As quickly expanding digital healthcare technologies promise to improve access and outcomes, many people face the risk of being left out.
Underserved populations, including geographically remote, economically disadvantaged or digitally under-resourced people, are experiencing a digital health divide — an inequality in the ability to access, use and benefit from healthcare technologies.
For instance, patients in rural communities without reliable broadband often cannot access telehealth services. As a result, they miss work and travel hours to see their doctors, or they simply don’t go.
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“When these barriers exist, people delay care,” says Michael Archuleta, CIO at Mt. San Rafael Hospital in Trinidad, Colo. “Patients often don’t seek treatment until they’re sick enough to require an emergency visit.”
But healthcare technology can help close the digital health gap. IT leaders are working to deploy sophisticated technologies while ensuring deployment doesn’t inadvertently deepen existing disparities in access and outcomes.
“Our responsibility as healthcare leaders is making sure innovation reaches every patient,” Archuleta says. “Technology should be the great equalizer.”
The Digital Health Divide by the Numbers
Income, location and age, otherwise known as social determinants of health, all play a role in digital access — and, in effect, the digital health divide.
Americans with the lowest household incomes are much less likely than higher-income Americans to have broadband internet at home: 54% of households earning less than $30,000 a year, compared with 94% of those making over $100,000, according to the Pew Research Center. And rural Americans are notably less likely than suburbanites to subscribe to home broadband (71% versus 84%).
While lower-income Americans are more likely to rely on their smartphones for internet (34% of low earners, compared with just 4% of high-earners), adults 65 and older are the least likely age group to own a smartphone (78%), compared with almost all adults under 50 (97%).
“The digital divide is about much more than internet access,” Archuleta says. “It’s really about opportunity.”
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Telehealth and Broadband: The Infrastructure Layer of Health Equity
As much as any healthcare technology, telehealth illustrates the stakes involved in bridging the digital health divide. “Telehealth has completely changed what’s possible for almost any healthcare group and especially for rural America,” Archuleta says.
But telehealth is only as good as the infrastructure behind it.
According to Alan Morgan, CEO of the National Rural Health Association, improving the infrastructure for telehealth and other digital technology will require public-private partnerships that can leverage federal and state resources. States could receive federal funds, he notes, from the $50 billion Rural Health Transformation Program to help expand telehealth, among other innovations.
“Access is a systemic issue well beyond any individual clinic, hospital or health system,” Morgan says.
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Remote Patient Monitoring for Underserved Populations
When faced with barriers to care, patients with chronic conditions often become badly ill before seeking medical help. To prevent such scenarios, health systems are implementing remote patient monitoring devices, which track patients’ health inside their homes and can send alerts to electronic health record systems.
“We can identify changes early and intervene before patients end up in the emergency department,” Archuleta says. “RPM changes healthcare from reactive to proactive.”
Because RPM provides clinicians with continuous insights, patients don’t have to travel long distances for routine visits.
“RPM helps patients take control of their own health, so they can monitor their real-time health along with their clinicians to make healthy choices,” Morgan says.
AI Tools That Reduce Language and Disability Barriers
One of the ways that many hospitals close care gaps is by employing onsite translators fluent in the languages their patients speak. Translation service, Morgan says, is “one of the most significant administrative costs for rural hospitals.”
AI tools are reducing these barriers. These tools provide real-time language translation during clinical conversations, facilitating communication between providers and patients who speak different languages. AI also helps patients with disabilities through accessibility features such as speech recognition, voice assistance and text to speech.
One AI tool, ambient documentation, has been “a game-changer in the healthcare industry,” Archuleta says. “It allows providers to focus on the patient instead of the computer.”
Mobile Health Solutions for Rural and Low-Income Patients
Many patients don’t own computers but do have smartphones. That’s why it’s critical that health systems leverage mobile applications that enable patients to schedule appointments, review test results, receive prescription reminders, communicate with their providers and engage in virtual visits.
“The smartphone has become one of the most important healthcare tools we have,” Archuleta says.
Wearable devices, another mobile solution, have gained increasing interest in the medical community. In a global survey of physicians conducted by the American Medical Association, 97% report reviewing wearable data. But they also report structural barriers to adoption, with less than 6% integrating wearable data into workflows.
Measuring Technology’s Impact on Health Equity
To determine if a technology helps alleviate and not exacerbate the digital divide, health systems must measure its impact on patient outcomes.
Archuleta considers metrics such as hospital admission, readmission and no-show rates. He looks at tech utilization across populations to see, for instance, if rural patients are using telehealth, if older adults are accessing digital services and if underserved communities are benefiting at the same rate as everyone else.
His team also helps make technology more inclusive by involving patients, clinicians and community members early in the planning stage of any tech adoption. His team tests new technologies with different populations before broad deployment.
“The future of healthcare isn’t simply about implementing more technology,” Archuleta says. “It’s about implementing technology for every patient’s benefit, regardless of where they live, what they earn or how comfortable they are with digital tools.”
