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Panelists of Improving Equity through Health IT in the US and Internationally and GHDonline staff

Improving Equity through Health IT in the US and Internationally

Posted: 24 Mar, 2014   Recommendations: 37   Replies: 64

The issue of rising income inequity is one of global concern. Health researchers have shown low-income countries contribute 56% of global disease burden, but account for only 2% of global expenditure on health (Mathers, 2006). In addition, there is great inequity within most countries. Among adults in the US with chronic conditions, 45% of those with below-average incomes reported going without needed care because of costs, compared with just 4% in the Netherlands (Davis, 2010). Economist Joseph Stiglitz argues, “We are paying a price in terms of our politics and society—inequity is undermining our basic values.” Many policymakers seek to understand how to bridge this gap.

This panel will look at how health IT ameliorates or deepens these health inequalities both in the US and low and middle-income countries (LMICs), and what can be done to decrease these inequalities.

We’re grateful to have the following panelists to lead our discussion:

     • Gonzalo Bacigalupe, Ed. D, MPH, Professor in Counseling Psychology and Director of the Family Therapy Master's Program, University of Massachusetts Boston
     • Andrea Cortinois, MPH, PhD, Assistant Professor at the Dalla Lana School of Public Health, University of Toronto
     • Esteban Gershanik, MD, MPH, Brigham & Women's Hospital
     • Soroya Julian, MSPH, Young Professional, eSAC
     • Jess Kadar, MFA, Principle Product Manager, Iora Health
     • Felipe Mejia, MSc, Young Professional, eSAC

Our panelists will offer insight on the following questions and others:

     1. How can health IT be used to increase equity in health care?

     2. What projects can serve as examples of improved health equity?

     3. How are improvements in health equity measurable? Can health IT help?

     4. Are there incentives that promote improving equity in health care?

This panel is a joint discussion between the Health IT and Innovating Health Care Delivery communities, the latter being a part of the US Communities Initiative, which is supported by the Agency for Healthcare Research and Quality (AHRQ), and aims to foster discussions between health care professionals on evidence-based practices, and translating these practices across disparate settings, to improve health care delivery in underserved populations in the US.

In an effort to understand the impact of our Expert Panels, please take our short (4 question) survey before the discussion begins: https://www.surveymonkey.com/s/MZ26R8H

Looking forward to a rich discussion next week – please join the conversation and share your questions or comments for our panelists!

Replies

 

Thom Walsh Replied at 10:32 AM, 24 Mar 2014

Hello,

Thank you for the invitation. Unfortunately, I'm traveling during the
timeframe for this conversation and I cannot commit to participation.

Rodrigo Cargua Rivadeneira Replied at 10:38 AM, 24 Mar 2014

Buenos días séra un placer poder participar de esta reunión muy importante
para la Salud y para las TI

ALCIBIADES BATISTA GONZALEZ Replied at 1:11 PM, 24 Mar 2014

Muy interesante. Gracias por la invitación. Como tema transversal a los tópicos propuestos, ¿podrían considerar los panelistas, el enfoque de derechos humanos dentro de la mejoría de la equidad, calidad y del desempeño en los cuidados de la salud? ¿Ayudan las TI en este aspecto?

Saludos.

akishore Kishore Replied at 3:06 PM, 24 Mar 2014

Thank you. Is there an agenda and timing for the event?

Marie Connelly Replied at 7:43 PM, 24 Mar 2014

@akishore This discussion will take place on GHDonline from March 31 - April 4. Our panelists will share their thoughts on the questions outlined above and respond to questions and comments from the community as well.

All are welcome to participate in this discussion. To share your questions or comments with our panel, simply add a reply on GHDonline.org, or via email—we look forward to hearing your thoughts!

Sandeep Saluja Replied at 5:44 PM, 26 Mar 2014

IT provides an opportunity to unite us globally.For those of us committed to improving health care,it is imperative that this opportunity is not missed.

David Ntirushwa Replied at 7:30 PM, 26 Mar 2014

This is a very interesting subject and hopefully the discussions from this panel will be used to find some solutions to the unfair distribution of resources to improve health globally. Excited for the discussions to start.

Stanley Blanco Replied at 2:28 AM, 27 Mar 2014

Hello:

IT initiatives are being pilot tested here in Africa; as equity is a
crosscutting issue, not only for health, sure this discussion will bring
several points of view.
S

Ron Hebert Replied at 6:45 AM, 27 Mar 2014

I appreciate receiving this invitation on such a currently topical subject as 'equity in health care' and how IT can benefit the health care system, particularly in the developing countries which are - unfortunately - so many years behind the developed countries. Being so far behind in health IT of course contributes severely to the much poorer health outcomes in the developing countries when compared to the developed countries, particularly in the WHO MDGs as will be shown next year in 2015. The inequity between these two groups will be clearly on display for the whole world to see, and hopefully act upon, for this serious health inequity must be resolved quickly.

Trisha Finnegan Replied at 11:53 AM, 27 Mar 2014

There is an interesting dialogue happening right now related to this topic. For those with access, you can join in on Twitter with the hashtag #BestBuys4GH or read the article below.
http://www.path.org/blog/2014/03/seven-lessons-for-interventions/#more-7156

I would be interested in hearing others thoughts on the first idea: "Best buys have three traits in common. Best buys in global health are efficient. They can be delivered in rugged settings. And they’re affordable for people in the regions where they’ll be used." Do you agree? Would you add anything else?

All the best,
Trisha

NextGenU NextGenU Replied at 1:18 PM, 27 Mar 2014

NextGenU.org is the world’s first portal to free, accredited, higher education -- it's been called the world's first free university (we're for credit, for free, unlike any other organization). Starting with a focus in the health sciences, NextGenU partners with leading universities, professional societies, and government organizations including Grand Challenges Canada, the American College of Preventive Medicine, U.S. CDC, NATO Science for Peace, and the World Health Organization. All NextGenU’s courses are competency-based, and include online knowledge transfer, a web-based global peer community of practice, and local, skills-based mentorships. Our accredited partners, North American universities that are outstanding in each particular course topic, give learners credit for this training (or institutions can adopt them and use them with their students), all for the first time ever cost-free, and also advertisement-free, barrier-free, and carbon-free.

Gonzalo Bacigalupe Replied at 1:40 PM, 27 Mar 2014

Sustainability and the ability for the locals to adopt them for as long as they need them. GH interventions may work when the bid NGO shows up (if it does work) but often soon after the effect and ability to keep it up is not there. There are many examples of this.

"Best buys have three traits in common. Best buys in global health are efficient. They can be delivered in rugged settings. And they’re affordable for people in the regions where they’ll be used." Do you agree? Would you add anything else?"

Trisha Finnegan Replied at 2:02 PM, 27 Mar 2014

Re: sustainability and ability for locals to manage:

Good add, Gonzalo. I whole-heartedly agree. Thank you.

Alicia de Jong Davis Replied at 2:15 AM, 28 Mar 2014

Thank you for the invitation... Looking forward to join the discussion next
week.
Alicia de Jong Salinas Davis

Sarada V Replied at 6:00 AM, 28 Mar 2014

Health inequities are a pertinent problem in many countries, India being no exception to this.

