Does the eHealth Revolution Help or Hurt Underserved Patients?
Payers, hospital systems, physicians, employers, labs, caregivers and government agencies have all invested significant time and money into the new eHealth infrastructure.
The collective hope is that this commitment of resources at the macro level will assure that every patient and consumer adopts and utilizes eHealth on some personal level.
The expectation is that every, or at least most, patients and consumers will quickly understand the benefits of using an eHealth tool, tracker, application, or device. Then, confidently they will “plug in” to the new personal health information ecosystem, while they hunt, gather and share.
Well, that may not be the case at all.
“IF YOU BUILD IT, THEY MAY NOT COME”
What I am learning is that many eHealth tools, trackers, applications, devices and resources are complex, not culturally specific, and many times intimidating to underserved and minority consumers.
In fact, I believe that underserved patients and consumers are actually at an increased risk of suffering greater disparities in health and health care simply because they are not being meaningfully engaged in the current technological shift.
On one hand, physicians, hospital systems and other providers have been federally incentivized and subsidized to adopt eHealth solutions. Yet consumers, particularly those from underserved communities, are often left unaware of the potentially transformative impact that eHealth adoption can have on their lives.
Furthermore, it does not appear that many of the respected and trusted minority, consumer-facing organizations recognize the scope of the technology changes taking place. And no group has become a leading voice to advocate for eHealth literacy. It is critical that every American understand the benefits of adopting and utilizing HIT to improve their health outcomes.
THE LITERACY ADVANTAGE
An eHealth-literate patient becomes a major, cost-saving asset to our healthcare system. Conversely, an eHealth-illiterate patient is a liability and possibly a significant added cost.
Currently, eHealth solutions seem to be geared and marketed to, and used by more affluent community members. This eHealth literacy advantage, or “head start,” may indicate that underserved communities might never catch up and be on a level playing field within the healthcare system. This trend, sadly, could result in an unintentional increase in health disparities because of technology.
With an ehealth literacy head start, a more affluent patient might now be proficient at using a current version of a web-based, disease management program to manage her diabetes and communicate results back to her physician. As technology advances, she is more likely to quickly understand and become proficient at any new versions of the ehealth program.
Meanwhile, a patient in an underserved community may have never had access to any of the earlier web-based versions. Understandably, the patient could be quite intimidated and frustrated enough to abandon using the technology altogether. Unfortunately, the diabetes disparity could continue to grow.
INVITE UNDERSERVED PATIENTS TO THE TABLE
All individuals should be engaged and empowered to use eHealth in sincere and meaningful ways.
Underserved patients must be included, and solutions designed and developed that provide them practical use within the context of their daily lives.
To best engage underserved patients, it’s important to have the input of the targeted community at the innovation stage of most eHealth solutions.
By not actively engaging this important community, we risk further eroding an already fragile trust paradigm between healthcare systems or providers and underserved communities. More importantly, we risk missing the opportunity to have underserved individuals directly participate in the innovation and development of new eHealth products, services, applications and devices.
I strongly advocate designing and building eHealth interventions for our targeted individuals with input from our targeted individuals, then promoting usage to our targeted individuals.
Ideally, this is done in concert with trusted organizations and institutions within in our targeted community.
It is important that every American understand the benefits of adopting and utilizing HIT to improve their health outcomes. It is absolutely imperative that the current disparities in health and healthcare not be exacerbated by a lack of thoughtful exposure, active engagement and/or culturally appropriate education around these benefits.