The Digital Divide & Technology In Healthcare

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According to a study from The University of Texas at Austin, nearly half of Americans are skeptical of the benefits of Health information technologies — such as wearables, patient portals and mobile apps.

Let that sink in for just a moment. Nearly Half. We discuss #Innovation, #DigitalHealth, #DesignThinking, #PatientExperience, #PatientCenteredCare, #HIT and other key aspects of what we know comprise a great, modern healthcare system – but if so many people are skeptical of the benefits of #HIT, we must address that now and as we move forward. If not, we’ll see progress that is not taken up/absorbed by the very people who are the reason behind all of this great work.

The UT study makes clear the connection between low health literacy and this skepticism of health technologies. The study found:

Americans who are less health literate — those who struggle to find and understand medical information — tend to be skeptical of health technologies. They also expressed a strong distrust for government, media and technology companies in general.

The lack of health literacy is exacerbated in minority, rural, and low-income populations that are already falling into the digital divide. We can’t just address health literacy without addressing the digital divide. There is not a one-step fix. Let me repeat that, there is not a one-step fix; we must not fall into the trap of, “build it and they will come.” That is not happening for many people, and more than one wall is standing in their way. What can we do to help?

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A stunning conclusion from a recent Microsoft study – “Digital Divide Is Wider Than We Think, Study Says” lays out a sobering challenge:

Over all, Microsoft concluded that 162.8 million people do not use the internet at broadband speeds, while the F.C.C. says broadband is not available to 24.7 million Americans. The discrepancy is particularly stark in rural areas.

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Jena Louise working on her company website at Sparky’s Coffeehouse in Republic, Wash. With internet access spotty in the area, she relies on the Wi-Fi there to do work. Credit: Rajah Bose for The New York Times

Cathy Newkirk of The Michigan State University Extension lays it out:

Those who are more likely to experience low health literacy are older adults, racial and ethnic minorities, people with less than a high school diploma or GED, people with low income levels, non-native speakers of English and people with compromised health status, such as those with chronic health conditions. Culture and access to resources also affect people’s health literacy.

It can be argued that the digital divide reduces health literacy and the converse – low health literacy worsens the digital divide.  Let’s take a look.

  • Someone without reasonable access to stable and affordable internet access and/or reliable devices to use that access? The chance that this person is going to spend time online reading about health, new options, and how to become a more empowered part of the healthcare system? De minimis.
  • Someone with low health literacy visits the patient-centered clinic. All the bells and whistles, quality EMR, useful portal, advice for tracking tools and apps, things to send home to try, you name it. This person’s low health literacy worsens their digital divide since they are not able to absorb, process, and effectively use what they have access to from their visit! They are simply overwhelmed and back away (while politely nodding and smiling).

David Tseng, MD mentions his concern that poor health literacy in and of itself is deepening the digital divide:

Patients with poor health literacy make less use of EHRs [& Portals], fitness apps

This week on #hcldr, let’s talk about technology access in healthcare, the digital divide, and health literacy

Join the #hcldr community of professionals, patients, clinicians, administrators, lurkers, counselors, social workers, designers, and advocates! Please join us on Tuesday, July 30, 2019 at 8:30pm Eastern (for your local time click here) as we discuss the following topics:

  • T1: What are the effects of the digital divide/low health literacy in healthcare? Examples?
  • T2: Is reliable access to the internet and associated resources a human right? Should this be a priority?
  • T3: How can we extend health literacy and needed access to patients now and keep them engaged? Examples?
  • T4: Where should health literacy begin? At home, school, clinic? Why or why not?

 

Resources

“Digital gap between rural and nonrural America persists.” Andrew Perrin, Pew Research Center. May 2019.

https://www.pewresearch.org/fact-tank/2019/05/31/digital-gap-between-rural-and-nonrural-america-persists/

Accessed July 30, 2019

“Digital Divide Is Wider Than We Think, Study Says.” Steve Lohr, The New York Times, Dec 4, 2018.

https://www.nytimes.com/2018/12/04/technology/digital-divide-us-fcc-microsoft.html

Accessed July 30, 2019

“The rural broadband divide: An urgent national problem that we can solve.” Brad Smith, Microsoft, Dec 3, 2018.

https://blogs.microsoft.com/on-the-issues/2018/12/03/the-rural-broadband-divide-an-urgent-national-problem-that-we-can-solve/

Accessed July 29, 2019

“Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide.” Mackert M, Mabry-Flynn A, Champlin S, Donovan EE, Pounders K. J Med Internet Res 2016; April 10, 2016. DOI: 10.2196/jmir.6349

https://www.jmir.org/2016/10/e264

Accessed July 29, 2019

“Bridging the Digital Divide in Health Care: The Role of Health Information Technology in Addressing Racial and Ethnic Disparities.” Lopez, Lenny and GREEN, ALEXANDER R. and TAN-McGRORY, ASWITA and KING, RODERICK K. and Bentancourt, Joseph R. Joint Commission Journal on Quality and Patient Safety, 37 (10). pp. 437-445. October 2011.

https://www.ncbi.nlm.nih.gov/pubmed/22013816

Accessed July 30, 2019

“Poor Health Literacy Worsens Healthcare’s ‘Digital Divide’” David Tseng, MD., Medpage Today, December 12, 2016.

http://www.medpagetoday.com/blogs/iltifathusain/62019

Accessed July 29, 2019

“Latinos face digital divide in health care.” Mariaelena Gonzalez, The Conversation, August 4, 2016.

http://theconversation.com/latinos-face-digital-divide-in-health-care-62473

Accessed July 29, 2019

“Bridging the Healthcare Digital Divide: Improving Connectivity Among Medicaid Providers.” Andy Slavitt, Karen DeSalvo, The CMS Blog, March 2, 2016.

https://www.healthit.gov/buzz-blog/interoperability/bridging-the-healthcare-digital-divide-improving-connectivity-among-medicaid-providers

Accessed July 30, 2019

“New Digital Divide: Low Health Literacy Connected to Distrust of Health Technologies.” UT News, November 29, 2016.

https://news.utexas.edu/2016/11/29/new-health-literacy-digital-divide

Accessed July 29, 2019

“What health literacy is and why we should care.” Cathy Newkirk, Michigan State University Extension, December 5, 2016.

http://msue.anr.msu.edu/news/what_health_literacy_is_and_why_we_should_care

Accessed July 29, 2019

Image Credit

“Hands across the Divide” is a bronze statue that stands just off the Craigavon Bridge on the entrance to the West Bank of Derry City. Creative Commons Licence [Some Rights Reserved] © Copyright zoocreative and licensed for reuse under this Creative Commons Licence. https://www.geograph.ie/photo/478600

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