A report published by the WHO – ‘Closing the Inequity Gap WHO 2013’ (http://www.paho.org/equity/index2.php?option=com_docman&task=doc_view&gid=103...) was an eye-opener for me.

I believe that Health IT can significantly bring down barriers by making healthcare more accessible and by communicating relevant information in a timely manner.

The penetration of the mobile phone market in India has presented us numerous opportunities to deliver healthcare to remote locations.

Thank you for the invitation and I really look forward to participating in this discussion.

Sarada V
Aavanor Systems, India

Attached resource:

Dr. Osita Okonkwo Replied at 6:40 AM, 28 Mar 2014

Thank you Joaquin and the team for this invite.

I am happy to participate.

Looking forward to learning from all of us.

Many thanks,

Dr. Osita

Andrea Cortinois Replied at 11:14 AM, 28 Mar 2014

Dear Joaquin and All,

Thank you for the invitation to this extremely interesting panel! To jump right into the discussion and offer my contribution to answering question #1, allow me to step back and look at this issue from a broader perspective, one that perhaps includes the excellent work done by GHD, instead of being part of GHD’s mission and scope. In my opinion, there are good reasons for choosing this path. The following two considerations are, I believe, important when trying to answer question #1.

First, the terms ‘health equity’ and ‘health care equity’ are not interchangeable. As discussed in a large body of literature published over the past few decades and acknowledged by the “WHO Commission on Social Determinants of Health”, equity is the result of the action of a large number of social determinants of health (SDOH). A high quality, universally accessible health care system is definitely one of the many SDOH. It is not the only one, however, nor the most important. Natural and built environments, access to safe water and sanitation, access to healthy and adequate food, access to school and education, and the conditions of work and leisure, among many other determinants, have a more significant impact on health outcomes than the health care system. Therefore, while focusing on health care equity is definitely justifiable, we should also look further if we want to make a real difference. This is not what is happening in the IT field, as an overwhelming majority of IT-based applied research and routine interventions focus on health care and, within health care, on clinical care.

Second, equity is essentially a political issue, not a technical one. Therefore, IT cannot be used to directly improve equity. In my opinion, this is a very important point. IT can, however, support equity-oriented policies and interventions. What matters here is the goal of such policies and interventions. They have to be unequivocally aimed at improving equity (equity improvements achieved ‘by accident’ are not sustainable, in the long run, and are unrelated to truly ‘equity-genic’ political will and decisions). The unique power and flexibility of IT can definitely play an important role in the successful implementation of equity-oriented intervention. At the same time, as IT are just tools, they can work against equity in equally powerful ways. This is to say that there is nothing about IT that is intrinsically equity enhancing.

I hope this is a meaningful starting point. I would love to know what the other participants think! The link between IT and equity (beyond clinical care and, possibly, beyond the health care system) is the central focus of the eSAC project (www.esacproject.net) and this post can be considered not just as my individual contribution to the debate, but also as the contribution of other eSAC team members. For reasons of space, I have not included references. However, I would be more than happy to share my sources with those of you who are interested in further exploring this perspective!

Andrea

dian marandola Replied at 12:13 PM, 28 Mar 2014

I appreciate your contribution. When I consider the issue of equity and health as a human right, I consider how all stakeholders must come together to achieve future sustainable development goals. Indeed, it is essential for political stakeholders working in concert with clinicians, environmentalist, government officials, NGOs etc to achieve equity.

Our current state of inequity is a failure of policy, yet it is also a sign that we are not working in concert to achieve a unified message. The goal for all stakeholders is to speak with a unified voice so as to champion health policies and systems that advance health as a human right. We may lack the answers as to the optimal balance of allocation of resources to address the multiple determinants of health over a life course. However through collaboration, we will maximize overall health outcomes and minimize health inequities at the population level. We will more effectively find answers and influence health policy and systems that impact the multi-determinants of health as we find commonalities within our given missions and partner with others.
I think about IT as an enabler to achieve our solutions globally, regionally and locally.
Thank you, .

Dian Registered Nurse

Attached resource:

Amanda LaBoucane Replied at 9:40 PM, 29 Mar 2014

Great responses so far, and looking forward to the panel this coming week.

Currently living and working in northern Canada, there are tremendous challenges with equity and accessibility.
Although Canada is very fortunate to have the health care system that we do, unfortunately not everyone is able to reap the rewards equally. In remote northern communities, there is the on-going challenge of obtaining and maintaining trained physicians. Many communities rely solely on amazing Nurse Practitioners, and send patients out of region (sometimes out of province) to receive the required treatment and services. Although it is positive that the patient receives the required treatment or procedure, there are many issues with this situation. Such concerns include: being removed from the home community, away from family, friends and familiarity, comes financial burden, potential concerns with childcare, and perhaps an inability to communicate if the patient's first language is not English. In addition to all of this, a major area of concern exists in that there is typically little to no communication between physicians/care providers who provided the service out of community/out of region, with those who will be receiving the patient back in their home community.

Given the severity of some potential treatments and procedures, this is a serious issue as side-effects, specific requirements, on-going care schedules, etc. are not always communicated. It is here, that health IT has the potential to make a tremendous difference to the lives of patients, families and service providers alike. In order for health care to become more equitable, patients and providers must be able to communicate, and have a continuum of on-going care in some cases. IT has the potential to facilitate this.

It is not equitable that 2 patients receive the same procedure, one from a remote community and one from a large urban centre, and the one who must travel back to the remote community ends up having complications, or worse, because follow-up communication was not in place; whereas the patient who was from the large urban centre received follow-up care and suffered no complications because the service providers sat at the same table during regular rounds that day.

Technology today should be able to break these barriers in order to connect service providers in different regions/provinces/countries to provide the best possible care for every patient.

A/Prof. Terry HANNAN Replied at 9:58 PM, 29 Mar 2014

Amanda, this text entry is very insightful,"Although Canada is very fortunate to have the health care system that we do, unfortunately not everyone is able to reap the rewards equally". It can be applied to many health care systems whether they are in developing or developed nations.
We can use the Australian model as being similar to Canada and other universal health care systems. From this the inequities in indigenous health and education are standouts.
I have a wonderful slide that shows the % health cost relative to GDP in OECD countries and ALL except the USA are in the same bracket. This means the funding mechanisms and models of care are wrong.
With respect to the USA if you look at the Medicaid/Medicare patients [John Wennberg's work from the Dartmouth Institute] the same factors affecting access, quality and outcomes apply. Terry

Imran Mirza Replied at 1:11 PM, 30 Mar 2014

Thank you for the invitation. Already a number of great comments and experiences have been shared. I look forward to the discussion.

Paul Freeman Replied at 7:21 PM, 30 Mar 2014

Thanks for the invitation. I have experience of the use of IT as part of rural health in Benin and previous experience in 14 countries. IT certainly has the potential to address equity issues especially concerning access through its use by trained CHWs and health professionals. However, some key questions are: (1) is it affordable by enough poor people- will it lead only to greater inequity of access?. In the trial in Benin the local provider of the Service provided IT connections at a locally affordable rate- that required the provider to be willing to forego profits. Will providers be willing to do this when most of the population lives on less than $1.5 a day and government resources are also limited. (2) People are always attracted to new technology but if what is actually transmitted per IT is not scientifically correct then it may only use up resources of time and personnel and not improve health services. First must come correct delivery of basic
health services then IT can help. Are promoters of IT willing to support this first step?

