Over the past few years, we have seen an increase in technology-based approaches to improving maternal outcomes and the birth journey. Although most women still have in-person visits to check the progress of their pregnancy, give birth, or check in after giving birth, technology can expand the reach of health services.
Digital solutions, including remote patient monitoring, mobile health apps and telehealth visits, can facilitate continuous communication between expectant and new mothers and their care teams. They can also provide a sense of comfort and security that is much needed during this period of life.
As hospitals and health systems increase their use of technology, it’s important to remember that not all patients have access to digital solutions. There are many barriers to access – including a lack of broadband or internet at high enough speeds to support these solutions. According to the Federal Communications Commission, 21 million Americans do not have access to broadband Internet; 42 million cannot afford to buy it. Also, many people still don’t own smartphones. The Pew Research Center reports that 14% of people living in rural areas own a cell phone but not a smartphone.
Even with access to technology, digital literacy – the ability to use, process and understand technology – can be a barrier to access. For example, people may face language or cultural barriers necessary to engage with digital solutions.
At Becker’s Healthcare Conference, I had the opportunity to discuss digital solutions and the work that needs to be done to improve equity in digital healthcare with two healthcare leaders – Alyssa Jackson, MD, CommonSpirit Health’s System Vice President of Innovation and Policy of Population Health, and Christina Yarrington, MD, director of delivery and director of the Division of Maternal Fetal Medicine at Boston Medical Center.
During this conversation, they each shared how their hospitals are using digital solutions to improve perinatal outcomes. They also shared how they select, implement and evaluate these solutions to ensure that all their patients have access to them.
Here are a few ways Jackson and Yarrington suggested we improve equity in digital health and ensure all mothers and their families have access to these digital solutions:
- Apply health equity lenses and be intentionally inclusive. Advancing health equity is not something you can just check off your checklist. This is a commitment that healthcare organizations and their technology partners must build into all of their strategic efforts. Before investing in a digital solution, initial conversations with digital solution providers should be viewed through the lens of health capital. “We are evaluating solutions for levels of accessibility and health literacy and whether their data collection capability includes the ability to stratify data by race, ethnicity, language and gender,” shared Jackson.
- Use simpler and more cost-effective approaches, based on your served community. One way to improve access is to bring the technology directly to patients. For example, Boston Medical Center partnered with Rimidi to provide blood pressure cuffs and a QR code to at-risk postpartum mothers to monitor their hypertension remotely, every day for six weeks. Instructions for using the cuff and submitting blood pressure results to the web portal are provided in three languages. However, Yarrington noted, “We can give patients the device, but we also have to anticipate any barriers to using it. Smartphone users may not have a data plan that supports video conferencing, or struggle with constant Wi-Fi access to communicate with their providers. To address this concern, BMC chose Rimidi because it operates on a local cellular network and its web portal is staffed by high-risk midwifery nurses who provide triage services and additional support. BMC’s program has been credited with significantly reducing readmission rates for high-risk postpartum mothers with hypertension.
Also, having a mobile phone does not mean you have access to virtual platforms. Text messaging, a common service available on all phones now, can become a cost-effective, two-way, multilingual way to reach and communicate with patients. CommonSpirit uses Docent’s Get Well digital patient navigation solution because it provides a text-based platform to connect mothers and their families with a “docent” who offers patient navigation services during and after pregnancy.
- Engage diverse patients to improve digital health literacy and individualize care. Hospitals can partner with community-based organizations, women in their community, and diverse voices of underrepresented patients, communities, and providers to assess whether these digital solutions are easily accessible and understood by all types of patients and communities. For example, health organizations and their technical partners can reach out to mothers with low health literacy to understand their communication preferences and tailor services to meet their needs and build trust.
- Track patient engagement with digital tools to measure success and assess scalability. Measuring how well patients respond and engage with a digital solution is a critical step in enabling access and scaling it across a larger footprint. In 2021, Boston Medical Center analyzed data on the first 1,000 people enrolled in its program and found that 98.7% submitted at least one blood pressure reading and received more than 17 unique readings from enrolled patients each day. At CommonSpirit, engagement rates for its multifaceted services with the Docent Health platform are 65% across all ethnicities, with the highest 73% in Hispanic communities. Jackson attributes this high utilization to his ability to offer services in the language and dialect preferred and spoken by patients.
As hospitals and healthcare systems explore technology-based services, it will remain important to meet patients and individuals not only where they are, but where they want to be. This will help ensure that every individual has equal opportunities to access and use digital solutions. To learn more about other digital solutions in perinatal care, listen to the AHA podcast series Seven in Seven: Digital Solutions for Perinatal Care.
Are you investing in digital solutions to improve maternal digital healthcare? Email Aisha Syeda at [email protected] and share your journey.
Priya Bhatia, JD, MHSA, serves as AHA’s vice president of strategic initiatives.