The Year Ahead: Addressing Health Equity Requires Closing the Digital Divide in Healthcare Organizations

This article is the last installment of a four-part series on the most important topics for health information professionals to be aware of in 2022. View part one, two, and three.

Digital advancements have significantly transformed the way we communicate, interact, and conduct business. The COVID-19 pandemic forced a paradigm shift in the modalities used to provide health care. Care that was once provided in brick-and-mortar locations is now being delivered with the help of technology, such as telemedicine. Health information technology (IT) has immense potential for improving access, retention, and quality through innovative solutions in service delivery as well as contributing to cost reduction. Healthcare is gradually embracing the potential of technology in closing equity gaps. Also, health IT products, like electronic health records (EHRs) continue to evolve and demonstrate their true promise. The combination of the increased use of structured data, the evolution of international standards, and interoperability are laying the groundwork for more personalized care recommendations and treatments.

Despite technological progress, many health care organizations continue to experience a deep digital divide. Health systems, particularly in the area of primary care, are facing competition and sustainability challenges to meet the growing health needs and demands. Barriers to care, shortage of healthcare providers, and unaffordable healthcare costs are creating an untenable situation. Reduced mortality and increased life expectancy will increasingly strain the current healthcare system (e.g., the “silver tsunami”). The health care industry is also experiencing unprecedented staffing shortages that are contributing to equity issues inasmuch that less affluent healthcare organizations are struggling to compete with hiring and retaining staff. Concurrently, different healthcare industry players are publically acknowledging how current care practices are contributing to health inequities and are actively developing practices to address these issues (e.g., insurers incentivizing providers for closing racial inequity gaps).

An abundance of literature has highlighted health inequities and disparities by different sociodemographics such as race, ethnicity, sexual orientation, gender identity, or social determinants of health. While we know these exist, we rarely consider how the availability of resources between organizations create disparities and trickles down to the patient. For example, Federally Qualified Health Centers (FQHCs), which receive funding from the US Health Resources and Services Administration, care for nearly 30 million people annually across the US and US territories. There are approximately 1,400 FQHCs that are nonprofit healthcare organizations on the front-lines of caring for the most underserved and vulnerable populations experiencing some of the greatest health inequities. In spite of their exceptional care, patient-centeredness and deep ties to the communities they serve, the exorbitant cost of health IT significantly disadvantages these organizations compared to larger health systems that have the resources to purchase and maintain these digital systems. Even though FQHCs’ cost of care is among the lowest, many lack resources to hire and retain health IT staff to support these systems, creating challenges to fully harness the benefits of these quickly evolving technologies. In this instance, instead of health IT reducing health inequities, it is contributing to the health equity gap.

Demand for innovative digital solutions to improve healthcare access and address care gaps is increasing. Patients living with chronic conditions require more care and thus more frequent contact with their care teams, while some patients may need to travel great distances in order to access culturally affirming care. Digital platforms can address these patient needs more quickly, center the patient, and foster patient engagement that not only retains patients, but attracts new patients. Health equity can be buoyed by digital tools that are innovative, affordable, consumer focused, and culturally inclusive. In order to address health inequities and disparities, we must make health IT more accessible to organizations providing services to the most vulnerable and underserved populations.

Health IT innovations are often developed in larger universities or hospitals and lack inclusion and the diversity of smaller organizations. Software developers would greatly benefit from fostering collaborations with FQHCs that have historically been on the forefront of health care provision, often paving the road when there wasn’t a roadmap. Their delivery models offer ideal environments to develop and pilot new innovative technologies under real-world conditions. Health IT investments in these environments could have a proliferation of benefits. Increasing digital capacity in FQHCs can improve continuity and access to high-quality care, health outcomes, address staffing shortages, and increase employment opportunities across the US.

The impact of the digital divide can be addressed by increasing digital technologies for all individuals and communities, regardless of their sociodemographics or where they receive care. Health IT is well poised to be the great equalizer in health care, but first we need to address the digital divide by creating digital disruption.

Chris Grasso (cgrasso@fenwayhealth.org) is the associate vice president for informatics and data services at the Fenway Institute.