Framework Addresses Inequities in Digital Health Design

A study published in December in JAMIA Open describes efforts to address inequities in digital technology access by guiding the intentional integration of equity throughout the lifecycle of digital healthcare solutions. 

The Digital Health Care Equity Framework (DHEF) was developed through a collaborative process involving a diverse panel of experts and supported by the U.S. Agency for Healthcare Research and Quality.

The research was led by Johns Hopkins Department of Health Policy researchers including Elham Hatef, M.D., M.P.H., and Jonathan P. Weiner, DrPH.

"The digital divide isn't just about internet access—it's about tailoring healthcare technologies to meet the diverse needs of every patient, regardless of their background," said Hatef, in a statement. "This framework provides a systematic way to embed equity at every development and implementation phase."

Studies show that racial, ethnic, and socioeconomic disparities hinder the equitable distribution and utilization of new digital health technologies. The new framework seeks to address these gaps by offering a structured approach to assessing and improving equity in digital healthcare tools.

The framework was designed to help stakeholders—healthcare developers, vendors, health systems, and policymakers—to intentionally assess and address equity across all stages of the digital healthcare lifecycle. These stages include: 
1. Planning and Development: Ensuring digital tools are designed with input from diverse communities. 
2. Acquisition: Evaluating the inclusivity and accessibility of technologies procured by health care providers. 
3. Implementation and Maintenance: Identifying barriers to use and adapting technologies to meet local needs. 
4. Monitoring and Equity Assessment: Measuring outcomes to ensure equitable benefits across all demographics. 

The framework emphasizes addressing "digital determinants of health," including infrastructure challenges like broadband access and individual barriers like digital literacy. It also highlights the importance of participatory design and community engagement to ensure tools are culturally and contextually relevant. For example, during the COVID-19 pandemic, many vaccination sign-ups relied heavily on internet access, disadvantaging individuals in rural or low-income areas. The framework would encourage systems to offer alternative methods, such as phone-based sign-ups, alongside digital tools.