Always of critical importance within the healthcare industry, the concept of public health was propelled into the spotlight in a big way with the sudden appearance of the novel coronavirus in the United States in early 2020, shining light on public health initiatives like never before.
According to the CDC Foundation, public health is the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles; researching diseases and injury prevention; and detecting, preventing, and responding to infectious diseases — topics that are now just as likely to be discussed among public health officials as they are to be discussed around the dinner table of most Americans.
With an urgent mission to communicate public health information, the industry is in need of digital health tools that reach all members of the community in a meaningful way that promotes education and action. The National Center of Biotechnology Information lists the objectives of digital health products and services as being to:
- Improve the quality of outcomes of care and service
- Improve population health
- Improve the patient experience
- Improve the physician and other non-physician provider experience
- Address health disparities
The convergence of public health needs and the promise of digital health is a partnership that will deliver better care for individuals across the globe. But how to make the public health/digital health partnership one of lasting impact?
There are three questions that should drive thinking around this partnership and its success.
Can digital health tools reach all members of our communities?
For digital health tools to positively impact population health, we have to be able to connect with community members. According to a 2019 Pew Research Center study, use of technology — from internet usage to smartphone adoption — has grown rapidly among all Americans, including those with lower incomes.
The study examined the use of smartphones, desktop or laptop computers, home broadband, and tablet computers, segmenting survey respondents by income (less than $30K, $30K to $99K, and more than $100K). While higher incomes showed greater use of these technologies, 71% of low-income respondents also claimed smartphone use while 54% and 56%, respectively, claimed desktop/laptop computer or home broadband use, suggesting use of digital health tools is widespread regardless of income level.
The COVID-19 pandemic has certainly accelerated the use of telehealth and virtual visit technology, but evidence suggests that such technology isn’t likely to fade away anytime soon. A 2020 Accenture study showed that 60% of patients will continue to access care via telehealth technology following the end of the COVID-19 pandemic, demonstrating that digital health tools have a role to play even outside of emergency situations.
The trends in adoption of communication and mobile health (mHealth) technologies have steadily increased over the past 30 years. While these digital health tools are not perfect, it is clear that a sizable number of community members can be reached with these technologies, making digital health tools a promising option to implement public health strategies.
Can digital health impact diverse public health needs?
At their core, digital health tools deliver education, communications, reminders, and encouragement while capitalizing on personal responsibility to manage specific conditions and/or enhance wellness. It is a fairly straightforward process, but it is by no means easy. There are a variety of challenges when designing digital care plans.
First, population differences rule against a one-size-fits-all approach. Social determinants of health (SDOH) related to economic stability, education, health, neighborhood, and community context must be a primary consideration. We know that people who use digital health technology to keep track of their health information tend to have better health than those who don’t. We also know there are gaps in use by income, age, and sex. Education around these tools and improved internet access may help reduce these disparities and increase use of digital health tools overall.
Care plans must also be flexible enough to address acute, chronic, behavioral health, and preventative needs. Finally, digital health tools are most effective if the tool can facilitate human connection when needed.
To address the digital care plan design challenges, we suggest focusing on the following areas:
Population Differences: Healthcare technology developments have enabled the harnessing of data. That ability, combined with the broadening use of artificial intelligence (AI), begins to account for population differences and permits individual customization of care plans.
However, technology in and of itself will not overcome population differences. Clinical knowledge, combined with an understanding of care processes and thoughtful care plan design, begins to address these differences.
The creativity of the care plan design and diversity of the designers are critically important factors. The design must account for the unique characteristics of the populations being served by the plan. This can be accomplished through the use of a design and design review team that understands or reflects the characteristics of the intended population.
Flexibility: All care must be person centered. Care circles are different from one individual to the next, involving different loved ones, friends, and a variety of caregivers. Care environments are different from organization to organization.
Designing flexibility into these sometimes conflicting perspectives requires the use of EMR and AI integration to harness and use data, designing care plans that span the care continuum and recognize an individual’s unique health needs while considering SDOH and allowing health organization-specific enhancements to base care plans.
Human Connection: At their core, digital health platforms are care extenders that allow caregivers to function at the top of their license while engaging and simplifying care for individuals. Technological advances enable care extensions, but they can’t always replace the human touch that connection facilitates.
A well-designed digital health platform recognizes this fact and embeds functionality that allows for human connection — connections via human contact (telephone), electronic means (SMS, email, apps), and the exchange of data and images to make mHealth as simple, relatively speaking, as the common electronic engagements most individuals experience today (think banking, ticketing, entertainment, etc.).
Establishing this connection can be accomplished by having a digital health support team that includes community guides (who can help navigate basic questions, SDOH, and triaging requests), social workers, nurses, physicians/physician extenders, and affiliated healthcare professionals.
Will individuals trust digital health platforms to positively impact their own health, resulting in improved public health?
Building trust in digital health could well be the final hurdle toward a positive impact on public health. In his September 2019 piece, “Building Trust Can Improve American Healthcare,” Dr. Richard Baron stated, “Over the past 30 years, even after major strides to expand access, improve outcomes and control cast, fulfilling the promise of delivering high-quality, affordable care that aligns with the individual goals and needs of this country’s patients remains elusive. Increasingly, the missing ingredient seems obvious: trust.”
Dr. Baron went on to say, “...although rebuilding trust may require new technology and procedures, it isn’t rocket science. It requires us to act toward others the same way we would like to be treated…”
The bottom line
For all of our societal advances we come back to the Golden Rule — treating others as you want to be treated. That is what person-centered care is all about. Making the Golden Rule the center of a digital health design, while observing the features previously discussed, will gain the trust necessary for positive public health outcomes.