López Lenny, Green Alexander R, Tan-McGrory Aswita, King Roderick, Betancourt Joseph R
Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, USA.
Jt Comm J Qual Patient Saf. 2011 Oct;37(10):437-45. doi: 10.1016/s1553-7250(11)37055-9.
Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities.
Several root causes for disparities are amenable to interventions using HIT, particularly innovations in electronic health records, as well as strategies for chronic disease management. Recommendations regardinghealth care system, provider, and patient factors can help health care organizations address disparities as they adopt, expand, and tailor their HIT systems. In terms of health care system factors, organizations should (1) automate and standardize the collection of race/ethnicity and language data, (2) prioritize the use of the data for identifying disparities and tailoring improvement efforts, (3) focus HIT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients, (4) develop focused computerized clinical decision support systems for clinical areas with significant disparities, and (5) include input from racial/ethnic minorities and those with limited English proficiency in developing patient HIT tools to address the digital divide.
As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.
医疗保健中的种族和民族差异在许多常见临床病症的诊断、治疗及结果方面一直都有记录。美国卫生信息技术（HIT）的实施加速推进，医疗保健改革立法包含多项收集和使用健康信息以改善和监测医疗保健质量与效率的条款。尽管实施情况参差不齐且总体水平较低，但研究表明HIT有提高医疗质量和患者安全的潜力。如果精心设计和实施，HIT也有消除差异的潜力。
HIT与差异：差异的几个根本原因适合通过HIT进行干预，特别是电子健康记录方面的创新以及慢性病管理策略。关于医疗保健系统、提供者和患者因素的建议可帮助医疗保健组织在采用、扩展和定制其HIT系统时解决差异问题。在医疗保健系统因素方面，组织应：（1）使种族/民族和语言数据的收集自动化并标准化；（2）优先使用这些数据来识别差异并调整改进措施；（3）将HIT工作重点放在解决种族/民族少数群体和英语水平有限患者的医疗服务碎片化问题上；（4）为存在重大差异的临床领域开发针对性的计算机化临床决策支持系统；（5）在开发患者HIT工具以解决数字鸿沟问题时纳入种族/民族少数群体和英语水平有限者的意见。
在对HIT进行投资时，必须考虑这些创新对所有患者（包括那些存在差异的患者）的医疗质量和成本的影响。
