The COVID-19 pandemic proved that telehealth, smartphone apps, and other digital health tools could increase both the quality and accessibility of healthcare. And yet, the Pandemic also increased awareness among health and technology leaders of how disparities in digital access and skills compound health disparities.
Due to its convenience and flexibility, it’s clear that virtual care and digital health technology are here to stay. Yet, absent thoughtful efforts to ensure inclusive adoption of digital health tools, health care systems may well exacerbate health disparities that many advocates have been working hard to mitigate.
Until the pandemic, many health systems seemed to believe that they couldn’t do anything about people who weren’t connected. Not able to have a virtual visit? No worries, we can just call you! Your connection? Not our problem. Not in our mission. Not a core competency. However, the Emergency Broadband Benefit (in the 2020 CARES Act) and its 2021 successor, the Affordable Connectivity Program, changes the equation. If health systems could justify screening people for health-affecting issues for which even scarce community-based resources were available, then how could they justify NOT screening people for free internet eligibility?
A First Step: Assessing Digital Readiness
Fortunately, many health systems are now trying to figure out what they can do, recognizing screening for telehealth readiness as a first step. Unfortunately, it requires a more nuanced approach than asking a seemingly straightforward question such as “Are you able to have a telehealth visit?” Elsewhere, Public Health Innovators has written about why this strategy will be ineffective. We can help your organization develop questions that are tailored for your objectives, patient population, community and available resources. In addition, you will need to determine a work-flow, an approach for addressing whatever gaps are identified during screening, and a method to track what’s been done or is needed. For many of these processes, Public Health Innovators recommends engaging (or training existing staff) to serve as Digital Health Navigators.
What is a Digital Health Navigator (DHN)?
A digital health navigator is an individual trained to identify someone’s barriers to using the internet. The DHN will then ensure someone has a device, connectivity and the basic skills needed to use the internet. So far, these duties mirror those of Digital Navigators (DNs). As developed over the last several years by the National Digital Inclusion Alliance and other organizations, DNs “help people address the whole digital inclusion process-home connectivity, devices, and digital skills—with community members, through repeated interactions.” DNs work in community settings such as libraries, educational and employment programs, or community-based organizations. DNs may refer clients to digital literacy specialists for basic skill training. While such specialists are generally prepared to help clients use common applications, most will need addition training to address digital health-specific functions. With this added training, Digital Health Navigators can work in community settings where people seek assistance, or they may work in the health care setting directly.
Who becomes a Digital Health Navigator?
Based on our experience, community health workers (CHWs), and or individuals deeply familiar with the lived experience of their clients are well-suited to be effective DHNs. A key element of this familiarity is understanding and addressing the fear facing many new or novice Internet users. CHWs scope of practice covers all of the functions of a DHN, and many have chosen this path because they want to help people who are like them. In turn, DHNs are likely to be trusted by the people they seek to help.
For each client, the DHN looks at their specific barriers to adoption but also factors that can support adoption. Examples of the latter include a family member who can help, or increasing awareness of specific ways that a portal could benefit them. This process often starts with screening that identifies whether or not someone meets a certain level of digital readiness. Screening involves administration of a common set of questions that have been carefully tailored to the institution’s digital equity objectives. Screening questions should also align with planned strategies to address any gaps that are identified. Screening may be followed by a more detailed assessment, including for needs specific to digital health tools that the patient may adopt.
DHNs can address these needs directly by providing a device, determining eligibility for discounted internet, helping to arrange internet service, and teaching basic digital literacy skills. Alternatively, the DHN may refer patients to community-based DNs to help the patient attain basic digital readiness. Many health systems now address non-medical needs such as housing or food assistance through a “closed loop referral system.” Digital readiness needs can be incorporated into this system after ensuring that the system’s taxonomy includes specific digital readiness needs and a complete and up-to-date list of organizations to receive the referrals.
Common examples include telehealth, patient portals, home monitors, wearables and smartphone apps. This training should address account requirements such as having a personal email address that is not shared, and ready access to a device needed for two-factor authentication. Logistical requirements specific to the digital health tool, such as having a private space available for a telehealth visit, should also be covered.
President & CEO, Public Health Innovators, LLC
When the COVID-19 pandemic spawned digital health equity concerns, health systems, technology companies and the telecommunications industry sought guidance from Public Health Innovators to reach and meet the needs of population groups that were excluded by the rapid shift to virtual care. Public Health Innovators offers virtually unmatched skills for meeting this challenge. Company founder, Amy Sheon, has worked with vulnerable populations for her entire 30+ year career, building deep and authentic relationships with community organizations most trusted by populations that have been historically marginalized. At the same time, she is an innovator and a powerful advocate for systems change, especially regarding conditions that give rise to institutional and structural racism, and conscious and unconscious bias. Finally, Amy is among a small handful of experts nationwide that are bringing digital inclusion approaches to the health and digital health sectors. Amy has provided health thought leadership to the National Digital Inclusion Alliance since the organization’s first annual meeting in 2016, and serving as their first Senior Fellow in 2020. During that time, she continued contributing to NDIA’s creation of the Digital Navigator Model, and began adapting that model to health care settings.