Why Aren't Our Digital Solutions Working for Everyone?

Abstract

The article explores a digital injustice that is occurring across the country: that digital solutions intended to increase health care access and quality often neglect those that need them most. It further shows that when it comes to digital innovation, health care professionals and technology companies rarely have any incentives to focus on underserved populations. Nevertheless, we argue that the technologies that are leaving these communities behind are the same ones that can best support them. The key is in leveraging these technologies with: (a) design features that accommodate various levels of technological proficiency (eliteracy), (b) tech-enabled community health workers and navigators who can function as liaisons between patients and clinicians, and (c) analytics and customer relationship management tools that enable health care professionals and support networks to provide the right interventions to the right patients. Finally, we argue that community health care workers will need to be incentivized to play a larger role in building and adopting innovations targeting the underserved. Narrative: Heart Failure and the Failure of Remote Monitoring Jeremy lives in a small subsidized housing development with his mother and three sisters. At 52, he struggles with heart failure with reduced ejection fraction. This year alone, he has visited the emergency department four separate times. Luckily, a nearby hospital has recently been focusing on reducing readmission rates for heart failure in response to increasing incentives related to value-based care. The hospital is exploring promising technologies that might help Jeremy: inexpensive remote monitoring devices that are connected wirelessly to a broadband router through Bluetooth ® . The solutions require Jeremy to use a scale and arm blood pressure cuff to record daily metrics that are sent wirelessly to his cardiologist. The idea is that, if clinicians can monitor Jeremy on a real-time basis, they can evaluate his health to see if he is deteriorating or stable. They can then use this information to proactively schedule an appointment or to make a medication adjustment. The solution, like many designed to prevent costly emergency visits or readmissions postdischarge, is considered to be integral in bending the cost curve and improving health. The problem is that none of these solutions are working. Jeremy is only becoming sicker and more frustrated. He lives in a home where wireless

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“…It is not entirely surprising that Internet connectivity, the availability of quality and upto-date equipment, and digital literacy are now considered "super-determinants of health": they indeed engage all the other determinants that directly or indirectly influence the health of individuals and communities by now being primarily accessible online (e.g., affordable housing, employment, social assistance, social and family networks, and access to care and services) (86). The crisis has also shown that the technologies used in the delivery of care and services "often neglect those that need them most" as health professionals and technology providers are rarely given the incentive to better meet needs and expectations of underserved populations in terms of digital innovation (86)(87)(88).…”

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