While there are some significant issues specific to provider adoption health IT to address the needs of the underserved, the issues for patient facing health IT applications are more complex. In part this is due to the fact that highly functional patient facing health IT applications such as PHRs and clinical messaging systems are so new and there are still many challenges associated with their adoption by the general population. It is also due to the vast diversity of personal and community characteristics included among the underserved and the difficulty of any one application to perfectly meet all of their needs. Finally, there are likely some hard limits to what patient facing health IT can accomplish in the face of structural barriers to improved health and health care for some segments of the underserved. These topics and others are elaborated below.
Language and health literacy. Several researchers and authors have noted the significant challenges associated with developing consumer-targeted materials on health and health care issues45. It is critical that these materials be comprehensive and accurate, while describing key concepts in terms that are digestible and well understood on the part of the intended audience. In some ways this information needs to be better understood than other materials that individuals may read, because they must understand the information well enough to feel comfortable taking direct action on the conclusions they draw. A Patient’s health or quality of life may be directly affected by their ability to take the right action at the right time. Developing audience-appropriate guidance on health care is difficult and costs are compounded when one considers the need to develop materials in a series of different languages or when targeting populations with low reading proficiency in any language.
Technology literacy. As noted earlier in this paper, there is some evidence to suggest that some groups within the underserved population have limited access to computers and the Internet. Even as access to these technologies expands as it has dramatically in recent years, proficiency with use of these applications is highly variable in several key populations. For example, even individuals who are comfortable using the Internet to browse specific sites to obtain information may not feel comfortable enough to interact with others online or conduct financial transactions online. While training is an important component of rolling out any new application, in the case of patient facing health IT, training often need to comprehensively cover all aspects of successful use of the application, from the question of where and how one can access a computer with Internet access, to the basics of using a computer and Internet browser to view and submit information to more detailed training on the specific components and features of the application.
Fear and stigma attached to health problems. One potential barrier to adoption of patient-facing health IT applications and use of the health care system in general may be the fear of learning about and acknowledging health problems, and relatedly, the stigma associated with having particular health conditions in some communities46. In these communities motivation for adoption of health IT and the very act of learning about health status and risk factors may be limited.
Structural issues barriers. While patient facing health IT applications can help empower patients by arming them with information relevant to the appropriate care and treatment, this information could be of limited usefulness if structural barriers prevent them from acting effectively in a manner consistent with the information they receive. Structural barriers that can prevent the benefits of having good information at the right time would include a dearth of health care providers for an uninsured or publicly insured individual, as well as the lack of public parks, bike paths and grocery stores in some communities to facilitate healthful living. While being armed with appropriate information from health IT can be tremendously useful to the underserved, its usefulness may be severely limited if structural barriers to health and health care prevent appropriate action.
Effective strategies for adoption. Finally, given individuals’ busy lives and the potential that health and health care issues may not be the most important priority for some underserved families who are struggling for economic survival, it is clear that if patient facing health IT applications are to bring significant benefits to underserved populations, concerted effort must be put into place to make these tools widely and freely available, to educate underserved populations regarding the benefits of taking advantage of these tools, and to offer providers incentives to cooperate the establishment of integrated applications that allow patient and provider coordination on health and health care issues.
Our examples also demonstrate the desirability of coupling patient facing health IT applications with other services that are of immediate day to day use to underserved individuals. For example, one of the rationales behind adding the feature of maintaining a picture ID as part of MiVIA was to motivate individuals who may not otherwise be interested in signing up for a personal health care application to learn about and eventually begin using MiVIA.