Sunday, May 31, 2009

How Health IT Would Have Changed My Childhood

Growing up in a nuclear, immigrant family, it seemed so natural to live among boxes - a symbolic state of perpetual transition, cultural flux and limbo. Whether at the kitchen table or in the bedroom, my brother and I always fought with what should have lived in a storage unit. No amount of outright complaint, rationale or protest would convince my father to purge his stash of historical accoutrement. Needless to say, my father’s pack rat tendencies always got the best of him (and us). However, the amorphous mass of old pay stubs, Thai newspaper articles, and grade school memorabilia would almost always produce the right piece of documentation when summoned.

A month or two before the start of every academic school year, I carried home a notice to my parents to provide the school with my immunization records, an enrollment pre-requisite. In hindsight, as I ask myself why, maybe it was because I transferred schools every so often as my parents searched for a “better” program. I guess it was possible for schools to misplace records from previous years. Additionally, it would probably be much too rational for school districts consider the successful completion of the previous grade as a proxy for having completed all immunizations. These fair assessments aside, without fail, the amoeba of “stuff” which housed the secret past of my immunity fell short every time. So, like clockwork, my father and I went back to our primary care provider – a different physician and insurance plan every time – to perform a panel of titers to assess whether or not I received an MMR or Hepatitis vaccination.

What appeared to be a minor childhood nuisance is indicative of a sick health care system, one that is built upon a system of documentation and paperwork that set patients up for failure, adding to the increasing burden placed upon immigrant families. Performing unnecessary screenings and procedures and over prescribing creates medical waste. The 2001 Institute of Medicine (IOM) Report, “Crossing the Quality Chasm,” outlined ten rules for a system re-design, one of which called for the elimination of waste – both in resources and in patient time.

My public health vision of medical practice is centered on the individual – where a system of intricate feedback loops create multiple interactive, transformative touch points, linking individuals to community based organizations and resources, local health departments, health care providers, various clouds of population health data, peers and other support systems. The implementation of Health IT in the American Recovery and Reinvestment Act (ARRA) of 2009 has the potential to usher Asian America into a new era – one that renounces paper records, promotes home health care and self-management skills, and encourages wellness empowerment.

However, we’re not there yet. We are far from 100% adoption and implementation of Health IT. But, I look forward to an age when the individual will own the entirety of their patient data and the creation, delivery, and communication of such systems are developed for and informed by immigrant Americans with limited health literacy and have limited English proficiency.

Maybe then, immigrant children won’t have to weigh the pursuit of an education against the sting of a needle at every turn of a corner.

Maybe then, immigrant parents will begin to share in decision making with physicians, trust the health care system, and have a tool to better manage their health and the health of their families.

Maybe then, we will start to live a culture of wellness and healthful living.

(And maybe then, my father will actually finally throw out some boxes!)

For tips on locating old immunization records, check out these hints from the San Diego County Immunization Initiative.


Sean Arayasirikul, MSPH, CHES, is a Queer Asian Americanist of Thai background and the Health Policy and Health Literacy Fellow of the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. He is also a Scholar in the CDC/AMIA 10x10 program in Public Health Informatics.


  1. This was not only personal but extremely informative. Thanks for sharing. I never thought about what a huge impact electronic records could make.

    What happens when computers crash though?

  2. That's an interesting situation. IT contracts will almost always have a vendor who will provide service support and data protection. It's usually backed up on a server. Some controversial issues are privacy and security - but we manage multiple domains of our digital identity online on a daily basis. Once we get over the hump with sharing our health information, de-stigmatizing it, I think we will see that the benefits far outweigh the minimal risks.

    Additionally, electronic health records are JUST the beginning. Personal Health Records (PHRs) are being developed where consumer-facing applications will make health information available, interactive and accessible to ALL people. Soon, I can imagine wigets and other apps taking shape in the market much like iphone apps have. It's an exciting time to witness this type of innovation; however, keeping the best interests of low-income, monolingual, immigrant API communitites will be increasingly difficult. Health IT has the opportunity to bridge and widen gaps in health and disparities.