While Informatics has been growing in popularity, we can't lose sight to what the end goal should be for robust use.
Health informatics is an interdisciplinary field that uses information technology to organize and analyze health data and knowledge to improve health outcomes.1 Health informatics utilizes resources, devices, and digital methods to acquire, store, retrieve, and use personal health data. A common example is the electronic health record (EHR) that is accessible by patients, doctors, administrators, insurance companies, and other members of the healthcare team.2 The adoption of the EHR by the Centers for Medicare and Medicaid Services has accelerated the development of health informatics.3 Overall, health informatics connects technology, communications, and healthcare to improve the quality and safety of patient care. This takes us one step closer to achieving health equity, defined as the fair opportunity for everyone to attain their full health potential, according to the World Health Organization.4
Despite efforts to improve the health of the general public in the United States, racial and ethnic minorities continue to bear the brunt of health inequalities, as seen by higher prevalence of chronic diseases such as cardiovascular disease, diabetes, and obesity.5 Social determinants of health (SDOH) are critical in predicting health outcomes and are correlated with health inequities. These are defined as the conditions where people are born, live, and work, and these are shaped by the distribution of resources at local and national levels.5 Social determinants validate how widely health informatics is adopted among racial and ethnic minorities. For example, data from the 2005 and 2006 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) indicate that EHR adoption is lower among providers who serve Hispanic or Latino and non-Hispanic black patients who are primarily uninsured or rely on Medicaid.6 Additionally, a study by Kaiser Permanente found there were significant racial and ethnic disparities among those who enrolled and used personal health records (PHR). PHRs are health informatics tools that are linked with EHRs and allow patients to access, change, or coordinate their own health information. Among African American PHR enrollees, 30.1% registered, compared with 41.7% of whites.7
With improved technology, the Institute of Medicine at CMMS are emphasizing that care should not occur only through face-to-face visits but should also be provided in different formats that increase patient access and engagement with their care.6 This is especially important when providing efficient proactive diagnoses and managing chronic diseases. Thus, resources that can increase patient engagement with their care include consumer health informatics (CHI) tools. These are characterized as digital resources to help patients research diseases and treatments. One-third of online health users have felt that these tools have helped them find pertinent resources, and there is early data that CHI tools may improve clinical outcomes.8 Social media is also playing a larger role in healthcare. Health-focused social networks, wellness mobile applications, and YouTube channels are a few examples of how social media can address healthcare disparities by spreading health knowledge. Online patient communities, such as PatientsLikeMe, QuitNet, and 23andMe utilize patient-contributed data. For example, the 23andMe database stores genotypic and phenotypic information from more than 5 million participants.9 Through these databases, providers can learn a lot from the attitudes, beliefs, preferences, behaviors, and cultural norms of underrepresented populations. By allowing clinicians to proactively target and adapt healthcare treatments, health inequities can be addressed.
Health informatics tools also need to connect providers with patients and enable increased monitoring of clinical parameters. Patient sensors or wearable technologies can enable remote monitoring and direct delivery of patient data to EHRs.6 This facilitates better clinical management to prevent downstream health complications. Furthermore, by allowing regular communication, these tools can aid in building stable connections between clinicians and patients. The availability of a consistent source of care for patients has been identified as a significant predictor of healthcare disparities.10,11 Frequent monitoring through the use of health IT technologies improves patient engagement and shared decision-making.
It is critical to conduct constant surveillance of these ever-changing health informatics technologies in order to determine success or failure. The “meaningful use” criteria, which assesses total acceptance and utilization by patients, clinicians, and other members of the healthcare team, will be a key indicator of success.6 It will also be critical to investigate any racial and ethnic disparities in the use of these digital tools through active community involvement, which takes into account varying levels of health literacy.5 As health informatics and digital health tools improve, the concept of user-centered design will become increasingly relevant. The most critical question about health informatics’ ability to reduce healthcare disparities is whether the healthcare system will embrace the entire range of future digital health tools and lead the effort towards more equitable healthcare for all.
- American Medical Informatics Association. “Informatics: Research and Practice.” AMIA – American Medical Informatics Association, amia.org/about-amia/why-informatics/informatics-research-and-practice. Accessed 20 Aug. 2021.
- Stobierski, Tim. “What Is Health Informatics? 3 Key Trends to Know.” Northeastern University Graduate Programs, 4 June 2021, www.northeastern.edu/graduate/blog/what-is-health-informatics/#:%7E:text=Health%20Informatics%20(HI)%20is%20a,also%20called%20Health%20Information%20Systems.
- USF Health Morsani College of Medicine. “What Is Health Informatics?” USF Health Online, 18 Aug. 2021, usfhealthonline.com/resources/key-concepts/what-is-health-informatics.
- World Health Organization . mHealth: New Horizons for Health Through Mobile Technologies.Geneva: World Health Organization; 2011.
- Brewer LC, Fortuna KL, Jones C, et al. Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health. JMIR Mhealth Uhealth. 2020;8(1):e14512. Published 2020 Jan 14. doi:10.2196/14512
- Gibbons, Michael. “Use of Health Information Technology among Racial and Ethnic Underserved Communities.” Perspectives in Health Information Management. 2011: 1-13.
- Roblin DW, Houston TK, Allison JJ, et al. Disparities in use of a personal health record in a managed care organization. J Am Med Inform Assoc. 2009;16(5):683-689. doi:10.1197/jamia.M3169
- Gibbons MC, Wilson RF, Samal L, et al. Impact of consumer health informatics applications. Evid Rep Technol Assess (Full Rep). 2009;(188):1-546.
- “23andMe Research Innovation Collaborations Program.” 23andMe for Scientists, 22 June 2020, research.23andme.com/research-innovation-collaborations.
- Carpenter WR, Godley PA, Clark JA, et al. Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use. Cancer. 2009;115(21):5048-5059. doi:10.1002/cncr.24539
- Shi L, Stevens GD. Vulnerability and unmet health care needs. The influence of multiple risk factors. J Gen Intern Med. 2005;20(2):148-154. doi:10.1111/j.1525-1497.2005.40136.x