Healthcare providers and digital navigators join forces to close the health equity divide

Health systems in Philadelphia are working together toward implementing systems and spreading education about why digital equity matters.  

However, barriers like funding and buy-in from patients are holding back progress. 

The same socioeconomic challenges that digital equity efforts face — lack of access to internet, devices and digital literacy — also impact healthcare. Getting more patients to accept telehealth and helping individuals learn how to use it can lead to more positive health outcomes, according to stakeholders. 

Making those efforts work better in tandem begins by bridging the gap between hospitals and digital equity orgs, just like Jefferson Health and the Health Federation of Philadelphia are doing.

“I’m definitely finding more healthcare institutions that are starting to have connections to digital inclusion organizations,” Amy Sheon, a former health subject matter expert for the National Digital Inclusion Alliance and president of Public Health Innovators told Technical.ly. “That’s great because the digital inclusion organizations are better equipped to manage those basic needs.”

For example, healthcare providers use patient portal data to determine who uses the platform and engages in telehealth services and screens for digital readiness needs. Then, that information helps narrow down who needs help and find trends in populations, she said. 

Once those needs are determined, they can also refer patients to orgs that do digital inclusion work that will help them access resources like devices and digital literacy classes, she said. 

It’s not a one-size-fits-all solution, though. Everyone’s circumstances are unique, and many people make decisions about care modality based on limited understanding and access, Kristin Rising, an emergency medicine physician at Jefferson Health and director of the Jefferson Center for Connected Care, told Technical.ly. 

To help patients feel more confident about engaging with technology, healthcare stakeholders need to meet them where they are, according to Rising. 

“I really want to make sure that people are selecting what works for them based on what truly is best for them,” she said, “and that they understand the value and they feel competent and able to be engaging … via all means.” 

Jefferson builds digital skills into its treatment plans

The digital health challenges that Rising sees in her patients are usually related to one of the three branches of digital inclusion: access to affordable and reliable internet, access to devices and digital literacy skills. 

Many patients don’t have large-screen devices like laptops, instead, they may only have access to a smartphone or tablet. If a person only has a mobile device and has a limited amount of data on their phone, they might not want to use it for telehealth because they need it for school or work. 

Beyond lack of access, populations have lower trust in receiving quality care through technology or they don’t trust the tools as a safe place to provide personal information, Rising said. Some people simply don’t want to engage in telehealth because they’re used to going to the doctor in person. 

“People not really being sure what they can trust, how to engage in a safe way as well as what is the quality of care going to be on the other side,” Rising said, “which I think makes a lot of people just say, I’m not even going to try that.”

Today, there are three main programs Jefferson has invested in to help upskill its patients.

Rising’s team at Jefferson developed a digital health readiness screener to address barriers to telehealth, she said. The screener’s purpose is to individually identify what barriers patients are facing and how they can be solved, whether that be providing a device, having someone show them how to navigate the portal or having them talk to someone about privacy concerns. 

Jefferson also has a Digital Onboarding Task Force, which approaches patients without an active patient portal account and walks them through setting it up and navigating it. So far, the task force has supported over 400 patients, Rising said. 

The Jefferson Bedside IT Training program offers patients one-on-one basic digital literacy skills training on mobile devices and computers. These lessons are more basic, helping people to access the internet, download an app or navigate a telehealth call. 

All of these programs are efforts to best target the limited resources available to people who really need them, Rising said. It needs steady funding to make that happen, though. 

There are federal funding programs like the Broadband Equity, Access and Deployment (BEAD) program and the Digital Equity Competitive grant program, which Philadelphia was selected to receive funding from. However, the new commerce secretary under the Trump Administration, said there will be a “rigorous review” of the BEAD program. 

Still, setting up systems to help patients now will make it easier to distribute resources if and when more funding becomes available, she said. These programs also gather information and data about the populations in need. 

“The better idea we have of exactly what numbers we’re talking about and who those populations are,” Rising said, “we can think about how to tailor our searching for funding.” 

Digital navigators take on the healthcare space

Collaboration between digital equity orgs and healthcare providers picked up in Philadelphia when the pandemic hit in 2020. At the time, health systems were reaching out to the city’s Office of Innovation and Technology (OIT) with questions about digital access, Juliet Fink Yates, broadband infrastructure and digital inclusion manager for the city, said. 

In response, OIT formed a Digital Health Equity Task Force for healthcare organizations to share resources and collaborate on digital access work. Five years after launching the task force, Fink Yates is seeing some traction in the digital health equity space.

“Folks realize that simply because the pandemic is not in our faces, doesn’t mean that folks still don’t have these access issues … or the digital health literacy issues,” she said. 

Equity orgs like the Health Federation of Philadelphia have poised themselves as part of the solution, placing digital navigators into healthcare settings and teaching existing staff why digital equity matters, Holly Nagy Hainsworth, director of population health initiatives, said. 

Digital navigators connect residents with community groups that can help them with technology challenges and digital resources like affordable internet options, devices and skills classes. In healthcare, they connect patients to resources like affordable internet programs, office portals, lab results, health education resources and telehealth visits.

“There’s a growing amount of information out there and resources out there related to digital navigation, but not a lot of it, if any, really pertains to health,” Hainsworth said. “We really feel like that’s a gap that’s out there, especially for folks who are working in a healthcare setting.” 

The Health Federation’s digital equity journey formally started in 2022 when it received funding to place a digital health navigator at a community health center. The feedback from that pilot was that the digital health navigator role is badly needed in health center settings, she said. 

After that, it started a new AmeriCorps program called the National Health Corp Community Health Fellowship to recruit more community members for its digital navigators efforts. The org is also working on a digital resiliency project, after receiving $40,000 in funding from the city’s Digital Literacy Alliance last year. 

In an ideal world, there would be more orgs with a dedicated person doing digital health navigation work, Hainsworth said. But hiring that person can be extremely cost prohibitive, so it’s important to help organizations understand the value of this work and find ways to weave it into what they already do. 

“Finding ways that existing staff can provide dedicated digital health navigation support to their clients to help bridge that digital divide,” she said, “help close that for patients in Philadelphia.” 

Digital literacy has positive health impacts all around

Digital inclusion is considered a social determinant of health, a non-medical factor that influences health outcomes, Sheon from Public Health Innovators said. Other examples are income, access to food sources and education level, which can all contribute to health disparities — and lack of digital access just further compounds that. 

“[Digital inclusion is] increasingly essential for enabling all of the other social determinants of health to be addressed,” she said. 

Sometimes, however, it’s about designing systems that are more inclusive and easy to use and not just helping people learn to use the existing technology, Fink Yates from OIT, said. 

Developers need to think about the people who don’t speak English as a first language, have a disability or don’t have reliable access to the internet, for example. 

The good news is that there’s momentum behind the movement and stakeholders are showing interest in making these programs sustainable, Fink Yates said. 

“I don’t think any healthcare system thinks that virtual or telehealth appointments are going away,” Fink Yates said. “It’s just a matter of, who is it best for, when is it best, and how is it best used to get the most desirable health outcomes for a patient.”