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Can Electronic Health Records Make Disparities Disappear?

According to Kendra Blackmon at and a new study published by the National Institute of Standards and Technology (NIST), the answer is maybe.

Earlier this year, NIST published a report – Human Factors Guidance to Prevent Health care Disparities with the Adoption of EHRs – which declares that “wide adoption and Meaningful Use of EHR systems” by providers and patients could impact health care disparities.

Making this happen, however, will require a different way of thinking about electronic health records (EHRs). While the report notes that EHRs primarily are used by health care workers, patients still interact with these systems both directly – such as through shared use of a display in an exam room – and indirectly. For patients to obtain the intended benefits of this technology, EHR systems should display or deliver information in a way that is suitable for their needs and preferences, the report says.

Therefore, it is “vitally important” that EHR developers and health care organizations implement Meaningful Use requirements “in a way that supports the patients, populations, and communities that they serve,” it adds.

Essentially, this means that EHRs should be designed to take account of the people who will end up actually using them. It opens the up discussion for EHR developers – and eventually health care organizations – to identify the many relevant patient user groups and their challenges to using EHRs. This includes EHR use when cross-cultural or communications barriers exist.

For instance, in some cultures, major decision making is considered an activity that requires input from family. However, informed consent and access to EHR information currently is constructed largely from the “Western perspective” which focuses on single users and individual rights, the report notes.

This can include looking at the needs of the adult caregiver of a senior relative. In many families, adult children caring for elderly parents is becoming increasingly common. This may be even more likely among patients from disparity populations who may lack resources to provide alternate care arrangements for their aging relatives, NIST says.

The demands and stress on the caregiver – when combined with childrearing, homemaking and employment demands – may create human factor challenges for the safe and effective use of EHRs.

What this implies in the long run is that understanding how patients from all walks of life use EHRs to improve their health care may be just as critical as understanding how EHRs adapt to clinical workflows in a hospital.

Without EHR design accommodations, current problems inevitably will lead to poorer EHR user experiences, limited EHR adoption among high-risk patients, and possibly even poorer health outcomes. To push outside these “digital disparities,” EHR developers and users will need to think outside the IT box to meet the needs not only of providers, but of all kinds of patients as well.

Chris Gibbons, MD, MPH

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

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