Advancing Meaningful Use through Disparities Analysis of Clinical Data: Lessons from the REAL (Race, Ethnicity, and Language) Data Project at UTMB

Meaningful use of clinical data for planning to improve quality and lower health care costs is a rapidly growing pressure on health care provider institutions across the country, and failure to achieve meaningful use goals as well as health outcome goals based on meaningful use carries significant penalties for those providers. However, early experiences demonstrate that significant barriers to effective and efficient meaningful use of such data exist.

Health care provider electronic medical record (EMR) systems  are potentially a powerful  resource for detailed and timely data to identify, prioritize, and remedy care quality deficiencies in a  patient population. However, these systems were generally designed with population-level clinical quality improvement or health research in mind, creating challenges for data access, documentation, and quality. Further, institutional practices may be more focused on immediate clinical applications and patient confidentiality rather than advancing meaningful use effectively and efficiently.

This discussion will highlight challenges and solutions in conducting health disparities research using EMR data from the University of Texas Medical Branch, a large academic medical center. Topics addressed include managing HIPPA and related privacy issues; changing institutional cultures that divide “research” and “clinical analysis” in unhelpful ways; strengthening institutional leadership and “buy-in” among partners such as Information Services departments; enhancing the efficiency and timeliness of access and documentation of data; and addressing missing fields related to health disparities. We will also discuss recommendations for improving the capacity for EMR systems to collect race, ethnicity, and language information for health disparities analyses, and structuring analyses for policy and clinical planning relevance. This presentation will share lessons for other institutions in implementing meaningful use initiatives, with an emphasis on institutionalizing efforts and creating quality improvement cycles.