Conversations around healthcare increasingly center on digital equity and inclusion, especially as more communities across the country embrace telehealth, expand broadband connectivity, and consequently recognize the importance, more than ever, of digital literacy.
According to Jaleen Johnson, program manager for the Northwest Regional Telehealth Resource Center (NRTRC), social determinants of health have long been connected to digital literacy and broadband connectivity. However, to better understand that relationship, digital equity and inclusion must first be defined, and an explanation provided as to why these concepts are important, and how they relate to healthcare.
In Johnson’s position with the NRTRC, she provides technical assistance in developing telehealth networks and applications throughout Alaska, Idaho, Montana, Oregon, Utah, Washington, and Wyoming. At the last quarterly meeting of the Arizona Telemedicine Council, Johnson expounded on her work, and its importance to telehealth.
“The National Digital Inclusion Alliance (NDIA) defines digital inclusion as the activities necessary to ensure that all individuals and communities have access to and use of information and communication technologies”, Johnson said. “Digital equity is when all individuals and communities have the information technology capacity needed for full participation in society, democracy, and the economy.”
According to the NDIA, “both of these are necessary for civic and cultural participation, employment, lifelong learning and access to essential services, and that includes healthcare services.”
“Digital literacies and broadband connectivity have long been called the super social determinants of health and that's because they address all other social determinants of health,” Johnson added.
According to an article in npj Digital Medicine, “… applications for employment, housing, and other assistance programs, each influences an individual's health, and are increasingly and sometimes exclusively accessible online.”  Access to information on healthcare providers is increasingly being digitized by things like patient portals.
“And that's making it difficult to manage one's health without proper broadband and those foundational digital skills,” Johnson said. “... the cost of equipping a person to use the Internet is substantially lower than treating a health condition. … that makes these efforts to improve digital literacy skills and access to valuable tools like broadband that reduce disparities increasingly important to everyone's healthcare management.”
Potential solutions: The digital navigator
A study published in Journal of General Internal Medicine in 2022 noted that telemedicine appears to be key to reducing healthcare disparities and follow up care after hospitalization. 
“I don't think I need to express that to any of you here, you're obviously on a telemedicine council, so I'm sure that you understand. But this study showed that follow up within seven days was 8.2 percent higher when accessed through telehealth, and that the visit completion rates were 22.5 percent higher with telehealth based on numbers collected,” Johnson said during her October 18, 2023, presentation to the Arizona Telemedicine Council. “... better access to care through telehealth means better health outcomes for everyone.”
Johnson added that what needs to be addressed is how the public is educated about telehealth.
From another study published in Digital Biomarkers in 2020, Johnson said the role of digital navigators is seen as a solution to bridging gaps that exist in the public’s use of technology, “showing that as interest in digital health expands, so does the need for a new role to guide technology use and implementation.” 
But what is a digital navigator?
Digital navigators are defined by the NDIA as a trusted guide who assists community members on Internet adoption and the use of computing devices. Digital navigation services include ongoing assistance with affordable Internet access device acquisition, technical skills, and application support.
“These people can be volunteers or staff who work at resource-giving institutions at places like libraries, community health centers, and social service agencies,” Johnson said.
The NDIA believes this model works because it's a replicable framework for organizations that already provide digital inclusion services. “And it's customizable to fit the needs and goals of its participants. For us as telehealth resource centers, we see the digital navigator as an essential role in mediating and building those digital health literacy skills and we find them also incredibly invaluable.”
Johnson gets to the heart of her latest project at the Northwest Regional Telehealth Resource Center – telehealth access points (TAPs) – which are open spaces designed for individuals to attend telehealth appointments.
“These spaces consist of an adequate Internet connection, a device with a working camera, speaker, and microphone, as well as privacy considerations in the form of a dedicated room or kiosk, where the telehealth visit can be conducted,” she said.
“… a digital navigator and TAPs are increasingly being seen across the nation at community anchor institutions like libraries and community health centers. TAPs are scalable on many different levels, and although some might be more elaborate than others, the necessities of a TAP are laid out for you in this definition.”
What the Northwest Regional Telehealth Resource Center and others have discovered is that while these spaces may exist in many communities, community members often aren’t aware that they exist, and as a result, they are underutilized. To help telehealth providers and others, the center participated in a digital inclusion fellowship to help increase patient digital health literacy and create more awareness of TAPs in communities across the country.
Last year, the fellowship started by creating a telehealth training for digital navigators, which is free and open to the public. There’s also a series of process maps with key questions and answers for the patient, which can help a navigator guide the patient to and through receiving care through telehealth.
“It's a really a great starting point … created for the the digital navigation piece in mind,” Johnson said.
The second project, Johnson said, is a layer of Telehealth Access Points (TAPs) to the NRTRC Find Telehealth maps. Find Telehealth launched in 2021 as a mapping of healthcare facilities that are in the NRTRC’s geographic region to identify healthcare services offered in-person , via telehealth, and hybrid, spanning from Alaska to Utah. Healthcare facilities for two Southwest Telehealth Resource Center region states, Arizona and Nevada, were added in mid-2023.
“We wanted to provide this as a tool for patients and providers, who were possibly looking to connect someone to telehealth or possibly looking to find a referral for someone a little bit closer to where they live. It's searchable by location area, radius, and specialty,” she added.
During the fellowship project, they recognized the benefit of opening the map to all 50 states and to include TAPs – dedicated public spaces for individuals to access a telehealth appointment. The center has a free online intake form that allows existing TAPs to put their location on the map system.
“… you can map a telehealth access point anywhere in the nation on this map. So, if you are with any organization providing a TAP in your community you can fill out the form and get that on the map. They populate about once a week.”
To enroll your location as a TAP, see the intake form here.
When asked if she sees a future in digital navigator careers, Johnson said 100 percent yes.
“The workforce can be trained as digital navigators, because I don't think that you necessarily must be an expert in tech to teach someone else how to use tech. I think that this is trainable on many, many different levels, and it could be a lucrative career for hopefully, many soon,” she said.
“We all need to learn more about technology at some point. We’ve all been there asking younger nieces, nephews, grandchildren, children how to use certain technologies. I've done that, and I'm a millennial. I still need help sometimes.”
- Sieck, C.J., Sheon, A., Ancker, J.S. et al. Digital inclusion as a social determinant of health. npj Digit. Med. 4, 52 (2021). https://doi.org/10.1038/s41746-021-00413-8
- Bressman E, Werner RM, Childs C, Albrecht A, Myers JS, Adusumalli S. Association of Telemedicine with Primary Care Appointment Access After Hospital Discharge. J Gen Intern Med. 2022 Aug;37(11):2879-2881. https://doi.org/10.1007/s11606-021-07321-3. Epub 2022 Jan 11. PMID: 35018569; PMCID: PMC8751457.
- Wisniewski H, Gorrindo T, Rauseo-Ricupero N, Hilty D, Torous J: The Role of Digital Navigators in Promoting Clinical Care and Technology Integration into Practice. Digit Biomark 2020;4(suppl 1):119-135. https://doi.org/10.1159/000510144