The Intersection of Health Informatics and Disparities: Understanding How Data Promotes Health Equity

Doctoral Candidate Name: Kala S. Wilson
Program: Public Health Sciences
Defense Date and Time: October 10, 2022 – 9:00 AM
Defense Location: https://charlotte-edu.zoom.us/j/96710653514?pwd=d01ubUJPYTdlZTQ1VTdzVHFLV2RjZz09; Passcode: 101022
Committee chair’s Name: Dr. Michael F. Dulin
Committee Members:
Abstract:

In this collection of manuscripts, I develop a deeper understanding and insight into how the Coronavirus Disease 2019 (COVID-19) pandemic and subsequent transition to telehealth impacted 1) clinical electronic health record (EHR) data quality and data entry patterns, 2) provider perceptions of the EHR’s influence on care delivery, and 3) patient perceptions on barriers related to pandemic-induced telemedicine.

The COVID-19 public health crisis has disproportionately affected individuals and populations historically marginalized in healthcare and public health, including racial and ethnic minorities and individuals with low-income status. The COVID-19 pandemic has drawn new attention to and compounded the existing health and digital disparities in healthcare, with Black Americans being almost 4 times more likely to die from the virus than White Americans. Racial and ethnic health disparities have been historically unwavering and persistent within the United States. Furthermore, this crisis has ignited rapid implementation of digital healthcare solutions such as virtual healthcare (telehealth and telemedicine capabilities) and health information technology (HIT) accessed via mobile applications or online platforms. When assessing HIT’s effectiveness, efficiency, quality, safety, and equity, it is important to consider the reciprocal relationship between HIT and the COVID-19 pandemic. This is of marked significance, considering that virtual care technologies have been shown to exacerbate the digital divide and worsen disparities in a patient’s ability to access high-quality care.

The research in this dissertation is informed by the socio-technical and complex systems perspectives of improved human health via high-quality, safe, HIT-driven care, which maintains two central concepts: 1) multiple levels of influence affect a patient’s health outcomes, such as care quality, costs, and patient safety; and 2) complex adaptive systems occur when many agents work together within an organization and patterns materialize as the agents adopt, “simple rules” that optimize outcomes, such as the patient experience and the clinical team’s performance. Understanding how these HIT-related behaviors and perceptions multidimensionally affect care delivery is imperative to maximizing the potential benefits of technology and data in healthcare and promoting the need for a concerted effort to ensure safe, high-quality, and equitable care delivery.

Chapter 1 reviewed literature on the relationships between HIT and care quality, patient safety, health equity, biases, and discrimination. In Chapter 2, we assessed the influence of external, societal factors on disparities in data quality and data entry patterns. We found that an external change to healthcare operations – which modifies clinical practice – was correlated with clinical data entry patterns. Also, we found significant differences between departments within the healthcare organization, suggesting there were data entry differences based on distinct care goals housed within different units. These findings underscore some of the conclusions found in Chapter 3 where we determined the multidimensional relationship between HIT processes and patient safety and quality by exploring how healthcare provider demographic and health system-related characteristics were associated with their perception of the EHR’s impact on care delivery.

Perception disparities were present by providers based on sex, age, race, ethnicity, board certification, telemedicine utilization, and years of EHR experience. The results from this research are striking – we uncovered that providers using the EHR and telemedicine were roughly 20 times more likely to perceive the EHR as beneficial for patient safety (OR=20.25; p