Four ways to improve digital health equity

In recent years, we have seen an increase in technology-based approaches to improving maternal outcomes and the birthing journey. While most women still have in-person visits to check on pregnancy progress, give birth or check in postpartum, technology can extend the reach of health care services.

Digital solutions including remote patient monitoring, mobile health apps, and telehealth visits can facilitate ongoing communication between expectant and new moms and their care teams. They can also provide a sense of comfort and security, which is much needed during this time of life.

As hospitals and healthcare systems increase their use of technology, it’s important to remember that not all patients have access to digital solutions. There is a lot of barriers to access – including lack of access to broadband or internet at speeds high enough to support these solutions. According Data from the Federal Communications Commission, 21 million Americans do not have high-speed Internet access; 42 million cannot afford it. In addition, many individuals still do not own a smartphone. The Pew Research Center reports that 14% of people living in rural areas own a cellphone but no smartphone.

Even with access to technology, digital literacy – the ability to use, process and understand technology – can be a barrier to access. For example, individuals may face language or cultural barriers necessary to engage with digital solutions.

At the Becker Healthcare Conference, I had the opportunity to discuss digital solutions and the work that needs to be done to improve digital health equity, with two healthcare leaders – Alisahah Jackson, MD, vice president of system innovation and population health policy at CommonSpirit Health and Christina Yarrington, MD, director of labor and delivery and director of the division of fetal medicine -kindergarten at Boston Medical Center.

During this conversation, each shared how their hospital is using digital solutions to improve perinatal outcomes. They also explained how they select, implement and evaluate these solutions to ensure that all of their patients have access to them.

Here are some ways Jackson and Yarrington suggested to improve digital health equity and ensure that all mothers and their families have access to these digital solutions:

  1. Apply a health equity lens and be intentionally inclusive. Advancing health equity is not something you can just check off your checklist. This is a commitment that healthcare organizations and their technology partners should incorporate into all of their strategic efforts. Before investing in a digital solution, initial conversations with digital solution providers should be viewed through a health equity lens. “We’re evaluating solutions for accessibility and health literacy levels, and whether their data collection capability includes the ability to stratify data by race, ethnicity, language, and gender,” Jackson shared.
  2. Take advantage of simpler and more cost-effective approaches, depending on your community served. One way to improve access is to provide technology directly to patients. For example, Boston Medical Center has partnered with Rimidi to provide blood pressure cuffs and a QR code to at-risk postpartum mothers to monitor their hypertension remotely, daily for six weeks. Instructions for using the cuff and submitting blood pressure scores to the web portal are provided in three languages. However, Yarrington noted, “We can give the device to patients, but we also need to anticipate any barriers to using it. Smartphone users may not have a data plan to support video conferencing or struggle with constant access to Wi-Fi to communicate with their providers. To address this concern, BMC chose Rimidi because it operates on a local cellular network and its web portal is staffed with high-risk OB nurses to provide triage services and additional support. BMC’s program is credited with a significant decrease in readmission rates for high-risk postpartum mothers with hypertension.

    Also, having a cell phone does not mean you have access to virtual platforms. Texting, a common service now available on all phones, can become a cost-effective, two-way and multilingual way to reach and communicate with patients. CommonSpirit uses Get Well’s Docent digital patient navigation solution, as it provides a text-based platform to connect mothers and their families to a “docent” who provides patient navigation services throughout and after pregnancy.

  3. Engage diverse patients to improve digital health literacy and individualize care. Hospitals can partner with community organizations, women in their community, and diverse voices of underrepresented patients, communities, and providers to assess whether these digital solutions are easily accessible and understandable by all types of patients and of communities. For example, healthcare organizations and their technology partners can connect with mothers with low health literacy to understand their communication preferences and tailor services to meet their needs and build trust.
  4. Track patient engagement with digital tools to measure success and assess scalability. Measuring how well patients are responding and interacting with a digital solution is an essential step in securing access and scaling it across a larger footprint. In 2021, Boston Medical Center analyzed data from the first 1,000 people enrolled in its program and found that 98.7% had submitted at least one blood pressure measurement and received more than 17 unique measurements from enrolled patients each day. . At CommonSpirit, engagement rates for its multi-pronged services with the Docent Health platform are 65% across all ethnicities, and highest at 73% in Hispanic communities. Jackson attributed this high utilization to its ability to offer services in the language and dialect preferred and spoken by patients.

As hospitals and health systems explore technology-enabled services, it will remain important to meet patients and individuals not just where they are, but where they want to be. This will help ensure that every individual has an equal opportunity to access and use digital solutions. To learn more about other digital solutions in perinatal care, listen to the AHA’s Seven in Seven: Digital Solutions for Perinatal Care podcast series.

Are you investing in digital solutions to improve maternal digital health equity? Email Aisha Syeda at [email protected] and share your journey.

Priya Bathija, JD, MHSA, is AHA’s Vice President of Strategic Initiatives.

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