Here in Detroit, the intersection of healthcare and technology is becoming a focal point of concern. The question at hand: Are Black Detroiters being left behind due to a lack of access to technology? As two new state-of-the-art healthcare facilities, the Henry Ford Health System and a groundbreaking center funded by Dan Gilbert, rise from the city’s skyline, the potential for a healthcare revolution looms. However, this progress may widen the existing chasm unless deliberate actions are taken to ensure inclusivity.
The Digital Divide in Healthcare
The digital divide in healthcare is a critical issue affecting Black Detroiters. Limited access to high-speed internet and digital services significantly impacts their ability to receive adequate healthcare. This digital disparity hinders access to telehealth services, electronic health records, and other digital tools vital for managing health. For instance, Black diabetic patients often struggle with managing their blood glucose levels due to economic barriers and the lack of coverage for continuous glucose monitoring devices. These devices, such as Dexcom and Lifestar, can significantly improve compliance and reduce complications, but they are often not covered by insurance, making them inaccessible to many.
Dr. Alicia Shelby, a practicing physician in Detroit, explains the challenges Black patients face: “Black patients are more likely to be uninsured or underinsured, impacting their ability to obtain necessary treatments. For example, one of the challenges/barriers to Black diabetic patients monitoring their blood glucose levels is the pain and repetition associated with pricking their fingers. However, there are several medical devices that continuously monitor the glucose levels of patients (Dexcom, Lifestar), but often are not covered by insurance or have high out-of-pocket costs. These devices would improve compliance and reduce complications associated with poorly controlled blood glucose levels.”
Dr. Latonya A. Riddle-Jones, an associate professor and healthcare leader at Wayne State University, shares her observations on disparities in access to healthcare technology among Black Detroiters: “Clinicians are required to use Electronic Health Records and Patient Portals. Patient portals were created with the intention of providing greater transparency to patients about their medical documentation and care. It’s a great idea, for those who have easy access! When we started rolling it out a few years ago, it seemed like a great idea. We had people sign up, which required their email address and/or phone number, then we realized that not everyone has an email address or continuous access to their email….and we realized that not everyone had the ability to receive text messages or could afford the fees associated with their text messaging services…and again we realized that not everyone has a phone or a mobile number! The people designing the systems were not representative of all of the people the system was designed to be used by. Big Problem! But, who can fix it?”
Preventing Technology from Becoming a Barrier
To prevent technology from becoming a new barrier in healthcare access, community-driven solutions are essential. Digital literacy programs and accessible telehealth services must be implemented to ensure that all residents can benefit from technological advancements in healthcare. Policy changes and investments in infrastructure are also necessary to bridge the digital divide. Without these measures, the gap in healthcare access and outcomes will continue to widen.
Dr. Shelby further emphasizes the importance of education and intervention: “One of the goals of the emerging non-profit, Shelby Health Equity Advocates, (I am executive director) is to bridge the gap in healthcare adversities and disparities through education, intervention, and innovative programming. We, as healthcare providers, have spent a vast amount of our careers learning the art of medicine, but who is educating our patients on how to be a patient? How to navigate the healthcare system? I pride myself on ensuring patients understand their plan of care, discharge instructions, and return to the ER precautions by reviewing the plan of care with patients and answering any questions prior to discharge. I will provide any resources available: social work, prescription assistance, low-cost clinics, or other resources available prior to discharge. It is imperative that Black patients are educated and have access to these tools and devices to decrease healthcare inequality.”
Understanding the Intersectionality of Healthcare and Technology
Technology has the potential to either bridge or widen gaps in healthcare access and outcomes. Experts highlight the benefits of integrating advanced technology in healthcare, such as telemedicine, electronic health records, and AI diagnostics. These tools can revolutionize healthcare delivery, but only if they are designed with cultural competence and consider the unique needs of Black communities. Culturally competent tech solutions are vital for ensuring that technology serves as a bridge rather than a barrier.
Dr. Shelby shares her efforts in ensuring her patients can utilize these technologies: “On several occasions, I have assisted patients in downloading the electronic medical record app (My Chart). Although my time is limited in the ER, this at least ensures there is some level of understanding of how to access the system. However, due to time constraints, it is often difficult in the ER versus in private practice, but I do my best. My motto is saving lives one patient at a time! If I have to be an IT tech, that’s part of my job as an ER physician, to do whatever is needed to save a life!!”
