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Digital health has led to some positive changes, but it is important to understand that all communities do not have equal access. Today, we explore how to advance digital health with equitable strategies.
The United States has many challenges that require improvement, like other health systems throughout the world. Historically, these challenges disproportionately impact distressed communities. Many of us are working to solve these challenges by leveraging digital health and health data solutions. But if we do not innovate from a health equity perspective, then we run the risk of designing solutions that are misaligned with the needs and desires of communities. If you want the right resources to advance healthcare innovations that work for all communities, stay updated with the most cutting-edge information with 21st Century Health. Tune in every other week as host Michael Crawford talks to global health experts, leaders, and innovators to find out what we need to collaborate and co-create healthcare solutions that enhance health and wellbeing for all communities.
Michael Crawford is the Associate Dean for Strategy, Outreach, and Innovation and Founder and Executive Director of Howard University's 1867 Health Innovations Project.
21st Century Health is a production of Howard University’s 1867 Health Innovations Project and Voxtopica.
Speaker 1 (00:05):
This is 21st Century Health, your trusted source of cutting edge information. Prior to the COVID-19 pandemic, we were just scratching the surface of digital health. There were a lot of barriers. After all, people were skeptical about things like digital health, especially telehealth. They wondered how they could receive high quality care over a video call. But then the pandemic happened. It left us with no choice but to dive into digital health. For the most part, it led to some really positive changes. Stacy Stewart of the March of Dimes mentioned how much digital health is impacting maternal health.
Stacy Stewart (00:45):
54% of all counties are either considered full-on maternity care deserts, meaning they have no access to a hospital to offers obstetric services, no OB-GYN, no certified nurse midwife, no birthing center. 54% of all counties are full on maternity care deserts or have very limited care. And think about how important telehealth and other kinds of ways to digitally connect to your healthcare provider can be to some of those individuals living in those communities even before and after the pandemic, right? I mean, these are things that are now just ways in which we think about the overall ways in which we provide for health access in this country is both with in person and physical facilities and providers, but also those that we reach through virtual means and through digital connection.
Speaker 1 (01:37):
But why digital health? Our healthcare system needs transformation. Digital health is to drive that transformation. And like Stacy just mentioned, there are already amazing ways digital health is helping people access high quality care. But there are also some concerns, because digital health may not be as easy to access as one might think. I'm speaking with the vice President of Digital Health at the Consumer Technology Association, Renee [inaudible 00:02:11]. Renee, before we delve into where digital health is going, what are some of the limitations? Can you tell us when we say digital health, what does that mean?
Renee (02:21):
It's just the electronic and computing systems and devices that are used for healthcare purposes. And so it includes all kinds of stuff, right? It includes your mobile apps that people are using for all kinds of health and wellness purposes. It includes telemedicine. It includes remote patient monitoring. It includes AI design, clinical decision support that are being used to help clinicians diagnose and treat. So it can go on and on and on and on.
Speaker 1 (02:49):
When did digital health start becoming a factor in healthcare?
Renee (02:54):
I wish I could answer that question. I think it's been, I would say since the oughts where we started getting a lot more of this. But I will tell you, I think the pandemic accelerated a lot of this because I think we didn't have a choice but to really look at digital health in a way we hadn't before. We were forced to the health insurance providers were forced to, health providers were forced to, consumers were forced to because we couldn't go into a facility, we couldn't go to a doctor's office. And people then realized that they needed to better manage their health. So I would say over the last 20 years, there's been a lot of movement here, but I think we've seen tremendous progress in the last two and a half facilitated by the pandemic.
Speaker 1 (03:41):
What healthcare areas are you seeing digital health have the most impact?
Renee (03:48):
Probably primary care, particularly when you look at telemedicine. I'm taking my own family as an example. I would say about half of our visits now are done virtually. And that wasn't the case two and a half years ago. You actually had to go in. A lot of physician practices were not set up to do virtual consults. Now they are. In fact, some practices prefer virtual consults unless you're having an emergency or you need some testing done and some other things as well. So I think primary care that I think is where you're seeing it. That's where the consumer's going to feel it most. But there are other areas which I think are undergoing profound change. For example, medical and surgical training using virtual reality tools. That's increasing tremendously. The use of digital twins to manage research or hospital operations. Those are the kinds of things that are occurring that consumers wouldn't feel. But I think in terms of primary care, I think that's where consumers are seen at on a daily basis.
Speaker 1 (04:50):
What are some of the limitations of digital health in the current healthcare environment?
Renee (04:54):
Look, there are several, but let's start with access, particularly when it comes to broadband. In order to use some of these solutions effectively, you have to have high speed internet. And as we all know, not everybody has access to high speed internet. And even if people have access to high speed internet, a lot of times it's not affordable for a lot of people. So we've got to start there. Digital literacy is the other component I always talk about, which is how comfortable are people using digital tools to manage their health? It's a very underrated aspect of this issue, but I think digital literacy is an important and overlooked component. People have to be comfortable using these solutions.
