EVALUATING THE USE OF HEALTH INFORMATION TECHNOLOGY TO ADVANCE HEALTH EQUITY IN PRIMARY CARE
Creators: name: Phillips, Ethan
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2023

description: Introduction: The concept of health equity has recently taken a central position in efforts to improve health care in the United States. With the 2021 National Academies’ report on “Implementing High-Quality Primary Care,” the United States is also experiencing renewed focus on primary health care. Follow up articles to the report highlighted the need for health equity to be centered in primary care and the importance of health information technology (HIT) in promoting high-quality care. Data-driven improvement has long been known to be an important building block of high-performing primary care, but the role of data and technology in advancing health equity is not well understood. 

Methods: This study aims to investigate the link between data systems and health equity within the context of primary care practices by presenting a case study of a single, high-performing primary care practice selected through reputational sampling. Researchers reviewed the practice’s policy documents related to equity and interviewed a clinic administrator, a physician, and a data specialist at the practice. The Consolidated Framework for Implementation Research (CFIR) was used to analyze interview transcripts. Themes derived from the interviews fell under the CFIR’s five domains, intervention characteristics, outer setting, inner setting, characteristics of individuals, and implementation process. 

Results: The practice was found to have a robust HIT system which includes an electronic medical record with both collection and analysis capabilities, a data reporting platform, and a data analysis and management team. As described by prior literature, the clinic followed a four-phase data use process which includes collection, analysis, reporting, and action. In addition to themes in each of the other CFIR categories, interviewees reported a number of process facilitators to data use for advancing health equity, including value-based contracting with payers, health equity champions, affiliation with a larger health system and with a university department, partnerships with peer clinics, receptive leadership, pandemic-motivated transitions to virtual care delivery, and external grant funding. Interviewees also reported barriers which included data limitations, data security concerns, staff burden, patient preference for convenience over continuity, and fee-for-service revenue models. 

Conclusion: We found that the clinic closely followed the proposed theoretical continuum in developing their HIT capabilities and health equity practices. This supports the continuum and offers an evidence-based framework for other primary care practices to follow in advancing equity through data-driven improvement. The facilitators and barriers identified through interviews point to the importance of implementing robust HIT and data collection, analysis, and reporting capabilities to achieving higher levels of clinic performance. Additionally, the findings of this study support the semi-cyclic nature of the proposed continuum where high-performing clinics must undergo continual reanalysis, rereporting, and reaction in order to perpetually improve equitability. Other primary care practices can learn from the facilitators and barriers identified in this study to navigate their own implementation of data-driven practices to advance health equity. Implications for the broader U.S. health care industry include the need for updated data security regulations which align with modern technology and the need for increased value-based care contracting which enables clinics to fund population-health initiatives.

Key Words: Health Equity, Data, Information Technology, Primary Care, Quality Improvement, Implementation Research, Social Determinants of Health, Electronic Health Records, Population Health