Ensuring accessibility: Crossing the digital divide in healthcare

“Rarely does the answer come from the boardroom” – what can user experience teach us about building accessible digital health?

No one should be left behind as the world embraces digital healthcare say leading user experience voices.

The experts discussed the benefits and merits of co-creation during a session on bridging the digital divide, held during the recent Patient Experience Digital Summit.

Kicking off the debate, Michael Crawford, Associate Dean for Strategy, Outreach, and Innovation at Howard University College of Medicine, highlighted figures from the Kellogg Foundation. Published in 2018, they said the US could increase its GDP by $8 trillion by 2050, by closing the equity gap.

“The report indicates that closing the gap means lessening, and ultimately eliminating, disparities and opportunity differentials that limit the human potential and economic contributions of people of colour.

“Further, it indicates that beyond the increase in economic output, advancing equity can translate into meaningful increases in consumer spending, federal and state and local taxes, and decreases in social services and spending and health related costs.”

Digital inclusion, or ensuring that all individuals and communities, including the most disadvantaged, have access to and use of information and communication technologies, is a crucial step on that journey, he said.

“It is arguably one of the most important issues of the 21st century, and the pandemic has merely amplified the need for a more digitally inclusive society.”

Human centred design and digital inclusion

Describing the importance of the mission, Regine Gilbert, User Experience Designer, Educator, and Author, at New York University’s Tandon School of Engineering, said it was hard to define inclusion.

“But we all know what exclusion is – we know what it's like when folks are left out. It’s about whether the experiences that we're creating are available to everyone,” she said.

There are, though, still significant challenges in providing that all-encompassing access.

“Half of America does not have high-speed internet,” she said, explaining that services and platforms were often built for systems that many people simply do not have access to.

Designers need to be aware of this, she said, adding that the pace of change in technology presenting another challenge: that of the ongoing education of users.

Toni Hightower, Human Centered Designer, Veterans Experience Office at the US Department of Veterans Affairs (VA), agreed.

She cited a lack of equipment as one of the major challenges in implementing telehealth services.

“There are bandwidth issues; there is issues around comfort with the technology and access to the technology,” she said, adding that the VA has overcome this by providing the hardware and tech support needed to ensure veterans could access their appointments.

Reflecting diversity

The panel also highlighted the crucial importance of ensuring service and experiences for the needs of the people who are using them. Again, this can be challenging.

The VA has a sprawling healthcare system, for example, serving people from across geographies, socioeconomic backgrounds, races, and ethnicities, as well as veterans with disabilities, health conditions, and language barriers.

Making sure their project teams reflect the diversity of the populations they serve is of paramount importance to the service, said Hightower.

“We bring them in upfront, do a lot of interviews, a lot of follow up, and lot of focus groups, and then make sure that they're with us, giving us feedback, all the way through prototyping and whatever we may design,” she said.

“I want to make sure they have the best experience possible, and that we identify and meet their needs upfront.”

Brian Wynne, Vice President of NRC Health, agreed, adding that once teams understood who they were designing for, they also needed to implement a feedback loop.

“You need some discipline around what we call intelligent design. You design, you ask, and you adapt, you deploy, and then you adapt again,” he said.

“That discipline keeps you tuned in and gives you some rigour around design for that individual.”

Inclusivity is the watchword, the panel said, agreeing that experience designers needed to include people from a diverse range of backgrounds and with a wide range of needs from the start.

Beyond the hardware

The process of co-creation is so important because digital exclusivity doesn’t start and end with hardware.

“There's also this emotional aspect to it, and each person brings their own biases and preferences to bear when they have an interaction with a healthcare provider,” said Wynne.

“When you think of the VA, the largest healthcare system in the world, you have millions and millions of people seeking care and consuming services.”

Developing a deep understanding of what is important to each of these individuals may seem a “large mountain to climb”, he said. It is, however, essential.

Said Wynne: “When we're talking about designing for what's best for an individual or for a population, rarely does the answer come from the boardroom.

“We're all healthcare consumers with unique needs, wants, preferences, and desires. I encourage people to stay disciplined on the idea of engaging with those individuals and asking them how you can best serve them.”

About the author

Amanda Barrell is a freelance health and medical education journalist, editor and copywriter. She has worked on projects for pharma, charities and agencies, and has written extensively for patients, healthcare professionals and the general public.