By Dr. Carrie Wolinetz, OSTP Deputy Director for Health & Life Sciences
Dr. Jackie Ward, OSTP Assistant Director for Community Connected Health
Dr. Paul Farmer, the late global health and health equity pioneer once said that we can design effective health delivery systems “by actually talking to people and asking, ‘What would make this service better for you?’ As soon as you start asking, you get a lot of good answers.” At the White House Office of Science and Technology Policy (OSTP) we have been taking that advice to heart.
We are seeking input, through a public request for information, on a new vision for health delivery, Community Connected Health. Community Connected Health combines digital health technologies and community-based approaches to care to lower the barriers to health care access and provide healthier lives for all Americans, especially those currently underserved.
While the use of technology in health delivery is key to broadening access, technology alone isn’t enough. Because as much as we are learning from the pandemic about how telemedicine and digital health technologies can reduce patient travel cost and wait times, we are also learning about technology’s shortcomings, and disparities in access to it.
We often use the word ‘connectivity’ to refer to digital connection via the internet, broadband, and technological tools that enable virtual communication. But it can also mean the ties within the place you live, your background, or the language you speak—as well as the healthcare system in your community.
Health care delivery systems that pair privacy-preserving and well-designed technology with a community- and person-centric approach is crucial for expanding health access and equity and can take a number of forms:
- A new mom has a regular online check-in with a post-partum doula to ensure things are going well for her and the new baby;
- A primary care doctor at a rural community health center virtually consults an on-call specialist while their patient is still there, in the exam room, during their initial appointment;
- A community health worker visits a client’s home and uses a tablet computer to refer them to the appropriate social services and update their electronic health record on the spot;
- Or a patient simply exchanges text messages with a health worker.
What would it take to get to a place at which privacy-preserving digital health technologies are used to improve and expand health care delivery? Many of you have already shared your ideas and experiences with us and we know that this kind of health care delivery is already happening in some communities. For example, over the past month, we partnered with our colleagues at the U.S. Health Resources & Services Administration (HRSA), along with collaborators from across the Federal government, to host a series of roundtables to spur honest conversations about community health and how some technologies could serve as an enabler of this work. At these roundtables, we heard from a variety of stakeholders, including providers and patients at community health centers; community-based health organizations; on-the-ground community health workers, doulas, and peer recovery specialists from across the country; and even community health leaders from around the globe to discuss what we may learn from the innovation and ingenuity in other settings.
We received many good ideas for how to expand health care access, including some suggestions that might be quickly adopted by government and others that would take a sea change across the health care delivery system to implement. Common themes emerged, including:
- It is critical to listen to patients and community-based organizations about what they need – sometimes it is not high-tech tools, but public health approaches, that help improve health outcomes.
- Well-designed technology can play an important role in health jobs, but it is still critical for patients and individuals to interact directly with someone they know and trust.
- Digital literacy is a real, but addressable, challenge. We can meet people where they are with the appropriate infrastructure, tools, and training.
- Providers may need more support in navigating the growing sector of digital health tools and technologies that link communities and health care.
- Health workers need to have a seat at the table and be involved in the design and governance of community health care systems and programs.
- Steady and sustainable funding sources for the community health workforce are critical to their success – one-time or limited term funding makes program continuity difficult and diminishes the power of this workforce.
What other actionable ideas can be mobilized to make Community Connected Health a reality? Over the coming months, OSTP will be compiling additional ideas and suggestions from the American public. We want to hear from everyone: patients, health care professionals, community health workers, caregivers, social workers, faith and community-based organizations, technologists, and more. How are privacy-preserving digital health technologies used, or might they be used, to enhance community health, individual wellness, and health equity?
We envision a future where healthcare could be centered in one’s home or community — and we believe technology can be one tool to help make this happen, if it’s done right in partnership with people and communities.