Challenges and opportunities for technology use in safety net settings

by Courtney Lyles, PhD

As a health services researcher, I have been interested in ways to engage individuals with their health or healthcare management – particularly ways that fit into their everyday lives outside of the doctor’s office or hospital.  That’s why the buzz about health information technology seems so promising to me: the potential to provide practical and customizable information/feedback at the right moment.  In addition, the financial incentives are starting to align to promote health technologies.  With the rollout of federal healthcare reform in the past few years, it has become clear that technology will be a fundamental, not tangential, part of healthcare in the near future. 

Yet when I think about patients receiving care in safety net systems like SFGH, I see both opportunities and challenges during this transition to technology-enhanced healthcare.

Opportunities:

First, there is strong evidence that technology access has become widespread in the US across income and education levels.  85% of American adults are internet users.   Among lower income adults, 77% are Internet users including 32% who have accessed the Internet for free outside of their home, school, or work in the past year.

Second, there is a lot of evidence to suggest that all individuals regardless of healthcare setting are interested in accessing their personal electronic healthcare records.  About three-fourths of patients say that they would like to go online to view their medical record, and 60% want to communicate with their provider electronically.  This is very similar to the levels of interest we reported among our patient population at SFGH last year.  

Challenges:

While the overall digital divide is rapidly shrinking, the age gap remains a problem, especially given that many of our health technology solutions are geared toward helping those with healthcare need: that is, older adults with chronic illness.  For example, my 69 year-old parents, who can use email and Facebook with ease, have an extremely challenging time managing a plethora of usernames and passwords across multiple accounts to review their bank and credit card information.  The issue of age is amplified further by income,  with the largest disparities in technology use among older, low-income populations. Pulling a slide directly from that Pew Internet Research Project report (below), the disparities by age among low-income adults are striking.

Among low-income adults, only 25% aged 65+ had broadband Internet access or owned a smartphone, compared to 92% of young low-income adults.  

Second, we have not developed most health technologies in multiple languages.   In San Francisco in 2010, 45% of the population spoke a language other than English at home, suggesting we have a lot of linguistic access to manage in the coming years.  This discussion about language is, however, largely absent in the health information technology community.

These thoughts are just a few of the many opportunities and challenges that lie ahead of us as we transform healthcare.   I would love to hear your thoughts about the most important health technology topics that await us -- chime in using the comments box below or tweet me at @CourtneyRLyles.