2020 saw a rapid increase in telehealth adoption across the globe, as COVID-19 prevented patients from seeking routine in-person care and required providers to adapt quickly to the new healthcare landscape. While telehealth cannot replace direct care entirely, it provides a more accessible, and often cheaper, alternative to costly and potentially risky in-person visits.

But telecare can only reach patients who have reliable access to the Internet in their houses, particularly now, when many libraries and community centers have limited their services due to the pandemic. Digital exclusion, which impacts the elderly, rural, and populations of color most severely, further exacerbates the existing inequities in health outcomes for those populations.

We sat down with Dr. Amy Sheon, director of the Urban Health Initiative at Case Western Reserve University and President & CEO of Public Health Innovators, LLC, to discuss the intersection of digital inclusion and healthcare and how the COVID-19 pandemic has helped crystallize the importance of connectivity for the healthcare field. Dr. Sheon was named a Senior Fellow at the National Digital Inclusion Alliance in February, 2020, for her work to elevate the connections between digital inclusion and health.

Q: Can you tell us about yourself and your work at the Urban Health Initiative?

A: I direct a program at Case Western Reserve School of Medicine called the Urban Health Initiative. We’ve launched a community health data platform where we show the social determinants of health and disparities in health outcomes in Cleveland and Cuyahoga County, Ohio. This research also shows how profound the digital divide is and how much it overlaps with factors that cause poor health (like poverty and segregation) and with health disparities. In other words, areas where there’s low life expectancy and high rates of diabetes and obesity are the very same areas where there’s high poverty and lack of Internet access. So, the health data platform has been a wonderful tool for finding disparities and getting the message out with interactive data stories.

Q: How does being unconnected impact a person’s health?

A: The COVID-19 pandemic has actually made this much more obvious and easy to explain, although the dynamics were there pre-COVID. With Internet connectivity, you do not need to leave your house to seek medical care. During the pandemic, that’s so important because if you’re uninfected, you’ll avoid putting yourself at risk by taking a bus to healthcare and sitting in a waiting room. And if you’re seeking a COVID diagnosis or treatment, you’ll avoid the risk of  transmitting the virus to other people by getting on that bus, sitting in the waiting room and exposing health care personnel. So, an immediate benefit of connectivity is connecting with healthcare electronically.

Digital connectivity also enables people to address the social factors that affect their health, and we see that so clearly with education and employment. There are so many jobs where, if you don’t have the Internet, you can’t work from home. And even pre-COVID, if you don’t have a digital skillset, you were consigned to low-wage jobs.

The social determinants of health are non-medical-related factors: the environment, access to healthy food, housing, living in a safe neighborhood, and physical activity, among others. Access to healthcare only explains a very little bit of people’s health outcomes. We have huge disparities in health outcomes in Cuyahoga County, for example. There’s a 24-year life expectancy difference depending on where you live in the county. Most of the variation in life expectancy is because of factors such as poverty and racism, not access to health care.

Q: How does connectivity impact the delivery of healthcare?

A: Connectivity can help healthcare achieve what I call the quadruple aim: better care, better health outcomes, lower costs, and avoiding provider burnout. Connectivity helps make health care much more efficient. It also enables patients to engage with their providers on a much more frequent basis than an annual visit.

Q: What are some impactful strategies to increase connectivity related to healthcare?

A: Just as health systems screen their patients for social needs (Do you have enough money for food? Do you feel safe in your home?), we could screen patients to determine if they digital gaps? Do you have a smartphone or computer? Do you have a data plan? Do you have the basic skills to use those devices or do you need assistance?

I am working with others across the country to develop the Digital Health Navigator model: training people such as community health workers or librarians to identify these digital gaps, to connect patients with community organizations to get devices and internet, and then train them to use telehealth, patient portals, and remote monitoring devices. Even people who have devices, a good data connection and digital skills can run into problems using telehealth. Organizations that fund  healthcare should pay for training and enabling patients to use these great digital health tools that now exist.

Q: What are you excited about for the future of connected health?

A: Suddenly, everyone associated with digital health is now recognizing that seniors, people of color, people who are low income, and whose first language isn’t English are being left out of virtual health care. I was banging on the doors of health systems about this problem for years without much success until the last few months when health systems looked at their data and realized who was being left out of telehealth.  That’s half the battle.  The other great news is that this problem is so fixable!  People are highly motivated to use digital tools. Getting everyone equipped and connected is within our reach.  Getting them trained is more difficult, but we believe that the Digital Health Navigator model is a scalable way to close these gaps.

Q: Anything else you’d like to mention?

A: In addition to the real potential for connecting everyone who wants to be connected, there’s also a lot of potential for using low-tech means like text-based telehealth for people who don’t want to use the internet. In some ways, healthcare technology jumped over texting into Internet-based solutions, but developing countries have demonstrated the incredible reach and cost-effectiveness of text-based programs. I’m working with a number of healthcare systems already and would love to work with anyone else who wants to promote digital health equity.