In an article published in July 2020, the Centers for Disease Control and Prevention (CDC) recognized that inequities in social determinants of health, including poverty and healthcare access, influence a wide range of health and quality-of-life outcomes and risks for members of racial and ethnic minority groups.
“To achieve health equity, barriers must be removed so that everyone has a fair opportunity to be as healthy as possible,” wrote the CDC.
To address that topic, CES 2021 (held virtually this year) brought together a panel of health technology leaders who are focused on using technology as a means to breaking down these barriers.
Lisa Fitzpatrick, MD, MPH, an infectious-disease physician and the former medical director of Washington, DC’s, Medicaid program, founded Grapevine Health to foster health literacy and patient engagement in low-income populations. The organization assists health systems, medical providers, and researchers in building community outreach and engagement through the use of computer technology and smartphones.
Iris Frye, as the founder and chief innovator at Parity Health Information & Technology, leads a company dedicated to enhancing healthcare delivery for underserved and at-risk communities by forming better relationships between them and healthcare providers. A major part of Parity’s efforts is the development of telehealth and remote patient monitoring systems.
Katherine Ryder, the founder and CEO of Maven Clinic, heads up a digital health company that offers virtual care and services in the areas of fertility, maternity, and pediatrics. The Maven Clinic operates the nation’s largest women’s and family health telehealth network, working with 1,700 healthcare providers and millions of families across the country. The business connects patients with obstetrician-gynecologists (ob-gyns), nutritionists, lactation consultants, and other specialists via video chat or messaging and assists women in advocating for themselves. Ryder said that Maven is focused on bringing health equity through telemedicine and plans to soon launch a product for women enrolled in Medicaid.
Educating Health Practitioners About Systemic Racism
In their comments during the conference session, titled “How Tech Can Reduce Health Disparities,” each of these health technology leaders highlighted a divide between healthcare providers and underserved communities.
“We noticed that providers do not have the knowledge to deal with patients in underserved Black and brown communities,” said Frye. “They’re at a loss.”
From Frye’s perspective, improving health equity begins with education, and real change starts by talking about issues like systemic racism.
“You have to teach providers about systemic racism, dealing with things like unconscious bias,” says Frye. “A lot of people don’t believe that it actually truly exists. Once the issue is in the open, then we can start building from there.”
Fitzpatrick suggests that this education can begin during medical training. Her idea is that by introducing medical students, pharmacy students, and nursing students to topics like systemic racism, it may help make conversations about these topics less uncomfortable and less difficult.
“I think it takes a little bit of courage and a willingness to take a risk,” said Fitzpatrick.
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Building Trust by Building Real Community Connections
Healthcare providers can educate themselves about racism, as one step toward fostering better relationships with communities that are underserved.
Ryder emphasized that better relationships can build trust, which is vital, because distrust in healthcare has contributed to poorer outcomes among racial and ethnic minorities.
Fitzpatrick says that to develop trust, health practitioners must spend time in the community. “There’s no shortcut to building trust — you have to get on the ground and talk to people,” she says.
“Don’t look through us, but actually see us,” says Frye. “You just can’t expect us to come into your office, spend five minutes with us, and walk away. You haven’t listened to us. You haven’t talked to us.
“If you haven’t allowed me to have a voice, then how am I supposed to trust that you have my best interests at heart? See the person that sits in front of you — see them as a whole [person] instead of as a number.”
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Telemedicine Can Play an Important Role
Healthcare providers may not always have the time and resources to be physically in a community as much as they would like, but telemedicine offers a way to be in communities virtually. Ryder believes that telemedicine can help foster trust and connection by allowing more interaction between healthcare providers and communities.
She stresses that telemedicine interactions can grow stronger by taking into account patient preferences.
“We know that when Black patients are working with Black providers, they do get better outcomes,” said Ryder. Research published in 2016 in Obstetrics and Gynecology found, however, that only 11 percent of ob-gyns are Black.
“I think telemedicine plays a really important role in delivering against that limited access [to Black doctors],” she said. Telemedicine makes it easier for the small number of Black ob-gyns to reach a wider population.
According to Frye, some populations are more open to receiving virtual care over in-person care. Generally, young people are more comfortable with technology, and virtual care may fit more conveniently into their busy schedules, she notes. Plus, telemedicine can reduce anxiety and concerns some patients may have about seeing a doctor.
“Mental health, for example, has such a stigmatism when it comes to the Black and brown community,” said Frye. By not having to discuss issues face-to-face, some patients feel more relaxed and comfortable sharing their feelings and what’s going on in their lives and with their health.
“I’ve spoken with so many mental health providers who stated that telehealth has really exploded their business when it comes to the minority community,” she said.
Lower-Income Americans Still Lack Broadband Access
Developing this stronger virtual link depends on underserved communities having the technological tools to take advantage of telemedicine.
Roughly 3 in 10 adults with household incomes below $30,000 a year don’t own a smartphone, according to a May 2019 report from the Pew Research Center. More than 4 in 10 don’t have home broadband services or a traditional computer. And a majority of lower-income Americans are not tablet owners.
Fitzpatrick, however, has found that more Medicaid patients she has seen have smartphones than the Pew survey indicates — “so even though they don’t have access to broadband, they are able to engage in a televisit.”
The panelists all agreed, however, that underserved communities still don’t have as much access to broadband and other technologies as they should to help enhance the delivery of telemedicine.
“That problem needs to be solved to build patient engagement,” Ryder said.