The use of telehealth and mobile health technologies is booming. From diabetes apps to virtual visits on patient portals, technology is providing a cost-effective and convenient way for patients and healthcare providers to connect and work together towards the goal of better health.
Evidence from the Miami Project, which studied the use of patient portals and telehealth on low-income diabetes patients, show that telehealth is giving those who typically have more difficulty accessing healthcare (due to income or rural residence) increased access to health. However, I happened upon a study from Health Services Research recently, which uncovered some interesting insights into the “digital divide”. This survey compared telephone versus online responses to follow-up care surveys. These follow-up surveys are vital to treatment. Understanding the outcomes from various treatments gives healthcare providers information about treatment effectiveness and the burden of disease within a geography. These surveys will be vital to the growing number of HIEs and the outcomes tied to incentives under accountable care. However, the barriers to collecting this information are similar to the barriers to receiving treatment. It all comes down to access.
By way of comparison, typical mail surveys have a response rate of only roughly 25%. Telephone response rates are higher but more expensive for providers. Responses by phone have also been decreasing over time due to the pervasiveness of respondants screening calls for telemarketers. Just as patient portals have become a great alternative to in-person treatment, using portals to provide online surveys has become a great alternative to follow up assessment. The cost for these online services is often 1/6th the cost of traditional methods.
What the Survey Says
In this particular study, a follow-up interview was conducted 3 months after treatment. Those who provided an email address were sent an online survey. If they did not respond online, then these participants were contacted by telephone along with those that did not have access to email. Information regarding zip code, race/ethnicity, education level, and annual household income were reported. In the end, surveys were completed by 98.8% of respondents with email and 89.7% of respondents without email. Of those with email access, 67.9% were completed online and 32.1% completed the survey by phone after not responding to the email request.
With these facts in hand, it appears that providing an email option does increase access to care and important healthcare data. This highlights the fact that we all know and love: portals offer a low-cost option to connect to a large and growing patient population. However, the remainder of the survey results uncover a pretty significant digital divide. Those who completed the survey online were more likely to be Caucasian than those that completed the survey by telephone. Also, those without email access were more likely to be Hispanic. Those without email access had lower incomes, or were more likely to be unemployed, than those with email access. Had this survey been limited to web access, then this would have eliminated 36.1% of African Americans, 73.4% of Hispanics, 55.5% of those with only a high school education or less, 53.5% of respondents in the lowest income category, 29.1% of the unemployed, and 32.6% of those living in rural areas.
Ultimately, this study stresses that providing a combination of options for follow-up care provides a significant increase in response by patients at a significantly reduced cost. However, more traditional options must be maintained. Integrating these sources of information will continue to be increasingly important to enable information sharing and the usefulness of important healthcare data.
