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Do Hospitals Treating The Poor Face A Digital Divide?



October 27th, 2009

A new study published yesterday in Health Affairs finds that hospitals that disproportionately care for low-income patients are falling behind in adopting electronic health records (EHRs). This is the first paper to use national data comparing EHR adoption between acute care providers primarily caring for the poor and those serving more general populations.

Ashish Jha of the Harvard School of Public Health and coauthors surveyed the 3,747 acute care nonfederal U.S. hospitals with available DSH (Medicare disproportionate-share hospital) indices and received responses from 2,368, a response rate of 63.2 percent. They found that for many of the functions examined, hospitals that served a higher proportion of poor patients had modestly lower levels of adoption of health information technology (IT). In addition, the results suggest that EHR systems could help improve the quality of care delivered, and that hospitals serving a larger proportion of poor patients cited cost as a major barrier to EHR adoption.

Since the 2009 stimulus bill authorized nearly $30 billion to establish a national health IT infrastructure, an important health care policy consideration is whether the stimulus bill IT reforms will be implemented in ways that will help close the “digital divide” and improve the overall quality of care in hospitals. Concluded the authors, “While the Obama administration and Congress seek to craft effective policies to stimulate the adoption and use of health IT, it will be critical to ensure that institutions that care for the most vulnerable Americans are not left behind.”

The research for this study was supported by the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services and by the Robert Wood Johnson Foundation.

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  1. uberVU - social comments
    October 28th, 2009 at 6:30 am

1 Response to “Do Hospitals Treating The Poor Face A Digital Divide?”

  1. John Ballard Says:

    My instinct is that there is a difference between for-profit and not-for profit hospitals, with profit-driven operations seeking early access to any fresh federal incentives. What’s not to understand about that?

    But a less obvious factor could be the role that officially “not-for-profit” hospitals play in the for-profit eco systems of service areas with high median incomes, hence, better access lubricated by employer-subsidized insurance and suburban mentalities. I worked five years for a “not-for-profit” network in suburban Atlanta with five hospitals (FIVE — count them) all nourishing a very profit-driven community of health care providers. There could have been a few card-carrying “hospitalists” on staff, but my impression was that there is an incestuous symbiotic relationship between the for-profit and not-for-profit corporate structures. And the role of the not-for-profit component of that relationship is to carry that part of the load not accessible to the rest of the system.

    For example, one hospital supports an “indigent clinic” for patients from the community who cannot afford the main hospital. (I don’t know if the other four hospitals have similar offerings.) Staff doctors take turns pulling (pro bono?) duty at the clinic, and I’m sure the expense of operating the clinic has to be part of any accounting write-off as “community service.”
    You would think that an indigent clinic would be treating Medicaid patients, but you would be wrong. Those patients, part of an important revenue stream of federal and state dollars, are part of the main hospital patient load, along with insurance and Medicare beneficiaries. The people sent for indigent care are directed there from the local department of family and children’s services.

    I don’t know the details of all I just wrote, but to me as an observer it looks riddled with conflict of interest aimed at using a not-for-profit institution to support a larger community of profit-driven medical services.

    By contrast, the real mother of all non-profits in Atlanta is Grady Memorial hospital, which only recently got wrested from political control by local politicians, seems well on its way to becoming another member of the not-for-profit-but-supporting-for-profit-enterprises club. When Grady was on the verge of closing its doors a couple of years ago every suburban hospital in Atlanta got busy and leaned heavily on local politicians not to allow that to happen. They knew well that Grady was treating many really poor people from their respective service areas and they didn’t want that responsibility, indigent clinics and Medicaid notwithstanding.

    The cited study underscores what I have written and observed.

    Another part of the remedy, in addition to “targeting hospitals that serve large populations of poor patients” for better and sooner adoption of EHR resources, should be a closer look at “not-for-profit” hospitals in other areas as well.

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