What impact has
technology made
on access to
medical care?

All of the social determinants of health (SDOHs) are interconnected, with deficiencies in one often impacting another—which, in the context of healthcare and broadband, prompts the question: What impact has technology made on access to medical care?

In May 2017, the American Medical Informatics Association (AMIA) wrote a letter to the chairman of the Federal Communications Commission (FCC). This letter urged the chairman to consider broadband its own SDOH. What the AMIA was asking was that broadband be added to the existing list of factors that are "the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks," as defined by the U.S. Department of Health and Human Services. This would put broadband in the company of factors like access to education, economic stability and neighborhoods.

When it comes to the impact of technology in healthcare, it's not a simple question to answer, but it is valuable for healthcare leaders since broadband access will affect almost every aspect of your existing and future patient-focused initiatives, a relationship that will only deepen over time.

What impact has technology made on access to medical care? To understand the potential impact of technology in healthcare and increasing broadband access on healthcare outcomes, it's important to first understand disparities in care access. The United States has a pressing problem when it comes to lack of access to healthcare, and one that's multifaceted.

Americans often don't have a primary care provider (PCP), and the trend is worsening, according to Reuters. Between 2002 and 2015, the percentage of U.S. adults with a PCP dropped from 77% to 75%, representing a decrease of millions of people with a PCP. This lack of access to healthcare and a PCP means many people won't get recommended services, like preventive screenings.

One out of every 10 people in the country doesn't have health insurance, according to KFF. That fact impacts care since people without insurance are less likely to have a primary care provider.

But even those with insurance face hurdles. Black and Hispanic older adults are a little over twice as likely as white counterparts to not have supplemental private insurance, according to the National Center for Biotechnology Information, which may contribute to lower levels of office visits and higher levels of emergency room, inpatient and nursing home visits.

Even if patients have insurance, they might not be able to afford the services, medications or products needed to address health concerns. The Centers for Disease Control and Prevention (CDC) reports that 8.3% of Americans failed to obtain the medical care they needed because of cost issues.

Many Americans also live too far away from providers that offer the services they need, a trend that is common in rural areas but also affects urban spaces where people face barriers to transportation.

Layered on top of these issues are disparities in access to technology, specifically broadband, which, in turn, affects the impact of technology in healthcare.

As a part of the American Jobs Plan, the White House has included the goal of bringing "affordable, reliable, high-speed broadband to every American, including the more than 35 percent of rural Americans who lack access to broadband at minimally acceptable speeds."

This is critical, as questions like connectivity issues, literacy and disability affect access to broadband—facts that make up the concept of the "digital divide."

The digital divide is the gap between those who have the literacy, ability, attitudes, language familiarity and access to technologies that facilitate health outcomes and the people who don't, according to PatientEngagmentHIT. This gap trickles down into disparities in access to telehealth, appointment scheduling and portal adoption.

A study out of the Journal of the American Medical Informatics Association reports that, during COVID-19, Black patients were four times as likely as white patients to access the emergency department instead of telehealth during early surges. These factors don't exist in a vacuum. People with language barriers often have to recruit the time and effort of children and family to schedule appointments and fill out forms. Those without transportation often do the same.

Population health initiatives and their use of large amounts of data to identify and prioritize at-risk patient groups have been especially important during the pandemic. SDOH programs used electronic health record (EHR) data to track and report on patients that needed additional support, according to the Journal of Ahima.

A team launched wellness check-in initiatives designed to reach out to high-risk patients, according to the report. They identified 733 unique SDOH barriers for 486 customers—including food access, in-home assistance and transportation. They were able to resolve barriers for over 400 of them.