E-health’s potential for health promotion and equity

Today’s article in the Globe and Mail’s series on healthcare rightly stressed the crucial importance of electronic health strategies to progressive health reform.  Unfortunately, this issue has been tainted by scandals around consultants and inefficient spending.  But we shouldn’t let that distract us from e-health’s importance; a Wellesley policy briefing sets out the potential of e health within a comprehensive equity strategy.

To realize the innovation potential of e-health we need to keep several things in mind.  Some of the most important equity-driven reform is taking place in grassroots community-based service providers.  Governments and LHINs should put e-health investments into these settings, not only in hospitals, major institutions, or individual physician’s offices.  One reason e-health is so important is that it underpins being able to monitor how effectively care is being delivered and resources allocated.  This means that we need to think big about what goes into the e-health record: not just clinical data, but information on people’s income, living conditions, support networks and other social determinant of health-type factors that are so important to understanding health needs.  Such social determinants data is also essential to drive performance management and monitor progress.  For example, e-health systems can include easy-to-use pop-up checklists for providers to ensure patients are receiving the highest standards of care; the same system can then yield the consistent and reliable data needed to monitor how many patients are receiving the highest standards.  As always, this measurement and monitoring needs to be seen through an equity lens.  So the goal is not to simply to raise the overall proportion of patients receiving the best quality, but to reduce any inequitable differentials between women and men, people of different backgrounds and incomes, and regions.

E-health also has great potential as a tool to support individual self-management of care and overall health promotion.  Among the many examples of community groups using e-health imaginatively, a personal health record called MiVA (My Way in Spanish) was developed to support migrant farm workers in California and extended to other vulnerable populations.  It allows access to medical histories in different provider settings and supports better continuity of care.  Peer outreach health promoters support clients in using the tool to manage their own care.  To achieve this potential, systems must be meaningfully accessible – not just in terms of internet access, but also easy to use and understand.