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The ‘Digital Health Divide’

I’m writing this week about an aspect of digital health that is often referred to, but I think is totally misunderstood. I was prompted by an event I attended in Liverpool to launch their ECHAlliance Ecosystem. One of the speakers asked the audience, ‘How many people here have online access to their medical record?’ – one lady put her hand up. ‘How many people have online access to their bank account?’ – the whole room put their hand up.

The Real Digital Divide

Usually when people talk about the ‘digital divide’ they’re referring to the notion that lack of internet and mobile access is a major barrier to the deployment of digital and mHealth, and furthermore we shouldn’t launch any digital services until 100% of the population is online.

This strikes me as one of the worst cases of the tail wagging the dog. I think the real digital divide is that I am disenfranchised from access to health services because the only way I could really access those services is via digital. Here’s my story:

  1. If I want to make a doctor’s appointment, the only way I can do it is by calling my doctor’s surgery at 8am Monday-Friday. They have two very nice receptionists who get bombarded with calls and you basically just have to keep trying until you get through – this usually takes half an hour. If I do get through this process, I get granted a timeslot of the surgery’s choosing, and appointments are only available 8.30am – 6pm Monday-Friday with very limited Saturday morning surgeries. If I was on the move, or at work, there would be no chance of doing any of this, so it all means time off work.
  2. I have no means of electronic communication with my doctor other than the ability to order repeat prescriptions online – and then I still have to go and collect the paper script myself and walk to the pharmacy.
  3. I cannot email my doctor’s surgery to ask for an appointment or if test results are ready, let alone see those test results.
  4. I cannot have a remote consultation with my doctor, even though I work and am frequently travelling. Once or twice my doctor has called me on the phone to discuss something, but only at a time of his choosing. If I’m in a meeting and can’t answer, tough luck.
  5. I cannot see any of my patient records, so no chance to a) check they’re correct b) use them for insights that may help me stay healthier. More insidiously, if I wanted to apply for insurance (life, travel, medical), I would be required to regurgitate my medical history purely from memory – and if I make a mistake guess what, my insurer immediately invalidates my insurance.

Bottom line – I am excluded from normal healthcare, even though I have lots of technology that could allow me convenient and cheap access. Let’s not forget that internet users are the majority here – in the UK it’s 83% of households (2013 figures, Office for National Statistics), in the US it’s 75% of households (2012 figures, US Census Bureau). That’s why I’ve been highlighting the work of leading clinicians such as Professor Shahid Ali and Dr Mohammad Jiva who stand out for their commitment to creating alternate channels to their services.

Time for Action

I’m definitely not saying that we should ignore those users who don’t have online access – but it seems to me they’re pretty well catered for already, I think it’s safe to assume that they’ll still be able to make their appointments in the traditional and only way open to them. But what about the rest of us? Other industries like banking, travel and retail have been delivering multi-channel access for years, so we know it’s all feasible – it’s simply time for healthcare to catch up. And without being too political, I also think it’s time for the majority of people to speak up and make sure that come election time, our elected representatives are putting digital citizen agendas into those manifestos.

So how committed are you? Do you want to join the ‘Digital Access’ party? Sign up below – or you can always contact me.

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