(05:36):
Related to that is the issue of trust, right? We're doing everything online. You're doing everything electronically. Where's my data going? Who's managing my data? Who's holding my data? Can my data be sold? What if there's a breach? What if there's a cyber incident? What happens to my data? Is my employer going to have access to my data? All those kinds of questions are certainly important questions that we need to ask, particularly for certain communities that have a distrust of the system to begin with.
Speaker 1 (06:06):
What are your feelings about the relationship of digital literacy and health literacy? Is there a strong correlation there? What does that look like in terms of being able to assist with the transformation that we would like to realize in healthcare?
Renee (06:24):
I think they're related different. Dr. Lisa Fitzpatrick, who you all know does phenomenal man and woman on the street videos, which are available on YouTube, where she goes on the streets of Washington, DC and asks some basic questions about healthcare, anatomy, physiology, health, to get a sense of what people are thinking. And every time I watch those videos, I'm struck by how little people know about their own health, about how the health system works, about their role in the health system. So I think health literacy is the foundation for it all. Now, you could be health literate and digitally illiterate, right? But I think it's important to be first health literate and then we can teach people to be digitally literate. But I think they're related. But I think health literacy is actually more important. I think people need to understand health, their health, how to manage their health first, before we get to the next step about accessing digital tools to manage their health.
Speaker 1 (07:26):
How important are digital health and data standards?
Renee (07:30):
So my colleague likes to say standardization for innovation. In other words, standards are important in an emerging area because they built trust, right, particularly when it comes to data. So we've released standards on AI, bias management, data governance. So it's very important. There are not enough standards by the government, by private industry. And I think those would go a long way to build trust in innovative solutions that people may have trouble... And when I say people, providers, consumers, health insurance providers, may have trouble fully trusting in terms of efficacy, in terms of privacy. So standards are key. And we believe in the development of high quality standards that are created by a multi-sector work group that includes various aspects of the healthcare ecosystem.
Speaker 1 (08:29):
What is the most exciting digital health area from your perspective?
Renee (08:35):
I think the use of AI, artificial intelligence and machine learning. Now, there have been some hiccups, right? There was an article just this week about how the promise of AI has not been really realized in healthcare. And there are all kinds of reasons for it. But I think AI and ML solutions have the ability to take healthcare up a notch to different levels and also impact things such as precision medicine, neurotechnology, and other sort of interesting new facets that I think could potentially bend the cost curve and could increase access for a lot of folks to these kinds of solutions. But again, I think I used the term before, frontier days. We're just in the beginning of this, right? We're still arguing about the efficacy of telemedicine, right? Medicare has only been paying for telemedicine in a broad way because of the flexibilities tied to the public health emergency. So I always think about this. If we are still talking about telemedicine, we can't even get to the other stuff that we've been talking about here today. And until we do, we're going to be stuck in this sort of gray area where there's a lot of hype, there's a lot of talk, there's not a lot of action.
Speaker 1 (09:55):
From your perspective as an expert in the field, where do you see the intersections between health data, digital health and health equity, and how is the digital health community making those connections?
Renee (10:10):
I'm not sure they fully are. I think the last two years have been a great education for a lot of people, particularly in the digital health community. I think a lot of issues that were ignored or more accurately were never even considered or not part of the conversation. So I think it's going to take time for people to fully understand intentionality and design in terms of diversity and inclusion. How are your solutions being tested? Are they being tested on heterogeneous populations? Are they being tested for the people who are going to use it? What does your design team look like? All those kinds of questions have come up all the time from the digital health community today are sort of new. And so I think it's going to take time for the community to really get its hands around a lot of these issues.
Speaker 1 (10:56):
Renee brought up interesting insights about the limitations of digital health and having standards for innovation. These standards are especially important because there is another concern I hear about regarding digital health. Our healthcare system has a lot of challenges. Adding new innovations to an already challenged system could lead to more inefficiencies and poor outcomes. I discussed this with the CEO and president of America's Essential Hospitals, Bruce Siegel. Bruce, you have some interesting thoughts on healthcare innovation. What are the concerns behind health innovations in the digital health space?
Bruce Siegel (11:38):
Innovation is always a double edge sword. Innovation, if it's purposeful and intentional, can move the ball on equity. Innovation that's not purposeful and intentional won't get us there. It actually can make these gaps worse. And we see that again and again with innovation when new things that may be very helpful are taken up by certain populations of higher income and higher education and others are left behind. We need to be purposeful about equity as we walk down this digital health pathway. And I think people are starting to do that, but we've got some work to do. We've got a lot of work to do.
