Investments in health information technology (HIT), particularly Electronic Medical Records (EMRs), have been significant since the passage of the Affordable Care Act in 2010. One provision of the law, known as “Meaningful Use”, requires that providers furnish online access for patients to view, download, and transmit information from their medical record. Many payers and providers have addressed this requirement through the development of enhanced functionality built into their websites, commonly referred to as “patient portals”. These systems may satisfy the Meaningful Use provision in the law, but there is some question whether this approach actually meets the needs for many of those it is intended to serve.
The Institute for Social Research at the University of Michigan recently published a study titled Health Literacy and the Digital Divide among Older Americans. It suggests that the proliferation of HIT may actually make it more difficult for vulnerable populations including minorities, the elderly, and those with lower socioeconomic status, to access their personal health information (PHI).
This disparity, known as the “Digital Divide”, describes a gap between those who have ready access and the skills needed to make use of information technology, and those who do not. Adding to the complexity of the issue is the reality that vulnerable populations may also have a lower degree of health literacy (a basic understanding of the terms and language used in healthcare), and would therefore be less likely to take advantage of the technology even if they did have access.
There is however, reason for optimism in bridging the Digital Divide, in the form of growing interest and adoption of mobile health (mHealth) technology, both by the healthcare sector AND by individual consumers. Several indicators support this conclusion:
- The number of people over the age of 65 who regularly access the internet passed 60% in 2014 and continues to climb. (Pew Research Internet Project)
- Smartphone and/or tablet adoption in the U.S., currently above 70%, is also on the rise. More than half of adults over the age of 55 now own a smartphone. (The Nielsen Company)
- Among smartphone owners – young adults, minorities, less educated, and those with lower incomes are most likely to use their mobile phone as their primary source of internet access. (Pew Research Internet Project)
- Mobile use for accessing the internet now exceeds personal computer use, and continues to increase. (SearchEngineWatch.com)
- 72% of internet users regularly search for health and healthcare related information online. (Pew Research Internet Project)
The common assumption in the early days of mHealth development held that mobile solutions could only play a limited role in driving Triple Aim goals of enhanced experience, improved outcomes, and reduced costs. The logic was that the most vulnerable populations (the aged, minorities, and low income) would be ineligible due to an unwillingness or inability to access the technology.
Ideomed’s experience piloting our chronic disease management solution, Abriiz, suggests just the opposite, and demonstrates the potential for mHealth to bridge the gap across the Digital Divide. Longitudinal measures of daily patient engagement in Abriiz implementations including Medicare (seniors) and Medicaid (predominantly low-income minorities), as well as commercially insured populations, show a high degree of understanding, interest, and motivation for using mHealth.
It’s important to recognize that mobile health and electronic medical records are fundamentally two different things, and that mHealth is not a panacea for all the challenges facing payers and providers in successfully complying with the ACA. But the purpose of a bridge is to provide passage over an obstacle, and according to that definition mHealth holds great promise.
In an upcoming follow-up, we’ll unpack some of the most common objections, frustrations, and obstacles, faced by “challenged” populations in engaging health information technology. We’ll also offer some suggested solutions for overcoming these issues, based on Ideomed’s trial experiences.