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How Does Digital Equity in Healthcare Affect Quality Data?

The digital divide can affect patients’ access to and acceptance of telehealth. Tannis Hargrove of the University of Montana Rural Institute for Inclusive Communities explains what quality managers should know about digital equity in healthcare.

How Does Digital Equity in Healthcare Affect Quality Data?

Currently, the phrase “digital divide” is everywhere in healthcare IT. It’s typically described as a situation in which economic, educational and social inequities exist between those who have computers and online access and those who do not. However, experts are recognizing that access to computers and the internet represents only a small part of digital equity in healthcare.

Just take a look at some of the measures CMS uses to paint a picture of quality of care:

      • Outcomes
      • Clinical processes
      • Patient safety
      • Efficient use of healthcare resources
      • Care coordination
      • Patient engagement in their own care
      • Patient perceptions of their own care
      • Population and public health as measures

Now, consider that the digital divide can potentially affect every single one of those measures. That means that for quality leaders like you, the digital divide also affects myriad aspects of your work.

What is Digital Equity in Healthcare?

For some background, we spoke to Tannis Hargrove, project director at the University of Montana Rural Institute for Inclusive Communities. One of the largest problems she sees in her line of work is a lack of infrastructure, both traditional (such as internet access) and more nuanced. “[Perhaps] there is internet access available in a person’s area, but they don’t have a router or Wi-Fi, or they can only access it through an expensive or unreliable data plan,” she says.

Hargrove works specifically with people with disabilities in rural areas, and one frequent healthcare challenge is making sure they have reliable transportation. Telehealth can remove that barrier, but only if the patient has everything else necessary to access virtual care. “It’s a multifaceted quandary,” says Hargrove.

For example, even if a patient has internet access and all the right equipment to complete a virtual visit with a clinician, they may not have a comfortable, private place to talk about their health. A person living in poverty may share their living space with roommates and simply not have a door to close.

Building trust is another important component of equity in healthcare. Many people simply don’t feel comfortable discussing their health issues over the internet, because they don’t believe their privacy and the security of their information is assured.

Hargrove says that having a strong prior relationship with a healthcare provider can make a difference for patients who don’t trust technology. Her team was involved in a research project at the outset of the pandemic and found that participants wanted to continue connecting with their providers virtually after the project ended.

“They were already in the workshop,” she says. “There was a carrot to drive the person to want to use the technology.” She adds that healthcare itself can be the carrot, too, “but sometimes there are a lot of barriers to just checking in and saying ‘Thanks, things are good.’ People may need a larger reason to access virtual care, because it’s so much work to do it.”

The Digital Divide is Not One-Size-Fits-All

HIMSS offers an illustration of the surprising forms the digital divide can take by describing the barriers faced by three different people:

“Examples from three socially distinct smartphone owners illuminate the need to expand healthcare digital divide considerations beyond device and internet access. A nurse practitioner bought her daughter a laptop but came home to find her writing a school essay on her smartphone. A PhD scientist calls his 12-year-old grandson for tech support to create a group video call. A Medicaid patient refuses a video visit because she thought forgetting her password meant her phone was broken.”

Barriers to healthcare access are distinct to each patient. Sometimes patients struggle because they don’t have infrastructure, but often preferences, skills and even cultural considerations play a role.

The Impact on Quality Measures

The challenge for quality managers is that the data might not tell the full story of a patient on the wrong side of the digital divide. For example, a patient involved in a program to help manage their diabetes might be dealing with specific barriers to digital inclusion, but it may not be at all obvious to their provider, affecting the quality of their care and the resulting data. 

Experts in the field have known for more than a decade that the digital divide is associated with inequities in the delivery of care, yet solutions are still unclear, particularly when it comes to quality management. The digital divide affects all the measures quality leaders routinely collect, but the effort to reduce inequity requires a coordinated effort from every level, including community leaders, administrators, clinicians and patients themselves.

The healthcare community is currently discussing several important questions about equity in healthcare. An article in Patient Engagement HIT asks, “Is the Digital Divide the Newest Social Determinant of Health?” and a recent study published in JAMIA explored the differences in how people of different races and ethnicities used telehealth services during the peak of the pandemic. HIMSS suggests that closing the digital divide should be about “innovating for the skills, cultural context, and technology” that communities have, rather than focusing on what they lack.

As healthcare continues to move toward patient-centered care and explores the challenges of achieving equity in healthcare, the needs of the communities they serve will become clearer. As Hargrove says, closing the digital divide is “about helping people understand what their individual barriers to access are, and what supports they need to access technology or healthcare or other services.”

The biggest question remains: What can you do about the digital divide? Unfortunately, there is no simple answer. Solutions vary based on the geographic and socioeconomic causes, and many stretch far beyond the four walls of your hospital. The most important thing you can do as a quality leader is to understand that your data might not tell the full story, and to keep lines of communication open with patient care providers.

Further Reading on the Digital Divide's Impact on Quality Measures

Problems caused by digital inequity in healthcare exacerbate many other issues that quality leaders deal with daily—and we’ve consistently covered those issues in this blog. The following posts all touch on complications that are, at least in part, a result of digital inequity:

Quality Measures and the Success of Hospital-at-Home Programs

Programs designed to work in patients’ homes must include bridging the digital divide. Could such programs help quality managers decide which data is most important in addressing digital inequity?

Read more

The Five Stages of Health Care Data Quality Maturity [Infographic]

The fifth, and most mature, stage of healthcare data quality maturity includes institutions that “operate proactively and achieve the highest levels of trusted performance data possible in the world of ever-changing measure specifications, data taxonomies and information technology environments.” These advanced organizations are seeking ways to measure data related to digital inequity—and finding innovative ways to bridge the gap.

Read more

Which States Had the Most Hospitals Penalized for Readmissions in 2022?

Hospital readmissions are a tricky problem, because once patients leave the facility, all sorts of things can affect whether they are readmitted. As this post states, “Much of what can affect a readmission is out of your control”—including factors related to a lack of access to or comfort with technology.

Read more


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While you're here. Here are some additional resources you may find helpful and informative.

Erin Heilman

Erin Heilman is the Vice President of Marketing for Medisolv, Inc.

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