This Special Issue responds to an urgent need for advances in knowledge at the intersection of health informatics and health disparities. We live in an era of widening inequality worldwide, especially in relation to income and wealth1—a fact that draws the negative impacts of inequality, such as differential health outcomes, into sharp relief. Moreover, in the United States, despite notable, coordinated governmental investments over several decades, troubling and substantial health disparities persist. The evidence is indisputable that differences in a range of health outcomes are linked to socially stratifying factors such as race and ethnicity, socioeconomic status (SES), disability, rural residence, and LGBTQ identities (“sexual and gender minorities”). Such disparities have been documented in infant mortality and preterm birth, childhood obesity, mental health challenges, injuries, chronic conditions such as cardiovascular disease and cancer, and life expectancy.2–7 Moreover, Galea et al8 showed that 874 000 deaths were attributable to social causes such as low education, racial segregation, low social support, poverty, and income inequality in the year 2000 in the United States.
In addition, recent changes in the United States have intensified the need for work at the intersection of health equity and health informatics. The Affordable Care Act of 2010 improved access to health care among previously uninsured Americans. Shifts in healthcare reimbursement to value-based care have forced healthcare organizations to respond to the impacts of the social determinants of health on patient health outcomes. The Health Information Technology for Economic Clinical Health Act’s stimulation of widespread adoption of electronic health records (EHRs) has led to increasing reliance on EHRs for care delivery. And although not all Americans use the Internet or smartphones, increases in adoption rates among all ages and socioeconomic groups offer new opportunities for communication, support, and intervention in the service of health.
On the other hand, with this computerization of society, we are also more likely to encounter unintended and negative consequences of computing. Recent ethical debates have focused on the responsibilities of computer science professionals and technology companies for the impacts of the technologies that they create, such as Hecht et al9 and Gotterbarn et al.10 In health informatics, parallel concerns have arisen about the potential for intervention-generated inequality resulting from informatics interventions,11 and the potential for bias involved in the application of machine learning and other data science methods to health care.12
This need for health equity-focused informatics research is clearly appreciated by our broader research community. Indeed, the Guest Editorial Committee was heartened to receive 68 submissions for the Special Issue, resulting in the acceptance of 23 articles—enough for the present double issue. Furthermore, we are pleased at the number of first-time Journal of the American Medical Informatics Association (JAMIA) authors in this issue, with 103 of 143 unique authors being first-time JAMIA authors. In the majority of articles, at least 1 author had published in JAMIA before; however, all authors of 7 articles had no previous JAMIA publications. Notably, this included authors who primarily publish in other fields such as computer science and public health. These patterns suggest that authors experienced with JAMIApublication might have established new teams to address the issue of health equity and that some new authors were drawn to JAMIA because of the health equity focus, thus enriching the perspectives offered on health informatics-based health equity solutions.
This JAMIA Special Issue joins broader conversations that are ongoing in related fields. For instance, the Computing Community Consortium and Society for Behavioral Medicine hosted a national workshop in April 2018 entitled “Sociotechnical Interventions for Health Disparity Reduction,” which resulted in the recent publication of a national research agenda.13 In the United States, the National Institute of Minority Health and Health Disparities (NIMHD) has also catalyzed work in this area through multiple initiatives. In June 2019, the health services research journal, Medical Care, published an NIMHD-funded supplement on “Addressing Health Disparities through the Utilization of Health Information Technology” as a follow up to an NIMHD-funded workshop. Also funded by NIMHD, a January 2019 supplement of the American Journal of Public Health on health disparities research included articles focused on technology.14,15 A recent funding opportunity at NIMHD also focused on “Technologies for Improving Minority Health and Eliminating Health Disparities.”16 Several 2019 workshops from other NIH Institutes concerning health disparities have also incorporated sessions on health information technology.17
With such work occurring in parallel fields, what are the unique contributions of health informatics? In our view, health informatics is unique in its simultaneous focus on—or “cross-training”18 in—health domain areas, information sciences and technology, and the social or behavioral sciences.19 As reflected in this Special Issue, this results in unique topical emphases such as technology implementation and uptake, support for clinical research, basic research on user requirements, health information needs and information seeking, data quality, interventions embedded in clinical information systems, and technology infrastructures such as standards
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