The uninsured are an invisible face in America. Their health care needs are great and are met by a patchwork of venues scattered throughout their communities. Access to health information technology may appear to be unnecessary, given the overwhelming needs of individual patients. In fact, health information technology (HIT) represents one possible way to increase quality care to this patient population. HIT is in a unique role to help the uninsured improve their health care outcomes. HIT is used as an enabler to assist in improving access to care as well as the elimination of health inequities. HIT can be designed to increase quality and contribute to cost containment in defined populations, such as the uninsured. HIT systems have been traditionally developed to capture billing and administrative costs and workload data. The current HIT systems, while secondarily designed to improve outcomes, are primarily driven by these revenue generation concerns. Since the uninsured may lack access to routine care, these HIT systems were not originally designed to address the issues that may confront this population - issues that may not be easily captured by standard code sets and that do not contribute to billing. Since the traditional EHR (electronic health record) is usually driven by practice management outcomes, including increased revenue and charge capture with a focus on the delivery of care that can be captured by standard code sets such as Evaluation/Management, ICD 9, V, and CPT codes, there may not be any connection between the available EHR systems and the needs of the uninsured. Since the uninsured primarily reflect a patient population with decreased access to care due to fiscal reasons, systems that are designed to increase charges may not be supportive of the interventions needed in these populations.
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