Sandeep Saluja Replied at 8:38 PM, 30 Mar 2014

Taking full advantage of the IT revolution for making health services
accessible to a wider population is a challenge and an opportunity
which should not be missed.As with any technology,the countries and
communities with greater resources always benefit more.

One option to help improve equity can be for an international
organisation(may be GHD) to develop a platform for telemedicine which
which is always updated with introduction of new technology and
countries,communities or organisations can be given free access to use
the platform for their telemedicine projects.

The user group would bring in their own medical experts and decide on
which communities they wish to serve and where all they would
establish their service kiosks but the IT platform would be provided
by the international organisation.The hard ware can also be provided
at concessional rates with local governments being requested to waive
off any local taxes etc.on procurement of such hard ware.

Dr.Sandeep Saluja

Samuel Tesema Replied at 9:14 PM, 30 Mar 2014

Thank you for the Invitation,
I am happy to be part of the discussion on this important topic,

Kind regards,
Samuel

A/Prof. Terry HANNAN Replied at 10:07 PM, 30 Mar 2014

Sandeep, in my humble opinion the ultimate technology availability (which should be facilitated by international collaboration) is not the problem. It is making it work effectively. We now have some very important models and knowledge on these endeavours. So how can we do it all together and properly and measure what we do? Terry

Busi Mombaur Replied at 2:39 AM, 31 Mar 2014

Thanks to the GHD team for facilitating this discussion. As others have already mentioned, access to health care is not guaranteed for every citizen, even in the most equitable societies. In South Africa, geographical location, income inequality and education are some of the major drivers of the wide treatment gap for neurological disorders. I am looking forward to learning from the panel. I am especially interested in technologies that have worked for improving epilepsy treatment in rural communities.

Roman Pathak Replied at 5:47 AM, 31 Mar 2014

Hi,
Thank you for the invitation.
I think the major challenge here will be to make the model efficient and effective. What we need is not only equitable but also fair, just, accountable and acceptable.

Isabelle Celentano Replied at 12:03 PM, 31 Mar 2014

Many thanks to all for the wonderful comments and questions so far. Paul, I think you raised a great point: in some cases, the use of technology may actually create a larger gap in access to care both in developed and developing countries.

As HIT initiatives in the United States aim to fulfill Meaningful Use criteria, several access issues have been raised. For example, web-based portals and patient health records (PHR) are playing an increasingly important role in access to quality health care, yet a home internet connection is optimal for their effective use. Internet access is limited in homes of people of color and Limited English Proficiency (LEP) individuals in the U.S., putting these already-marginalized groups at a further disadvantage.

A report by the California Pan-Ethnic Health Network suggests that new HIT efforts should be rolled out alongside already-existing health communication options, like over the phone or in-person assistance, so as not to increase disparities in access to care. The report can be found here and offers many other suggestions for culturally competent HIT implementation: http://www.cpehn.org/pdfs/EquityInTheDigitalAge2013.pdf

As you mentioned Paul, most people are attracted to the idea of new technology. It is important, however, not to completely abandon the more “analog” methods of health care delivery and to make sure that all these delivery methods are accurate and equal, so as not to exclude those with less reliable access to newer technological advances.

I look forward to hearing more global perspectives on this very important issue!

Joaquin Blaya, PhD Replied at 2:09 PM, 31 Mar 2014

Thank you to everyone that has posted so far, we got an early start to this panel last week, and now we're happy to be able to open it formally for discussion.
We've put forth these questions as a way to start the discussions, but welcome any other comments or questions regarding this topic.
- How can health IT be used to increase equity in health care?
- What projects can serve as examples of improved health equity?
- How are improvements in health equity measurable? Can health IT help?
- Are there incentives that promote improving equity in health care?

I'm attaching short bios of our panelists to this email and welcome their input to these questions.

Attached resource:

Felipe Mejia Medina Replied at 2:27 PM, 31 Mar 2014

I think that using ICT to provide public health related services to different populations: remote, vulnerable, etc, works towards decreasing inequity in health. One example is the project OSITA developed by Universidad de los Andes here in Bogota. This project uses different ICT for displaced women due to the internal armed conflict. The projects through ICTs such as mobile phones offer mental health-related support, information about available health services and digital literacy activities. This group lacks access to education, proper housing, healthcare services, public health services, among others.
In order to avoid creating a larger gap, as it was mentioned before, this project fosters the use of the technology that is more likely to be used by the displaced women: mobile phones. In Colombia, even in poor areas, the mobile technology penetration is around 102% and the end of this year, according to the Ministry of ICT, the 100% of all municipalities in Colombia (roughly 1100) will have optical fiber plus the program Vive Digital that offers training to the population on how to use on their benefits such technology.

Felipe Mejia Medina Replied at 2:36 PM, 31 Mar 2014

Just thinking about this question: How are improvements in health equity measurable? Can health IT help? I would say: given that there is a defined framework for measuring health inequity, as long as ICTs are used to track in relation to that framework different health indicators or any other indicators across individuals and populations, there is always room but especially information available to assess health equity. ICTs for health and PH surveillance can provide fast information to inform policymakers which could consequently take decisions towards reducing health inequities.

Gonzalo Bacigalupe Replied at 2:47 PM, 31 Mar 2014

In response to question 1, I had extracted something from one of my recent articles:

Emerging information and communications technologies (ICT) enable new ways of archiving, creating, and searching for health information, hypothetically accelerating and deepening collaborative health care opportunities. ICT defy the financial, geographical, and logistical barriers that exist in creating a context for ongoing interaction, easy access to information, and collaborative learning. A variety of ICT support the development and maintenance of relationships that overcome geographical distance and time constraints, increase transparency, and enable better community outreach and participation. Besides obtaining information, searching, and archiving, emerging ICT foster the creation of new media in the form of narratives, stories, and other forms of expressions that transform consumers into active producers of information. For self-help and support groups, for instance, the advantages are substantial; their development can be sustained and invigorated through virtual social networks. Therefore, emerging social media can significantly alter how people participate in their health management and the ability of patients and various health care providers to collaborate more effectively and, hypothetically, reduce health care disparities.

Jess Kadar Replied at 2:51 PM, 31 Mar 2014

Thank you for inviting me to take part in this forum! Sorry for the delay in responding.(I had the flu last week and was busy being a patient.)

Some background: My experience is in mostly in the U.S. and building technology specifically for patients across the Iora Health network. To date we have partnered with a large variety of self-insured entities (unions, colleges, companies), and are moving towards new ways of structuring our engagement models to reach various patient populations. Our practices support a wide spectrum of patients across multiple income levels, geographical regions and cultures. I serve as the Principal Product Manager for our collaborative care platform (Iora Clinical Intelligence System, aka ICIS) which integrates team-based collaborative care (task management, scheduling, clinical documentation) with population health and downstream care information.

