We cannot guarantee that the content will display correctly while using Internet Explorer. To have the best browsing experience, please upgrade to Microsoft Edge, Google Chrome or Safari.

November 15, 2019

Closing the Digital Divide - Designing for Inclusive Healthcare

Commentary
Tessy Huss
&

Last month, the WHO Digital Health Technical Advisory Group convened for the first time in Geneva to discuss and devise a roadmap for the adoption and scaling of digital technologies to meet the world’s health needs. The resolution underpinning the formation of the advisory group and the WHO’s newly established Digital Health and Innovation Department specifically urged member states to assess how an increased deployment and utilization of digital healthcare technologies could promote “equitable, affordable and universal access to health for all, including the special needs of groups that are vulnerable in the context of digital health”. In light of this recent development, we take a look at the shortfalls and successes of digital health inclusivity to date.   

In theory, digital health advancements should benefit all of us, but even more so those who are hardest to reach. Unsurprisingly, however, the benefits of digital advancements are not equally distributed, and instead, often serve to further marginalize those already most vulnerable in our societies in a technological sense. It seems counterintuitive that technological innovations should have such unintended consequences when their original intention is to improve the quality of care, facilitate access to and speed of assistance. So the question arises: How can we prevent health interventions from failing and accentuating health disparities? 

Access, design and context matter

Simply put, blanket ‘out of the box’ interventions are not going to work for vulnerable or underserved populations. Without a contextual understanding of vulnerability, how it operates, influences people's needs and determines barriers to access, any intervention is doomed to fail. 

Despite significant advancements in internet penetration globally, the digital divide remains a stark reality both within and across countries. A study conducted by Microsoft highlights that internet poverty in the United States is much more prevalent than the Federal Communications Commission’s (F.C.C.) estimates would suggest. Globally, the majority of people access the internet with a mobile phone (as opposed to via a computer); yet 4G and 5G networks are accessible to only those with the latest and most expensive smartphones. Many people across low or high -income countries, however, cannot afford smartphones and/or connected wearables that would allow them to gather continuous data to share with their doctor to avail of more personalized healthcare plans. While a person may have access to technology, he or she may not be sufficiently literate or lack the digital skills necessary to use the technology, and consequently cannot access educational health content online. Lower socioeconomic status is often associated with lower literacy and reduced digital skills. Financial reasons, functional and cognitive impairments for instance limit smartphone usage in older homeless adults. Trust and confidence also influence the up-take of technology in underserved populations, as technologies can be perceived as invasive or too tightly linked with social services or governments.

Oftentimes devices or technologies, by their very design, are simply not accessible to everyone. For instance, a study conducted by researchers at the University of Washington found that many mHealth apps were not sufficiently accessible to people with vision impairments. Language is also a significant barrier in accessing healthcare services for many non-native speakers. Besides ensuring that the technology and the user can draw on the same language, it is fundamentally important that vernacular and cultural nuances are sufficiently incorporated to ensure comprehensive communication with consumers. Linguistic exclusion also occurs at a more basic level, that of evidence generation about the health of vulnerable populations. Participation in the Apple Heart Study, for instance, was open only to those “proficient in written and spoken English” (albeit defined by self-report) and with access to an iPhone (5s or later) or Apple Watch. Beyond linguistic biases, ethnic minorities are also notoriously underrepresented in clinical trials

All of this leads us to question who digital technologies are designed for, if not for those most in need of improved service delivery. In their 2013 publication, Chris Showell and Paul Turner rightly question whether eHealth systems are in fact designed for “People Like Us” (PLUs) by “People Like Us”, that is privileged, literate, tech-savvy and motivated individuals.

Designing for inclusion: overcoming the PLU hurdle

One way of overcoming the PLU hurdle is to adhere to inclusive design principles. Microsoft’s Inclusive Design Methodology is a great example of how a change in perspective can fundamentally alter the meaning of user-centric designs. The company’s methodology centers around the following three principles: 

1. Recognize exclusion; 

2. Solve for one, extend to many, and 

3. Learn from Diversity.

Many companies are evidently developing their solutions with such principles in mind:

Washington, D.C. based Babyscripts aims to improve pregnancy care coordination, particularly for underserved women and high-risk pregnancies. Cognizant of “the differences both in the depth of technology and the level of connectivity”, Babyscripts’ CEO Anish Sebastian describes his company’s inclusive approach to service delivery as one wich, where warranted, defaults to simple text-based messaging and phone calls for which there is a high guarantee of delivery. Where women don’t have access to a connected blood pressure monitor and weighing scale, Babyscripts includes these devices in the Mommy Kit they send to mothers enrolled in their program.

Senior adults are less likely to download apps or access telehealth services through smartphone apps; yet they are a cohort for which telemedicine has great potential as it enables regular and consistent follow-up care. Within this context, American Well and Cisco recently announced a partnership aimed at developing technology which could see the delivery of home care via people’s home television sets. This partnership is even more significant in light of the announcement made earlier this year that in the US Medicare Advantage insurers will be reimbursed for additional telehealth services in 2020.

