The Digital Divide and Health Equity: Ensuring the Digital Transformation of Healthcare Doesn’t Leave the Vulnerable Behind

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Although increased utilization of technology in healthcare has the potential to improve access to care for many, we must be wary of how the digital divide could further exacerbate healthcare inequities.

Since the invention of personal computers and the adoption of electronic health records in the 1980s, the healthcare industry has been slowly adopting increasingly more technology. With the arrival of the COVID-19 pandemic, we are now witnessing a true digital transformation of the healthcare industry. 

The Potential of Technology

Perhaps the most visible increase in healthcare tech was the rapid rise in audio-visual telehealth visits utilized by patients and their providers to maintain care when in-person visits were unsafe and sometimes not possible. In early 2020, when COVID-19 started spreading throughout the U.S., telehealth visits increased by 50 percent. By the end of March, telehealth visits increased by 154 percent compared to the previous year (Koonin, et. al., 2020).  

Both supply and demand drove this rapid increase. Although telehealth options had been available in the past, medical providers were hesitant to incorporate new processes into their workflow, and patients were skeptical of the effectiveness.  As the pandemic evolved, both patients and their providers became increasingly concerned about the safety of in-person visits. 

In many areas across the U.S., non-essential travel was restricted, including routine medical services. Patients and providers alike recognized the need for a virtual alternative. As demand increased and virtual healthcare delivery regulations loosened, healthcare IT companies began offering more virtual telehealth platforms. Options ranged from stand-alone video conferencing smartphone apps to virtual visits fully integrated into existing electronic health record software. 

In addition to live, synchronous videos and phone calls between patients and their medical providers, asynchronous virtual services are also available. This refers to communication that occurs when a patient sends a message to or completes a form for a medical provider to review later. Several U.S. companies offer prescription medication services to patients utilizing asynchronous telehealth. 

Chronic care management is another virtual healthcare service that is growing rapidly. People living with chronic diseases can benefit from their medical care team remotely monitoring and managing their health status. Chronic care management uses specifically designed software programs to help medical teams interact regularly with their most fragile patients and catch early warning signs of decline. 

Physiologic monitoring using smart devices and wearables is becoming popular as well. Many patient and caregiver teams are utilizing smart scales, blood glucose monitors, blood pressure machines, and activity wearables to report and monitor real-time physiologic data. 

The Gap to Bridge

At first glance, one may assume that the many ways medical providers are connecting with their patients virtually must increase access to care for the population. It is true that many people who may not have transportation, can’t take off work, or live too far away from medical care can access their providers more easily. The benefits are valid, but when examined more closely, we can see that comparatively, our most vulnerable population does not reap the benefits of virtual healthcare equally.

According to surveys reported by Pew Research, those living in rural America are less likely to have internet service in their homes and less likely to own a smartphone, tablet, or computer (Vogels, 2021a) and over 40 percent of lower-income households do not have internet services or own a computer at all (Vogels, 2021b). 

In addition to concerns with internet and device access, technology literacy can also be a major divider. This term refers not only to the simple use of a device but also to how to take advantage of all the capabilities of the technology. Eberly, et. al. studied almost 3,000 records from the Hospital of the University of Pennsylvania and found several significant barriers to utilization of their telehealth services. One interesting find revealed that requiring an app download to complete a video telehealth visit was a barrier. To overcome this issue of technology literacy, the health system simply made it possible for the user to open the video visit directly from a text message invitation.

Another significant limiting factor to the utilization of healthcare technology in the U.S. is the language barrier.  Eberly, et. al. showed that their non-English speaking patients were more than 50 percent less likely to use telehealth services. “Our results suggest that in the current COVID-19 era, inequities may be compounded even among patients without COVID in outpatient routine care via inequitable access to telemedical care for female, non-English-speaking, older, and poorer patients. The non-English language was independently associated with more than 50 percent lower telemedicine use (Eberly et al., 2020).” 

People living with lower incomes and in rural areas already experience health disparities. Without access to high-speed internet, smartphones, and computers, those who need more access to care the most are already at a disadvantage. 

It’s worth mentioning the technology used “behind the scenes” in healthcare and how it can worsen health equity. Data collection, analysis, studies, and interventions must include a fair representation of all populations in trials and interventions. Simply put, data and research must include all populations, not just English-speaking people who know how to use a smartphone and have high-speed internet access. If the data doesn’t represent everyone, public health professionals and medical care providers will be making recommendations based on unfair and biased data.  

Public health professionals, medical providers, private technology companies, and government programs must work together to solve the digital divide to ensure the digital transformation of healthcare doesn’t leave our most vulnerable citizens behind. 

Adrienne Garbarino, MSN, FNP-BC, APRN

Sources:

Eberly, L. A., Khatana, S. A. M., Nathan, A. S., Snider, C., Julien, H. M., Deleener, M. E., & Adusumalli, S. (2020, June 8). Telemedicine outpatient cardiovascular care during the covid-19 pandemic. Circulation. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.048185?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%2B%2B0pubmed&.

Koonin LM, Hoots B, Tsang CA, et al. Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:1595–1599. DOI: https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm.

Vogels, E. A. (2021a). Digital divide persists even as Americans with lower incomes make gains in tech adoption. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/06/22/digital-divide-persists-even-as-americans-with-lower-incomes-make-gains-in-tech-adoption/

Vogels, E. A. (2021b). Some digital DIVIDES persist between rural, urban and suburban America. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/08/19/some-digital-divides-persist-between-rural-urban-and-suburban-america/

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