Some of our practices:
http://www.culinaryextra.com/
https://www.freelancersmedical.org/
http://www.turntablehealth.com/
http://www.CarpentersCare.com/

We are currently preparing to open a primary care practice to support women (and their families) who participate in the Grameen Foundation’s lending program as part of Grameen Vida Sana, a health care program or Grameen America members. https://grameenprimacare.org/our-program/grameen-vida-sana/

How can health IT be used to increase equity in health care?
Although I believe deeply in the power of technology to change lives, I have never been one to believe that IT alone is a magic bullet for anything. I firmly believe, and evidence suggests, that to truly increase equity you’ve got to fundamentally change the architecture of the entire system. IT can be a support tool, but not the solution on its own.

What projects can serve as examples of improved health equity?
From my own experience, we design our care model to address the patient as a whole person, rather than just their medical issues alone. We believe that more time understanding the patient’s complete life leads to actionable insight and a clear path to collaborate and achieve better outcomes. Many of our patients live in communities often described as “underserved”— but we’ve found that many of them are not underserved, but rather poorly served. They have access to care, but the design of that care is focused around the wrong things. Most of our work is focused on “equity” in quality— as we believe everyone deserves quality care, and quality in care delivers results.

In a traditional health care setting the physician may tell a patient what he/she needs to do, wait 3-6 months (or never) for the patient to schedule a follow-up visit only to find out the patient didn’t do any of the things on their care plan. With a 15 minute visit every 3 months, a physician will definitely not have the resources to identify, let alone address the many barriers that the patient has to following through with the plan— whether it be financial, psychological, life stressors, etc. And the traditional physician view is so extraordinarily limited in scope, as they can only see how someone is interacting with their system—

We are often asking the question how can IT enable us to see the whole life of the patient, rather than a list of medical diagnosis and medications? How can we use IT to “unblock” patients, keep people engaged in their own health and in the relationship that is the fundamental context for healthcare delivery in our practice?

One way we do this at Iora Health is to build tools to help trigger proactive care and outreach. We try to give as much actionable data as possible to our care teams so that they can reach out to a patient when the need arises, without waiting for the patient to schedule an appointment, or relying on face-to-face visits. Examples of events that might trigger prompts for engagement — when a lab test arrives, when a patient enters the E/R, when a patient sees a specialist, when it’s a patient’s birthday, etc. We try to use claims, hospital census, demographic info and patient-reported data to widen the view of the patient for the care team.

Most of our work is focused on establishing and maintain human connection and relationships amongst care teams and patients. It behooves us then to design technological systems that do not get in the way of human relationships or human lives. My biggest fear is that we spend a lot of money building beautiful tools that no one uses.

Gonzalo Bacigalupe Replied at 6:55 PM, 31 Mar 2014

Here is a brief interview on the subject of Health 2.0 and Inequity 2.0

Attached resource:

ALCIBIADES BATISTA GONZALEZ Replied at 9:29 PM, 31 Mar 2014

- How can health IT be used to increase equity in health care?

I think that it is important to leave aside for a moment, the traditional focus of health care IT, and take another point of view. Working with communities through community health promotors (CHW) in remote places, in order to improve different socio-economics determinants of health including health care, could be a interesting form of application for mobile IT.

Felipe Mejia Medina Replied at 10:46 PM, 31 Mar 2014

I totally agree with Alicbiades's point of view. Using ICTs to offer a range of services to a migrant population such virtual-related education, information of rights and duties, training on water and sanitation basic infrastructure, employment possibilities and so many others work around and in the core of some of the social determinants of health beyond healthcare. At the same time, ICTs can also help policy makers, surveillance agencies, community based workers to take prompt action on health issues and other areas impacting health and hopefully decreasing health inequities.

Gonzalo Bacigalupe Replied at 2:22 PM, 1 Apr 2014

Question 2 (an extract of one of my pubs that could help with this question)

2.

Public health and prevention comprise tools designed to enhance the health status of the population and prevent the emergence of disease. Thus, E-health tools included in the public health and prevention category meet the aforementioned goal. Txt4Baby was designed to support mothers in caring for themselves during pregnancy and their newborns for one year after birth. The intervention consists of delivering approximately three “text-length messages” per week that convey relevant health information and resources. Users may register online or via cell phone at no cost by texting the word “BABY” or “BEBE” (for Spanish) to a U.S. number. The Healthy Mothers, Healthy Babies Coalition in partnership with several founding partners, including Johnson and Johnson, Voxiva, Inc., CTIA – The Wireless Foundation, and Gray Health care Group, launched Txt4Baby. Several governmental departments also partner with the Healthy Mothers, Healthy Babies Coalition to support Txt4Baby. It is primarily managed by the Healthy Mothers, Healthy Babies Coalition, and text messages are developed by the Healthy Mothers, Healthy Babies Coalition. Txt4Baby does not have a pri-vacy seal but lists its own privacy policy on its Web site.

The primary direction of communication is unidirectional as the primary purpose of the tool is to deliver text message information to users in an easily accessible manner. However, we rated Txt4Baby as highly collaborative and focusing on reducing health disparities. Research seems to also demonstrate this tendency. The core of this program is for users to receive “scientifically accurate” information from health professionals. Collaboration between users and creators and partners and creators include sending suggestions about message content. Additionally, TxT4Baby invites external organizations to become “outreach partners” and promote the service. Txt4Baby received a rating of high in terms of collaboration potential. Txt4Baby is offered in more than one language and is accessible to underserved populations as it is free and information is delivered via mobile phone. Furthermore, it was designed with the purpose of reaching underserved populations. Txt4Baby received a rating of Culturally Proficient and may serve as an E-health model to imitate in terms of its potential to address health disparities.

Mighty Casey Replied at 7:59 PM, 1 Apr 2014

Gonzalo, I *love* that - simple, effective, accessible. And I bet it drives great outcomes, too.

Felipe Mejia Medina Replied at 10:39 PM, 1 Apr 2014

I'd like to focus on specifics areas in which ICT can increase health equity. One example is the use of ICT on gender equity. I am going to share with you all an extract from one of the pieces the eSAC project team has developed. For your information, eSAC stands for Public eHealth Innovation and equity in Latin-america and the Caribbean. Here it is:

"A relevant matter when we relate ICTs to healthcare is gender equity. The Fourth World Conference of the United Nations on Women held in Beijing in 19951 defined the media and new technologies (ICT) as a crucial sector for greater equality, democracy and social justice. Some international studies show that not only are there differences in accessing the Internet, but also in the way women and men use it. Men tend to make more use of the Internet for consumption and leisure, in the that, in addition, the presence of technology products is more pronounced, while women have a tendency to opt for practical content services and social....
Due to their multifaceted nature, ICTs present an interesting avenue in improving access to health services amongst to all groups, especially those who have been traditionally excluded from access, such as women and girls. Currently, the majority of ICT-focused initiatives in LAC either aim to improve women’s technological fluency or address high-level policy and research issues. Few projects utilize ICTs to augment healthcare access amongst remote, indigenous and/or marginalized women or mainstream ICT, healthcare and gender policies at national and sub- national levels. Initiatives leveraging ICTs to generate income amongst women while improving healthcare access both at the field and policy level are needed".
Editorial By:
Gladys Faba, PhD, International Consultant to PAHO for the eSAC project on knowledge management
Báltica Cabieses, PhD, Consultant to PAHO for the eSAC project on equity in health

Attached resource:

Gonzalo Bacigalupe Replied at 11:10 PM, 1 Apr 2014

Considering the developments in Chile. I will make two suggestions:

1. It would be helpful to know how Chile is doing citizen crowdsourcing in emergency disaster situations. Experiences from other countries.

