AllianceChicago is a unique organization. A federally funded health center network of more than 76 community health centers operating in more than 23 states, its work focuses on improving individual, community, and public health through innovative collaboration.
This partnership has been in place for over 25 years and is committed to developing and implementing systems that promote equity and optimize health and well-being.
The organization does this by supporting the development and optimal use of health information technology, conducting rigorous community-based research and evaluation, and cultivating innovative partnerships with community health centers and stakeholders to explore new ways to promote individual and community health.
CHCs are ahead of the rest of the healthcare world in understanding impact of social determinants of health and apply that knowledge to support the communities they serve. Andrew Hamilton, RN, CIO and associate director of AllianceChicago, and his team partnered with the National Association of Community Health Centers to develop a tool called PRAPARE, which is used by most CHCs across the U.S.
Healthcare IT News spoke with Hamilton to discuss a range of issues that all service providers can learn from. We talked about how healthcare information technology helps promote equity, the role of healthcare-generated data in supporting public health surveillance, and the collection and use of data on social care needs.
Q. Healthcare equity is a large and important issue that needs to be addressed. How can healthcare information technology help promote equity?
ONE. IOM Organization [now the National Academy of Medicine] identified six areas of quality in health care in which health information technology can play an important role: safety, efficiency, patient-centeredness, timeliness, effectiveness, and equity.
It is widely understood that health IT is an important aspect of each of these areas of health care. For health IT and equity, the technology framework provides an approach to the strategic design, development, and deployment of technology to advance health equity. It includes the concept that technology can either support or inhibit advances in health equity if not deployed in a purposeful and comprehensive manner.
It is important to note that techquity is not an “individual or consumer level” issue. Rather, promoting or developing techquity will require collaboration, transparency, inclusivity, and a commitment to ensuring organizational transformation at the system level to achieve equitable care.
Three key elements of health IT are essential to optimizing technology to promote equity in care: unhindered access, utilization (adoption and usability), and sustained engagement. These elements impact technology with high correlations to Health-related social needs include (but are not limited to) access to internet/broadband service, affordability of technology services and tools, language support features (beyond English and Spanish), and digital and health literacy.
In other words, the design and implementation of health IT must consider these health-related needs to ensure the technology promotes equitable care.
Q. Public health is an important issue that everyone in the healthcare industry needs to support. What is the role of healthcare-generated data in supporting public health surveillance?
ONE. The COVID pandemic has highlighted several opportunities to strengthen both our health care delivery system and our public health infrastructure. In terms of surveillance, the public health system in the United States is largely informed by vital records (birth/death certificates, mandatory case reporting, laboratory data), survey data (consumers, health care providers, insurers), environmental surveillance (water and air quality), and animal health (veterinarians, farms, and food producers).
A key issue in each of these areas is the timeliness, consistency, and interoperability of information. These factors significantly impact the overall time it takes to access, process, and analyze this data, which hinders a timely and coordinated public health response, especially during a new disease outbreak.
For electronic health systems, there is a clear opportunity to modernize public health surveillance infrastructure, especially with advances in data standardization and interoperability that underpin the 21st Century Cures Act, part of which regulates EHR systems.
AllianceChicago, in partnership with the National Association of Chronic Disease Directors and other partners, recently completed a five-year CDC-funded demonstration project to establish an EHR disease surveillance system for both inform public health surveillance and demonstrate how a shared system of public health and health care delivery can improve surveillance, coordination of surveillance, and public health response.
There have been similar efforts demonstrating the use of EHR data to support public health including childhood obesity, sexually transmitted diseases, and maternal health outcomes. It is clear from all of these programs that EHR data are an important and rich asset to support public health surveillance.
I believe the next important phase of work will be to harmonize these efforts as well as develop a roadmap to expand these networks to incorporate additional data contributors to ensure full and equitable representation of the U.S. population as well as incorporate data sources relevant to the social drivers of health.
Q. You are interested in addressing social care needs. Please discuss the collection and use of social care needs data..
ONE. In both of my previous responses, it is clear that in order to develop an equitable, person-centred health care delivery system (including public health systems), it is important to collect, analyse and develop coordinated responses to social care needs as a key aspect of improving health outcomes and equity.
In terms of collecting data on social care needs, there is growing evidence that a “mixed methods” approach is needed; that is, collecting information directly from people in care as well as using population-level social care needs data (e.g. risk indicators).
The challenge with individually collected social care needs data is that it is often a ‘snapshot’ of the individual (collected while the person is in care) and therefore, as an individual’s circumstances change over time, the time and place data may misrepresent need.
That said, population-level social care need data are estimates of people in a concentrated population and may therefore over- or under-estimate an individual’s need. In addition to data collection issues, work is underway to standardise these data to ensure comparability and interoperability.
Standardization work, such as that of the Gravity Project, is critical to ensuring that data can be processed, analyzed, and shared in a consistent and meaningful way. Data collection and standardization are critical components to ensuring optimal and efficient use of data.
At the individual level, significant use of social care needs data is related to incorporating social care needs into a patient’s overall care plan. Our understanding of how best to use this data in developing a care plan is evolving.
While we have much to learn, we do have some real-world examples that include integrating support for access to housing, food and transport. Interventions to address social care needs often require data sharing and cross-sector collaboration, which also requires change at the system and community level, which can be difficult.
In addition to using this data at the individual level, health systems are learning to use this data at the population level, which is critical to improving overall outcomes and health equity. Finally, the relationship between population health and public health creates clear opportunities to coordinate health system-level interventions with public health programs.
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Healthcare IT News is a publication of HIMSS Media.