Butterfly Networks have developed a hand-held portable ultrasound imaging device with enormous diagnostic potential. The device connects to iPhones and can be used by doctors as a single point full body ultrasound in remote and deprived settings. Backed by the Bill & Melinda Gates Foundation, Butterfly Networks uses microchips rather than piezoelectric crystals which allows the company to sell its device for less than $2000 (compared to other leading portable ultrasounds which cost in the region of $7000).

The growth in popularity of mental health chatbots has much to do with the fact that they lower inhibitions,  allow people to talk freely, and are also more affordable than in-person therapy sessions. Most importantly, however, mental health chatbots are always available, especially in a time of need and irrespective of location. San Francisco based X2AI has developed Karim, an AI chatbot that can be used by refugees in camps where access to mental health services is especially scant. Users don’t have to download an app to talk to Karim, the bot converses over text or instant message. Different versions of the company’s flagship chatbot “Tess” have also been developed for the elderly and new mothers with postpartum depression in Kenya.

Cognizant of the fact that many people are denied healthcare access on the basis of affordability, Doc.com combines blockchain-based cryptocurrency and telemedicine consultations in a novel way to provide increased access to healthcare services. To date, the company has provided telemed services to over 250K consumers. Services are free in exchange for third party access to the anonymized data generated from consultations. This data is shared with research, clinical and pharma companies to aid in augmenting and understanding future healthcare interventions.

In partnership with the Ministry of Health in Rwanda, Babyl (the Rwandan equivalent of Babylon) offers its users many different ways to access its services free of charge. Those who have smartphones can download the app and check their symptoms with an AI chatbot. In remote and rural towns, booths have been established equipped with tablets that people can use to receive medical consultations. Dialing *811# connects users with a triage nurse, who will subsequently schedule an appointment if a condition is deemed treatable. 

The bottom line

Innovative and inclusive solutions are being developed by defaulting to simpler but more wide-reaching tech features. Best practice accessibility guidelines have been developed and their adoption will be key to delivering more inclusive digital experiences. The only real way that we can ensure digital health inclusion is by co-designing solutions together with intended users. The moral obligation does not stop at creating inclusive designs however. Even the seemingly most inclusive technologies, while free and accessible to all, can be questionable, especially when access to services is traded for personal information. Truly inclusive solutions are those that equalize the terms of engagement, seek no harm, and are fully transparent and clear about their terms of service. But beyond that, we need digital health solutions to be economically viable, accessible to those who need improved access most and prove the efficacy of their improved health outcomes.

Interested in social innovation for health and companies pushing this agenda? Get in touch, we can help you explore this environment on our digital health intelligence platform!

We can provide an introduction on your behalf so that you can contact them directly with any questions/queries on this topic. Simply click on the link below to request an introduction.

We can provide an introduction on your behalf so that you can contact them directly with any questions/queries on this topic. Simply click on the link below to request an introduction.

Request an Introduction

We can provide an introduction on your behalf so that you can contact them directly with any questions/queries on this topic. Simply click on the link below to request an introduction.

Request an Introduction

Ready to read more? HealthXL members can access the full peak of the report on the HealthXL Community Hub.

Not yet a member of HealthXL? Download your 11 page snapshot of the report.

Download your 11 page snapshot

Connect with peers and share insights

Don't miss out on the discussion of the latest insights and reports on digital health. Meet with peers and take a deep dive for 75 minutes. Unlike at webinars, you can freely exchange experiences and insights to solve challenges and design the future of DTx.

Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)

DTx- Employer Partnerships

5th August @ 9:45AM EDT

Join our Digital Health Meeting as discuss employer partnerships for DTx companies. Apply now to hear valuable insights from thought leaders in the industry and connect with new people.

Featuring
Eugene Borukhovich
Eugene Borukhovich
Chairman and COO of YourCoach.Health
Caleb Bank
Caleb Bank
Product Marketing at NuvoAir
Featuring
Eugene Borukhovich
Eugene Borukhovich
Chairman and COO of YourCoach.Health
Caleb Bank
Caleb Bank
Product Marketing at NuvoAir
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)

Masterclass: Reimbursement models for DTx in the US

10th August @ 10:45AM EDT

Join us in this US-focused interactive masterclass led by Happify Health where we will discuss the best reimbursement models for DTx. Apply now to gain valuable insights from thought leaders in the industry.

Featuring
Chris Wasden
Chris Wasden
Head of HappifyDTx, Happify Health
Featuring
Chris Wasden
Chris Wasden
Head of HappifyDTx, Happify Health
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)

DTx opportunity for pharmaceutical companies

11th August @ 9:45AM EDT

Join this informal conversation with other thought leaders to discuss the current and future opportunities for pharma in DTx. Great opportunity to connect with peers and meet new people in this space.