2. To our Chilean colleagues in public health, let us know if you need assistance in letting others know of needs or assistance needed, information that needs to be spread, etc. I am listening to Cooperativa and obviously Chile is an example of how to react to a disaster.

Radha krishna Behara Replied at 10:19 AM, 2 Apr 2014

After reading some outstanding comments I felt that we are having a tunnel vision in terms of solving the root cause of making patient behave as required to improve his health. We have aging population who are not tech savvy, we have others who are tech savvy with varying degree of comfort levels. Then we have countries with different languages/cultural barriers, beliefs and different intelligence levels. Added to this is how we communicate and how patients understood what we said also matters. We need to provide solutions based on several such factors i just mentioned. Technology is now allowing us to have Gene mapping (https://www.23andme.com/) , body implants (http://www.wired.com/2014/02/toys-tools-revolutionizing-digital-health/) , Apps (http://9to5mac.com/2014/03/17/this-is-healthbook-apples-first-major-step-into...) and also controlled delivery of drugs (http://www.theguardian.com/science/2012/feb/16/microchip-implant-drug-doses-o... ). As planet's population becomes digitally connected and also tech savvy all the above mentioned solutions and suggestions by all of you will start showing results. But those who are challenged by language, culture and technology should also be considered. For those who are not tech savvy (especially senior citizens) I suggest some of the following.
1. Assuming most of the house holds might have a clock.. Today it is possible to make household gadgets talk to internet and send and receive messages. SO we can program a clock to ring alarm bells (may be a voice in local language) reminding to take Medicine and until some one physically stops the alarm it will continuously reminds people to act. This will help senior citizens and non tech savvy people to take medicine on a timely manner.
2. A special programmable band can also be envisioned for those who does not have a clock , and does not want to use Technology to remind them with timely alarms for taking medication.
3. A regular training sessions , classes at regular intervals to be arranged at village levels in community halls etc to educate everyone about how to use tech gadgets or importance of timely medication intake etc might also improve health of the people.
As a corporate skills trainer/software developer and blogger (http://skillsnest.wordpress.com ) i focus more on the behaviors,cultural habits and other aspects of students and others I train to motivate them. So I feel that all the great efforts of eminent doctors, nurses and all other who are contributing to this forums should not go waste and for that we have to come out of the tunnel vision and look at the problem holistically
I request this forum to come up with more such NON IT, global language friendly ideas and share. Comments are welcome.

Marie Connelly Replied at 12:29 PM, 2 Apr 2014

Many thanks to all of our panelists and participants for such a rich dialogue so far this week! It has been encouraging to learn more about the programs everyone is working on, and I hope members will continue to share thoughts and examples of programs that are using technology to improve equity, and how these successes can best be measured, or adapted for various settings.

One program I wanted to share is Únete Latina, an initiative of Youth Tech Health, a California-based non-profit. My colleague Isabelle has posted a bit about YTH recently (available here: http://www.ghdonline.org/innovation/discussion/youth-tech-health-technology-s...) but I thought Únete Latina might be of particular interest to participants in this discussion. Únete Latina is a text-based support program for Latina women living in Fresno County, California. The program sends messages with information on local resources and programs that are available in Spanish—these resources are also vetted to confirm that those seeking services won't be asked to provide a social security number.

In addition to health care services, the program also shares legal resources, information on local programs for victims of domestic violence, as well as general messages of affirmation and support. While there are obviously many other factors related to the social determinants of health, I think it's encouraging to see programs like Únete Latina attempting to address a broader range of issues than just the clinical aspects of health care. For those interested, more details on Únete Latina can be found in this article: http://colorlines.com/archives/2014/03/can_cell_phones_improve_womens_health....

While the program is still in the early stages of evaluation, it does seem to be having a positive impact, and hopefully will be rolled out to additional parts of California. I'm curious if others are familiar with similar programs in their communities? Text4Baby, which Gonzalo mentioned yesterday, seems like one of the larger mhealth/text initiatives we've seen (at least in the US), but I'd also be eager to learn about additional programs like Únete Latina, which are focused on particular populations or communities.

Jess Kadar Replied at 12:54 PM, 2 Apr 2014

Does anyone know of any specific health tech initiatives for the elderly?

Gonzalo Bacigalupe Replied at 2:34 PM, 2 Apr 2014

Day 3, Question 3:

3.

Accessibility to ICT is a powerful factor—one not to be taken for granted—in resource scarce environments. With the combination of a collaborative health approach and the emerging social technologies potential, we could be better prepared to challenge the financial, geographical, and logistical barriers that exist in creating a context for ongoing interaction, collaborative learning, fast access to information, and transparency. Social technologies in health care, therefore, have the potential to address perennial health care quality and access inequities.

New technologies appear at an accelerated rate, and it seems logical to predict their potential for addressing access and quality issues related to the active participation of patients in their care, and the health care system’s ability to effectively reach more patients. These emerging technologies could, therefore, foster empowered patients. Innovation per se, however, is not enough. This is especially relevant in the case of low-income segments of the population, racial and ethnic minority populations, English language learners, those with low levels of health literacy, and other vulnerable populations. In light of the digital access and literacy divide, the developers of these tools must focus on the amelioration of disparities in health care. Otherwise, the risk of deepening these disparities is inevitable. To access patients from disenfranchised communities, a combination of offline and online tools is necessary, together with a seamless integration of both including “traditional” technologies like phone and printed mail. The virtualization of care will need to be one part of the continuum of health care. Assessing for cultural competency may not yet, therefore, be mostly about the virtual instrument but how it is integrated in the continuum of care. The digital divide in E-health is a serious barrier and a contributor to health disparities. If E-health were about reducing health care inequity, we would need to measure to what extent it is part of a strategy that focuses on access and quality for those who are left behind in the race for health care innovation.

Felipe Mejia Medina Replied at 3:30 PM, 2 Apr 2014

Dear Jess, in the links you can find some examples of ICT targeting elderly. All are links from the eSAC database.

Also, if you are interested, there is also the third eSAC Magazine Issue of ageing, ICT and health.

Attached resources:

Aaron Beals Replied at 10:29 AM, 3 Apr 2014

Question 3 ("How are improvements in health equity measurable? Can health IT help?") got me thinking about mobile-device tools for data collection, especially in light of the great points made so far about mobile devices being the leading-edge of technology adoption in many settings.

Two of the tools that jump to mind are Medic Mobile's (formerly FrontlineSMS:Medic) Muvuku and Dimagi's CommCare. To Gonzalo's point in #41, these tools have been used in crises, most notably in the 2010 Haiti earthquake.

