For those who may need the most assistance with their health–older adults, those with chronic conditions who have less income and/or education–will the digital health and consumer engagement advances we chronicle, debate and generally huzzah about make any real difference in their health? We have generally assumed that health tech will level the playing field by being faster, cheaper, super-functional and generally cooler. This provocative essay debates the distinct possibility that digital health and the adoption of technology may further increase health disparities despite all this. Examples are the older, even affluent person, who has difficulty coordinating their care even non-digitally and is in a spider web of confusion; the less educated person for which ‘self-empowerment’ in healthcare doesn’t blip their phone screen, much less their mind. When you review the ideal state infographic by Misfit and the Digital Health Group and try to place people like this into it, you realize the buzzy talk of ‘convergence’ zips right by these needy folk like a Boeing 787 Dreamliner back to the hangar for a battery swap.
Of course, the writer also caveats his discussion by stating (Editor’s emphasis):
However, for innovations to significantly worsen disparities, they would have to both meaningfully improve health outcomes, and not be made available to people of lower economic status. Although the digital divide is real, access to digital tools is increasing for almost all levels of society. Payers may also eventually subsidize tools that have been shown to improve outcomes.
Hmmm…so it kinda doesn’t matter at this stage?
When Editor Donna thinks back to say, 2005, and the promise at that time on how telehealth and telecare were going to revolutionize health and independence for older adults, disabled people and those with chronic conditions, the alacrity with which much of digital health’s business model and development funding has shifted towards essentially healthy people measuring personal fitness and ‘quantified selfing’ away–analogous to what psychiatrists call ‘the worried well’–is perhaps economically sound, but disconcerting to those of us who entered the field wanting to do, let’s say, a little good. Can we pause for a moment, and consider this? Technology, Innovation, Disparities, and the Elderly (GeriTech, author Leslie Kernisan MD, a board-certified geriatrician) Hat tip to George Margelis, GM of Care Innovations Australia