The third installment in a series of articles commemorating the two-year anniversary of Mass General Brigham’s United Against Racism initiative.
A lot of people take access to technology — like a computer or smartphone — for granted. It’s assumed that people inherently know how to interact with technology interfaces like website logins, apps, and more. It’s an unfounded assumption, however, and with many healthcare supports moving to the digital world, it’s vital to account for patients who either don’t have access to technology or don’t know how to use it. Technology-based programs supported by Mass General Brigham’s United Against Racism initiative are helping to bridge this digital divide.
The new initiatives aim to better identify disparities, close existing gaps, and prevent future disparities from taking root.
“We must be diligent about identifying and addressing inequities related to digital access. We’re trying to shape a future where everyone is supported by these advancements in care delivery,” says Tom Sequist, MD, Chief Medical Officer, Mass General Brigham.
As healthcare organizations grapple with dismantling health inequities, clinicians first need a deep understanding of the outcomes and experiences of their patient populations. Demographic data such as ethnicity, age, and medical history, are crucial in measuring and providing tailored, equitable care for all.
Researchers, including those from Mass General Brigham, have consistently shown that there are clear healthcare disparities for patients based on race, ethnicity, and whether English is the primary language. But without those data, we cannot measure inequities in care and health. Collecting data is critical to designing impactful, equitable programs and services for our patients.
“We know that across our country, people have unfair differences in health and healthcare based on race, ethnicity, language, sexual orientation, gender, and ability,” says Allison Bryant, MD, MPH, Senior Medical Director for Health Equity at Mass General Brigham. “Making sure everyone gets the same excellent healthcare starts with knowing more about each person. Healthcare needs to be fair and open to all. Equity is our goal.”
To start to combat this problem, Mass General Brigham launched the REaL Patient Data program along with the “We Ask Because We Care” campaign to collect more accurate and complete demographic data from its more than one million adult primary care patients. The goal is to ultimately provide fairer access to quality healthcare programs and services.
Before the program was implemented, Mass General Brigham’s “REaL” data — patients’ race, ethnicity, and language — was only entered for about 80% of patients depending on the community surveyed. That meant there was no demographic data for about a fifth of our primary care patient population. The initial goal was to bring that rate down to less than 5% across the primary care population. As of December 2022, Mass General Brigham has surpassed its 5% goal in two of the three demographic areas: race (4%) and language (2%). Ethnicity is currently at 10%.
While collecting the data was a top priority for this project, it was even more important to develop methods to obtain accurate data. Often, healthcare organizations rely on clinicians to enter patient demographic data into patient charts, perceiving that they are relieving that burden from the patient. However, clinicians who enter this data can’t determine racial, ethnic, or gender identify by physical appearance alone. The best method, and what the REaL program hopes to accomplish, is having patients self-report.
Since June of 2021, the Mass General Brigham Quality & Patient Experience and United Against Racism teams have conducted broad, phased, patient outreach campaigns via mailed demographic surveys and digital messages through Patient Gateway, our patient portal. These messages encouraged patients to report or re-confirm their demographic information.
Patients were asked to share race, ethnicity, ethnic background, and language (REaL data). They were also asked about sexual orientation, gender identity, sex assigned at birth, and pronouns (called “SOGI” data). Sharing this data was encouraged, but not required.
These secure data can only be accessed by patients’ clinicians, clinical support staff, and quality improvement staff. All information is part of patients’ medical records, which is protected by law under HIPAA.
The data collected are essential for making decisions to improve care access, including identification of languages and availability of interpreters to help patients; development of new online healthcare tools; and additional assistance for patients to help access food, medicine, accommodations, and other needs.
The next wave of interventions includes staff training, scripting for on-going data collection to make social determinants of health resources available online, improving resources in expanded languages for non-English speaking patients, and creating unique medical interventions — like a food delivery pilot — for more tailored support.
New healthcare technologies, such as a portal connecting you through your phone to your entire care team, can often sound like ideas pulled from a science fiction film. Accessing and understanding these technologies can be a huge hurdle for patients from marginalized communities. But more often than not, all a patient needs is a helping hand to guide them through these new innovations.
To help combat inequities while rolling out new digital tools like our patient portal or telehealth visits, Mass General Brigham has launched new initiatives to support patients with limited access to technology and digital care.
The Digital Access Program brings digital resources directly to patients in high-risk communities. The program focuses on a three-tiered approach — providing patients access to physical devices like tablet computers, connecting patients with software technologies like web access and digital tools, and offering digital literacy training. Mass General Brigham has acquired over 2,000 cellular-enabled tablets to start a loaner program for patients in primary care practices.
Additionally, Mass General Brigham has embedded Digital Access Coordinators in clinical practices to support digital literacy training for patients on-site. Coordinators help patients sign up for Patient Gateway, distribute tablets, and train patients to be able to use virtual visit platforms. Many of the digital access coordinators have ties to the communities they serve, which offers them insight into the needs of their patients and a deeper connection to the goals of the project.
To date, the coordinators have provided outreach to over 16,000 patients for Patient Gateway enrollment. Patient Gateway is now available in the top languages most spoken by our patients — English, Spanish, Portuguese, Haitian Creole, Russian, Traditional Chinese and Arabic. With the help of our Digital Access Coordinator program, Patient Gateway is more accessible to our patients than ever before.
“This three-pronged approach is critical. If we were just offering tablets to patients, it wouldn’t be enough. If you hand a tablet to a patient, and they don’t know how to use it, and the programs aren’t in their language, that’s not breaking barriers. You have to offer the complete package,” says Lee Park, MD, Chief Patient Experience Officer at Mass General Brigham. “It’s been really meaningful for the teams. Mass General Brigham is really making equity a focus and meeting patients where they are. Our aim is to break down the systemic barriers that some patients face to getting the same care as others.”
This is just a tiny sample of all the incredible work happening across the system to combat digital healthcare inequities. For a deeper dive into this strategy, we recommend reading our interview with Dr. Lee Park, Chief Patient Experience Officer at Mass General Brigham.
In our next installment, we’ll be looking at how we’re working with our communities to mitigate social risk for needs like transportation and access to healthy food.
If you missed it, read our previous article, “Making Clinical Care More Equitable,” along with our interview with Dr. Allison Bryant, Senior Medical Director for Health Equity at Mass General Brigham.