A panel of physicians and technology experts asserted at Health 2.0’s Open Roundtable on the Underserved that low-income and vulnerable underserved populations are quickly becoming important consumers of healthcare information technology. Those thinking of creating the next big app should consider the underserved market.
Sarkar explains that the acceleration of health IT spurred by HITECH in 2009 incentivizes companies to do so. The Patient Protection and Affordable Care Act in 2014 will increase healthcare options for lower-income populations.
The underserved are also increasing demand for health IT options. Dr. Sarkar, a professor of Internal Medicine at UCSF, has found that 60% of San Francisco’s safety net clinic patients used e-mail and 71% were interested in electronic communication. As many as 19% even used e-mail informally with their providers.
The underserved face significant barriers with Internet technologies, says Sarkar. Health literacy can be a challenge for patients not proficient in speaking English, for instance. Additionally, there can be mistrust, privacy concerns, and cultural barriers that can lead to a lack of engagement. These can be solved, Sarkar notes, with a user-centered design to involve diverse patients and a participatory design to involve them at early stages.
“Everyone likes clear and simple explanations. If you take information and make it understandable to people with limited health literacy, you will make everyone happy,” noting that all users — not just the underserved — benefit.
“If you use the safety net as a test bed, it’ll likely work everywhere. Financially, culturally, diversity, all those add up to a lot of different factors that can throw any project off the rails,” adds Michael Aratow, MD, emergency physician at San Mateo Medical Center. “If you can make [your app or product] work there, you can make it work anywhere.”
Aratow runs a small hospital with 40,000 ED annual visits and a strong IT infrastructure. He recommends that for those vendors and developers who wish to engage with hospitals, there are 3 rules to follow:
- pilot tests should be free
- product managers should be present on both the hospital and vendor sides
- ethnographic research should be conducted
In addition to internists and emergency physicians, dermatologists are also interested in this space. David J. Wong, MD PhD, CEO of Direct Dermatology, runs a service in which users send photographs, along with a medical history, to dermatologists. The dermatologists then send back diagnoses and treatment recommendations. This also provides access to specialists for the underserved.
“The segment is large, with 50 million individuals,” Wong states. Such a large scale of patients could balance out the cost per user request to make the business viable.
Another unique area of opportunity is streamlining assessments and providing less expensive ways to provide healthcare. Aratow’s hospital uses computer-based testing for dementia to bypass more extensive clinical psychological tests. Julie Murchinson, Executive Director at Health Evolution Partners, sees a need for investment in solutions to triage people away from emergency rooms and to the right area of the healthcare system from the start.
“In the safety net,” concludes Murchinson, “because of potentially more complicated coordination & depth of clinical teams, triaging anyone to more specific parts of the delivery care is where we all need to be heading.”
Steven Chan, M.D., M.B.A., is a resident physician at the University of California, Davis Health System, researching mobile technology, psychiatry & human behavior. Steve previously worked as a software & web engineer & designer at Microsoft & UC Berkeley. Reach him at @StevenChanMD or www.stevenchanMD.com.