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.