摘要：Ensuring health care services for populations outside the mainstream health care system is challenging for all providers. But developing the health care infrastructure to better serve such unconnected individuals is critical to their health care status, to third-party payers, to overall cost savings in public health, and to reducing health disparities. Our increasingly sophisticated electronic technologies offer promising ways to more effectively engage this difficult to reach group and increase its access to health care resources. This process requires developing not only newer technologies but also collaboration between community leaders and health care providers to bring unconnected individuals into formal health care systems. We present three strategies to reach vulnerable groups, outline benefits and challenges, and provide examples of successful programs. DURING THE PAST DECADE , the United States has experienced a rapid growth of electronic health information technology in hospital and health care provider systems to enhance access and quality for service recipients. State health departments have developed health information exchanges across large health care networks, insurance providers, and independent physician practices, and the use of electronic health records has greatly accelerated. 1 These initiatives evince progress toward achieving a fully connected national health care system by 2014. 2 Nevertheless, cities and counties struggle to understand the health care needs of individuals who do not or cannot easily access formal health care networks but use expensive services for emergency and routine care. Health information technology is currently designed to benefit primarily populations already connected to such systems. As systems increase their use of health data to influence treatment and policy, developing strategies to include individuals who are largely outside health care networks is critical. The US health care system has been criticized for low-quality care that produces multiple medical errors 3 , 4 and high-cost services that limit access to care, 5 perpetuating health disparities. Primary care focused on preventing illness and death is associated with more equitable distribution of health and better outcomes than is specialty care 6 – 8 ; countries directing resources to primary care and enhancing population health have lower costs and superior outcomes. 9 Although the United States has the world's most expensive health care system, other countries regularly surpass the United States on most health indicators, including quality, access, efficiency, equity, and healthy lives. 10 Capturing data on individuals unconnected to health care systems can improve health care access and outcomes while reducing costs—important public health goals. The federal government allows states and local communities to develop their own health care infrastructures. By making changes at the local level, communities can become more effective in using existing services to capture health care data for hard to reach populations. We have examined several strategies for using existing electronic technologies to better connect such individuals to some aspect of their local health care system.
