How do physicians care for the digitally isolated?

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Although some patients are already harnessing the capabilities of new and emerging technologies enabled by high-speed internet, others are missing out.

From online shopping and banking, to video visits with family and friends, the internet has weaved its way into the fabric of daily living.

Along the way, entire industries have been upended, and the world of healthcare is undergoing a facelift as well. Remote monitoring devices and digital doctor visits connect patients with professionals while eliminating the commute, smart pill bottles tell seniors to take medications on time and activity trackers enable earlier diagnosis and intervention.

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Although some patients are already harnessing the capabilities of these types of new and emerging technologies enabled by high-speed internet, others are missing out. According to the Federal Communications Commission (FCC) 2016 Broadband Progress Report, 34 million people, or 10% of all Americans, still lack access to benchmark service. And some groups are particularly hard hit, including 39% of rural Americans and 41% of Americans on Tribal lands.

As part of the effort to overcome these coverage disparities, the FCC’s Connect2Health Task Force has developed a Mapping Broadband Health in America platform that allows users to visualize health and broadband internet statistics at the county, state and national levels. The latest data update, announced in June, reinforces many of last year’s findings-including noticeable gaps between rural and urban areas.

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"By many measures, connected communities are simply healthier communities,” says Michele Ellison, JD, chair of the FCC’s Connect2Health Task Force. For example, the least connected counties have 1.5 times as many preventable hospitalizations as other counties. “As the Task Force continues to conduct deep-dive analyses like these, we’re consistently finding that areas that need broadband for health the most tend to have it the least.”

Next: Gathering Input to Tackle Gaps

Gathering Input to Tackle Gaps

The FCC also released a Public Notice in April seeking comments, data and information on a range of regulatory, policy, technical and infrastructure issues to help accelerate the adoption and accessibility of broadband-enabled healthcare solutions.

The American Medical Informatics Association (AMIA) was among those who heeded the call. While research in this realm is still in its infancy, there is a growing body of work suggesting that connectivity, or lack thereof, could impact the health of individuals and entire populations. Within its comments, AMIA pointed to a Journal of Medical Internet Research study that revealed mobile health technologies relying on broadband services have a wide adoption variance based on geography, population density and socioeconomic status.

In addition, research published in the Journal of the American Medical Informatics Association revealed that while patient portals have shown promise for improved quality and efficiency, lower rates of use were found for racial and ethnic minorities, patients of lower socioeconomic status and those without neighborhood broadband access. Internet access and other factors influencing usage could worsen health disparities, the study concluded.

Using the input from stakeholders across the country as well as information gathered in response to the recent Connect2Health Public Notice, the task force is in the process of making recommendations to the commission about how to best design broadband health policy that can meet the needs of rural and underserved Americans.

Next: Implementing Internet Alternatives

Implementing Internet Alternatives

In the meantime, there is a current and ongoing need to support patients who are unable to utilize online options. Yul D. Ejnes, MD, MACP, a practicing general internist at Coastal Medical Inc. in Rhode Island and a clinical associate professor of medicine at the Alpert Medical School of Brown University says his practice encourages the use of electronic communication but also offers alternatives.

There are times when Ejnes would like his patients to be able to learn more about their condition, for example. While he can refer some to online resources, he realizes that others would not be able to go that route. “If a patient doesn’t have internet access that’s reliable,” he says, “then we’re usually able to find printed materials or print off the web page in the office and hand them things to take home.”

Similarly, when treating overweight patients, his conversations include questions about access to the internet and the types of devices available. Based on that dialog, he can determine whether calorie tracking apps such as MyFitnessPal or Lose It! may be a good fit or whether an option like Weight Watchers would be a more suitable tool.

It is also important to remember that this a bigger issue than access alone. “I don’t think it’s limited to who has the technology and resources versus who doesn’t,” Ejnes says. “It is a matter of who uses it and who does not.” After all, there are plenty who can use a tool like an online patient portal but choose not to.

“Don’t make critical functions for individual patient care as well as the practice contingent on people having electronic access,” he recommends, and communication methods such as phone or mail should not be ignored. “I think what’s very important is that until we’re convinced we know for a fact that patients have access, are using the access, and prefer to use the access, we shouldn’t abandon the pre-portal methods.”

Paul Nicolaus is a freelance writer specializing in health and medicine. Learn more at www.nicolauswriting.com.