(12:14):
Digital health is creating the tools and the environment that support people achieving the very best health they can achieve. So digital health and equity are inextricable and I would say digital health... Some people would say digital health, it augments what we do in person. That's true. Hey, it may replace what we do in person and that may not be a bad thing.
(12:49):
Looking at our hospitals and our whole healthcare system in the throes of a workforce crisis driven many ways by the pandemic, but other changes in our economy, in our systems. We've got to look at different ways of delivering healthcare that will allow us to do it in the most effective and efficient way. And that may not be in a physician's office or a clinic or my hospital. I'll give you my own example. So I go to, even though I'm a doctor, I don't like doctors, but my wife makes me go to them. And when I go to the doctor, it takes time. In the recent year or so, I have been able to start to use telehealth, part often through an app linked to my patient portal. And it's been great. And so many of the visits that used to take up half my day, I can now do from my office or from my home and achieve and really get the same information. Is that true for everybody? No, but for me, I think it's been transformational and I think it can be for millions of others.
Speaker 1 (13:57):
And what do you see as the most exciting digital health solution in the future?
Bruce Siegel (14:06):
I think the most exciting solutions are going to be the tools that allow me to manage my own health and care, that provide me feedback in a convenient fashion, that allow me to not have to take half a day off from work, which I can't afford, or unfortunately my employer won't let me do at some points... And that's true for too many Americans, that allow me to overcome many of those barriers. From my perception, and this is just again, from the hospital perception, I think that the rise of patient portals is a great thing. They were very clunky at the outset. I remember a few years ago when I first started using them, I was like, "Why am I bothering me with this?" Today, I open up my app on my phone, which is a very common app, and links right into my patient portal and the health system that I use. It is all laid out. I move appointments. I have my appointments fee app, I get my test results back. I get reminders. It's kind of hard for me to remember what it was like without it. And I think that's very empowering and very positive. And I think making sure that everyone has the ability to have that environment is going to be absolutely critical to digital health equity. And I think that's going to be one of the big challenges for the healthcare system going forward.
Speaker 1 (15:36):
Who would you say is doing the most to drive these types of innovations? Healthcare providers, insurers, academia, entrepreneurs? Are there any specific examples that stand out?
Bruce Siegel (15:51):
So I would say that entrepreneurs are doing a lot here, and that's great. I think academics are helping us to understand what we're doing right and what we be need to be wary of. I think frankly, individuals like yourself who have taken this up in positions of influence because they care deeply about these issues, are absolutely critical to this conversation. So I won't point to particular brands necessarily, but I think it's, I don't think there's any one area. I think government is important just to create a level field with things like broadband. And I think government's also going to be important in at least making sure that the things we do promote equity and not inequity. One of the things we don't want to see happen is digital redlining where we decide, "Well, we're going to market to this group and not that group through our app or whatever, our portal." And that's something we have to be very, very cognizant of. Government can also help with things like, "How do we keep bias as much as we can out of artificial intelligence" is a emerging literature on that as well.
Speaker 1 (17:08):
From your perspective as an expert in the field, where do you see the intersections between health data, digital health equity, and how are the American essential hospitals making that connection?
Bruce Siegel (17:25):
So we see all of these modalities, these tools we're talking about, have the ability to collect really helpful information. Well, we got to put guard rails around that, no doubt. And I think one of the things I worry about in digital literacy is, do people know what their data's being used for? And I've been on, I hate to say it, a few too many platforms where, "Do I check that box or not and who gets to see it?" And that that's just too confusing still. But with that said, it's powerful to collect this data and if we can collect it with the right guardrails and understand what it means for how we care for diabetics for different populations and how their A1C may be moving over time. If we can start to use this data to essentially figure out what works or doesn't, that's amazing. If we can do that instead of having a 10 year trial and do that with real time data, it's not going to be simple, I don't doubt that, but that is a very exciting prospect.
(18:36):
If we can recruit people from those populations who are not reflected in our clinical trials through these digital platforms, that's very exciting also. That'll allow us to not just jumpstart new therapy, but to make sure that whatever we're doing in terms of positive change in therapies in healthcare are coming from the experience of everyone in this diverse nation, not just a subpopulation. And when we've seen the downsides of some of that, like of pulse oximeters lately and the like. So I think these things very much all speak to one another and can really jumpstart healthcare in general and jumpstart equity, in particular.
Speaker 1 (19:24):
We can advance health equity with digital health, but digital health cannot advance without equity. This means that innovators working to transform healthcare must include equity in their product development process, data analytics, clinical workflows, and business processes.
(19:45):
In the coming episodes, we will explore exactly how this can be achieved. Until then, subscribe now on Apple Podcast, Spotify, or wherever you listen to great podcasts.