Assessing EHRs and health IT in outpatient HIV/AIDS clinics across four continents

Background: Despite substantial progress in the nation's effort to prevent HIV/AIDS, it is still a disease that disproportionately affects certain US populations, such as blacks, Hispanics and men who have sex with men. The disparities are abundant on a global scale as well; in 2008, adult prevalence of HIV/AIDS in sub-Saharan Africa was 5.2% compared to 0.4% in North America. Additionally, in developing and transitional countries, 9.5 million people are in immediate need of life-saving AIDS drugs with only 4 million (42%) are receiving the drugs. In other words, we are still struggling with meeting the needs of populations that need it most. Objective: Evaluate how EHR functionality can directly contribute to the elimination of health disparities. Methods: First we conducted an assessment of electronic health records and health IT infrastructure in 20 countries worldwide and the US. Then we developed a tiered system in which we could place each country on a continuum of EHR use/preparedness based on political landscapes and health IT infrastructure. Next, we looked at HIV/AIDS prevalence, access to HIV/AIDS medication and treatment clinics in each country. Finally we compared each countries placement within the health IT ecosystem to disease prevalence and access to treatment in order to analyze how EHR use can directly contribute to the elimination of health disparities. Results: Our analyzed data elucidate ways in which the diffusion of EHRs designed specifically with the HIV/AIDS patient in mind will help improve care and eliminate disparities by standardizing decision support and patient education tools. Furthermore, specific to the US, these same technologies will help HIV/AIDS clinics gain access to funds by streamlining their necessary reporting requirements and by making them candidates for reimbursement through the American Recovery and Reinvestment Act.