A Call to Action: Digital Health, Reform, & the Underserved


Blog post by Lygeia Ricciardi (Introduction by Joe Babaian)

We are pleased to share this important follow-up to the recent thoughtsojzy0ej_400x400-provoking blog written by @Lygeia – a 2017 HIMSS Social Media Ambassador. Lygeia’s well-received #HCLDR tweetchat from January 31st, 2017 has been resonating for the past two weeks. The follow-up topic is A Call to Action: Digital Health, Reform, & the Underserved.  Deep thanks to Lygeia for pulling the essence of that chat together for this timely follow-up blog and discussion as we head into #HIMSS17. Without further ado, Lygeia’s follow-up blog and spot-on analysis:

Recently the Health Information Management Systems Society (HIMSS) and the Healthcare Leadership Blog (HCLDR) teamed up to co-host a tweet chat on the topics of digital health, healthcare reform, and underserved populations. As the featured guest, I framed the discussion with a blog post. The chat, which trended on Twitter, was widely attended, yielding more than 15 million impressions. You can review some key direct takeaways in the latter part of this post.

A Call to Action for Healthcare Leaders

Before the chat, I was nervous. Media and especially social media are on fire with anger and criticism on a wide variety of topics in these first weeks of the Trump Administration, but the repeal and replacement of the Affordable Care Act (ACA) is among the most contentious. Issues of race, class, and privilege are unusually touchy, too. I was concerned the chat could descend into a gripe fest, or even a virtual brawl. I considered picking a “safer” topic, preferably involving pictures of cute animals, but I wanted to follow up on my previous exploration of digital health and the underserved—and how could I without addressing politics and health reform head on?

Thanks in part to the deft skills and positive tone set by the moderators, Colin Hung and Joe Babaian, the tweet chat ran smoothly, and the participants shared constructive ideas in a civil (yet passionate) way. Whew. But the experience got me thinking about social media and leadership in a time of uncertainty. Avoiding confrontation has its appeal. After all, offending the wrong person could cost you—socially and/or financially. And online it’s so easy to seek and read only what you agree with. But if too many of us remain silent or, by contrast, sink to the level of personal attacks, it will likely cost us our democracy: a price we cannot afford to pay. The #HCLDR community was able to navigate a tweet chat on some contentious topics in a constructive way, though to be fair, members didn’t express a wide variety of political views. The chat also provided a glimpse of how we might leverage social media to express and comprehend more diverse perspectives.

So here’s your challenge, healthcare leaders (not just participants in the #HCLDR chats): to be a leader, have your own opinion, and don’t hide it. But also check your temper and the fear beneath it. Be brave enough to engage with a variety of people to understand where they are coming from. Maybe they are your colleagues, or your healthcare providers, or your patients, or even your relatives. All you Twitter pros—do you follow people you don’t agree with? Do you ever listen to or read media that fall clearly outside your comfort zone? Listen first. You can also help to connect the dots that only you may see for others. Successful changes in digital health—and democracy itself—will require both effective strategies and competent, compassionate communication. Use your influence and social media to stand up for your principles and for people—including members of underserved populations—who may not be able to stand up for themselves.

Some Direct Takeaways from the Tweet Chat

Repeal and Replacement of the ACA 

On the topic of the Affordable Care Act (ACA), there was a great deal of uncertainty and some significant concern. It’s still not clear when or how the law will be impacted, but by some estimates it could take until 2018 before we see significant change.

Multiple tweet chat participants were opposed to the potential elimination of healthcare insurance protections for people with pre-existing health conditions, many of whom fall into the underserved category. Representing a patient perspective, one feared he might lose his job—without therapy or meds for PTSD (Post Traumatic Stress Disorder is classified as a pre-existing condition), he said, “I don’t do well.”

