According to the Kaiser Family Foundation a person’s risk of premature death is 40% related to individual behavior, 30% genetics, 20% environment, and just 10% due to access to healthcare.((Artiga, Samantha, and Elizabeth Hinton. “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity.” The Henry J.Kaiser Family Foundation, 9 July 2019)) Many integrated healthcare organizations are shifting focus to actively address the social determinants of health found in their client population. Organizations who serve under-insured, un-insured, or state-insured clients regularly say, “they don’t have access to cell phones/computers/internet, so we don’t/can’t use tech based solutions to reach them.” At blueEHR we disagree.
One of our clients is a free clinic based in a suburban-rural county outside of a major metropolitan area. According to a recent study the health disparities in this county are huge. People living in neighborhoods off of the major highways are expected to die 10-15 years earlier than people living in the ‘mid-county’ area.((“Getting Ahead: The Uneven Opportunity Landscape in Northern Virginia.” Northern Virginia Health Foundation, 1 Mar. 2018)) The major barriers to healthcare in this county are transportation, money, education/language, and childcare. These roadblocks to healthcare were felt by the approximately 50,000 uninsured members of the county, before medicaid expansion.
From the public data that our client has shared with us of their approximately 2,000 customers 65% of them do not speak English as a first language. The average literacy level is that of a seventh grader. Approximately 50% of their clients do not have their own transportation, and rely on friends, family, the bus system, or walking((We learned that one of their clients walks five miles, one way, crossing two major highways with no dedicated pedestrian footpaths, once a month to attend a one-hour diabetic education class & receive free diabetic test strips so they don’t have to pay over $20 a month for strips out of their pocket.)). The majority of clients do have cell-phones, but do not have data plans or email addresses. As many as 20% of their clients are homeless or at risk of homelessness. A family of three will make less than $30,630 a year in one of the most expensive places to live in the nation.(( Kiersz, Andy. “The Most and Least Expensive Places to Live in America” Business Insider, 28 Dec. 2018))
So how do they use technology to reach their patients? With blueEHR. blueEHR is a health IT based platform and electronic health record. It is configured and customized for each client to receive and EHR meant for them and their needs.
blueEHR has automated appointment reminders, that can be set by each facility how far out in advance they are sent to clients. They can be scheduled far enough in advance to remind clients early enough to re-route a bus or to help organize a ride. Messages can be sent to the clients phone or email, or perhaps someone involved in their care, like a child or family member. To overcome language barriers, intake forms can be sent in advance to their client or their caregiver by email, or completed on a tablet in office. Copies of completed documents and access to the patient portal are available in over 20 languages. Patients with access to their health records in their native language recieve more culturally competent care. But, the use of technology isn’t limited to direct patient connections. Indirect technology improvements will help improve a patient’s health outcomes and can help communities overcome their social determinants of health.
A common issue seen in the U.S., is ED admissions for primary care and managed chronic care issues. For example, if a client runs out of insulin, but their primary care office is closed they will go to the Emergency Department for a prescription. The ED not having a record of the client might 1) put them on a different medication or 2) add more medications that interact with their already existing medication therapies. Through API key integration anyone on blueEHR can connect to their local Health Information Exchange (HIE) and have records pulled into the internal system in real time. For those that are not connected directly to another EHR or HIE patients can access their medical records and share that with other doctors, or an ED through the patient portal.
Another comprehensive use of indirect technology is blueEHR’s ability to aggregate, analyze, and act (AAA). With the ability to integrate with other technology portals, EHRs, and HIEs, we can pull the client’s dispersed records into their chart and make the information live and dynamic. Our system can then parse that information to evaluate the population’s health. With reports, and custom built dashboards, the data for a facility’s important health measurements can then be acted upon. With configurations unique to your organization, the system could send and track messages sent to clients or their caregivers about important topics of the month. For example a reminder about getting a colonoscopy in March is sent only to the appropriate populations. Or for patients who are due to return to your clinic for an updated A1c, a message would go to them asking them to make an appointment. These are just a few examples that allow for greater client outreach, without burdening an organization’s staff.
As medicine and new treatments for our clients continue to evolve it’s important to have and electronic health system that can keep up. A system that works today should be able to grow with you and meet your needs in five and ten years. This also means having a system that can assist in providing culturally competent care, and is able to meet and support the clients, where possible. Whether it is with direct contact, such as appointment reminders or access to their health records remotely. Or indirect contact where a system can aggregate all of their medical records from the primary care office, to the local HIE and pull it together to create actionable reports to improve their health. I can confidently say that blueEHR is the only health IT platform that provides solutions to these needs and continues to grow with the future of the healthcare industry.