By EHR Association SDOH & Health Equity Task Force
Global Health Equity Week, October 23 – 27, 2023, is a week of action that seeks to spotlight the transformative capabilities of health information and technology in reshaping healthcare, reducing health disparities, and improving access to healthcare for all communities. As part of its mission to improve the quality and efficiency of care through innovative, interoperable health IT adoption and use, the EHR Association continues to appeal to lawmakers and national regulators in support of expanding access to telehealth, addressing social determinants of health (SDOH), and increasing interoperability between healthcare providers and community-based organizations (CBOs).
Telehealth as a Global Equalizer
The COVID-19 pandemic magnified the longstanding disparities in healthcare access and outcomes, hitting marginalized populations the hardest – particularly Black, Latinx, American Indian / Alaska Natives, and those residing in underserved regions and rural areas. These underserved and marginalized communities, whether in the heart of America or in distant corners of the world, continue to face similar barriers to healthcare access, including a lack of electricity and running water, access to telemedicine, transportation limitations, and the distance to testing facilities. Amid these challenges, telehealth emerged as a beacon of hope, leveling the playing field for healthcare access on a global scale.
During the pandemic, expanded authorization and special waivers paved the way for increased telehealth availability. This technological innovation proved to be a game-changer by breaking down the traditional barriers to care. It enabled communities worldwide to access essential healthcare services virtually, empowering patients to take control of their health and well-being. In many ways, the pandemic catalyzed the global adoption of telehealth as a means to bridge the healthcare gap.
We recognize the power of digital tools in advancing global health equity…Nonetheless, the use of these tools often hinges on patients having access to high-speed internet, a resource that remains lacking in numerous rural and underserved areas.
Bridging the Digital Divide
We recognize the power of digital tools in advancing global health equity. Smartphone-accessible telehealth and consumer applications have the potential to empower patients and connect communities in new and transformative ways.
Nonetheless, the use of these tools often hinges on patients having access to high-speed internet, a resource that remains lacking in numerous rural and underserved areas. While the focus is rightly placed on the availability of broadband internet, it is equally essential to broaden initiatives that offer access to supportive technologies, like tablets. These devices aid patients in staying connected to their healthcare providers and facilitate data sharing through personal health records and patient portals, thereby fostering active participation in telehealth consultations.
The urgency of addressing this issue is compounded by the alarming trend of rural hospital closures. Reports from the Center for Healthcare Quality and Payment Reform indicate that one-third of rural hospitals in the United States are at risk of closing. These closures exacerbate challenges for individuals in underserved areas, leaving them with fewer care options while the lack of broadband infrastructure and internet-facilitated devices hinders their ability to receive remote care and monitoring – all of which underscores the critical need for broadband access as an integral component of healthcare infrastructure.
Addressing SDOH
Federal funding is needed to address SDOH-related needs in rural, tribal, and underserved communities where they are most pronounced. Further, greater funding is needed in geographies with dispersed populations to ensure access to essential services such as telehealth and online schooling.
The prevalence of unemployment and underemployment contribute to numerous challenges, including insurance coverage gaps, difficulties in affording prescription medications, missed medical appointments due to financial constraints, increased incidents of food insecurity, and a higher prevalence of substance use disorders. These interwoven challenges create a complex web of barriers to accessing healthcare and maintaining overall well-being in these communities. Targeted investments to address these socioeconomic determinants are essential for improving health outcomes and healthcare accessibility.
To drive change and ensure a unified approach to addressing SDOH across the nation, Congress has a unique opportunity to invest in standards specific to SDOH. By requiring state agencies to adhere to these standards when implementing programs, Congress can make substantial progress toward mitigating health disparities related to social determinants.
Connecting Community Resources
Sharing clinical information with CBOs and non-medical providers provides a comprehensive context for technology-enabled data sharing and access, ultimately contributing to more effective care delivery. Support for CBOs that assist individuals facing healthcare access challenges and life circumstances affecting their health outcomes is necessary for them to continue playing a critical role in bridging the gap between health and social care. To enhance this collaboration, investments in information exchange capabilities between CBOs and healthcare providers are essential.
Even in cases where healthcare organizations have established relationships with nearby CBOs, a significant gap exists in information sharing and program coordination. There is a glaring disparity in information exchange capabilities between healthcare organizations, which handle tens of millions of daily record exchanges, and the rudimentary levels of exchange between care providers and the CBOs they intend to refer patients to.
While much of the necessary information transfer would typically occur from the clinical setting to the social service agency, there are also scenarios in which community professionals may come across information that could benefit the patient’s healthcare provider. This information should be seamlessly incorporated into the patient’s medical record. At the very least, constructing the infrastructure for a closed-loop referral process would be immensely beneficial to all parties involved. Additionally, enhancing funding for CBOs to further invest in their interoperable technologies, beyond the scope of traditional health IT, is a crucial step in addressing this issue comprehensively.
Ensuring Permanent Medicare Telehealth Reimbursement
The simplified reimbursement policies for telehealth implemented during the pandemic allowed vulnerable and underserved communities to access healthcare services they would otherwise not have been able to avail themselves of.
The pandemic’s telehealth expansion demonstrated remarkable efficiency and effectiveness, particularly in clinical use cases like mental health treatment. Contrary to initial concerns, telehealth did not increase costs but rather proved to be a cost-effective solution that improved patient outcomes. There is growing evidence that telemedicine decreases overall mortality and length of stay without substantial cost increases.
The simplified reimbursement policies for telehealth implemented during the pandemic allowed vulnerable and underserved communities to access healthcare services they would otherwise not have been able to avail themselves of. These services were consistently utilized across race and ethnicity, providing healthcare providers with an additional opportunity to address social determinants of health effectively.
Therefore, we have strongly urged the permanent continuation of Medicare telehealth reimbursement without artificial barriers to utilization. This recommendation enjoys strong bipartisan support, with 78% of respondents (including 72% of Republicans, 87% of Democrats, and 66% of Independents) in favor of enacting permanent measures to ensure continued access to telehealth services.
Additional Information
EHRA Response to Ways and Means Committee Rural Health RFI
EHR Association Feedback on the Congressional SDOH Caucus RFI
EHRA Blog 