We need more physicians to invest in physician led solutions and companies. Docs want this but rarely invest in better solutions led by their own, they purchase the "less costly" product which doesn't solve their problems over the long term. Physicians have to value the input of a CMO or physician founder..

To garner trust, the healthcare industry must revisit how to become trustworthy. Like other social institutions, we have a history of many breaches of trust that have resulted in significant harm, particularly for people of color. We need to acknowledge that harm and partner differently, learning from and alongside people with lived experience of inequity (PWLE) as we transform to better meet their needs. PWLE can also help us identify metrics and measurement processes to understand progress in rebuilding trust.

Trissa, I completely agree we need to peel back the layers of institutionalization and understand more of the personal experiences before jumping to solutions. I'm curious what you've found from your work - are there any measurement processes or metrics that you've found can indicate how PWLE of inequity do/don't, are increasing/decreasing in their trust of the healthcare system? If we're trying to get to more personalized/humanized care, do surveys even scratch the surface? And if not, how can personalized stories be aggregated to identify trends in populations that we can better design for?

I think the best way to do this is to think about equity and access as part of your initials plans to roll out a new digital initiative. Part of the work that I lead involves custom development of applications for employees, patients, and visitors. When we build out our requirements, we try to think about strategies to be as inclusive as possible from an early stage. Additionally, I think taking regular feedback and adjusting and adding features to make solutions more accessible is another core component to consider adopting.

Finally, from our experience, there will likely be a small percentage of your targeted population that will be unable to utilize a digital solution. Acknowledging this early on and creating a non-digital solution to address this population should also be part of any digital technology rollout plan.

The way I think about equity is similar to how we practice medicine. We design and implement individualized care plans to fit the needs, goals and preferences of patients. In digital health terms we need to build and design care around the patients based on their needs, skills, resources, infrastructure, and preferences. Creating cookie cutter digital health solution will lead to failure and further inequities. Internet access should be a essential service and should be available to everyone.

I think it's important to start by recognizing that digital readiness disparities reflect and reinforce existing disparities and social injustices. Most profound is digital redlining that has reduced affordable broadband access to urban populations, many of who are poor or are racial or ethnic minorities.

NODE.Health's annual digital medicine conference and Digital Medicine Foundations Course had great content on these questions.

Through my consulting practice, I use an integrated set of solutions with health system and tech clients including:
1) Tailor your solutions for different digital readiness barriers that patients face. Patient portals can be a great one-stop shop but the opportunities to facilitate equitable access have not been fully exploited (e.g. incorporating translation, transcription and dictation)
2) Monitor utilization equity for populations that face different barriers to digital health adoption
3) Partner with local digital inclusion organizations to address skill, equipment and connectivity gaps
4) Advocate for broadband equity
5) Use digital navigators to screen and refer patients to address gaps in digital health readiness. Take advantage of Emergency Broadband Benefit resources for devices and broadband subscriptions
6) Use digital health coaches to help digitally ready patients/customers use technology and/or engage family caregivers to help
7) Engage (and compensate) people who have been digitally marginalized in developing and deploying digital technology
8) Offer tech support that is prepared to address problems common to people with low digital literacy, older devices and poor connectivity

nodehealth.org/
digitalinclusion.org/
publichealthinnovators.com/

For an example of how practices can enable and engage patients skeptical of telemedicine who have high burdens in the area of SDOH, have a look at www.TEAMtelemed.net .

The healthcare delivery system can use our significant advocacy power to support policy change to assure equitable access to connectivity. In addition, healthcare systems can partner locally with community organizations and community members to problem solve together leveraging all community assets in service of increasing access.

Delivery of care at home is patient centric, high-value, and provides a wonderful experience for both patient/families/clinicians. Virtual care can be positioned to deliver medical oversight for acute/urgent/episodic care (Hospital-at-Home) or more comprehensive approach (virtual PCP). Workforce development to meet new alternative models of care and close partnerships with health systems and home care groups will be critical to success.

Home health in the traditional sense meant supportive care provided by a professional caregiver in the individual home. It comprises a range of activities, especially paramedical aid by nurses and assistance in daily living for ill, disabled, or elderly people but excluded higher acuity clinical care. Technology and digital health have changed the game. Now with digital health, its possible to organize care around patients rather than organize care around brick and mortar settings. The critical factors for providing excellent health at home include progressive leadership, a financial model which supports well care rather than sick care, value-based care, innovative technology, and most importantly trained and willing patient-centric clinical workforce.

