Who are we?

Posted | Posted in Opinion

So – what is this whole, “digital health in medically underserved populations” thing, anyway?

Let’s start in 2000, when President Bill Clinton mentioned the “digital divide” in his State of the Union. Back then, YouTube wasn’t even a word, Gmail had not blown our collective minds, and they sold things like “computer desks” that had specially designed shelf space for your computer tower. I know. It was crazy.

The digital divide to which President Clinton referred were differences in access to computing technologies (home computing, infrastructure in schools). At the time, rates of computer ownership, Internet access, and computer literacy varied by a host of sociodemographic characteristics (e.g., socioeconomic status, race/ethnicity, geographic location). He was concerned that unequal access to technology and high-tech skills by income, educational level, race, and geography could “deepen and reinforce the divisions that exist within American society.”  It certainly could have.

However, during the past decade, we have witnessed dramatic changes in the information technology landscape. Simply put, the global digital divide looks nothing like it did over a decade ago. While historically disconnected populations remain less likely to own desktop computers and to have broadband connectivity, the picture changes dramatically when mobile access is considered. Many previously disconnected populations now have higher rates of laptop computer and mobile phone ownership than do their more advantaged counterparts. Indeed, in several studies, disparities in Internet access disappear when mobile access is considered. According to recent Pew Research Center data, low income populations in the United States are more likely than the advantaged to use their mobile phones to access the Internet. They’re also almost as likely as their higher income counterparts to send text messages (78% vs. 89%) and use mobile apps (41% vs. 50%). We expect that in the next 5 years, these differences will all but disappear.

Digital health has evolved along with advances in both technology and health. Called by many (many many) different names, the term digital health refers to the “space at the intersection of healthcare and technology; and not solely in medicine, but across healthcare, including wellness and administration” (that’s Rock Health’s definition and we like it). For our (mostly research) purposes, we include terms like mHealth, eHealth under this digital health umbrella. The term “digital health,” then, encompasses the universe of technology-based advances to the health system, from consumers and patients, to providers, to entire health systems. Development and investments in electronic health records starting 11 years ago provided hospitals and healthcare providers a wealth of automatically collected data. Data right there, just hanging out, being collected and stored as practitioners went about their business, waiting to be leveraged. t also expanded the box within which providers could think in terms of connecting with and giving care to their patients. Instead of a front desk administrative assistant spending hours making reminder calls to patients, a real-time automated call or email system does it. Instead of having to request medical records, patients can log into portals and see their results as soon as they are ready.

On the consumer side, a plethora of fitness tracking hardware can, for the low low price of at least $100, turn the everyday wo/man interested in getting exercise into a data scientist. New devices can make your smartphone a blood pressure monitor, your contact lenses double as glucose monitors, and even give you a tattoo that just also happens to include your medical records (which leads me to the natural question, does it have to be a tribal design?)

Remember a few paragraphs ago when we told you that there was no digital divide?

You can’t have already forgotten that, we literally just covered it.

Well in case you need a refresher, there’s no digital divide.

Except…There absolutely IS a digital health divide.


I know.

Take a sec.

Ready? Ok. Here’s what it is:

The great revolutions in healthcare quality and access that happened because of advances in technology take place mostly in private hospitals, or in/near university settings or places like Silicon Valley or New York City. This revolution is not reaching the medically vulnerable at the same speeds as their better connected counterparts.

Who are the medically vulnerable? In the US, they reside in the poorest areas of cities, or in rural areas. They are [mostly] white, Black, and Latino. They qualify for Medicaid, or make just enough not to qualify for Medicaid, but they are unable to afford health insurance. They often seek health care at community health centers. As a function of where they were born, their income, race or ethnicity, and their education level, the medically vulnerable  are at higher risk for chronic conditions like obesity, hypertension, type 2 diabetes, asthma, and infectious diseases like HIV.

As recently as 2010, a survey run by Pew Internet and American Life found that only about half of households in rural areas have internet access at home. Since most of these people live in areas where there is less broadband coverage and they don’t have the financial resources or type of job where they work with computers, they depend on mobile phones and cellular networks to access the internet. This means that they are less able and less likely to take advantage of the promise of digital health because they are less likely to log into a health provider’s website to view medical records or to make an appointment, probably can’t afford a fitness tracker and, if they do invest in one, may not be able to access what they need to follow the tracker’s advice (take a walk in a safe place after work, for example).

Without intervention, the digital health revolution will continue to favor those in the highest income areas with the most advanced infrastructure & access. In contrast, those who are at highest risk of chronic disease, those whom the health system spends the most money, will struggle to keep up. So what can we do about this?

…Well, for a start, you’ve come to the right place. We’re the Duke Global Digital Health Science Center! You can call us Duke Digital Health for short. We believe that digital health can help people change their health behaviors for the better, no matter their education level or income. We believe that there’s a market for low-cost, effective digital health interventions. We specialize in designing and adapting technology-based interventions for low-income, medically vulnerable populations. Digital health needs science, and the most vulnerable in our society need digital health. With a special focus on prevention and a passion for designing platforms as opposed to single use solutions, we keep up with the latest in industry to push the science and policy forward. With a robust and diverse research portfolio, we design and test behavior change interventions that are largely automated, fully tailored, and easily adaptable. We publish a bi-monthly digital health science roundup of relevant policy developments, research studies, and industry advances. We work domestically and globally with partners both inside and outside of academia to continue the conversation and set research and policy agendas for digital health. We are Duke Digital Health.