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The Digital Divide and Age?

May 27, 2014
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I recently read an article entitled “Are EHRs creating a digital divide for the elderly?” on FierceHealthIT’s Breaking News web mail by Susan D. Hall.  The article references a study in the JAMA Internal Medicine that researched computer usage amongst a sample of 19,000 Americans who were at least 65 years old and who did not live in nursing homes.  The reported usage of the internet doubled from 21 percent in 2002 to 42 percent in 2010.  Usage among people with physical impairments have more difficulty using the internet and patient portals to view their health data.  The premise is that this has implications for the patient engagement requirement of Stage 2 Meaningful Use.

Over the long Memorial Day weekend, two other incidents reinforced the concern.  A neighbor’s daughter broke her elbow on the school playground.  The parents returned from the hospital with hard copy images of the before and after, as the multiple break required surgery and four pins.  In the past, I would venture to guess they might have been shown the X-Rays, but they would never have been given hard copy.  This couple happens to be in their thirties, and is digitally savvy. 

Contrast that with a 75-year old relative with a smart phone that did not know about the Bluetooth capability in their car!  Talking them through setting up Bluetooth in their car was like a child discovering a new toy on Christmas!  I wouldn’t describe this person as being digitally illiterate – just challenged by all the technology. 

The net of these experiences?  It reinforces the challenge of demanding an electronic healthcare environment on all age groups.  To the technically savvy, it seems only natural, and in twenty years, no one will give it a thought.  But today’s older generations, the ones with the highest demand on healthcare services, the digital age is a tough sell. 

Would I welcome the opportunity to schedule healthcare services and receive all my medical records electronically?  You bet!  And, my provider is almost there.  But then again, I recognize that at my age that I am the exception.  What do you do with the Generation X’ers who don’t own a computer or a smartphone, let alone even have an email address?  Is it realistic to support the previous manual environment along with the digital one for the foreseeable future?  Isn’t this really increasing the cost of healthcare?  So what should healthcare providers do?

It seems to me that there are bridging technologies that could be employed.  For example, today I already get automated phone calls reminding me of my appointments.  Would it be a stretch to get an automated call with a summary of my test results?  Clearly, it would be preferable for the doctor to make a personal call, but aren’t they already busy enough?  However, an automated call using text to speech might be an alternative.

Similarly, if I have computer access I can easily see diagnostic exam results such as an X-Ray or CT exam, perhaps even with radiologist annotations.  Alternatively, why wouldn’t it be possible to print the images and send them with an explanation through the mail for those who don’t have internet access?

It seems to me that healthcare providers will have to be creative in finding alternatives to transition from the digitally illiterate to the digitally literate base of patients to make further technology investments worthwhile in these transition years.  Maybe healthcare providers could take a page from Amazon, and other consumer-oriented companies to enhance the delivery of healthcare.  Amazon seems to have the delivery mechanism down pat, in that I can order something today and have it delivered in some cases overnight.  Why couldn’t the same be true for diagnostic results? 

I personally think this is one of the greatest challenges facing healthcare providers today – how to hold costs down and transition from today’s manual to tomorrow’s digital environment.  I’m looking forward to watching the evolution.



It's easy to neglect the "real" seniors aged 75+, 85+ and 95+, because too often market researchers quit segmenting the market at "65+". I noticed first hand the disturbingly low tech adoption rates among this older demographic when doing a presentation at a large assisted living facility in Austin.

The talk was on “Moore’s Law and the Future of Healthcare,” and it looked 30-40 years into the future through the lens of a technologist. All of my examples would likely occur in my lifetime (I’m 65) but probably not in theirs. Still, the audience was very engaged and interested. But there were some surprising and disappointing observations. Fist was that no one there used the Internet or owned a PC, tablet or smartphone. So, there was little chance that they would personally visit my website afterwards.

This group had never experienced Skype or FaceTime or even email to keep up with their adult children or grandchildren online. They didn't participate in e-banking, even though their Social Security checks were direct deposited. And, of course, they didn't benefit from telehealth.

I shared this experience at a Broadband Communities Summit in April, where I shared a panel with two gentlemen from the Good Samaritan Society. They showed a heart-warming video with testimonials of real seniors who had completed training in how to use the Internet and how it changed their lives. It's a MUST WATCH. (