Part III: Making the Case for Culturally Competent Data Management

This post is the final in a series ZeroDivide has designed to explore some of the opportunities to integrate cultural competency into each stage of the Affordable Care Act enrollment and implementation process. Be sure to read Part I on Linguistic Competency and Part II on Culturally Competent eHealth Tools. 

by Kelly Henderson, ZeroDivide eHealth Analyst

With the growing momentum around outreach efforts for ACA enrollment targeting diverse populations, it is important to stay committed to planning for the ongoing cultural and linguistic needs of patients once they are enrolled and can begin accessing care. Accordingly, understanding and establishing best practices for the care of diverse patient populations has become a top priority for healthcare providers and operators around the country.

As Part 2 of the Cultural Competency blog series detailed, the National CLAS Enhanced standard was launched in April of this year with the specific aims of advancing health equity, improving quality, and eliminating disparities in care and outcomes. Significant effort has been devoted to defining and building the framework for incorporating cultural and linguistic competency principles into healthcare settings, but there remains a need to build out this framework into meaningful action and measurable outcomes.

From the structural level to daily clinical practice, there is mounting evidence that suggests that communication and cultural barriers play a critical role in determining quality of care. In a recent webinar explaining the Enhanced CLAS Standards, Dr. Nadine Gracia, Director of the Office of Minority Health, further illustrated this point by explaining that medical errors are more likely for the Limited English Proficiency population. For example, there are significantly greater rates of readmission and longer lengths of stay in care settings as a result of organizations not having the infrastructure in place to meaningfully address the CLAS standards. Beyond language barriers, research indicates that there is growing concern of how to handle cultural traditions and orientations that may influence how a patient reports pain, responds to authority figures, adheres to medications, and follows particular gender roles (Gadon, Balch, & Jacobs, 2007).

Overcoming language barriers and cultural barriers is particularly pronounced in the case of specific patient-physician communication through data collection and management.

This is illustrated through qualitative research with physicians, which suggest that obtaining a detailed and accurate medical history is a major issue influencing quality of care (Gadon, Balch, & Jacobs, 2007). In particular, physicians expressed concerns about recording accurate information, explaining a treatment plan, and obtaining informed consent from their patients. From the patients’ perspective, issues arise regarding being able to effectively explain and describe symptoms and  lack of understanding about diagnosis and treatment plan. This may be particularly heightened in the case of collecting health data related to a patient’s management of a chronic disease like diabetes or hypertension—both of which may require strict medical and behavioral regimens.

As a result of communication issues in the data collection and management process, inaccurate data may directly lead to adverse health outcomes and medical errors. For this very reason it is critical to better understand and establish best practices for providing culturally competent care.

Establishing a system for ensuring cultural competent data collection and management will require building a framework for sharing and communicating data throughout the health system that allows for simple and efficient translation, and other features to support diverse patient needs.

As data management moves towards increasingly digital format, it will be important to understand how electronic health records (EHR) and other data tools may influence the way data is collected, communicated and accessed for diverse patient populations. Patients understanding, interest and use of eHealth tools have the potential to dramatically affect the communication between patient and physician, which may exacerbate already limited communication, and ultimately reduce the quality of care delivered.

Considering these potential adoption and use issues, it will be important to develop strategies to detect if medical errors have occurred in the data collection process, and if so, how they can be remedied in the EHR and other data storing systems.

In particular, it will be important to document specific information on the EHR, such as ethnicity, language and interpreter service needs to ensure that this information is available to all service providers to enable continuity of care. Creating reporting systems within the data management process that allow tracking of cultural and linguistic factors will be another critical step in establishing culturally competent and responsive practices.

Still, however, many questions remain about how data collection and management methods influence patients’ experiences and their resulting health outcomes. Currently, limited research exists exploring this particular aspect of adopting measures to ensure cultural competency, and additional inquiry is urgently needed.

To this end, it’s necessary to build an evidence base for how translation and interpreter services, in-language eHealth tools and data management systems informed by culturally and linguistically equitable principles can improve quality of care for diverse patient populations. Without better understanding this critical aspect of health care, we run the risk of reducing the quality of care for the millions of newly insured people with diverse cultural and linguistic needs, many of whom will be accessing institutional health care for the first time.

Given the multiple cultural and linguistic communication challenges that exist throughout the patient’s journey accessing care—from enrollment to outcomes—it is critical that CLAS Standards are adopted throughout the entire health system. This means that every stage—from governance to workforce development to critical patient-physician interactions—data collection and management processes are culturally and linguistically appropriate to ensure that every patient receives safe, effective and quality care.

As ZeroDivide seeks to make cultural and linguistic competency central to our work in the eHealth space, it will be critical for patients, caregivers, physicians, nurses, hospital administrators, community-based organizations and clinics alike to make a strong commitment to upholding CLAS Standards in a meaningful and measurable ways. We must continue our advocacy efforts beyond enrollment, and push for equitable and respectful care beginning the moment patients enter the health system and share their medical history.