Digital health literacyShortly after the Coronavirus pandemic rise, Jefferson Health received funding to provide iPads and remote patient monitoring devices to patients across the enterprise. The funds were issued by the Federal Communications Commission (FCC) as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. They were intended to help health care centers expand their telehealth-related services during the pandemic. Kristin Rising, MD, MS, director of acute care transitions at Jefferson University Hospital, recognized the need for a digital health literacy program and noted that not everyone knows how to use digital health tools or feel comfortable with them.

A digital health literacy program would promote patient engagement through the use of mHealth devices. “People vary significantly in their degree of ‘digital readiness’ for using technology,” Rising said. “It didn’t feel right to provide patients with these devices without offering support to help them learn to use the devices to engage with telehealth services.”

Dr. Rising sought the expertise of long-time collaborator Rosie Frasso, PhD, program director of public health at the Jefferson College of Population Health, and together, they launched the Digital Onboarding Taskforce (DOT) in September 2020.

Drs. Rising and Frasso focused their efforts primarily on Jefferson’s northern division and worked closely with Steven Spencer, MD, MPH, and Lori Merkel, RN, PhD, to organize initial DOT tasks. Drs. Spencer and Merkel designed algorithms for patient selection and workflows to ensure equitable and efficient deployment that fully integrated the DOT’s services with each practice’s staff. “Our practices were inundated with managing increased volume and rapidly-changing care guidelines in addition to being short-staffed at times. The student DOT made this patient-focused initiative come to fruition,” says Dr. Spencer.

Jefferson’s practices realized that MPH students could fill the role of DOT members. “Public health professionals have to be nimble and ready to fill in gaps, meet new challenges, educate communities, create connections, and make things happen,” explained Frasso. “This is where our students came in. MPH students are required to do a clerkship where they apply what they’ve learned in the classroom to real-world health challenges. This [digital health literacy] project was just that.”

Digital Health Literacy Students

Amanda Guth, an MPH student, is one of over 30 medical and public health students who made up the initial members of the task force and served as the student leader of this digital health literacy project. She was responsible for setting up protocols for patient outreach and training students to serve as DOT ambassadors. “Under normal circumstances, we would have been able to do in-person training, but we had to navigate all of this over the phone and with limited patient contact,” explains Amanda. “We had to make the trainings really visual – ‘press the green button’ or ‘tap on the app with the blue square.’ While it can initially be frustrating for the patient, in the end, we’re empowering them by taking them through each step,” Guth continued.

Dr. Rising explained that patients’ requirements varied dramatically. Some were more than capable of completing the setup by themselves, while others were unfamiliar with the patient portal or how to connect to the Wi-Fi network; others just needed help resetting their passwords.

The program has helped highlight certain barriers to telemedicine, including trust, and there are still questions to be answered to ensure equitable access to telehealth. Questions such as “What impacts patients’ willingness to engage with technology? How do healthcare providers improve the trust in telehealth, particularly amongst vulnerable populations?” The digital health literacy project has confirmed that it is essential for health care providers to be proactive and determined in educating and empowering patients to interact with the virtual health care world.

Digital Health Literacy and Patients

The digital health literacy project has prepared patients for telemedicine and students for this new era in health care. “It has been a really valuable experience getting to know all the logistics involved and the small steps that we as future clinicians can take to ensure our patients feel comfortable using virtual care,” says Amanda. It has also had an impact on the patients during a time of social distancing: “We end up having little side conversations here and there, talking about random things,” said Guth. “Many of these patients are older and live by themselves or maybe see a caregiver once a day. I think they appreciate the human connection, and so do we.”

“We’ve gathered data on what patient needs are and where we can refine our process,” Rising said. “Our ultimate goal is to build this patient support system for telehealth into standard clinical operations, with a focus on improving overall digital readiness of patients — not just during the pandemic and for COVID-related concerns — but for their overall well-being.”

“Our healthcare system is due for some disruptive structural changes to improve the equitable access to high-quality care,” said Geoffrey Hayden, MD, an emergency physician at Jefferson who recently joined the DOT team to facilitate patient outreach. “Health technology definitely has the potential to level a playing field that has long been uneven and frankly unfair to some patients.”