Health equity is an essential component of high-quality care. By intentionally designing systems and processes that prioritize equity and access, healthcare organizations can help to ensure that safe, high-quality care is accessible to all. In part II of our blog series on health equity and techquity, Theresa Demeter, Tegria’s managing director of clinical transformation, discusses the relationship between health equity and quality care, and how emerging trends are shaping both individual and community health.

Healthcare quality is monitored by CMS and by a number of organizations that publish healthcare quality and safety ratings, so healthcare organizations are continually striving to improve their quality and safety scores. But more work remains to be done. How is healthcare quality related to health equity?

You can’t have one without the other. According to the Agency for Healthcare Research and Quality, otherwise known as AHRQ, there are six domains of healthcare quality including that care is safe, effective, patient-centered, timely, efficient, and equitable.

Equity is within the definition of quality healthcare. If you have patients who don't have access to timely care, who don't receive culturally appropriate care, who are more likely to experience worse outcomes due to implicit bias or the use of technology, then you have neither quality nor equity.

Equitable care ensures that access and care don’t vary based on your social determinants of health (SDOH), such as not having access to the internet or living two hours and three bus rides away from the nearest hospital. So, health quality and health equity are different sides of the same coin. You can’t have one without the other.

How can healthcare organizations address systemic inequities in access to care, information, and other critical components of modern healthcare?

There’s much innovation in healthcare technology right now making care easier to get for many. We can make appointments online. We can complete our visit virtually. We can have our medication sent to us through the mail. We can find our test results in a patient portal. We can receive care at home through remote patient monitoring. But there are risks in all that technology.

We risk leaving people out by increasing the digital divide for people who don’t have a computer, access to broadband internet, or even an email address. We leave behind people who have lost trust in the healthcare system and its technology. We risk perpetuating the systemic problems caused by biased and incomplete data.

To flip this story, let’s look at something that’s less obvious. Use breast cancer as an example. If we look at organizational breast cancer outcomes data, it may tell us that an organization has great outcomes for patients with breast cancer. But when we sort that data by gender, we may find that while women have good outcomes, men do not. We wouldn’t know this unless we dig down and sort the data to look at the different patient populations. For a long time, we didn’t reliably collect the SDOH data that allowed us to understand the disparate outcomes of different patient populations. An important way to address systemic inequities in access and quality is to reliably collect SDOH data and then systematically review that data stratified by SDOH filters. This tells us who is not able to access care and where outcomes are worse.

Healthcare must prioritize health equity as a core strategy to address systemic inequities. We can’t keep the status quo. We have to look closely at policies, treatment plans, access, workforce and hiring policies, data collection, technology, the vendors we work with, all through the lens of health equity. Healthcare organizations needs to ask the communities they serve what is the best way for you to access care? What do you need to feel welcome?  What do you need to feel valued?  What do you need to reach your full health potential?  The only way healthcare organizations will know the answer to those questions is to ask their communities.

Has the trend toward more individualized healthcare encounters and information (e.g. telehealth and personal health data from wearable devices) had a positive or negative impact on healthcare equity?  

Mostly very positive, but it can be both. Individualized care is doing so much for access and specific treatments. Remote patient monitoring is allowing people to stay at home. They may live two hours away from a hospital, or may not have transportation, so it’s making care easier and safer for more people.

Better data is another example of a positive impact. We can provide the best and most appropriate care when we know a patient as an individual. Our SDOH can make us more or less at risk for certain conditions and diseases and make certain treatments more or less effective.

When we are introducing new technologies, new treatments, new processes, we must pause to think about what unintentional consequences may result if the design of that treatment or process didn’t consider the individual being cared for.

Let’s go back to the pulse oximeter which provides very individualized care. This device, placed on an individual patient’s finger, should provide accurate information about how that specific patient is doing, but because the device wasn’t calibrated to be accurate for all skin colors it caused harm to many during COVID. Providing individualized care using technology, data, and medical devices is accelerating improvements in outcomes, but we must incorporate the concepts of techquity and health equity by design to make sure those improvements benefit everyone.

Can you talk about the relationship between emergency or disaster planning and equity? 

Emergency preparedness and mass casualty incidents are something we hear about in the news more and more frequently. Emergencies can include naturally occurring emergencies such as hurricanes, flooding and earthquakes, or man-made emergencies such as multi-vehicle car crashes, mass shootings or a chemical explosion. In either case emergencies and mass casualties can cause chaos, increase the incidence of medical error, and increase the risk of harm from implicit bias. From remote to rural to urban, hospitals must be prepared to provide a coordinated, efficient, and safe response to whatever mass casualty incident may happen. That includes having a plan to care for diverse patient populations appropriately and safely.

In a community near me, around 26 different languages are spoken. If there were to be an emergency within that community, is the hospital prepared to care for people who may not be able to communicate easily with hospital staff? Is there a plan for emergency translation services? Only through intentional consideration of the needs of the individuals in the community during emergency preparedness planning, can the hospital and staff ensure quality care for everyone. It is important that health equity is at the core of the priorities of the hospital.

I can give you an example of some work we’ve recently done with the Southeast Alaska Rural Health Consortium (SEARHC).  The leaders and Chief Medical Officer of SEARHC were concerned that their remote facilities weren’t as prepared as necessary for an emergency. Tegria worked with leadership, physicians, emergency preparedness officers and staff to test and improve their emergency preparedness and mass casualty incident response including participating in an onsite macrosimulation, in which providers, nurses, and safety experts realistically tested policies, processes and technologies. The goal of the work was to ensure that in an emergency SEARHC facilities can provide timely and quality care even in remote locations which serve native Alaskan communities, that technology supported their goals and that all were more confident in their ability to respond to a mass casualty incident.

How is your team approaching project design and project management with health equity in mind?

Like many organizations we are still learning in terms of understanding how to improve health equity through technology and better care delivery. Our perspective is that the concept of health equity shouldn’t be owned by a person. It shouldn’t be thought of as a project, it’s not a bullet point or an afterthought. Our goal is to apply a health equity lens in everything we do.

From every project we design, every program we manage, every service we provide a client, we start, continue, and end that project with the lens of health equity. That means we need to continuously ask the question who is being served? What are the unintentional consequences of this technology, this treatment, this new policy, this data? What are we doing to mitigate those risks? Are we being inclusive? Are we asking communities and individuals, what do you need?"

To be inclusive and to adopt the principles of techquity, we need to ask, not assume, what people need to have equal opportunity to reach their full health potential. We are learning how to do this but are committed to doing our part to eliminate health disparities.

Is there anything you’d like to add that we haven’t covered here?

Much of the work of understanding the risk of new technology and operationalizing risk mitigation efforts to ensure equitable healthcare remains conceptual. COVID helped us understand that we weren’t doing a good job and energized many to set new standards and goals of inclusivity.

If I am a project manager, a nurse, or a hospital CFO, what is my role? How do I move from concept to action? There are some tangible things that can be done now to help move us forward in terms of inclusive care, and inclusive technology.

The first is to make the commitment. Learn what it means to be inclusive and intentional in the design, implementation, and use of technology, data, and artificial intelligence.

Center equity as a strategic priority in everything you do, no matter your role. From the strategy of the hospital to the policies, procedures, hiring practices, workforce development, to the implementation of new technologies, to community partnerships and community needs assessment, health equity should be at the core.

Partner with community organizations. Eighty percent of our health comes from outside the walls of your doctor’s office or hospital. Healthcare organizations need community partnerships to ensure they can meet each person where they are at. To improve food security, ensure reliable shelter, increase access to the internet and comfort using a computer and increase trust, healthcare must collaborate with community organizations to provide whole-person care.