IxAction Alliance member Kaiser Permanente has launched a national public relations campaign to draw attention to the need to address health care disparities in the context of comprehensive health care reform.

Indeed, the growing ranks of uninsured (nearing 50 million Americans) is more than a huge problem. It’s a national embarrassment (or “national disgrace” as Kaiser puts it). But a lack of insurance is only part of the issue, as a variety of vulnerable populations suffer from both health disparities and health care disparities, even beyond insurance status. Kaiser has also put together a great clearinghouse of resources on the subject.

The Center for Information Therapy has been increasingly tacking the dual questions of:

1. What particular challenges do health & health care disparities mean for implementation of information therapy (Ix)  interventions? and
2. In what ways can Ix initiatives provide leverage in overcoming health & health care disparities?

This two-pronged approach is rooted in two related beliefs. First, it’s imperative that — in our quest to drive Ix advancement — we do it in a way that reduces disparities and a lack of attention to the issues of safety-net populations might result in the opposite. Second, we believe that we need to be innovative in developing solutions to overcome disparities rather than presume that simply by achieving universal coverage or investing money that we’ll solve the problem (not that both aren’t incredibly important).

For more on what we’re doing in this area, look at the Safety-Net Populations and Ix & Health Disparities categories down the right nav bar of this blog. Also, we’ve written an issue brief on innovative HIT solutions for the Medicaid population for the Georgetown Health Policy Institute’s Center on Children & Families.

Happy New Year!

So much excitement is on the horizon in the new year. Here are five IxCenter priorities for 2009:

• The intersection of information therapy (Ix) and Health 2.0
  • There has never been a conference like the upcoming first-ever “Health 2.0 Meets Ix” Conference in Boston April 22-23!
• More intensive efforts in Ix implementation in safety-net populations
  • New IxAction safety-net providers as well as a few potential new Ix grant projects with underserved populations have great potential to show the reach of Ix initiatives.
• Building the Ix infrastructure in the context of health care reform
  • How do we build on 2008’s Ix private sector infrastructure successes by developing Ix-oriented performance measures and integrating these efforts into the national health care reform debate?
• More detailed exploration of Ix strategies for Rx management
  • What is the role of Ix in improving medication management, reducing medication errors, and streamlining medication selection decisions?
• Deep dives on key Ix applications
  • These may include pre-visit prep, after-visit summaries, prevention reminders, decision aids, and others.

What matters most to you as we work to advance the practice and science of information therapy in 2009?

Ok…well, not by itself.  But follow with me for just a couple of minutes…

I attended an excellent briefing on Capitol Hill yesterday sponsored by the Institute for Alternative Futures in Conjunction with the Congressional Hispanic Caucus. The briefing, “The Health Disparities Collaboratives: Enhancing Quality and Reducing Disparities,” is part of the IAF’s Disparity Reducing Advances project, in which I have been involved for a few years.

Two of the central messages from all the excellent presenters (David Stevens, MD, Director, Quality Center, National Association of Community Health Centers; Paloma Hernandez, CEO, Urban Health Plan; Roland Gardner, CEO, Beaufort, Jasper, Hampton Comprehensive Health Services) were (not surprisingly):

1. Targeted patient education that is tailored to the community’s needs and supported in a variety of ways and is designed to engage and empower people to manage their own health (basically information therapy or Ix) is critically important to successful health care interventions in underserved populations.
2. No matter what these excellent CHCs do to improve health care services, these populations will continue to experience disparities because of the underlying poverty of their communities.

That got me thinking…  If those interventions described (in #1 above) have been shown to have an enormous impact on the health of these populations, maybe Ix and related initiatives can be applied to a wide variety of challenges that underserved populations face — to help with education, employment, and ultimately, poverty itself.

Sometimes I need to be kept in check that Ix is not a panacea for health care (and I am well aware that it is part of a panoply of tactics needed to redesign health care delivery), but perhaps sometimes I also need to think bigger. Where are the opportunities to extend the principles, research and insights we have gained from years of Ix advancement to improve society more broadly?

I’m sure there are many examples out there, so please let me know where you see them.

(Continuing to post on some of the session from our 7th Annual Ix Conference from June 12-13. Note that the PowerPoint presentations are now available. We had a minor glitch in our transfer to PDFs, so you need to rotate them sideways. We’ll get that fixed tomorrow.)

One of the most innovative Ix leaders in the safety-net provider community is Neil Calman, MD, the CEO of the Institute for Family Health (IFH), a network of federally qualified community health centers in New York. He presented in our Ix & Health Disparities Track in a session on “Engaging Safety-Net Providers in HIT” with Kyu Rhee, MD, MPP, Director of Innovation & Program Coordination, NIH Center for Minority Health & Health Disparities. IFH was one of the sites we visited during our Patient-Centered HIT Initiative.

Neil has a direct way of putting things and his presentation probably set a PowerPoint font size record. He started off by telling the audience that, “For the past 6 years we have done everything we could to help bring information to our patients to help them improve their health.”

He then frames this in terms of what it means for the clinicians at IFH: “We have worked really hard to be a model for how electronic health records could be used to help us become…Information Therapists!!”

Neil explained what they learned from their patients when they studied what the health care experience was like for people with chronic conditions in the southwest Bronx. What they found out was that–for many of them–going to the doctor’s office was often “traumatic.” They found two really important things. First, there was great distrust of, and disrespect by, health care providers serving racial an d ethnic minorities. Second, there was bad communication resulting in major misunderstandings.

So when IFH decided to invest $2 million in its EHR deployment, they did it with these two lessons from their patients in mind. Neil said, “We deployed our EHR in a way that would build trust wit our patients. And give them the tools to help them find their way through the health care system.”

That’s why they designed their exam rooms so there were flat-panel monitors that clinicians and patients could look at together and put printers in there so clinicians could print out Ix for their patients and hand it right to them.

It’s amazing what clinicians can do for their patients in EHR implementation if they start by asking them what they need and then bake that into their implementation plans. It’s too bad that’s not a requirement for every EHR deployment in the country.

African American men have the highest incidence and death rates for prostate cancer than any other racial/ethnic group in the US.  How can information therapy (Ix) promote increased health equity in prostate cancer outcomes?  One of the functions of Ix is to deliver relevant health information to consumers where they are – in this case, the barber shop.

Research suggests that community-based education efforts by barbers could increase prostate cancer screenings among African American men.  Barbers were trained on an educational intervention based on the principles of Paulo Freire’s critical pedagogy.  In this ongoing pilot study, barbers ask male clients over the age of 40 if they have been screened for prostate cancer.  Clients who have not been screened are educated about prostate cancer and informed that they are a candidate for screening.

The training resulted in a statistically significant increase in barbers’ knowledge of prostate cancer.  Screening rates are not yet available, but preliminary results from qualitative interviews indicate increased knowledge about prostate cancer in clients.

If you are interested in promoting health equity, join us at the 7^th Annual Ix Conference in Washington, DC on June 11 and 12.  The Ix and Health Disparities track on June 12 will address promising new interventions that have been developed to narrow health disparities.