May 30, 2022
Hamilton Health Sciences
King West
P.O. Box 2000
Hamilton, ON
L8N 3Z5
Dear Rob MacIsaac,
Re: A call to action - Epic health information rollout must include health equity
Important conversations regarding health equity in Hamilton have surfaced, re-emphasizing the need for action across systems and services. We know health inequities exist and continue to do harm. Specifically, there have been numerous calls for change at the levels of governance, policy, as well as service delivery in healthcare settings.
Recently, Hamilton Health Sciences announced a launch of its electronic health information system, Epic. Community leaders have asked important questions about the new system as to whether and how data regarding historically marginalized groups are being included in the new system. The questions as to whether and how the social determinants of health and well-being are being taken into account in the new electronic medical record (EMR) have been left inadequately answered considering this is a multi-million dollar initiative.
The responses have indicated that training on collecting “equity” data, its use, how to collect data respectfully, why it is important to collect, as well as consultation with impacted communities has not been included and therefore, although the capacity exists within Epic, these priorities have been pointedly left out of the Epic launch.
The omission of attention to equitable health systems and processes will continue to leave issues of health equity to be considered as an afterthought, unnecessary, or too complex to integrate. These practices perpetuate systemic inequities.
Recent research authored by Hamilton healthcare physician’s titled Race-Based data collection among COVID-19 inpatients: A retrospective chart review, found limited hospital data may prevent research into racial disproportionality among inpatients. The article states, “Adequate data collection is necessary to study racial health disparities in the hospital setting”
The Journal of the American Medical Informatics Association article titled -Transgender data collection in the electronic health record: Current concepts and issues, highlighted forms of discrimination have been codified in EMRs, as well as in diagnostic and billing codes and criteria including the Systematized Nomenclature of Medicine Clinical Terms
There are numerous resources that exist to provide guidance to health leaders to address these issues. The Canadian Institute for Health Information has publicly distributed specific guidance on Race Based and Indigenous Identity Data Collection and Health Reporting. The Data Standards for the Identification and Monitoring of Systemic Racism have existed since 2017 to support compliance with the Anti-Racism Act. Several other resources have already been developed and disseminated to support health equity work with respect to data collection. The Black Health Equity Working group developed the EGAP framework, and Toronto Health Equity has also developed specific resources for health equity and measurement.
It is not too late to change course. We call upon Hamilton Health Sciences to take action now to commit to resourcing and implementing the necessary changes to their Epic health information rollout to respectfully attend to matters of health equity to which it has deemed a priority. We have learned with the COVID pandemic that our health systems are in fact agile, flexible and responsive to continuous improvement if we felt it was important to do so.
The Hamilton Anti-Racism Resource Centre (HARRC), local health equity leaders and impacted community groups are ready and willing to assist in implementing these urgent and necessary next steps.
Lyndon George
Executive Director
HARRC
