The Role of Human-Centered Design in Healthcare Innovation: a Digital Health Equity Case Study.

Healthcare delivery has become more complicated, particularly with the addition of digital tools and advanced technologies that can further exacerbate existing disparities. New approaches to solve complex, multi-faceted problems are needed. Human-centered design (HCD), also known as design thinking, is an innovative set of methods to develop solutions to these types of issues using collaborative, team-based, and empathetic approaches focused on end user experiences. Originally advanced in technology sectors, HCD has garnered growing attention in quality improvement, healthcare redesign, and public health and medical education. During the COVID-19 pandemic, our healthcare organization recognized notable differences in utilization of virtual (video-based) services among specific patient populations. In response, we mobilized, and using HCD, we collectively brainstormed ideas, rapidly developed prototypes, and iteratively adapted solutions to work toward addressing this digital divide and clinic and systems-level struggles with improving and maintaining digital health access. HCD approaches create a cohesive team-based structure that permits the dismantling of organizational hierarchies and departmental silos. Here we share lessons learned on implementing HCD into clinical care settings and how HCD can result in the development of site-specific, patient-centered innovations to address access disparities and to improve digital health equity.

Telehealth and the Digital Divide: Identifying Potential Care Gaps in Video Visit Use.

In recent years, telehealth visits have surged in response to the COVID-19 pandemic. However, existing structural inequities impact the access and use of information technology based on social and geographical characteristics, which is referred to as the digital divide. This has created disparities between patients with access to video visits vs. telephone visits. Previous telehealth research has focused on the completion of video visits. However, further research is needed to understand patients who decline video visits and rely on phone visits. We conducted semi-structured interviews (n = 13) of older patients (n = 9) and clinical support staff (n = 4) to understand the barriers in accessing virtual care. Most patients reported feeling left behind with telehealth, despite having access to a computer or smartphone. Clinical staff identified access to reliable technology and the ability for patients to navigate the technology as primary barriers to accessing virtual care. Many patients indicated an interest in video visits, but wanted low tech solutions and at-the-elbow support to build confidence with the technology.

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers.

Despite effective treatment for chronic hepatitis C, deficiencies in diagnosis and access to care preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record-based prompt on hepatitis C virus (HCV) screening rates in baby boomers in primary care and access to specialty care and treatment among those newly diagnosed. We implemented an electronic health record-based "best practice advisory" (BPA) that prompted primary care providers to perform HCV screening for patients seen in primary care clinic (1) born between 1945 and 1965, (2) who lacked a prior diagnosis of HCV infection, and (3) who lacked prior documented anti-HCV testing. The BPA had associated educational materials, order set, and streamlined access to specialty care for newly diagnosed patients. Pre-BPA and post-BPA screening rates were compared, and care of newly diagnosed patients was analyzed. In the 3 years prior to BPA implementation, 52,660 baby boomers were seen in primary care clinics and 28% were screened. HCV screening increased from 7.6% for patients with a primary care provider visit in the 6 months prior to BPA to 72% over the 1 year post-BPA. Of 53 newly diagnosed patients, all were referred for specialty care, 11 had advanced fibrosis or cirrhosis, 20 started treatment, and 9 achieved sustained virologic response thus far. CONCLUSION: Implementation of an electronic health record-based prompt increased HCV screening rates among baby boomers in primary care by 5-fold due to efficiency in determining needs for HCV screening and workflow design. Streamlined access to specialty care enabled patients with previously undiagnosed advanced disease to be cured. This intervention can be easily integrated into electronic health record systems to increase HCV diagnosis and linkage to care. (Hepatology 2017;66:1805-1813).

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Primary Care Physician Perspectives on Hepatitis C Management in the Era of Direct-Acting Antiviral Therapy.

BACKGROUND: Primary care physicians (PCPs) play a critical role in the care cascade for patients with chronic hepatitis C (CHC). AIM: To assess PCP knowledge and perspectives on CHC screening, diagnosis, referral, and treatment. METHODS: An anonymous survey was distributed to PCPs who participated in routine outpatient care at our hospital. RESULTS: Eighty (36 %) eligible PCPs completed the survey. More than half were females (60 %) aged 36-50 (55 %) from family (44 %) or internal (49 %) medicine. Overall, PCPs correctly identified high-risk populations for screening, though 19 % failed to identify baby boomers and 45 % failed to identify hemodialysis patients as populations to screen. Approximately half reported they were able to screen at risk patients <50 % of the time secondary to time constraints and difficulty assessing if patients had already been screened. 71 % of PCPs reported they refer all newly diagnosed patients to specialty care. 70 % of PCPs did not feel up to date with current treatment. The majority grossly underestimated efficacy, tolerability and ease of administration, and overestimated treatment duration. Only 9 % felt comfortable treating CHC, even those without cirrhosis. Practice patterns were influenced by specialty and Veterans Affairs Hospital affiliation. CONCLUSIONS: Although the majority of PCPs are up to date with CHC screening recommendations, few are able to routinely screen in practice. Most PCPs are not up to date with treatment and do not feel comfortable treating CHC. Interventions to overcome screening barriers and expand treatment into primary care settings are needed to maximize access to and use of curative therapies.