COVID-19 has highlighted over and over again how underprepared our country and global community were to battle a pandemic. Misinformation was rampant, our healthcare systems were overwhelmed, and testing was severely lacking. As we transition back into a more “normal” society, we must focus on what we can do to improve responses in the future. I believe developing our digital health infrastructure will play a key role in reshaping our emergency preparedness plans as a nation.
The necessity of access
Our access to health news and the most updated guidelines are tied directly to the internet. In emergency times, when social distancing and “stay-at-home” orders are high, we have turned to technology as our source of information. According to research, about half of Americans receive their vaccine news from social media (1). More so than ever, news, information, and updates have been delivered via the digital world. But what happens to the 22.5% of households without internet access, the 8% without a computer, and 16% without access to a smartphone (2,3)? For those without digital access, while the nation is socially distant, where do they learn about emergency alerts, new mask mandates, or vaccine policy announcements?
To ensure compliance with public health guidelines and a unified nationwide emergency response, there needs to be a population base with access to the correct information in a timely manner. Even outside of contagious disease, the internet and smartphones are used to transmit other forms of emergency response information such as tornado or hurricane warnings. The biggest tool we have at our disposal in preparing for a national emergency is technology. With social media, the internet, and various other platforms, we have the ability to arm many citizens with quick, uniform knowledge on how to protect themselves and families. For example, it was well within our limits to “flatten the curve” and prevent our health systems from becoming overwhelmed if people properly adhered to health guidelines. However, to properly adhere, we need everyone to have access to the information. Furthermore, during emergencies, the daily activities of life have become more dependent on technology as well. COVID-19 has forced the rapid adaptation to social distancing (e.g. Telehealth, online school). These innovations are certainly powerful and allow more flexibility to patients who have the technological means to access these programs. However, we as a nation cannot continue to marginalize those without the means to use these programs. Telehealth, for example, is used significantly less frequently in areas where there are larger populations of non-English-speakers and people with lower household incomes (4). Certainly, the infrastructure bill’s expansion of broadband access is progress, but we must continue to build towards increasing access. The internet has become a vital way to help citizens be more prepared for emergencies, but in order to do so equitably, digital infrastructure needs to be provided to all households so everyone has access to this information rapidly, not just those with the means to acquire high-speed, reliable internet services.
Proper Education of the workforce
On the other side of the digital patient-provider relationship in emergency preparedness is the necessity for providers to fully understand and utilize electronic health records (EHRs) and Telehealth, specifically for tracking national data. Today, EHRs are the top cause of physician burnout, and a transition to reliance on Telehealth services has compounded this (5). In a pandemic or national emergency, EHR health informatics are essential to supporting therapeutic treatments and facilitating care. However, high patient volumes and an increased demand to record necessary tracking information worsen stress.
For example, electronic case reports (eCR) are an added burden of sending the correct information to the CDC on COVID-19 positive patients. Recording information, whether it be EHRs or eCRs, is vital to understanding a pandemic and planning for its trajectory, but places an additional burden on physicians. In a high stress, fast paced environment, information may be omitted or recorded incorrectly. A national emergency requires the medical team to quickly adapt to new policies and digital health tools. Therefore, education on digital health tools needs to be continuous and built into the curriculum for continuing medical education. This has been proven effective with the emerging generation of physicians, who view EHR as an unlikely source of burnout (6). Technology can be challenging to learn and use efficiently in a short span of time, especially combined with a high-stress workplace and high patient volumes. However, as we move forward and more and more of our information is digitized, it becomes imperative to incorporate digital health training to prevent steep technological transitions for physicians and to ensure the correct usage and reporting of EHRs and eCRs.
Define and Control Digital health information
As the expansion of digital health continues, more and more patient data is stored across various platforms. Health has transitioned further into an online sphere and while that eases patient-provider connection, it also opens doors for vulnerability. Even as the pandemic regulations fade, 47% of millennials said they prefer Telehealth to in-person visits (7). Therefore, more patient information is being stored digitally and across multiple different platforms. Without proper security, this data is vulnerable to misuse, leading to false insurance claims and stolen medical equipment if used illegally (8). Government agencies must not only ensure the information is protected, but also ensure it’s stored correctly to minimize the possibility of a security breach. We’ve already observed privacy breaches, such as Facebook’s Cambridge Analytica scandal (8). It is imperative there are regulated measures taken to ensure the privacy and security of data in EHRs. There will be no time to create policies during the next emergency. Therefore, regulations must be developed in an anticipatory manner to quell future data security concerns.
The COVID-19 pandemic has completely changed our way of life and taught us numerous lessons in emergency preparedness, particularly with regard to health emergencies. However, we need decisive action, not just words, to propel the next generation into a place of harnessing digital health for future emergency response. Through increasing access to the internet, technological literacy, and legislative policies surrounding data privacy and security, we will be more prepared to protect citizens in emergency times.
- Mitchell, Amy, and Jacob Liedke. “About Four-in-Ten Americans Say Social Media Is an Important Way of Following Covid-19 Vaccine News.” Pew Research Center, Pew Research Center, 24 Aug. 2021, https://www.pewresearch.org/fact-tank/2021/08/24/about-four-in-ten-americans-say-social-media-is-an-important-way-of-following-covid-19-vaccine-news/.
- McNally, Catherine. “Nearly 1 in 4 Households Don't Have Internet-and a Quarter Million Still Use Dial-Up.” Reviews.org, 18 Oct. 2021, https://www.reviews.org/internet-service/how-many-us-households-are-without-internet-connection/.
- Bureau, US Census. “Computer and Internet Use in the United States: 2018.” Census.gov, 8 Oct. 2021, https://www.census.gov/newsroom/press-releases/2021/computer-internet-use.html.
- “Telehealth Used Less in Disadvantaged Areas, Health Affairs Study Finds.” Healthcare IT News, 3 Mar. 2021, https://www.healthcareitnews.com/news/telehealth-used-less-disadvantaged-areas-health-affairs-study-finds.
- “Telehealth Is Working for Patients. but What about Doctors?” Harvard Business Review, 22 Jan. 2021, https://hbr.org/2020/11/telehealth-is-working-for-patients-but-what-about-doctors.
- Berg, Sara. “Generational Divide: 4 Ways Physician Burnout Differs by Age.” American Medical Association, 7 Oct. 2020, https://www.ama-assn.org/practice-management/physician-health/generational-divide-4-ways-physician-burnout-differs-age.
- Msearles. “New Data from HIMSS Shows Rapid Digital Health Adoption Necessitates Personalized Patient Technology.” HIMSS, HIMSS, 15 June 2021, https://www.himss.org/news/new-data-himss-shows-rapid-digital-health-adoption-necessitates-personalized-patient.
- “Your Privacy in Digital Health: The Medical Futurist's Guide.” The Medical Futurist, 21 Jan. 2021, https://medicalfuturist.com/your-privacy-in-the-digital-health-era-the-medical-futurists-guide/#.