Houston Methodist

Pam Potter

An expanding body of evidence establishes that actively involved patients have better health outcomes and lower costs, characterizing the optimal health care experience. This has led health organizations to employ various digital strategies keeping their patients informed, involved, oractively monitoring their care. Access to bidirectional health portals to communicate medication status, diagnostic reports, billing information, appointment reminders is becoming the norm. These strategies include efficiencies for the organization, online forms feeding directly into the electronic health records, monitoring devices providing feedback data on the patient’s condition or telehealth visits to monitor evaluate and treat. As we relyon these digital tools to provide an optimal health care experience, we need to recognize the digital divideand the types of exclusions faced by our unique patient populations.

The FTC states 25 million households lack internet access because of network access or consumer access to broadband. A 2021 report from Older Adults Technology Services states 42 percent of patients over 65 lack home broadband access. AMA reported research from the University of California, San Francisco Geriatrics division identifying barriers impacting 13 million order adults. Barriers included difficulty hearing even with hearing aids, difficulty speaking or making oneself understood, dementia, difficulty seeing even with glasses, no internet enabled devices or unaware of how to use one, or not using email, text, or the internet in the month prior to the study. This unreadiness impacted theseolder patients; Black or Hispanic, less educated, lower incomes, rural, unmarried, male, or had worse self-reported health. For patients 85 years and older, 75 percent were in a state of unreadiness. In orthopedics, the patient population includes additional disabilities such as loss of limb or limb use, arthritis, or other chronic pain.

These populations are digitally excluded, risking exacerbating any problems they already faced when trying to access health and social care services. To address this divide technology design must take on the responsibility for these populations. Providers, when sourcing technology or operationalizing its use, must be aware and sensitive of the unique challenges faced by their patient population. Further research to understand the technical characteristics is needed to assure equity of access to appropriate health and social care services. Not making this a priority adds the digital divide as another service deficit impacting the overall health desert currently experienced by over 75 percent of the US population.

“Perfusionists are commonly quiet enablers in the OR. But with advanced data, they can be critical contributors to successful patient outcomes”        

The Affordable Care Act’s Section 1557 defines “Meaningful Access” in the Anti-Discrimination requirements for providers receiving federal financial assistance to enhance communications in an accessible, electronic manner. To meet this goal, creating user friendly technology with Universal Design such as touch screens for arthritic hands, or personalized technology for those with a high degree of disability, for instance voice systems for those visually challenged is imperative. Communicatively simple, intuitive, flexible, technology with minimal physical effort and a low margin of error is key. Only then will we reach all patients regardless of their size, age, ability,or disability.

For providers it is important we start to operationalize processes for those reluctant to engage, due to low technology self-efficacy, by offering focused demonstration, education, and training to facilitate use. Resource awareness is helpful for patients having trouble paying for broadband access, through federal or other community organizations. This emphasis maximizes the potential effect technology will have on their health care outcomes. As we strive to create a world that is inclusive and socially conscious for our patients, digital accessibility and equality are necessary.