Overcoming Digital Access, Technology Integration Hurdles to Connected Care

CLOSING THE DIGITAL DIVIDE

The digital divide refers to "the economic, educational, and social inequalities between those who have computers and online access and those who do not." In the healthcare context, the digital divide manifests as a lack of access to care among those who do not have the necessary devices or internet connectivity.

According to Jenny Azzara, senior director of performance improvement and organizational development at Community Care Cooperative (C3), the digital divide in healthcare is also exacerbated by dwindling provider resources.

"Part of the digital divide is the health delivery system just not having enough resources to make sure everything that we do is in multiple languages and [that] we're always able to access interpreter services on whatever platform we use," she said at a virtual panel discussion. "We haven't had enough resources and time to build [out] the systems to make sure that all of our patients can access care in an equitable way."

C3, a nonprofit accountable care organization governed by 18 federally qualified health centers across Massachusetts, has implemented several strategies to break down digital access barriers to connected care, including leveraging actionable data.

Data is critical for developing interventions specific to different patient populations, Azzara said. C3's FQHCs track utilization by race, ethnicity, and language and develop interventions accordingly. These interventions include using a telehealth navigator — an employee who receives additional training in helping patients access virtual care services.  

Like C3's FQHCs, New York City-based Maimonides Health leverages data to create tailored interventions for vulnerable populations facing technology gaps.

"We use our care management and our care transition staff to really make sure that they're tracking the important data and important metrics on our patients that are in those high-need situations, particularly demographic data like language and age," said Brian Pisano, the health system's senior manager for IT implementation and support, during a panel.

A text message-based program is one of Maimonides Health's interventions to bridge the digital divide.

"Using SMS was a real revolution for us because that is the lowest [barrier] tech in the very technological society we live in now," Pisano said.

Most people have a cell phone and know how to text, making it easy for people to access virtual care via SMS, he added.

Another key driver of the digital divide is the lack of broadband access in some regions of the country.

Though this is an issue that transcends healthcare, providers are trying to find ways to circumvent the lack of internet connectivity and expand access to virtual care.

"Our iPads have connectivity packages in them," said Novella Thompson, administrator of population health at UVA Health, during a panel discussion. "Each patient is assigned a patient advocate that educates and continually supports [them]. I have a 24/7 team that manages and troubleshoots the iPad [and] any of the equipment that the patients are sent home with, whether it's Bluetooth or non-Bluetooth."

Bluetooth-enabled devices, in particular, can help curb challenges patients may face with technology use "because you can put them on with very basic instructions, push a button, and it's an automatic feed to our electronic medical record," she added.

SELECTING THE RIGHT TECHNOLOGY

Technology selection is a critical first step in any connected care effort. Faced with a crowded health technology market, providers are spoiled for choice, making the selection process challenging.

For Adria Grillo-Peck, vice president of integrated care management at Indiana University Health, vetting vendors is a crucial aspect of the process.

"It's just looking at who your vendors are, what they have to offer, what their reputation is, talking to other facilities or systems that have used the same vendor just to get their perspective on how did the training go, how did implementation go, how did it end up operationalizing?" she said at the virtual event. "So yeah, I would say [do] a lot of homework to find out what best meets your needs for your system and then also for the patients."

This is how Grillo-Peck's team went about selecting technology when they revamped the health system's post-discharge outreach efforts. The automated platform they implemented calls the patient or a family member — 24 hours after discharge if they were seen in the emergency department and 48 hours after discharge if they were hospitalized — and walks them through a series of questions.

"And then based on how the patient or family member answers that question, then they get a call back from a nurse," said Grillo-Peck. "And since we started this program, our reach rate has increased to 96 percent."

INTEGRATING MULTIPLE TECHNOLOGIES AND EXPANDING ACCESS

As healthcare devices and digital tools proliferate, providers must consider how best to integrate them into the care environment to improve patient outcomes and ensure a return on investment.

Some facilities, like Nicklaus Children's Hospital, rely on user feedback and testing to ensure that new technologies are being integrated with the least disruption to clinical workflows.

When implementing new technologies to support telehealth services, for instance, the hospital created a telehealth task force that included subject matter experts and virtual care champions, who provided feedback on the plans for deployment, said Evelyn Terrell, director of telehealth and special projects at Nicklaus Children's Hospital, during a virtual panel.

The task force was also involved in the testing phase of the implementation, where the technology was tweaked and modified in accordance with clinical workflows.

"There's going to be some hiccups," said Terrell. "It's not always going to be perfect in the beginning, but we want to make sure that at the end of the day, we're addressing the consumer need."

Similarly, UPMC Health Plan has created a dedicated digital health team that works with clinical partners to ensure seamless technology implementation and boost provider adoption, said Natasha Khouri, the payer organization's associate vice president of digital health strategy and solutions, during the conference.

"This is something that I've seen debated — do you need a dedicated digital team, or do the resources sit with an IT team or the business [team]? And we have really found that digital health is a unique beast," she said. "It's like a really unique set of expertise and intelligence and experience."

Further, health equity must remain top-of-mind for providers and payers as they deploy and integrate solutions across their networks.

To boost health equity, UPMC Health Plan not only tests technology solutions with multiple populations in mind, but it is also developing a team of technology guides, said Khouri. The guides will offer onboarding services and technical support at the care site, in the community, and in patient homes.

The health technology revolution is well underway. To further move the needle on digital transformation efforts, healthcare stakeholders must overcome hurdles without erecting new ones to ensure access to connected care for all.