Several others, representing a healthcare provider perspective, worried about their patients losing coverage. Dr Ruth Ann Crystal (@catchthebaby) highlighted the negative impact ACA repeal would likely have on new moms, ER costs, and OBGYN care, while Dr. Esther Choo (@Choo_ek) stated that “so many of my patients without coverage gained it over the past few years,” and they could be “left out in the cold.” Others cited potential job losses across the country and pointed out that preventive care, which is significantly expanded under the ACA, saves lives and money.  Patricia Anderson (@Pfanderson) reminded everyone that “underserved” populations in healthcare include members of groups beyond those with lower incomes and socio-economic status, including people with disabilities, non-native English speakers, and members of the LGBQT community.

Finally, Dr. Rasu Shreetha shared a website chronicling stories of lives saved by the ACA and the following graphic from the Center for Healthcare Strategies which gives a snapshot of the health of underserved populations. He added to it the widely-retweeted observation that “we can, and we must do better.”


Both Health and Technology Policy are in Flux

Congress and the Trump Administration, including newly-confirmed Secretary of Health and Human Services Tom Price, are now in the hot seat to change or replace the ACA in a way that serves Americans well. The task could be complicated by the fact that people who voted for Trump—many of whom rallied behind his promise of “dismantling” Obamacare—are statistically in poorer health than those who voted for Clinton. At the same time, as Nick Adkins (@nickisnpdx) brought up in the tweet chat, more than a third of Americans (disproportionately those with lower incomes) don’t understand that “Obamacare” is actually the same thing as the ACA.

In the world of digital health, it’s important to also pay attention to technology policies that are not tied exclusively to health. Since the chat, under its newly appointed Chairman, Ajit Pai, the Federal Communications Commission (FCC), recently limited participation in the Lifeline program, a longstanding subsidy which provides affordable Internet and phone access to low-income Americans. Facing a flurry of criticism, Pai explained the decision as a largely procedural one that was meant to avoid abuse of, not undercut, the program, stating that “hyperbolic headlines always attract more attention than mundane truths.” Indeed, they do. (As an alumna of the FCC who worked on a closely-related program I admit to hyperventilating about the headlines before I dug deeper.  Which brings us back to the call to action: use your voice for positive, constructive change, and try to listen and dig before you react to news or allegations.

Opportunities to Leverage Digital Health & Narrow the “Digital Divide” 

Tweet chat participants shared advice and specific strategies for supporting underserved communities through digital health, including the following:

  • Use mobile to reach underserved populations since they are relatively likely to access the Internet via phones rather than desktop computers. See this article.
  • Leverage eHealth (including telemedicine) to bridge the gaps between in-person healthcare visits.
  • Stop adapting technology to healthcare; identify problems first, then find solutions (which may or may not include technology).
  • Use technology to streamline administrative processes in support of underserved populations. (Example: Chicago is using technology to fast track food stamp applications.)
  • Get better at assimilating lessons from elsewhere in the globe, particularly since most people on earth are relatively “underserved” compared to Americans.
  • Serve and support people where they are geographically (Example: this community–based court for homeless people in Denver.)
  • Apply the “microservices” model used by other industries to healthcare.
  • Emphasize empathy, sympathy, and human relationships in healthcare; technology is secondary.

Success Stories and Resources

Chat participants shared some resources and successful examples of digital health use by and with underserved populations, though the group acknowledged that we have a long way to go. Following are some of them:

While I hope some of the ideas, success stories, and resources shared in the tweet chat will be useful for you, I especially look forward to learning from and with a wide variety of healthcare leaders through social media and in at in-person events like the HIMSS Annual Conference next week. See you in Orlando!

Please join this #hcldr Twitter chat on digital health, health reform, and the underserved on Tuesday, February 14 at 8:30 p.m. ET (for your local time click here) when we will be discussing the following:

  • T1 What is the current landscape telling you about the changes that are coming to the ACA? Other policies?
  • T2 Is there value seen when you authentically engage the community on reform, the underserved, healthcare change? Examples?
  • T3 What opportunities do you see to truly leverage digital health & narrow the “Digital Divide”?
  • T4 With both health and technology policy in flux, what implications, opportunities, & pitfalls do you see right now?


Photo used with permission of Maja Daniels http://majadaniels.com/

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