Bridging the Digital DIvide

by Dr Nick

This week I will be at the Medicine 2.0 Conference on a panel Bridging the Patient Digital Divide moderated by
Melody Smith Jones

and includes
Lauren Still

and
Nick Genes

The session was put together by Melody to take on the oft talked about but perhaps poorly understood “Digital Divide”. Patients spend less than 1% of their time with doctors – the balance of our time represents (lost) opportunity to interact with people helping them live fulfilling healthy lives and making the best possible choices.

On average, patients only spend 1% of their time in the clinical care setting.  Traditional medicine has focused upon patient engagement during that eight minute doctor visit.  Yet, it is the other 99% of the time, when patients are at home, at work, at school, and in their communities that matters most.  It is outreach to patients while they are living, working, and playing that determines how their overall wellness is managed.

We have seen a plethora of technologies that attempt to address this area with everything from diet and fitness apps to specific applications designed to address long term health issues.
But there is variability with access in the community to information technology preventing access and knowledge and skills necessary to derive the value from these tools. Melody has addressed this divide specifically focusing on apps doe Low-Income Mothers in her recent post: 3 High Health Apps for Low-Income Moms. Check out Melody’s top 3 picks for low income mothers – some great apps focusing on the Food stamps including clever use of Bar code scanning technology to check eligibility of food and the nutritional value and a novel use of simple text messaging to improve maternal and newborn health < ----- approach="" font="" love="" of="" simplicity="" the="" this="">

As she points out many of us make assumptions about accessibility to technology in lower social economic groups- as she puts it

Many make an assumption that those with low income or low education levels would not have mobile technology to use in the first place

But despite the budgetary restrictions we see a very high level of adoption of mobile technology – this is true worldwide as demonstrated by the statistics of mobile phone in the world: More People Have Cell Phones Than Toilets, U.N. Study Shows.

Out of the world’s estimated 7 billion people, 6 billion have access to mobile phones. Only 4.5 billion have access to working toilets.

In one of my personal areas of passion – Africa that is replete with examples of successful use of technology to impact the health of the population at levels that we can only dream of here in “the West”.  Here in this study: Text message reminders improve healthcare practice in rural Africa
and this piece in the Atlantic: Medicine by Text Message: Learning From the Developing World

It might seem counter intuitive to spend money on what some might consider a luxury or discretionary spend – but for some this is the only means of communication replacing the plain old telephone line (POTS) and these devices come with capabilities and a reach that was pervasively unavailable to many in our society. The statics suggest as many as 80% of low income consumers own a mobile device.

But despite this opportunity the technology and apps are often times targeted at the higher income who already have fitter healthier lifestyles. Some of this is because of the existing developer community (higher social economic group) who develop for the problems they perceive and the harsh economics – this is where the money is (or at least we think it is). Despite Malaria being such a big killer there is limited investment in prevention and treatment of the disease as it affects the poor nations with limited capacity to buy any solutions that are developed despite significant progress and the impact of World Malaria Day

This was covered eloquently by J.C. Herz at wired in this piece: Wearables Are Totally Failing the People Who Need Them Most. We are awash with wearables, new devices and new apps and buckling under a Tsunami of data but:

…developers continue flocking to a saturated market filled with hipster pet rocks, devices that gather reams of largely superficial information for young people whose health isn’t in question, or at risk. It’s a shame because the people who could most benefit from this technology—the old, the chronically ill, the poor—are being ignored. Indeed, companies seem more interested in helping the affluent and tech-savvy sculpt their abs and run 5Ks than navigating the labyrinthine world of the FDA, HIPAA, and the other alphabet soup bureaucracies.

There are some economic reasons for these current trends, some social aspects of the development community but these may be based on false belief of the economics when you consider the opportunity exists to shake up the $2 trillion annual cost of chronic disease….!
I’m with Kabir Kasagood, director of business development for Qualcomm Life who said

Go from the children’s table to the grown-up table…If you’re serious about this, embrace the FDA. Learn how HIPAA works… move away from fitness and go hardcore into health. That’s where the money is

Around 45% of US adults are dealing with at least on chronic condition and picking on one Diabetes and look at the market opportunity of $6.3 Billion spent on blood glucose strips gives you a sense of the economics of this market. These are motivated people for whom the quantified self can mean the difference between an (expensive) admission to hospital or managing and improving at home.

At some point, you’ve got to ask yourself whether it’s just the friction created by health-industry regulation—the HIPAA security rules and FDA approval (or waiver) process and the hassle of integration with legacy systems. Or is it too daunting for a twenty-something engineer to develop technology for people who aren’t like them at all? An obese diabetic on a motorized scooter? Or a frail old lady with memory loss? Or her caregiver? Someone who’s three bus transfers away from a doctor’s office? 

We plan to address these issues in our panel – if you can’t join us maybe you can join the conversation using the hash tag from the conference #Med2 here at Symplur


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