Featuring
Eugene Borukhovich
Eugene Borukhovich
Chairman and COO of YourCoach.Health
Jim O'Donoghue
Jim O'Donoghue
President , S3 Connected Health
Featuring
Eugene Borukhovich
Eugene Borukhovich
Chairman and COO of YourCoach.Health
Jim O'Donoghue
Jim O'Donoghue
President , S3 Connected Health
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)

The future of companion DTx

17th August @ 10:45AM EDT

Join us as we discuss the future of companion DTx products. This 75 minute session is guaranteed to be filled with interesting debate and great conversation so apply now to secure your place.

Featuring
Céline Ulmann
Céline Ulmann
Head of R&D Digital, Almirall
George Platings
George Platings
Market Development Specialist at uMotif
Featuring
Céline Ulmann
Céline Ulmann
Head of R&D Digital, Almirall
George Platings
George Platings
Market Development Specialist at uMotif

Are you a HealthXL Member? See the Full Report Here

Non-HealthXL Member? You can purchase the report HERE

HealthXL Digital Health Meetings

Want to join the discussion now?

Join our Digital Health Meetings and take a deep dive for 75 minutes into topics like digital therapeutics, patient support, telehealth, clinical trials, dermatology and many more. These Meetings are not regular webinars: No audience, no recording and no hiding behind a screen. You actively participate in a discussion to solve your present challenges and design the future of digital health. And with a free account on our Community Hub, you stay connected and up-to-date on the latest news and insights, allowing you to fully immerse yourself in the topic before, during and after.

Telemedicine & Virtual Care Delivery
Telemedicine & Virtual Care Delivery
Telemedicine & Virtual Care Delivery
Telemedicine & Virtual Care Delivery

Virtual Care for Diabetes: Commercialization models

4th August @ 10:45AM EDT

Join us as we discuss what are the most scalable and sustainable commercialization models for Virtual Care companies in the diabetes space. Apply now to get involved in the conversation, network with peers and share your thoughts on the topic.

Featuring
Jim Howard
Jim Howard
CEO, Readout Health
Michael Freni
Michael Freni
Director, Business Development, Partners Innovation at Partners HealthCare
Featuring
Jim Howard
Jim Howard
CEO, Readout Health
Michael Freni
Michael Freni
Director, Business Development, Partners Innovation at Partners HealthCare
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)

DTx- Employer Partnerships

5th August @ 9:45AM EDT

Join our Digital Health Meeting as discuss employer partnerships for DTx companies. Apply now to hear valuable insights from thought leaders in the industry and connect with new people.

Featuring
Eugene Borukhovich
Eugene Borukhovich
Chairman and COO of YourCoach.Health
Caleb Bank
Caleb Bank
Product Marketing at NuvoAir
Featuring
Eugene Borukhovich
Eugene Borukhovich
Chairman and COO of YourCoach.Health
Caleb Bank
Caleb Bank
Product Marketing at NuvoAir
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)

Masterclass: Reimbursement models for DTx in the US

10th August @ 10:45AM EDT

Join us in this US-focused interactive masterclass led by Happify Health where we will discuss the best reimbursement models for DTx. Apply now to gain valuable insights from thought leaders in the industry.

Featuring
Chris Wasden
Chris Wasden
Head of HappifyDTx, Happify Health
Featuring
Chris Wasden
Chris Wasden
Head of HappifyDTx, Happify Health
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)
Digital Therapeutics (DTX)

DTx opportunity for pharmaceutical companies

11th August @ 9:45AM EDT

Join this informal conversation with other thought leaders to discuss the current and future opportunities for pharma in DTx. Great opportunity to connect with peers and meet new people in this space.

Featuring
Eugene Borukhovich
Eugene Borukhovich
Chairman and COO of YourCoach.Health
Jim O'Donoghue
Jim O'Donoghue
President , S3 Connected Health
Featuring
Eugene Borukhovich
Eugene Borukhovich
Chairman and COO of YourCoach.Health
Jim O'Donoghue
Jim O'Donoghue
President , S3 Connected Health

What’s a Rich Text element?

The rich text element allows you to create and format headings, paragraphs, blockquotes, images, and video all in one place instead of having to add and format them individually. Just double-click and easily create content.

Static and dynamic content editing

A rich text element can be used with static or dynamic content. For static content, just drop it into any page and begin editing. For dynamic content, add a rich text field to any collection and then connect a rich text element to that field in the settings panel. Voila!

How to customize formatting for each rich text

Headings, paragraphs, blockquotes, figures, images, and figure captions can all be styled after a class is added to the rich text element using the "When inside of" nested selector system.

We cannot guarantee that the content will display correctly while using Internet Explorer. To have the best browsing experience, please upgrade to Microsoft Edge, Google Chrome or Safari.