Health Equity as a Guiding Principle: A Challenge and an Opportunity

Health Information Technology has long been touted as part of the solution to much of what ails the healthcare sector, with affordability, accessibility, and patient engagement often topping the list of identified opportunities. The increased availability and use of telemedicine and other digital health services are starting to move the needle in these areas, but where technology really has an opportunity to make a needed impact is on health equity.

Every fall since 2006, the Healthcare Information and Management Systems Society (HIMSS) has used U.S. National Health IT Week to bring together stakeholders to demonstrate the power of information and technology to transform health. This year, HIMSS made a significant pivot – using their platform to elevate the conversation with Global Health Equity Week and offering suggestions of ways we can all take action. 

Here at Health Gorilla, we are dedicated to creating a more equitable healthcare ecosystem through data access and optimal use. One of the primary reasons I joined Health Gorilla was because of the company’s stated intention to apply to become a Qualified Health Information Network (QHIN) under the Trusted Exchange Framework and Common Agreement (TEFCA). Established by the 21st Century Cures Act and rules issued by the Office of the National Coordinator for Health IT's (ONC), TEFCA and the associated prohibition of health information blocking are foundational to advancing interoperability – and consequently health and health data equity. 

Key components of the bipartisan Cures Act of 2016 languished under the previous administration but have been prioritized since President Joe Biden tapped Micky Tripathi to lead the ONC in January 2021. Under Tripathi’s leadership, the agency has emphasized the critical importance of “health equity by design,” in which equity is a guiding and foundational principle for ONC programs and policies.

The cause and effect interaction of interoperability and health equity has also been recognized by Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, who notes that data exchange is crucial for us to identify, understand and address gaps in the system. "We need to build a data connected healthcare system," Brooks-LaSure said during a talk at HIMSS22. "We must do this to address the inequities in our healthcare system."

In healthcare, information can be a superpower. It enables providers to deliver the best possible care where, when and how it is needed most, and allows patients to obtain better, safer, more coordinated care, while granting them agency over their own health and health data. While greater access to health information has great potential to improve population health, we must be mindful of the risk of unintended consequences. As artificial intelligence is increasingly incorporated into health tech tools, we must recognize and eliminate bias in systems and algorithms that perpetuate racial and other forms of discrimination.

Setting aside the issue of healthcare access, which to be clear should be a right and not a privilege, there are also significant inequities among those who do receive healthcare on a regular basis. The quality and completeness of available health data can have a huge impact on the quality and completeness of care one receives.

Someone who receives healthcare in a catch-as-catch-can manner – piecing it together from disparate sources when and where it is available – is at a clear and significant disadvantage today compared to those who receive all of their care within an integrated health system. These patients can also suffer from an open-loop referral process because siloed information held by individual organizations does not allow clinicians to efficiently track patient progress and follow up on outcomes to safely and effectively coordinate care. For those with complex or rare conditions, who often seek care from multiple provider organizations that are disconnected from one another, the challenges are even more acute.

Also vital is maintaining accurate data so we can identify and understand health and healthcare inequities, evaluate systemic effects on individuals and populations, and to inform and monitor needed change.

As a primary care physician for more than three decades, I can say with confidence that interoperability of electronic health records (EHRs) and other health data is one of the best tools we have at our disposal to advance equity and justice within our healthcare system.

TEFCA, once fully operational, promises to serve as a “network of networks” and an on-ramp for frictionless health information exchange nationwide. But getting there will not happen on its own. There is work for all of us to do to make this vision a reality. Let’s get to it.