Coronavirus in Context: Bridging the Digital Divide in Health Care

[MUSIC PLAYING]

You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. With everyone staying at home using the internet, we often forget there still exists a digital divide, people who don't have access to broadband, to the internet, and how does that compromise their health? To help answer that question, I've asked Dr. Lisa Fitzpatrick, a physician and epidemiologist to join me. Dr. Fitzpatrick, thanks for joining me today. Hello. Thank you for having me.

You have this great thing that you do where you go on the street, and it's called Dr. Lisa on the Street, where you're trying to communicate about health topics. Tell me why.

I do that for a few reasons, foremost because my patients don't understand their bodies. They don't understand how to talk to doctors. And most of the time, they don't understand what we're saying to them.

And I learned this the hard way, because I, many years ago, probably dating back to 2008, I saw a woman who was referred to me for HIV, but she also had heart disease and high cholesterol. And I was talking to her about her diet, and she said, no one ever told me that the things I eat would increase my cholesterol.

And I-- I couldn't believe that. So from that point on, I started to quiz patients about what they understood about all the health information that had been communicated to them up to that-- up to that point when they saw me. And I-- I was humbled by the low health literacy, and I really wanted to do something about it.

So I realized people aren't really paying attention to the information on the internet, the pamphlets that we make for them. And I wanted to find a-- a more effective way to really hear from people and try to engage them with health information.

We've been talking a lot about telehealth during this pandemic, and how it's helping people who may not typically have access. Let's start with the positive. How is telehealth, telemedicine improving health in underserved communities?

This is a great question, and I appreciate you covering this topic. We submitted a survey at the beginning of the stay home measure here in Washington, DC, and asked people if they had access to telemedicine. We-- we've only had about 75 responses so far, mostly because we sent those out through Facebook channels and through some of our-- our community partners, and didn't expect the uptake to be that great.

But what we've learned is that 75% of those people had access to a doctor's visit, whether it was a phone call or a video visit. The video visits can become a bit more challenging because we also study what kind of services people have on their phones.

And although almost everybody, cell phone usage is-- or cell phone ownership is ubiquitous, but not everyone has access to a four-- at least a 4G network that has the strength and capacity to conduct a video visit. So I think there's definitely a disparity there. But people are open to video visits and televisits.

I want to read you a statistic I found that said in a 2020 broadband study, 42 million Americans do not have adequate access to broadband. So how does that impact particular communities?

Well, particularly in communities where you don't have the volume of providers or access to providers, particularly specialists, such as heart-- heart specialists or kidney specialists, I think this provides an access issue that create-- creates an-- and exacerbates disparities. Rural areas also, where you don't have access to, um, providers, and in some cases, even primary care.

So I think the challenge is if we don't have access to telehealth or telemedicine, um, technology so that people can access care, we're going to see an increase in these disparities, because people, they either give up or they think it's too hard to access a doctor. And the longer-- you know this. The longer people delay care, the sicker they become, and the more costly to-- to the health care system.

All right, so take out your magic wand. How do you fix it?

Well, I-- I believe-- I believe that internet should be a public utility. And, you know, I think with the expanding access to Wi-Fi in a lot of communities, particularly in urban areas, we are seeing increasing access to telemedicine for underserved, uh, populations. But I-- I also think we have to educate the community about telemedicine.

Remember cities, we're going to make free access to Wi-Fi. That didn't go as well as places wanted it to.

Right. So I think that it has to be coupled with, uh, the education about the service. But also, remember there is a lot of distrust in a lot of our underserved communities, and even some of our rural areas. And a perfect example is during this pandemic, I heard-- I heard many people talk about 5G exacerbating coronavirus infection, or helping to spread coronavirus infection.

So with that kind of misinformation about technology and distrust of tech-- technology, we really need to educate people and build trust to get them to use or at least try these tools. And I think if the messengers are trusted messengers, we can increase access and uptake of telemedicine tools in underserved communities.

Let's talk about the generational divide. You know, the young kids are always on their phones and tablets. And I don't even have the tech savviness that some of them do. Let's compare that to an elderly population, where the perception is they don't have the ability to use some of the services because they, you know, do not have as much experience with smartphones. Do you think that's true? Has that changed?

I think it's-- I think it's changing a lot. I think there are-- there are some misperceptions around usage and access to, uh, uh, ability to use these tech tools among the elderly, or among people, let's say, over the age of 60 or 65. Case in point, during the pandemic, I have been meeting via Zoom with a senior center here in Southeast.

These seniors have been prepared. They've been-- they have been very engaged to do all sorts of things by Zoom. Last week, they told me, Dr. Fitzpatrick, we are being-- we've been going around the world. We've been to all these countries, and it's all been on the internet.

So I think also, older people are also connecting to the internet because it keeps them connected to their families, particularly their grandchildren. And we haven't paid attention to-- to understand just the penetration, how much this has penetrated the-- the elderly population.

And my mother who's 75 years old lives in a retirement community. And she served as a computer monitor teaching pe-- her fellow residents how to use the computer. So I think it's-- it's not as bad as we think.

So some of it is education and some of them is-- is about getting people used to it. But what do we do in those communities that don't have access? How do we fix it there?

Well, this is a great question, too, because I think telemedicine, as much as we'd like it to, is not going to bridge all the-- the health divides we're seeing and address the disparities we're seeing. People still need to trust in the health care system. They still need to trust their health care providers.

And when we're out on the street, even during the pandemic, it's become painfully clear that the response needs to be out in the community where people are. So I think telemedicine can serve as an-- an-- an adjunct to reaching out to people. So there-- there needs to be the human element enabled or bolstered by-- by the tech tool.

And so tech is not the panacea or the answer. But again, you know, I started Grapevine Health because I know that there is a missed opportunity to reach underserved populations using technology, particularly related to health literacy and engagement in health care.

Where can viewers find more information about what you're doing?

People can find this on our website at grapevinehealth.co. Or we're on all the social media channels, Instagram, Facebook @GrapevineHealth and at-- on Twitter @HealthGrapevine.

Terrific. Dr. Fitzpatrick, I want to thank you for taking time to speak with us today.

Thank you very much.

And I want to thank you for watching Coronavirus in Context. I'm Dr. John Whyte.

[MUSIC PLAYING]