How can data collection like this be used on an ongoing basis in non-emergency settings, and how can we ensure that the data collected about heath care inequity is fed back into the proper systems for improvement?

Attached resources:

Joaquin Blaya, PhD Replied at 3:38 PM, 3 Apr 2014

Radha, I think you have a point in that technology itself doesn't really
care about equity, but rather the people and programs using it. So the
question becomes more what programs, projects and others are looking at
decreasing health equity. An example is the Electronic Medical Record (EMR)
team at Partners In Health (PIH), where since PIH focuses on health equity,
the EMR team has been able to develop several health IT tools to do that.
For example, while I was part of the team, we implemented a web based
system for Tuberculosis laboratories to communicate their results to some
of the poorest health centers in Lima. Another project the EMR team helped
with was OpenMRS, the open source EMR, and now OpenBoxes, an open source
inventory/supply chain management system (http://openboxes.com/)

At the same time, though, as Aaron mentioned, there is a growing
marketplace for organizations and companies that want to provide these IT
services to those in the frontline of the equity battle, such as Dimagi
with CommCare and Frontline with Medic Mobile, which is great to see.

But what I would like to ask the panelists and our community, is if the
decision makers in organizations in this kind of work, everything from the
WHO to those on the ground, are seeing that IT and specifically health IT
can be a way to fight inequity.


Joaquín
___________________________________________________________________
Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/>
Research Fellow, Escuela de Medicina de Harvard <http://hms.harvard.edu/>
Moderador, GHDOnline.org <http://www.ghdonline.org/>

Gonzalo Bacigalupe Replied at 4:07 PM, 3 Apr 2014

In response to your question Joaquin: But what I would like to ask the panelists and our community, is if the decision makers in organizations in this kind of work, everything from the WHO to those on the ground, are seeing that IT and specifically health IT can be a way to fight inequity.

But also in relation to Q4 for the panel. I think that decision makers make some wrong assumptions and miss some opportunities as they go on deploying HIT initiatives. Yes, they can be used to fight equity. However, I think there are engrained practices and ways of thinking even in the more progressive technology communities that prevent this from happening. I wrote in advance this as a response to Q4 and it addresses some of these concerns.

The digital divide is not dictated solely by economic access to social media tools or lack of health literacy on the part of patients, but also by the choices that health care systems make. The tools that may have been adopted by early adopters, for instance, may pose difficulties to underserved and vulnerable populations. Innovators do not seem to first include these populations in participating in the design of tools, or even investigate what tools these patients are already using and can possibly easily access. Furthermore, consideration of the health issues faced by vulnerable populations as well as the cultural contexts in which they live is critical in developing digital tools that aim to reduce health care disparities. Culturally competent evaluation of E-health innovations, therefore, should include social determinants of health in determining which E-health tools health care providers should use. In examining social media that may impact health care, we aimed at developing criteria to evaluate, which tools and processes to design, implement, and sustain to strengthen a collaborative family health care practice that also, advances health care equity.

Peter Urbain Replied at 5:36 PM, 3 Apr 2014

The "inequalities" sited above manifest in many ways including availability of and access to technology, adequacy and effectiveness of training and ongoing education, and last, but not least, the scarcity of resources that are exacerbated by issues #1 & #2. And, thus, I would advocate that health IT alone cannot/will not solve the challenge -- we need to take a three pronged approach that targets:

1. Recruitment, education and retention of clinicians in a "rural/limited resource" setting
2. Development of education content, technologies and tools that work in "limited resource" settings
3. Adoption of health IT that not only drives operational workflow, but also enables clinicians to have access to external resources for additional information & education, and external consultation/telemedicine

To Answer the 4 Questions:

How can health IT be used to increase equity in health care?
> Clearly define the "inequality"
> Identify and rank the IT ("health" and other) enabling technologies that address the inequality
> Develop action plan to implement, test and verify

What projects can serve as examples of improved health equity?
One that I know of just beginning in rural Ecuador at www.andeanhealth.org (I am an advisor) with the help of many including OSF Hospital and Jump Trading Simulation and Education Center from Peoria, Illinois

How are improvements in health equity measurable? Can health IT help?
Depends on the definition of equality. IT (not just health) can measure # and competencies of clinicians; Can enable and measure accessibility to the correct (limited resource/localized) capabilities; Can enable delivery of care; And can measure outcomes and impact.

Are there incentives that promote improving equity in health care?
In Ecuador, we've proven at Hospital Pedro Vicente Maldonado that there are actually plenty of local $$ available to maintain a quality locally funded 16 bed hospital that serves the extended community. We achieved this goal via a public/private partnership and with the help of benefactors who helped fund portions of the start-up and build out of the physical plant, experimentation with funding models and the development of a residency/training program.

Felipe Mejia Medina Replied at 7:57 PM, 3 Apr 2014

Well, the STRATEGY AND PLAN OF ACTION ON eHEALTH 2012-2017 from the Panamerican Health Organization stresses link between that agenda and the Health Agenda for the Americas 2008-2017: "(c) Equity in health. The search for equity in health is manifested in the effort to eliminate all health inequalities that are avoidable, unjust, and remediable among populations or groups. This search should emphasize the essential need for promoting gender equity in health.2"

At the same time, in the Bulletin of the World Health Organization 2011;89:394-394. doi: 10.2471/BLT.11.090274, raising evidence around ehealth is presented as key to achieve health equity: "Evidence is needed to promote equity of access to information and health services, and to strengthen activities and programmes that support local, regional, national and global health communities. There is a critical need to communicate evidence and to provide examples of best practice in the development of effective and efficient solutions to major health challenges. These could include: governance and multisectoral engagement, funding systems, system architectures, information systems implementation, capacity building, and areas such as equity in health systems, strategic planning, policy and regulatory frameworks, infrastructures, human capital development and system and data interoperability".

Following that idea, I think there is the believe, and probably no more than that, among different organizations that ICTs can be helpful to decrease inequities, however, by also pointing out the lack of proper evidence to support any ehealth intervention, such assumption is basically that: just an assumption.

Attached resources:

Murali Ramachandran Replied at 10:49 PM, 3 Apr 2014

thanks for the invitation.
Regarding discussion topic.
IT useful only when there is participation from the end users
Utilization of data collected and analysis required with feed back to the end users.
OR can be used for selection of Projects
Measurable after developing reliable reports generation in the software.
Incentives incorporated in RCH care in Tamilnadu - India.
Prof. Dr.R.Murali

Radha krishna Behara Replied at 11:34 PM, 3 Apr 2014

Joaquin I agree with your point "decision makers in organizations in this kind of work, everything from the
WHO to those on the ground, are seeing that IT and specifically health IT
can be a way to fight inequity"
In spite of me in Software development for 24+ years i look at the problem as i said from cultural , habits and other criteria. Majority of the comments are tilted towards IT Solutions but not focusing on Behavioral changes that have to accompany the new habit of using IT effectively in the daily life of a common man. I just happened to read an article that all the latest devices like fitbit, jawbone and other IT gadgets usage is declining and the gadgets are thrown into a drawer once the batteries of the gadgets Die.
http://news.yahoo.com/one-third-wearable-device-wearers-133740140.html
http://wearableworldnews.com/2014/04/02/one-third-wearable-owners-abandoning-...
http://www.technologytell.com/gadgets/141918/wearables-bubble-marketing-aband...

