Bridging the Digital Divide in Health Care: A New Framework for Equity

A new study published in December in JAMIA Open and led by Department of Health Policy researchers including Elham Hatef, MD, MPH, and Jonathan P. Weiner, DrPH, aims to address inequities in digital technology access by guiding the intentional integration of equity throughout the lifecycle of digital health care solutions. The Digital Health Care Equity Framework (DHEF), developed through a collaborative process involving a diverse panel of experts and supported by the U.S. Agency for Healthcare Research and Quality, marks a pivotal step toward ensuring that digital health tools benefit all communities equitably.

"The digital divide isn't just about internet access—it's about tailoring health care technologies to meet the diverse needs of every patient, regardless of their background," said Hatef. "This framework provides a systematic way to embed equity at every development and implementation phase."

Digital health care tools, ranging from telehealth platforms to wearable devices, have transformed patient care. Yet, according to the study, for many underserved populations, barriers such as limited broadband access, low digital literacy, and cultural mismatches in technology design exacerbate existing health disparities.

Studies show that racial, ethnic, and socioeconomic disparities hinder the equitable distribution and utilization of these technologies. The new framework seeks to address these gaps by offering a structured approach to assessing and improving equity in digital health care tools.

The framework was designed as a comprehensive tool to help stakeholders—health care developers, vendors, health systems, and policymakers—to intentionally assess and address equity across all stages of the digital health care lifecycle. These stages include: 

1. Planning and Development: Ensuring digital tools are designed with input from diverse communities. 
2. Acquisition: Evaluating the inclusivity and accessibility of technologies procured by health care providers. 
3. Implementation and Maintenance: Identifying barriers to use and adapting technologies to meet local needs. 
4. Monitoring and Equity Assessment: Measuring outcomes to ensure equitable benefits across all demographics. 

The framework was informed by a two-year research process and included a scoping literature review that analyzed 124 studies and existing frameworks, focusing on health equity and digital health care. Additionally, the study involved key informant interviews engaging thought leaders from diverse populations and geographies to understand challenges and opportunities, as well as a technical expert panel that gathered input from 31 national experts in digital health and equity. From there, the framework synthesized key domains such as patient characteristics, health system capabilities, and technology usability.

The framework emphasizes addressing "digital determinants of health," including infrastructure challenges like broadband access and individual barriers like digital literacy. It also highlights the importance of participatory design and community engagement to ensure tools are culturally and contextually relevant. For example, during the COVID-19 pandemic, many vaccination sign-ups relied heavily on internet access, disadvantaging individuals in rural or low-income areas. The framework would encourage systems to offer alternative methods, such as phone-based sign-ups, alongside digital tools.

One of the framework's unique aspects is its emphasis on collaboration among diverse stakeholders. Patients, caregivers, community leaders, and public health officials contribute to developing and refining digital health care solutions.