Leveraging Data Visualization Tools to Promote Health Equity

While health equity has been a top priority among leaders in the industry for several years, the equitable distribution of resources became even more critical during COVID-19.

From testing to care access, organizations had to develop strategies to ensure they were reaching populations most at risk during the pandemic. With the availability of vaccines, entities had to refine and enhance their health equity efforts to adequately protect all patient groups against the virus.

For leaders at Hennepin Healthcare, a health system in Minneapolis, this meant employing knowledge gained earlier in the pandemic.

“We realized pretty quickly that it’s one thing to know your patient populations and have a certain amount of vaccine, but equitable distribution of the vaccine is a different ball game,” Deepti Pandita, MD, chief health innovation officer at Hennepin Healthcare, told HealthITAnalytics.

“Our experience with COVID testing taught us that outreach strategies need to be tailored to the individual – one outreach method is not going to work for all patients. For example, if we have outbreaks of COVID in certain populations, we need to get trusted community leaders to do the testing rather than wait for them to come to the healthcare system. So, we aimed to apply the same lessons to our distribution strategy.”

A big part of tailoring those outreach strategies involved gathering patient data.

“We knew that we needed to be deliberate and intentional in choosing where to target the vaccines. But we also knew that we had to comply with the requirement of getting enough vaccines allocated in time,” said Nneka Sederstrom, PhD, MPH, chief equity officer at Hennepin.

“We used our technology to strategically target the zip codes that we knew we needed to reach before expanding to other areas, like having our interpreters and clinicians reaching out to patients to try and get them in.”

The health system used the EHR to capture social determinants information and identify patients with transportation barriers, unstable housing, limited English proficiency, and other elements that could impact their ability to get the vaccine or their susceptibility to the virus.

Leaders then combined that information with data visualization tools based on zip code to identify neighborhoods that needed more attention.

“Without data, we wouldn't know where to start,” Pandita said.

“When we heard the vaccines were coming, we identified which of our patient populations needed vaccinations, created registries, and then developed outreach strategies that could be tailored to those patients. We considered which ones had online portal access, which ones had telephone numbers listed, which ones had emails listed, and their preferred language. Our operational people could then get to work on designing outreach strategies and setting up vaccination sites.”

Incorporating all of this information into a visualization tool is key for demonstrating why targeting strategies are necessary, Sederstrom explained.

“Without the data, it can be really hard to make the case for why equity needs to win out,” she said.

“People often push back on equity efforts because they’re worried or concerned that these strategies mean preferring one group over another. The reality is that if the goal is to decrease spread, decrease impact, and decrease mortality, then we've got to use the data to prove where those pockets are.”

Additionally, data visualization tools can help healthcare executives understand what’s working, and what needs to improve.

“We also have to see the data to know how we’re doing. We can see if we’re closing in on a gap, and how that will impact next steps. It’s not just a one-and-done process,” Pandita added.

With social determinants information, leaders can ensure they’re meeting patients where they are.

“We've used zip codes to do targeted community outreach – to connect with religious organizations, community groups, and others within those zip codes to try and set up community-based vaccine clinic opportunities. That way, we can target the populations we’re missing,” Sederstrom said.

Although it’s important to get vaccines to enough people as quickly as possible, Pandita stressed that equity efforts can’t get lost in the shuffle.

“Because we are in a pandemic, speed is important. But speed and equity often clash with each other. So, while one stream is the speed part of the vaccination process, the other stream is equity. And you need to keep an eye on both streams as you go forward,” she said.

Leaders also shouldn’t look at equity efforts as harmful to other patient populations.

“We're not sacrificing others when we focus on equity,” said Sederstrom.

“The people who have access and resources will be able to get vaccinated at a steady stream anyway. Being deliberate and intentional in finding the people who need the most help is part of what we need to do.”

For other organizations designing vaccine distribution strategies – or any health equity strategy – personalization and trust go a long way.

“One outreach strategy is never enough. You need to tailor the strategy and understand the population you’re serving,” Pandita said.

“The other part of that is building trust. Just because someone is seeking care in your healthcare system doesn’t mean they have enough trust in the system to come to you for the vaccine. That has been a learning experience. You have to engage trusted community partners to educate patients, and actually go into the community to understand the needs and barriers.”

It will also help to understand the reasons behind patients’ uncertainty in the first place.

“Hesitancy does not mean refusal. It just means that we need to figure out why there's hesitation and take steps to address it,” said Sederstrom.  

“People may interpret hesitation as outright distrust of the system, and they may think that's too big a barrier for them to try and address. But we need to learn more about why there’s hesitation, what we are missing in our communication, and what struggles these communities are facing.”

Even after COVID-19 is behind the healthcare system, the combination of social determinants data and visualization technologies could help inform health equity efforts.

“Our methodology could serve as a template not only for other safety net systems, but all healthcare systems,” said Pandita.

“These strategies should drive public policy and advocacy around vaccination for any future pandemics, because diseases don’t differentiate between who has resources and who doesn’t. These situations automatically disadvantage those who don't have the means and resources, and we have to be very cognizant and very methodical about keeping that front and center in our strategies.”

The lessons learned about health equity during the pandemic should influence care delivery going forward.

“We can’t be scared to have the hard conversations that need to be had, and look at the truths that the data shows us. The knowledge that there are inequities within our systems, within our communities, and within our patient outcomes is real. And we have to be honest and open about it, and be intentional in addressing it,” Sederstrom concluded.

“In the times when the pandemic is on hold, or in between pandemics, that's the time to do the work to rectify inequities. That way, when the next one comes around, we don't have to have the same conversations.”