Digital health equity is a new crisis that connects urban and rural health and impacts unique and diverse populations. Based on the World Health Organization, “health equity is defined as the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically, or geographically.” As health systems begin to expand and refine their digital health systems, digital health equity should be a fundamental aspect of this digital development.
The pandemic has demonstrated the value of online platforms, especially in health care. Telehealth visits skyrocketed nationally during 2020. According to the Health Transformation Alliance, “telemedicine visits increased by a factor of 28.” Locally, we saw a 40x increase in telehealth usage. Despite the impressive decline in COVID-19 cases, twenty percent of health care visits are online. Interviews with our providers indicate that clinicians, patients, and families suggest that telehealth will remain a central health care delivery service line after the pandemic.
Digital health platforms are much more than telehealth. Digital health moves health care from the point of care to the “point of need” everywhere that health happens. Digital health platforms are part of an interoperable public health infrastructure that spans homes, public institutions, and health care organizations across communities. Digital health tools allow providers, patients, and community institutions to maintain close contact and share data in new, more timely ways, enabling cheaper and more effective treatment paradigms. This feature is vital in the current climate, whereby specialty services are regionalized, and many underserved communities do not have nearby access to necessary health care services. Telehealth has the potential to overcome these barriers that contribute to health care access inequities.
“One in five Americans lack smartphone access, and one in four Americans lack computer access or broadband, which prevents them from accessing care through telehealth,” according to the Pew Research Center in 2019. Digital disparities in smartphone and broadband access and digital literacy frequently occur in low-income, rural, and tribal communities who are also greatly affected by health disparities. These compounded risks due to digital and health disparities threaten to worsen health for our most vulnerable populations.
Health systems continue to make significant investments in their digital health platforms. Still, digital public health platforms are needed to improve access to and continuity of care for vulnerable populations in the United States. These digital public health platforms should include a digital front door for electronic access to digital telehealth and brick-and-mortar patient care services. It should also have interoperability for enhanced care coordination and partnership with federally qualified health centers (FQHCs) and technology and services to address digital disparities among vulnerable patients and community members. Community organizations should be incentivized and encouraged to join the platform to improve care coordination and patient access. The resulting tools, resources, and lessons learned should then be disseminated to regional and state health care partners, including public health and health care organizations.
The scope of services enabled by this interface should include online scheduling, on-demand telehealth visits, subspecialty referral, eConsult services, mobile health coaching, wearable device monitoring for chronic conditions, and on-demand tele-interpreting services. Digital health navigators recruited from the community will help provide culturally appropriate, high-quality care by effectively preparing patients to use the digital platform. These digital health navigators are crucial to assuring digital literacy and efficient access to care, particularly in our multilingual population.
The pandemic has demonstrated the value of online platforms, especially in health care – but equitable access has not matched this growth. Sadly, many Americans cannot reap the benefits of connectivity. State and federal funding sources are required to enable digital health equity. Moreover, there should be a focus on measuring/creating standards of care in digital health equity. Public financing and public infrastructure (broadband) will be essential to coordinate organizations and defragmenting care. Now is our moment to create a new and better health care system that emerges from the dark days of COVID-19.
Joshua W. Elder is an emergency physician. Tamara Scott is a program manager.