The Path Toward Equitable Health Care is Paved With Intentional Tech

Last year was a wake up call—in more ways than one. The pandemic forced us to reckon with our methods of clinical practice and operational management, and the social unrest brought the systemic prejudices within our country’s institutions—and more specifically, our healthcare system—into sharper focus. And while I’ve discussed the issues surrounding our profession’s diversity and inclusivity issues in great detail (from the lens of both a physical therapist and an industry thought leader), I realize I haven’t yet addressed the important role technology plays in our industry’s larger diversity, equity, and inclusion (DEI) efforts.

So, let’s address it here and now.

Improving Equitable Care Through Tech

Here’s a little bit of background knowledge. In 2009, the US Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act to empower healthcare providers to adopt and use healthcare information technology to:

• Manage and coordinate care in real time;
• Encourage data collection and sharing to promote evidence-based care; and
• Collaborate with other healthcare stakeholders to reduce health disparities.

The overarching goal with this initiative was, of course, to push providers down the path of patient-centered care—a term defined by the Institute of Medicine as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” In other words, it’s about furnishing equitable care to any and all patients regardless of race, religion, socioeconomic status, sexual orientation, gender, or other differentiating quality.

For the most part, evidence shows that the healthcare community has made notable progress toward achieving the goals outlined by the HITECH Act. The advancements we’ve witnessed along the technological front have enabled providers to:

• Access data in real time, thus helping them better understand and care for patients;
• Share clinical and behavioral patient data across the healthcare aisle to promote better outcomes; and
• Collaborate to “improve quality of care, access to care, health outcomes, patient engagement, and chronic disease management in underserved communities and those experiencing health disparities” (as stated in this study).

While these improvements have been amazing to see, some technological shortcomings hinder our journey toward true inclusivity.

Acknowledging PT’s Prevailing Diversity Issue

The physical therapy industry still faces an enormous disparity between the makeup of our country and the makeup of our workforce. According to our most recent industry report, more than three-quarters of rehab therapy professionals are white. By contrast, according to the 2020 US Census data, just under 60% of the country’s population is white.

This diversity gap presents a number of challenges, however, the most troubling one is that it can inhibit us from serving a significant number of patients who could actually benefit from our care. According to this article from St. George’s University, “when a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, it may delay or prevent them from seeking care.” I know that therapists are capable of providing high-quality care to people from all walks of life, but sometimes implicit bias and our unconscious beliefs and assumptions about the world can influence a patient’s care—and ultimately their healthcare choices. 

This spirals into an even larger problem. If we—both PTs and other healthcare providers—are unable to reach or perfectly serve diverse patient populations, how will we ever gather the data required to better understand the social determinants of health that impact various patient populations? This puts us at a disadvantage when identifying solutions to ways we can expand access to care (and hopefully whittle away at PT’s persistent 90% problem).

Addressing This Issue Through Tech

At the end of the day, patients just want to feel that they can trust their providers. This becomes inherently easier when we have the technology in place that not only helps us reach patients far and wide, but also that helps us better understand those who come from different backgrounds. While we have a ways to go in this regard, some exciting advancements in tech aim to narrow this gap.

For instance, since the pandemic, the medical research community has been working diligently to recruit candidates and study participants from underrepresented populations. To put this in context, according to recent commentary from the scientific journal Cell, 86% of participants in clinical trials are white—and fewer than 3% of the participants in large-scale, comprehensive studies are of African, Hispanic, or Latin American descent. So, in an effort to solve this long-standing issue, medical research institutes have begun forming DEI task forces to ensure participant demographics in research trials are inherently more diverse, and that these clinical trials are accessible to more people—particularly non-English speakers as well as to people with disabilities. 

Bringing This Lesson In-House

One way we’ve begun to improve inclusivity here at WebPT is by being more conscious about choosing individuals for our Home Exercise Program (HEP) imagery and videos. I’ll be the first to admit that our existing library (which includes more than 5,000 images and videos to-date) is too homogenous. To begin amending this, we’ve begun filming and adding videos with more non-white models, as well as more geriatric, pediatric, and amputee models, too.

Additionally, we currently offer more than 20 different language options for providers to use when customizing and printing out exercise programs for specific patients.

We recognize that the work we’re doing to expand diversity and inclusivity in our HEP product isn’t quite done. However, it is a step in the right direction—and one we hope to see echoed by other HEP software. These types of changes benefit patients the most, helping them feel seen, heard, and understood.

Adding Inclusive Language in EMRs and EHRs

Another prevalent issue affecting our ability to provide equitable care is the lack of inclusive language in health IT software. Ever since EMRs and EHRs became widely adopted, there has been a lack gender-inclusive terminology in electronic patient charts—an oversight that only has become more obvious over time as general understanding of transgender and gender noncomforming individuals has increased.

Addressing this Issue Through Tech

At first glance, you may think that changing gender terms is an easy back-end fix. However, the lack of cohesion among various EMR and EHR products and platforms outside of the WebPT umbrella (e.g., billing software, patient relationship management software (PRM), digital patient intake software) means that adding more nuanced gender options can create a huge interoperability problem. For example, if an EMR is billing a payer that is not using the same gender terminology, it could lead to incomplete data transmission and denied claims. 

Although some simple solutions aren’t enough to fix this critical issue, it is one we must prioritize. According to research published in the Journal of General Internal Medicine, non-inclusive language in EHRs can potentially influence clinician bias—which can then spread from one clinician to the next. Therefore, the more we look to expand inclusive language in healthcare tech, the more we can promote patient-centered care—and in turn, reduce healthcare disparities among marginalized populations. Correcting this issue at scale will require cooperation and a united commitment to diversity across the entire health IT community—not just a few companies. 

Bringing This Lesson In House

The WebPT team has been testing ways to make the language we use in our software more inclusive. For instance, our EMR and patient relationship management tool, Reach, have long had the ability to adapt to gender non-comforming options from other incoming systems. We’ve also recently reconfigured our digital patient intake solution so that it offers patients six different gender options to choose from. What’s more, we offer each of our Members the option to scale up these selections dependent on their patient populations.

When developing our digital patient intake software, inclusivity was certainly a concern of ours. We plan to incorporate these changes within our EMR and PRM, as well. Our goal with these improvements is to not only foster more inclusivity as it pertains to patient care, but also that these efforts will lead the charge for transformation within the industry at large.

Driving Inclusivity at an Individual Level

I would be remiss if I didn’t talk about some other ways you can propel DEI efforts in your clinics beyond the scope of technology. While myself and my team have talked about these strategies extensively in this blog post and this one, I think it’s important to revisit them. Some highlights include:

1. Seek learning opportunities to understand the causes and effects of systemic racism in healthcare and the physical therapy community.
2. Be mindful of your word choices when interacting with your colleagues and patients. Taking this a step further, I’d encourage you to also be mindful of asking for patients’ preferred pronouns and then documenting them so your entire team knows how to address each patient.
3. Take a deeper dive into the topic of implicit bias and consider how it may affect your interactions with patients, as well as your hiring decisions.
4. Learn about the social determinants of health as well as the various ways you can work to diversify your profession.
5. Support PT-led, diversity-driven organizations, as well as efforts to improve inclusivity in physician education practices.
6. Show your dedication to DEI on your website and social channels.

DEI is an incredibly important topic in the physical therapy—and greater healthcare—community for many reasons, but I believe the most important one is this: We do not stand a chance at extensively achieving patient-centered care, ensuring better outcomes, or reducing healthcare costs if we don’t first address the existing inequities in health systems. And to deliver on this objective, we must leverage the untapped potential that resides in the tech we use.