Digital divide plagues slow e-health records rollout

EHRs can sometimes be the difference between life and death

The digital divide is alive and well when it comes to health care technology.

Although President Barack Obama has made it a priority to have medical facilities deploy electronic health records (EHR) over the next four years, the people most likely to benefit -- those in poor and minority communities -- are unlikely to see them anytime soon.

Physicians' practices and small clinics, where most doctors work, don't have the money to implement the technology, which can cost tens of thousands of dollars.

In an open letter to IT vendors, David Blumenthal, National Coordinator for Health IT, asked that they do what they can to improve health care for low-income and minority communities to prevent health disparities caused by a "digital divide."

EHRs, which can help ensure that medical best practices are followed and aid in tracking illnesses by geographic regions, can mean the difference between life and death.

"It is absolutely necessary that the leading EHR vendors work together, continuing to provide EHR adoption opportunities for physicians and other health care providers working within underserved communities of color," Blumenthal wrote. "Despite our best efforts, data from the National Ambulatory Medical Care Survey indicates that EHR adoption rates remain lower among providers serving Hispanic or Latino patients who are uninsured or relied upon Medicaid."

EHR adoption rates among health facilities that offer care to uninsured African-Americans are lower than they are among providers of care to privately insured white patients, Blumenthal said in his letter. At the same time, racial and ethnic minorities remain disproportionately affected by chronic illnesses, a contributing factor to high mortality and morbidity rates.

Ruth Perot, managing director of the National Health IT Collaborative for the Underserved, said there is surprisingly little data on the overall adoption of EHRs by health care facilities. But recent statistics show that only about 8% of community-based health clinics are using the technology.

"Among health providers in underserved communities, the percentages are considerably lower," she said. "African-American and Latino consumers are much less likely to be served by a physician with an EHR."

Cost is a barrier

Perot said the biggest barrier is cost. Most of the clinics in underprivileged areas serve patients who rely on Medicaid and Medicare for health insurance, so the providers have less money to install EHRs, hire IT specialists or train staff to maintain the systems.

"This is a transformation of your practice. We're talking about moving from paper to electronic records. That doesn't happen overnight. Many of these providers simply can't afford the downtime required," Perot said.

Another barrier to adoption is education. Health care practices in rural or underserved communities don't always have information about what EHRs are available, how to migrate to them and what needs to be done in preparation for that, Perot said.

Even at larger hospitals, where EHR costs can quickly rise into the millions of dollars, adoption rates remain relatively low.

Overall, only 20% of physicians and 10% of hospitals use even the most basic EHR technology, according to the U.S. Department of Health and Human Resources (HHS). The HHS Centers for Medicare and Medicaid Services, which created the so-called meaningful-use rules for EHRs, estimates that between 66% to 92% of hospitals and between 21% and 53% of private practices will implement EHRs by 2015, the deadline for receiving reimbursements from the federal government to defray the cost of EHR deployments. But the HHS doesn't break those numbers down by demographics.

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