]. If this evidence is correct, then what policies and strategies should health care organizations (HCOs) adopt to ensure that the benefits from health care technological innovations are more equitably distributed among all target populations, including resource-poor communities and individuals?…”

Section: Introductionmentioning

confidence: 99%

How Should Organizations Promote Equitable Distribution of Benefits from Technological Innovation in Health Care?

Nambisan

2017

AMA Journal of Ethics

View full text Add to dashboard Cite

Technological innovations typically benefit those who have good access to and an understanding of the underlying technologies. As such, technology-centered health care innovations are likely to preferentially benefit users of privileged socioeconomic backgrounds. Which policies and strategies should health care organizations adopt to promote equitable distribution of the benefits from technological innovations? In this essay, we draw on two important concepts-co-creation (the joint creation of value by multiple parties such as a company and its customers) and digitalization (the application of new digital technologies and the ensuing changes in sociotechnical structures and relationships)-and propose a set of policies and strategies that health care organizations could adopt to ensure that benefits from technological innovations are more equitably distributed among all target populations, including resource-poor communities and individuals. IntroductionIn the past decade or so, the health care industry has seen a rapid infusion of a wide range of digital technologies and associated innovations-from enterprise-level systems such as electronic medical records (EMRs), e-prescribing systems, and patient portals, to personal health systems such as personal health records and personal health mobile apps. There is emerging consensus among researchers and policymakers that these health information technologies do have a positive impact on many different health care outcomes including efficiency and effectiveness of care, access to care, patient involvement in care, patient satisfaction, and preventive care [1][2][3][4].

show abstract

Health Information Technology and Disparities in Quality of Care

Cited by 16 publications

References 10 publications

Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net

How Should Organizations Promote Equitable Distribution of Benefits from Technological Innovation in Health Care?

Contact Info

Product

Resources

About