It’s 6 AM and Anna’s alarm clock goes off. She has a busy day ahead of her, starting with getting her children to school, heading to her doctor’s appointment and taking on a double shift at her part time job. Anna is on a tight budget and has difficulty juggling work and her kids. On top of her often stressful situation at home, Anna suffers from Type 2 diabetes and has been inundated with medical bills. Although Anna doesn’t own a computer, her doctor introduced her to a smartphone application that helps her to monitor her glucose levels and communicate with her care team if she needs medical assistance.
Millions of individuals across the U.S. have experience with at least one aspect of Anna’s situation. As a country, the U.S. spends less money on social services and more on healthcare.1, 2 Yet, a large majority of what makes us sick can be attributed to the social determinants of health (SDOH)—factors such as socioeconomic status, availability of resources, employment and access to healthcare. While using technology to address social factors in underserved regions has generated momentum, it’s an area of healthcare and digital health that is emerging with the shift from reactive to proactive healthcare.
Startups and local organizations face several barriers when trying to adopt technologies in community health settings. According to Johns Hopkins University’s Jonathan P. Weiner, Director of the Center for Population Health and Information Technology, 95% of healthcare organizations are still learning how to use Electronic Health Records (EHRs), which makes it difficult for them to access social or population health data.3 There is often a lack of community stakeholder engagement and support to implement technologies such as medical devices and smartphone applications that help to increase understanding of SDOH.4
Another major hurdle to tech adoption is the lack of commercial business models in the community health environment. It’s no surprise that startups will engage settings where there is financial incentive. Many have avoided entering the space due to limited opportunities for commercial growth and the difficulties/costs associated with integrating a scalable solution. Additionally, both startups and community stakeholders face challenges of not having access or information about best practices when implementing technology in local communities. Valuable data and insights garnered from successful technology implementation in community settings are rarely shared for use by others in the space. This lack of education restricts the understanding of tech integration, community engagement methods, the necessary financial models for effective implementation and the health outcome metrics that exemplify the benefit of implementing health technology in underserved regions.
So, what can be done to pave the way for tech innovation and improve SDOH in local community settings? Piloting new technologies is an important pathway for community health organizations. It allows them to understand how the solutions can benefit their members and helps them learn how to adopt new technologies into their current workflow. For example, the Technology for Healthy Communities program was designed as a vehicle to address the SDOH through piloting. The program matched health technology startups, Healthify, Welkin Health5 and CTY, with community organizations in 3 regions across the U.S. The pilots range from addressing transportation/public safety in Jacksonville, FL, connecting individuals to community resources and social services in Spartanburg, SC, to improving community health worker efficiency and patient outreach in Alameda County, CA. Together, the pilots are projected to reach over 5,000 patients.
Based on the initial success of the pilots, we have seen that multi-sector collaboration and data sharing have led to community health tech models that are mutually beneficial. For example, as one of the most dangerous cities in the U.S. for pedestrians and cyclists,6,7 the city of Jacksonville relied on traffic data collected from law enforcement agencies and manual counting in a limited number of locations. In the pilot with CTY, sensors retrieve bike/pedestrian counts and behavior data that could not be efficiently and accurately collected before the pilot. With a collaboration between CTY, the City of Jacksonville, the Health Planning Council of Northeast Florida, and the Clinton Foundation, they will implement interventions in the built environment to improve safety for residents. The Healthify pilot has also required multi-sector collaboration to help improve the SDOH. At ACCESS Health Spartanburg, Healthify is screening patients with complex needs and referring them to local services such as food banks, affordable housing and behavioral health support, increasing their access to healthcare and community-based resources. Through partnerships with organizations in the Spartanburg community, Healthify can track the referrals to community partners that are onboarded to the platform.8 The Technology for Healthy Communities program helps inform how these startups will work with other community health organizations. The outcomes demonstrate the benefits of technology adoption at the community level and how to launch a pilot and engage the community successfully.
The successful implementation of these pilots demonstrates the need for multi-sector collaboration and community stakeholder engagement. The innovators worked closely with the local organizations to ensure there was buy-in from the necessary stakeholders in the community to support the pilot and sustainability efforts. Health tech pilots are important in community health settings because they establish proof of validation. By field testing in a subset of the population, innovators and community organizations can assess the impact of a solution without dedicating extensive time and resources to a large roll out. Key metrics are agreed upon early on in the process, enabling stakeholders to determine pilot success and formulate a sales strategy for commercialization. From the beginning of the Technology for Healthy Communities program, the pairs were encouraged to think about long term sustainability and engage in discussions about commercial relationships, so that the community residents continue to benefit from the technology post pilot.
Piloting health technologies is just one way to drive adoption and improve SDOH in the regions that need it the most. By piloting, health technology startups have a pathway to commercialization in underserved communities. Data collected from the pilot allow community health organizations to gain insight into SDOH trends and complex health issues in underserved areas. Most importantly, patients like Anna have access to the much needed care and resources to support everyday wellness.
1. Elizabeth H. Bradley and Lauren A. Taylor, The American Health Care Paradox Why Spending More is Getting Us Less (New York, NY: Public Affairs, 2013).
3. Robert Wood Johnson Foundation. 2016 Using Social Determinants of Health Data to Improve Health Care and Health: A Learning Report.
5. Welkin Health & Community Health Center Network Pilot Video
6. Smart Growth America. 2014 Dangerous by Design.
7. Alliance for Biking & Walking. 2016 Benchmarking Report.
8. Healthify & ACCESS Health Spartanburg Pilot Video