The Promise of New Healthcare Facilities
The new Henry Ford Health System and the Dan Gilbert-funded healthcare facility represent significant advancements in healthcare services in Detroit. These facilities promise to bring state-of-the-art services and programs that can improve health outcomes for Black residents. One notable program is the 72-bed physical medicine and rehabilitation facility for stroke patients at the Henry Ford campus. Given the disproportionate impact of stroke on Black people, this facility can play a crucial role in improving recovery and quality of life for affected patients.
Dr. Shelby speaks to the potential impact of these new facilities: “Black people have a higher risk of stroke and stroke-related death, with Black men 70% more likely to die from a stroke than non-Hispanic white men. Black women are twice as likely to die from a stroke than a non-Hispanic white woman (Office of Minority Health). One of the programs is a state-of-the-art 72-bed physical medicine and rehabilitation facility for stroke patients in Detroit on the Henry Ford campus. Given the disproportionate number of Black people affected by stroke, this facility in Detroit will help with the recovery and improved quality of life of patients affected by stroke.”
Addressing Bias in Medical Technologies
Addressing potential biases in medical technologies is another critical aspect of ensuring fair and effective healthcare for Black patients. Dr. Shelby points out that until recently, different calculations for kidney function were used based on a patient’s race, leading to misdiagnoses and delayed treatment for Black patients. Advocacy from medical organizations led to the removal of this biased calculation, highlighting the importance of representation in research and technology development.
Dr. Shelby elaborates on the significance of these changes: “Until recently, there were different calculations for kidney function based on whether a patient was Black or not! This was only recently removed after several years of advocacy from various medical organizations. Race was used to estimate a person’s estimated glomerular filtration rate (eGFR) until 2022. This miscalculation led to missed or late diagnosis of kidney disease as well as Black patients not being on the kidney transplant list. The earlier kidney disease is detected, the better the chance of managing it or keeping the condition from getting worse.”
The Importance of DEI in Bridging the Divide
The commitment to Diversity, Equity, and Inclusion (DEI) is paramount in addressing the digital divide and ensuring equitable healthcare access. Dr. Riddle-Jones, who also serves as the Associate Center Director for DEI at Karmanos Cancer Institute, emphasizes that DEI initiatives are essential for creating a healthcare system that serves all patients fairly. “We are working with colleagues who understand this across the nation and collaborating on best practices for all of the communities that we serve. We are changing the way that we have traditionally done research and community engagement so that we know the best way to serve our patients.”
Dr. Riddle-Jones highlights the need for better training on cultural competence and equity, particularly in using healthcare technology: “This training is needed, even in the environments that I work in. We look to national programs from the NIH, HRSA, local universities and healthcare systems, if available. What we are finding is that we have to create the training for our institutions ourselves because it is not readily available or tailored to the populations that we serve.”
The story of Detroit is one of resilience and innovation, but the scars of systemic racism and economic disparity remain. As the city embarks on a new era of healthcare innovation, it is crucial to ensure that Black Detroiters are not left behind. This narrative delves into the complexities of technological advancement in healthcare and the imperative of equity, blending personal stories, expert insights, and actionable solutions to provide a comprehensive view of the challenges and opportunities ahead.
Bridging the digital divide in healthcare is essential for ensuring equitable access and outcomes for Black Detroiters. Community-driven solutions, policy changes, and investments in infrastructure are necessary to address the disparities in digital literacy and internet access. Culturally competent tech solutions and the inclusion of Black healthcare providers in technology development are vital for ensuring that technology serves as a bridge rather than a barrier. The new healthcare facilities in Detroit hold promise for advancing healthcare services, but deliberate actions must be taken to ensure that progress benefits all residents. By addressing these challenges head-on and incorporating DEI principles, Detroit can lead the way in creating a more inclusive and equitable healthcare system for all.
This story is part of the Digital Equity Local Voices Fellowship Lab. The Lab initiative is made possible with support from Comcast NBCUniversal.
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