It's well documented that our technologies have emerged into point solutions that are beginning to show more and more of a positive impact but nevertheless siloed. A compelling home health experience though, is more driven by complementary solutions all integrated to depict a whole view of the environment and stakeholders that support care. And integration does not mean from a technical integration standpoint, but more from an orchestration of all aspect of a home that can impact care. This is the same in a provider environment, with unique complexities within the home environment to include community circumstances (influence of neighbors for example), floor plans, food resources and home care givers. In other words, the need for coordinated digital care is even more important in a less controlled environment of the home. It will also need to consider more and more, individual preferences given that the environment is less controlled, and therefor requires more coordination than less.

Critical to the success of creating a compelling home health experience is to co-design that experience with patients and families. Patients and families know best what works and doesn't work for them - what matters to them. Ask and listen. Be intentional to center the voices of those historically marginalized or risk worsening inequities.

Health system delivery will continue to move out-of-hospital with on-demand digital heath solutions to support personalized care at home. Digital health offerings will also support specialized care for particular populations with future development of more comprehensive care platforms.

Clinical integrations come in various flavors ranging from no integration to employment. A clinically integrated network (CIN) strikes the right balance between clinical coordination for patients between health systems and private practice. A successful CIN is built on a common digital health platform that can exchange data and leverage the clinical network bench strength of its partnering organizations. I predict the continued growth of CIN and other value-based mechanisms which will foster collaboration and alignment between private practices and health systems. Digital health is foundational to its functioning and integration

Specific to telehealth, despite a desire to want to continue using virtual care, 73.3% of clinician respondents indicated that no or low reimbursement will be a major challenge post-COVID if the current expansions do not remain. 50% of respondents indicating that 75% of patients being seen via telehealth were patients with which there was an existing patient-physician relationship. There is a desire to want to have this option continue. In addition, there are opportunities for technology and workflow improvements as we work towards optimized digitally enabled care....but the good news, is that there is tremendous progress and interest from both patients and physicians.

To build on what Meg said, the age of Covid has certainly been a driver in the increased interest in digital health tools and technologies from both the patient and practitioner/health system side. Interestingly, pre-Covid, many start-ups/companies were already developing technologies to address workflow inefficiencies and patient care challenges. Covid was an eye-opener for all of us, forcing us to think outside the box and rethink not only how we engage with and care for patients but also manage the unpredictable increases in workflow and sick patients. As a result, many of these digital health tools/technologies saw accelerated development paths and increased visibility and interest from potential end-users (health systems). Here in North Carolina, we certainly found ourselves engaging more with health systems as we assisted in connecting them to digital health accelerators and companies with technologies that met their specific needs.

A big challenge in the space is making sense of all the innovation in the market. While there has been a great deal of excellent innovation happening around care, there is too much complexity. There are over 350,000 mobile health apps available to consumers, with many geared to wellness along with a rise in digital therapeutics.
Employers and patients are blinded by this blizzard of point solutions and struggling with what to use and adopt. Navigators are arriving to help make sense, however this creates more friction for employers and employees and removed from the actual delivery of care.

COVID-19 spurred a dramatic increase in the adoption of telehealth. While widening adoption was initially seen as a temporary solution to challenges faced during the pandemic, many physicians and patients have experienced the value of delivering and receiving medicine virtually. Video visits, point-of-care home devices, sensors, remote care monitoring, and augmented intelligence (AI) tools integrated into in-person care delivery models create a new venue of care to enable the right care at the right time in the right setting delivered by the right modality. There is a significant gap in scientific knowledge and clinical and operational best practices, which I believe will be a big challenge in developing, adopting, scaling, payment, and building trust in digitally-enabled care models. Additionally, the lack of clinical workforce training is another big challenge.

With speed to delivery comes the need for more policing mechanisms to ensure no harm. Full speed ahead with digital adoption and acceleration, but where there is opportunity and speed - comes misuse and negligence. The business incentives related to digitally enabled care is still opaque, as well.

As with any improvement opportunity in health and healthcare, centering our efforts on what matters most to our patients and families is critical to success. Co-design and co-production with people with lived experience is essential. I advocate that we redesign the system for improved, equitable health outcomes and then redesign the flow of resources to best support the solutions - not the other way around!