Small and rural hospitals treating economically and socially disadvantaged groups are less likely to exchange health data, a recent study from the Office of the National Coordinator for Health IT shows – a wider digital divide for marginalized ZIP codes than previously thought. 

WHY IT MATTERS

While economically and socially disadvantaged groups are at higher risk for fragmented, poorly coordinated care, said ONC officials, research published earlier this year showed that socioeconomic drivers directly correlated to low investments in interoperability. 

ONC sought to find out whether differences in hospital interoperability are related to the extent to which hospitals treat marginalized groups. It found that 20% of hospitals' ZIP codes with the highest Social Deprivation Index (SDI) were 21 percentage points less likely to engage in interoperable exchange than the other 80% of hospitals.

Previous data on smaller, rural and independent hospitals with lower rates of data exchange relied on Medicaid caseload, the Medicare Disproportionate Share Hospital Index, uncompensated care burden and Critical Access Hospital designations to identify those reached by the Centers for Medicare & Medicaid Services State Innovation Models and ONC's regional extension centers program. 

For the new study, the agency researchers also used the SDI, which is based on seven demographic characteristics collected in the American Community Survey to quantify the socioeconomic variation in health outcomes, to better hone in on the relative deprivation of a geographic area and its residents. 

"We found that these five measures identified overlapping, but clearly distinct sets of hospitals. Of the five measures, only the SDI consistently identified a difference in interoperability," the ONC researchers said.

The SDI applies statistical methods that yield correlation strength between the variables that comprise the factor and the factor itself. The higher the factor loading score, the greater the variation explained by that variable.

ONC analysts Jordan Everson, Vaishali Patel and Bob Phillips said policies aiming to improve interoperability and address health disparities may be more effective if they are guided by an empirical understanding of which hospitals need additional support. 

THE LARGER TREND

Achieving interoperability may also be a means of advancing health equity, a panel of experts at the HIMSS23 said this past spring, noting that exchange of important health information between healthcare entities is an important first step in bridging the health equity divide.

"We have such limited data in an interoperability environment that we tend to look for clusters and focus on that," explained Ammon Fillmore, associate chief legal officer, information and technology at AdventHealth.

Rethinking which data can and should be interoperable is a part of addressing health inequity, he said: "Interoperability exposes data silos and data deserts, where there isn't any data to be found."

A lack of interoperability has also held patient care back, according to Dr. Ben Zaniello, chief medical officer at PointClickCare.

In October, he discussed three pathways to improve care coordination and visibility with Healthcare IT News and shared his personal experiences engaging social determinants of health on post-acute care coordination.

ON THE RECORD

"These findings indicate that relying on a single proxy [like Medicaid caseload] could lead policymakers to focus on only a subset of hospitals that serve populations that have been marginalized, and perhaps inadvertently exclude hospitals that also need it," said ONC officials about their recent study.

"Further evaluation of these and other proxy measures will be important to help policymakers at the federal, state and local level effectively reduce disparities in who benefits from the proper flow of health information."

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.