I'm hoping that this panel will consider other factors as you and me suggest.. Let's hope..

Thomas Mohr Replied at 1:21 AM, 4 Apr 2014

Dear Colleagues,

I have been following the discussions with interest and find the range of the discussion to be very enlightening and educational. The discussion itself highlights the broad landscape within which we are working and the many opportunities, some not yet realized, that are available across many areas of health (e.g. Geriatric care, wearable devices, to basic text messaging). In my own experience, I have a family member who initially had an implanted defibulator and now a Left Ventricular assist device. For years, these devices have been accessed remotely to get readings and then used to consult both my relative and doctors actions to manage the heart condition. Clearly in this case, our family has been lucky to be in the U.S. and to have health coverage that would allow us access to such advanced levels of care. This highlights equity issues that have been discussed. It is clear that very few people in the US and globally would have such access to this level of care.

While I am still new to Health IT or what I usually refer to as MHealth (Mobile health), I have been studying this field and planning to incorporate it into work that we conduct in Central Asia. My interest in doing this is driven by the potential MHealth has in addressing issues of access to health care (e.g. There are geographic and climatic issues that isolate many communities and individuals for long periods throughout this entire region.). When I visit these locations, even in the poorest communities, many people have and are using mobile phones. This clearly represents an opportunity to address equity issues; this can be the case even if health care providers would be the only ones with mobile phones (e.g. Transferring images to get assistance with diagnosis ... and more).

I believe we should reiterate a point from the Stanford Social Innovation Review (Opportunities in Mobile Health, 2011) which highlights how the penetration of mobile phones in the developing world presents opportunities to work with communities and individuals to ensure Health IT can be used to also reach the most vulnerable or, in the very least, reduce the gaps in accessing care and support. We can add another tool to our belts while understanding much more is needed.

"More than three-quarters of the world’s 5.3 billion mobile phones are located in the developing world. These increasingly
powerful devices are proving to be a lifeline for people who need improved access to health services. The trend of using
mobile phones for health—known as mHealth—represents an unprecedented opportunity for improving public health."

Soroya Julian Replied at 5:51 AM, 4 Apr 2014

Thank you all for a very enlightening discussion thus far. I would like to make a contribution on question 2.

What projects can serve as examples of improved health equity?
I think that at this stage many projects will find it difficult to prove impact (improvement) in health equity from general sense or at a national level. However, it could be said that once the opportunity for health (services, knowledge etc.) has reached even one population that has not previously accessed it, they serve as examples for improved health equity. From the Caribbean region (where I am from) one such mhealth project which was focused on advocacy (not clinical care) is the Healthy Caribbean Coalition's The Get the Message campaign which was a mobile phone text based advocacy campaign. Digicel and LIME mobile subscribers in the Caribbean were asked to send a free text message in support of tackling non communicable diseases as a regional priority. Through social networks, they were also able to share their personal stories and ideas about healthy living.The campaign ran television and radio PSAs, worked with local radio stations and concert venues, leveraged Facebook and Twitter, and staged two all day text-a-thons.

Another example is the Rio Youth Project where young people from the favelas use GPS enabled mobiles to map environmental risks in their communities. This information is then aggregated and displayed in a manner that engages stakeholders and decision makers.
A similar use was recently applied in Haiti, where teenagers attempted to identify and document barriers to access to preventive services for HIV, using mobiles. This example yields very concrete results, related to public health, equity (through the participation of vulnerable populations), social and environmental determinants of health and of course ICTs.

Ivahn Dockter Replied at 10:22 AM, 4 Apr 2014

Peter, I agree with your statements that follow below as to IT focus.

I am an IT person in the U.S. who is pulling together an IT team go to Compassion Evangelical Hospital in Guinea and upgrade their current IT environment, which is very basic at this point. One of our primary concerns is finding local IT talent to learn and maintain the hardware and software solutions we plan to install. It is one thing to have a team from the U.S. go to the hospital, install the solution, educate the users, and have everything working as it should when we leave. But, when the first problem arises there needs to be someone local at the hospital that can fix things. To make things more difficult currently they have no cell phone reception or internet connection.

What Peter says here is critical to having a successful IT solution that is available 24x7:

1. Recruitment, education and retention of clinicians in a "rural/limited resource" setting
2. Development of education content, technologies and tools that work in "limited resource" settings
3. Adoption of health IT that not only drives operational workflow, but also enables clinicians to have access to external resources for additional information & education, and external consultation/telemedicine

Rebecca Weintraub, MD Replied at 10:33 AM, 4 Apr 2014

Thank you to all of our panelists and community members for sharing their expertise this week.
It is encouraging to see so many examples of programs striving to improve equity, how vital to address the disparities among the social determinants that impact health outcomes.

What guidance can we offer programs to ensure their providers leverage technologies to promote more equitable care?
What can we fix today?

Rodrigo Cargua Rivadeneira Replied at 12:27 PM, 4 Apr 2014

Buenos días estoy totalmente de acuerdo con Ivanh la educación en TI en
Salud es de suma importancia para poder implementar y sostener un sistema
de informático de salud, el desconocimiento de la parte medica y
tecnológica tiene una gran brecha, hablo de mi país Ecuador donde todo los
días luchamos para que el personal medico e informático entienda lo
importante de la informática medica y los estándares que debemos aplicar en
este tipo de sistemas con el cual se da servicios a seres humanos la misma
es debe de ser con estándares y SLAs muy altos.

Esteban Gershanik Replied at 1:13 PM, 4 Apr 2014

Thank you very much for the opportunity to take part in this discussion and I apologize for my delay in participating as I just finished taking part and working with the Institute for Patient and Family Centered Care annual meeting hosted by Stanford in San Francisco where the discussion of how health IT can be used to engage and enhance patient care was brought up in some of the breakout sessions.

To begin with the first couple of questions, how can health IT be used to increase equity in health care and what projects can serve as examples of improved health equity, I wanted to first touch on the impact of the ONC’s recent history of mandating EHRs in the US and the impacts of meaningful use. While this mandate has led to implementation of EHRs and several improvements and consequences of EHRs, the way that this can be used to improve equity have been projects surrounding healthcare disparities and utilization of aspects of EHRs to perform this and focusing on tools to enhance patient-centric care. Many of the initiatives surrounding the optimization of EHRs has only been performed at many of the leading academic and healthcare providing systems as the majority of domestic hospitals are still trying to figure out this new Health IT market and how to meet standards and survive in a tight economic market. In doing this, the healthcare system in the US still needs to figure out how to optimize the health IT systems and how to reach those that most need to be reached. There are several centers evaluating healthcare disparities and if there can be a bridge as to how to utilize health IT to bridge these gaps it would be optimal. However, what we have seen is a huge explosion in health/medical apps that still seem to be more available for those of resources and not those without resources questioning how this is affecting healthcare equity.
Since there are these mandates domestically, it has created some restraints within the current market for some providers as they try to figure out the future of healthcare delivery in a health IT market, but I believe many of this will change in the next 5-10 years due to the innovation that will surround this new market along with the data analytics that will be performed in the setting of all of this new data via healthcare exchanges that will help target and improve some of the underlining issues in healthcare equity and disparities.

