Mobile First: Socio-Economics, Technology Usage and Chronic Disease Risk

Mobile First: Socio-Economics, Technology Usage and Chronic Disease Risk

The jury is in.  Patient portals don’t work.

Research shows that, despite spending tens or hundreds of millions of dollars on patient portals, some of the leading healthcare providers in the US have achieved very low levels of patient engagement using these technologies.  Likewise, in Australia, the level of patient engagement with the My Health Record through the “consumer portal” has been minimal.

Whilst the reasons for this are complex and multi-faceted, I’d like to focus on one of the key reasons for the lack of success of patient (web) portals.  They use the wrong technology channel for the patient cohorts that they are trying to target.

Take a look at the following diagram:


Looking at the socio-economic spectrum (from lower socio-economic status on the left to higher on the right), it’s possible to draw a correlation with the risk factors for many types of chronic disease, i.e. the lower your socio-economic status, the higher the risk of developing one of these chronic diseases.  Much research exists to back up these claims, with causation found in the social determinants of health, shown in the diagram at the top of this page.

The risk factors for some chronic diseases such as heart disease and type 2 diabetes have strong correlations with socio-economic status, others less so but still noticeable.

None of this should come as a great surprise.

Now consider, as shown in the bottom half of the diagram above, the use of technology across the socio-economic spectrum.  Participation in Digital Health Communities and use of Consumer Health Devices tend to be (with notable exceptions) activities undertaken by more engaged patients, who by definition, tend to have higher socio-economic status.  And having access to high-speed broadband and desktop computers are also privileges reserved for patients with higher socio-economic status.

But guess what?  Patient portals nearly always rely on patients using the web, on a desktop computer, over broadband.  But the patients most likely to be suffering from key chronic diseases (or at least at risk of developing them) typically don’t have access to this technology channel!

This is a major strategic error!  Inadvertently, by developing a patient portal we are typically targeting the “worried well” – those patients who want to engage with health providers but don’t have a great need to do so.

I see this basic error in strategy repeated over and over.  It remains a key underlying cause of the failure of many EHRs and PHRs, including Australia’s My Health Record.

In response to this, you can see in the diagram above that the only technology channel available across the socio-economic spectrum is the smartphone.  Australia leads the way in this regard, with over 90% of adult Australians owning a smartphone – the highest rate in the OECD.  Therefore, the smartphone is often the only way to target the patient cohorts suffering with and at risk from chronic disease.

Consequently, it is puzzling when health organisations start their patient engagement strategy with a patient (web) portal, and then look to bolt on a mobile app as an afterthought, if funding permits.  The analysis above clearly shows that we have to target our patient cohorts more carefully and specifically, conscious of the particular patient engagement problem that we are solving and the technology channel that best aids that solution.  Sure, there might be times when a patient (web) portal is appropriate, but improving the health behaviours of an already fairly compliant group of patients is not the highest priority in a health system that is drowning under the weight of chronic disease.

For the majority of health IT solutions we should think “mobile first”.  How can we offer a compelling native mobile solution that engages the patient cohort we’re seeking to influence?  Do we even need a web channel, and if so, why?

Food for thought as you read this on your mobile device…


4 thoughts on “Mobile First: Socio-Economics, Technology Usage and Chronic Disease Risk

  1. Just wondering, do you need to have an app,or could you just make sure your portal is mobile friendly? What do you perceive the difference in use? Do you think the community just now expects an app?

  2. Do you have a source for the diagram? Is it published and do you have evidence to support it? I would be very interested in referencing it but I would need to see the evidence base. Thank you.

  3. In Canada smartphone data plans are very expensive so lower income people tend to not use them. The most universally accessible tech is the web portal.

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