The swift adoption and uptake of telemedicine during the pandemic has thrust the concept of a digital divide into the spotlight. In healthcare, we have seen this discussed as technology and internet access gaps between underserved populations and everyone else. But access is not the biggest gap. In 2018, 86% of the more than 70 million Americans on Medicaid owned a smartphone. During the coronavirus pandemic, young Americans of color were more likely to post on social media about their COVID-19 experiences than white Americans. Underserved communities have and use technology, but digital health solutions are not tailored to older people or those with lower digital literacy.
At a time when a telemedicine visit can be as simple as a telephone call or video chat, the conversation must expand beyond access to technology and internet. When considering the digital divide in healthcare, what if we stopped talking about what communities lack and focused on innovating for the skills, cultural context, and technology they have?
Examples from three socially distinct smartphone owners illuminate the need to expand healthcare digital divide considerations beyond device and internet access. A nurse practitioner bought her daughter a laptop but came home to find her writing a school essay on her smartphone. A PhD scientist calls his 12-year-old grandson for tech support to create a group video call. A Medicaid patient refuses a video visit because she thought forgetting her password meant her phone was broken.
Lack of access to technology has been called a social determinant of health, but these examples tell a different story. Those who are less likely to connect to healthcare through digital tools are not unconnected, uneducated, or slow to technology adoption. These examples provide missing context needed to expand our perspective beyond access as a barrier to care, support and innovation in healthcare for the underserved.
The acceleration and increased adoption of technology during the pandemic is a positive takeout, but the digital divide must be addressed by greater investment, professor Sam Shah, founder and director of Faculty of Future Health shared with HIMSS TV.
To bridge the digital divide in healthcare, digital health innovation should focus on Medicare and Medicaid beneficiaries. We should tailor digital health solutions to patient context and communication preferences. Smartphones, not computers. Secure links sent via text messaging, to keep things simple and encourage engagement. Patients should be trusted to choose how they wish to communicate with providers and health systems. Patients can learn how to share and control their data.
The solutions can be straightforward. Instead of static, one-way text messaging, we can use interactive two-way SMS systems to triage patient needs, provide timely information, and improve patient engagement. Instead of sending patients home with a mountain of paper, follow-up information can be transformed from PDFs to JPG images that fit on a phone for bite-sized, actionable health education. Instead of communicating about health plan benefits in English to non-English speaking patients, or providers incurring costs for professional translation of a consent form, technology can provide a seamless native-language experience. We can even adapt to low literacy contexts with images, emojis, and symbols that help communicate the message.
In addition, as illustrated by the PhD grandfather and the Medicaid patient with the forgotten password, digital health tools must be accompanied by skills development to improve digital literacy. Many older and lower-tech literacy patients have a fear of technology and need guidance to learn how to use their smartphones. Providing support for less tech-savvy but capable users can maximize engagement with digital tools and build trust with providers. The first step is to help understand the benefits of using their phone to access care and ways digital health tools might support them, like eliminating transportation barriers, providing on demand health advice or during a pandemic, enabling them to minimize risk of exposure to COVID-19 by keeping safe at home. Providing digital literacy support can be as simple as sending step-by-step instructions by SMS to a patient using video conferencing for the first time or recording a mobile-friendly video to explain how to access lab results in real time.
The pandemic has highlighted the nation’s persistent struggle with health disparities and forced a national conversation about health equity. To make progress on health equity, policymakers, health systems, innovators and funders must recognize the opportunity to reassess and strengthen connections with underserved communities. In a time of unprecedented smartphone ownership and supportive regulation, we need to incorporate social and personal context into the design and deployment of digital health tools. The alternative, continuing to prioritize and innovate exclusively for digitally savvy patients, will broaden the digital divide and exacerbate health inequity.
Everyone deserves an equal opportunity to benefit from health technology. The digital divide in healthcare highlights our failure to adapt tools and provide the support people need to maximize use of the technology they already have. At a time when access to technology and the internet is higher than ever, it is imperative we pivot to provide the technology support the underserved need. If we are ever to achieve health equity, this pivot is essential.
The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
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