Healthcare Technology's Digital Dilemma

 In the space of 1 year, the healthcare sector has undergone a veritable transformation in how care is delivered. The impetus for such a swift change was, of course, COVID-19. In the thrall of the pandemic, clinicians quickly embraced digital tools and technologies in order to avoid the health risks of face-to-face encounters. This will have broad implications across multiple sectors and populations.

The impact of the pandemic on the healthcare technology sector has been, and will continue to be, substantial. Recently, a colleague at Credit Suisse Securities forwarded me a copy of its publication projecting digital growth and innovations for 2021.

The surveys of investors and industry stakeholders on their expectations around various developments in digital health revealed that digital health adoption was "one of the silver linings in 2020," the report found. With the healthcare system under extreme stress during the pandemic, there has been a pressing need for technology and processes to boost capacity. This has led to what researchers described as a huge spike in adoption and use of digital health platforms, with once-underutilized digital tools and technologies now used to their full potential as staples in providing care.

In the coming year, the analysts predict a realignment in digital health as interrelated trends drive digital health growth and innovation. Their list of potential positive trends is lengthy and well within the realm of probability – e.g., continued adoption of virtual care; acceleration in employer activism; increased focus on addressing the mental health crisis (one that has been compounded by the pandemic); a continued shift to home-based care; continued progress on addressing waste, fraud, and abuse in the healthcare system; a reinvention of primary care; a shift to value-based care; and a recognition of the importance of cybersecurity.

While the preceding report shows industry stakeholders to be very bullish on virtual care, telemedicine, and healthcare information technology in general, a broader context takes into account the effects of these changes on various patient populations. The "great digital divide" is a serious ongoing issue for many in this country, and particularly for the elderly population. Herein lies the dilemma.

For instance, data from the National Poll on Healthy Aging conducted at the University of Michigan Institute for Healthcare Policy suggest that, although most major health systems are using patient portals (e.g., MyChart) to schedule COVID-19 vaccinations, many older adults are unable to set up these accounts without assistance. The poll found that 45% of adults ages 65 to 80 (and 42% of all adults ages 50 to 80) reported they had not set up an account with their provider's portal system. Although the percentages represent a small improvement over time, it is clear that more encouragement and assistance is needed. For example, a trusted adult might be appointed as a proxy to access accounts of those without computers, or of those who need help navigating technology.

Of particular concern, wide gaps in patient portal use were observed among various subsets of older adults who have the highest risk for severe cases of COVID-19 if unvaccinated. Almost 50% of Black older adults and 53% of Hispanic older adults lacked patient portal accounts as of June 2020, compared with 39% of White older adults.

The most significant gap in patient portal use was related to income. Approximately 54% of older adults with income less than $60,000/year did not have a patient portal account, whereas only 35% percent of older adults with income over $60,000 lacked an account. A similar gap was noted with regard to the level of education: 53% of those with less than a high school education lacked a patient portal, compared with 31% of those with college degrees.

In polls prior to the pandemic, older adults reported unawareness, lack of comfort using technology, and dislike of communicating about their health online as reasons for not setting up a patient portal account. Although the recent poll shows an increase in the percentage of older adults reporting participation in telehealth visits (4% in 2019 versus 26% in August 2020), the digital divide persists.

From my perspective, it seems an ideal time to pause and take stock. Is the plethora of "MyChart" accounts making things even more complicated than having no patient portals at all? Does the continued proliferation of patient portal platforms without interconnectivity make sense? To date, there is no coherent policy on electronic medical records. Shouldn't we be working on one?

Perhaps connectivity should be considered a "vital sign" -- something we routinely ask about, and check on, at every patient visit. Without connectivity, or even intermittent connectivity, we won't be able to maintain health in the digital world of the future.

https://www.medpagetoday.com/columns/focusonpolicy/91392