Health care policy proposals tend to aim at three major goals: improving quality of care, enhancing access to care and containing health care cost. Many experts believe progress toward one of these goals requires a tradeoff, with sacrifices for the other goals. For example, providing access to health care for more people may only be possible by either increasing health care cost or through cuts in the quality of care.
But increasingly, innovations in applying information technology to digital health make it possible to progress toward several of these goals at the same time, without tradeoffs.
As an example, for many Americans, it is now possible to electronically schedule a doctor’s appointment. Electronic scheduling may lower the cost of health care by saving time for registration staff. It may also improve access to health care by offering another option for scheduling appointments. And, electronic scheduling could improve the quality of care by reducing the waiting period before a patient goes to an appointment.
Similar examples of potential benefits are widespread. For example, the Covid-19 crisis has resulted in a rapid increase in the use of telehealth, which involves providers and patients interacting online. Research studies frequently report examples where the application of information technology has led to treatment/clinical benefits, monetary savings, enhancement of programs for prevention and patient education and improvements in data sharing between providers (Wise 2016).
Of course, if information technology is done poorly it may have negative effects in all three areas: higher cost, lower quality and poorer access. But over time the U.S. health care sector is becoming more adept at designing, implementing and operating IT to provide a range of services through digital health.
So is information technology the answer to help reach all three goals of access, cost and quality? Certainly digital health has the potential to help, but there can be barriers because access to IT is less available to certain sectors of society. This issue is referred to as the “digital divide.”
The digital divide greatly impacts use of digital health care services. The problem of the digital divide goes beyond physical access to computers and the internet. Depending on the specific situation, use of digital services (of any type) may also be influenced by factors such as an individual’s age, income, education, literacy, disability, health status and social relationships.
For example, in a study using nationwide U.S. data Mahmood et al (2019) found that individuals who had a usual source of health care were about three times more likely to have access to the types of digital services which are linked to electronic health records (appointment scheduling, online lab results, prescription refills, etc).
Unfortunately, many of the groups that tend to be on the underserved side of the digital divide are also the groups that most often face disparities in the access to other medical services, for example because of lack of insurance. These same groups can also be those with the highest rates of medical problems, and who therefore have a greater need for care. As a result, there is a danger that due to the digital divide those Americans who most need care, and those Americans who have the most trouble accessing care, will also be reached less often by digital health.
Consequently, the design and implementation of digital health services should recognize that Americans’ ability to access digital services ranges from very high levels to very low levels. Clearly those individuals with the least of these abilities should get particular attention. If done well, digital health could most benefit those Americans who face the greatest barriers of cost, access and quality.