Esteban Gershanik Replied at 1:22 PM, 4 Apr 2014

As far as internationally, because in some of these markets where there are limited to no resources in health IT and is somewhat of a blank slate, it may be easier at times to create a platform for these settings. One group that I have worked with for the last several years is the Sana group out of MIT which has creating a teaching community about the utilization of mobile health in resource poor settings and learning from different environments for this open source platform that can be integrated with OpenMRS. We have been able to discuss as a community the issues faced in implementing such mobile health needs to improve healthcare delivery in resource poor settings in Argentina, Columbia, India, South Africa, Philippines, etc. What it has provided has been an opportunity to work with and learn from one another the opportunities and challenges with such projects. I believe key in these resource poor settings is to understand the socio-economic-political setting of each and to assure the integration of local resources and support in order to assure the sustainability of health IT resources in such regions and to assure academic schools and political support can be used to assure improvements in the regions they serve and narrow the gap of the health equity in regions where the disparity is greater than in other regions of the world.

Leo Celi and Hamish Frasier have mentioned this in prior GHD discussions and for those interested the link is at http://sana.mit.edu and the current course is HST.936, Global Health Informatics to Improve Quality of Care where its provides a project-based course focusing on innovations in information systems to accelerate improvements of health outcomes in developing countries.

Esteban Gershanik Replied at 1:38 PM, 4 Apr 2014

To answer Rebecca's questions:
What guidance can we offer programs to ensure their providers leverage technologies to promote more equitable care?
As I mentioned above, we need to assure that providers fully understand the complete landscape of the health IT delivery system they are in. How can you reach those that are often not reached in the current healthcare disparities around the world? Any opportunity to provide access to care is a good first starting point. The advances in mobile health in resource poor settings has demonstrated the ability to perform ultrasounds and labs remotely that could have never been done before. Now we must assure that the ability to capture the data accurately and continuously can still have both a short and long term impact that is sustainable in improving these advances. As I mentioned previously, since in some of these settings, we are working on a blank canvas that does not need to be completely redesigned due to prior implementations of more archaic health IT advances, we can be more innovative and impactful than before. What anyone who does such an implementation must understand is the necessity to assure the input of the local community in the integration and enhance their say and power in such interventions so that they can learn and advance themselves as well.

Another key component is that we must capture the data on this information that we are implementing so that we can learn what is working and what is not working and why in order to advance such initiatives.

What can we fix today? The understanding of just to provide a technology in a certain setting is not the solution, but the overall understanding off healthcare in the region, socio-political climates, etc. to the advancement of such technologies to improve healthcare delivery, along with the support that can be provided. We also must all work and learn from each other in the advancement of such initiatives. Partnerships and forums such as these allow us to learn. Together we can make such greater strides than alone and partnerships are keys. Additionally, there are older technologies that are not being utilized in many of our hospitals in the US that can be utilized in resource poor settings and we must understand how to use such inventory to improve healthcare delivery in other parts of the world. A colleague of mine in New York who works at a community hospital in Pennsylvania found ventilators that were not being used by the hospital anymore. He was able to get three of them for free and raise money for funds to deliver these ventilators to a hospital he worked at in Ethiopia that saw patients die weekly due to a lack of ventilators (amongst many other resources they did not have). In addition, he and others with the organization created a critical care/pulmonary fellowship in this hospital in Ethiopia so that the local physicians could learn and with the newer technologies they were receiving improve the outcomes of healthcare delivery in their community. Again, an understanding of bringing a new technology and not only enhancing care, but enhancing the power of knowledge in the community so that they could be self-sustaining and advance the healthcare delivery in their community.

Patrick Crisp Replied at 2:36 PM, 4 Apr 2014

Thanks for this opportunity to contribute.

My background is family medicine in New Zealand and healthcare software development (personal and practice electronic health records).

In my opinion, one of the major issues contributing to the lack of equity in healthcare is the lack of healthcare personnel available to certain areas or certain sectors of the community. IT initiatives are useful when they make it easier for that isolated community (physically/culturally/financially) to access those healthcare personnel. For example, a community that may not have access to a doctor may have access to a nurse practitioner. In this situation: Provide the nurse with a full featured EMR with decision support software; Provide a physician who can check the patient records remotely and provide specific assistance where necessary; Provide telemedicine services for the more complex problems; Provide access to remote education for the nurse and community. The IT cost of this is not that significant these days (can be done for a few thousand dollars up front) and it does not require that the remote community has 'always on' internet/phone/electricity access. The personnel cost is the issue. Using mobile phones is complimentary to this system.

Another healthcare inequality issue that we face here in New Zealand is the problem where a healthcare system is not as sensitive to cultural issues as it should be. This has lead to poor health outcomes for certain sectors of the community. There is an initiative underway to address this: Whānau Ora (http://www.tpk.govt.nz/en/in-focus/whanau-ora/) which is a multi-agency approach to provide social and healthcare services to the community. Our traditional 'family doctor' EMR system focuses on the individual and has limited connections with other healthcare services. Whānau Tahi is the IT system that adds to the traditional EMR that is designed to coordinate treatment/services from all the agencies involved in the health and social well being of the patient and their family unit.

Joaquin Blaya, PhD Replied at 5:33 PM, 4 Apr 2014

We would like to thank all of the panelists and members who participated in
this panel. It has been an amazingly diverse discussion, that hopefully
will continue outside of this forum as well.

We will be creating a Discussion Brief summarizing this panel and attach it
to this discussion.

Warm regards,


Joaquín
___________________________________________________________________
Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/>
Research Fellow, Escuela de Medicina de Harvard <http://hms.harvard.edu/>
Moderador, GHDOnline.org <http://www.ghdonline.org/>

Marie Connelly Replied at 9:03 AM, 7 Apr 2014

Many, many thanks to our exceptional panelists, and all of our community members who participated in this rich discussion!

As Joaquin mentioned, we will be working on a Discussion Brief to summarize the key points from this Expert Panel, and will share details as soon as that is available on the website.

In the meantime, we would be grateful for your feedback in our short, 9 question follow up survey. These surveys are very quick and help us understand the impact of our Expert Panel discussions.

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With thanks,
Marie

Andrea Cortinois Replied at 4:35 PM, 9 Jul 2014

Thank you Joaquin! Appreciated!

Un abrazo,

Andrea


--
Andrea A. Cortinois, PhD
Assistant Professor
Dalla Lana School of Public Health
University of Toronto

People, Health Equity and Innovation (Phi) Research Group
Centre for Global eHealth Innovation
Toronto General Hospital & University of Toronto

Co-Director, Public eHealth Innovation and Equity in Latin America and
The Caribbean (eSAC)

Mentor, Social Aetiology of Mental Illness (SAMI) Training Program

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Panelists of Improving Equity through Health IT in the US and Internationally and GHDonline staff