There is an emerging digital divide in healthcare between those who care for disadvantaged patients and those who carefor less vulnerable populations. In the past decade, electronic health record (EHR) adoption and use has increased butunequally. Providers caring for disadvantaged populations are less likely to have and use advanced EHRs withsophisticated clinical decision support, analytics, and other functionalities. While EHRs are failing to meet the needs ofUnited States' providers more generally, EHR-related challenges are particularly acute for providers who treatdisadvantaged populations due to time pressures, limited resources, and the need to address many social issues.Furthermore, EHRs have resulted in the accumulation of vast amounts of data, but providers do not have time to siftthrough it all in a patient encounter - better tools are needed to summarize, organize, and display the data in a way thatbetter supports care. For chronic conditions such as diabetes, providers need to instantly see, assess, and take action ontheir patients' status in a glance, without searching through laboratory results, weights, diet, history, medications, notes,and comorbidities scattered throughout a system. ASP.MD and the RAND Corporation have developed preliminarydesigns for a more usable EHR user interface (UI) that organizes and consolidates clinical data into "Viewers" based onclinically meaningful problems. Viewers are far more advanced than traditional problem lists. They visualize context-relevant longitudinal data, set visit agendas, track tasks, and execute other clinically useful activities. These visualinnovations help providers quickly assess a patient's overall status and specific clinical needs based on their data andsymptoms. In this work, we will engage providers who care for Medicaid and other disadvantaged populations to furtherdevelop and test this novel EHR UI. In Aim 1, we will use user-centered design methods to develop detailed prototypesand clinical scenarios for testing. The scenarios will be common for providers who treat disadvantaged populations andthey will promote improvement on established quality measures. We will integrate these prototypes into an existingEHR, developed by ASP.MD. In Aim 2, we will test the usability of the prototypes through structured sessions. ASP.MD isan ideal setting for developing and testing this innovation by building off its existing, federally certified commercial EHRand practice management systems. ASP.MD's EHR is web-based, making it possible to immediately distribute newfeatures to all users. We will build using the standards-based fast health interoperability resource (FHIR) applicationprogramming interfaces (API), making it possible to use our Viewers with other EHRs as well. This work has the potentialto substantially reduce disparities by giving providers who care for disadvantaged populations an affordable, advancedEHR. Providers will have access to relevant, organized, synthesized clinical data at the point of care, facilitating theirability to close quality of care gaps and reducing burnout. It also has the potential to greatly improve the quality of datain EHRs, which can enable further innovation.
Public Health Relevance Statement: PROJECT NARRATIVE
Healthcare providers who serve Medicaid and other disadvantaged populations struggle to afford and use electronic
health records to improve care for their patients. We will design and develop a novel, affordable approach for organizing
clinical and social data so that these providers will be able to have relevant, actionable data at the point of care through
a cloud-based electronic health record. This innovation has the potential to reduce disparities by empowering providers
who care for disadvantaged populations to work more efficiently, optimize their access to relevant clinical data, and
facilitate improvements in patient health outcomes.
Project Terms:
