Digital-divide in eHealth applications in the city of Chicago

Arkalgud Ramaprasad, Shobhna Gupta, Sridhar Papagari, Amit Prakash, Ramachandran Venkatasubramanian
University of Illinois Chicago, Chicago, United States

Objectives:

1. Demonstrate the digital divide in availability, accessibility and type of eHealth applications deployed by hospitals in a major metropolitan area.

2. Demonstrate the above digital divide by patients location (zip code) and associated demographics in a major metropolitan area.

3. Explain how hospitals, community technology centers and government can promote the effective use of eHealth applications

Information technology, by disseminating information to the public and facilitating their participation in government can create an informed citizenry. By the same token, eHealth applications, using Internet technology, can create informed patients. These applications can help patients obtain information, learn interactively, manage their transactions, and monitor their progress. A citizenry of informed patients will make a country of healthy people through improved health care. The Center for Research in Information Management at the University of Illinois, Chicago conducted a study on the availability of, accessibility to and the type of eHealth applications across all 46 hospitals in Chicago, the capital of the largest health care system in the world. We collected data on 55 eHealth applications. We followed a standard protocol to judge the number and type of eHealth applications available on a hospitals web site. An eHealth application was classified either as an informational, interactive or a transactional application. We derived the measure of the number and type of eHealth applications by zip code by using a weighting scheme. The weighting scheme is based on two factors - number of patients patronizing hospitals from a given zip code and the total population of that zip code. Essentially, it is formulated to remove biases due to these two factors. For mapping the distribution of the population by race, Chicago zip codes have been classified into seven categories based on hierarchical clustering. The study revealed significant variations in both the number and the type of applications provided by these hospitals. Almost all the applications are informational; very few are interactive or transactional. The mapping of the data on these applications, the location of the hospitals patients, and the corresponding demographics revealed a digital divide based on geography, race, income and education Our research highlights the institutional, infrastructural and individual digital-divide that exists in the eHealth applications in Chicago. An institutional digital-divide exists when the number of eHealth applications offered by the different hospitals varies considerably; patients of some hospitals will have more applications available to them than of other hospitals. An infrastructural digital-divide exists when there is a significant variation in the telecommunication infrastructure in the different geographical areas; patients in some locations will be able to access the applications more easily than others. An individual divide exists when the number and type of eHealth applications vary by an individuals race, education and income; privileged individuals may have more applications available and accessible to them than less privileged ones. The research suggests that active participation is needed from the hospitals and patients alike to tackle the problem. Hospitals need to bridge the gap between the state-of-art and the state-of-practice of health information as broadcasted on their individual websites. More interactive and transactional applications can help hospitals reduce costs, increase satisfaction, and be more effective. Apart from providing access to information and communication technologies, government and community organizations should be involved in teaching health consumers to use eHealth applications, and providing incentives to do so. Patients should be educated about the presence of eHealth applications. Community organizations could promote an informed patient by creating a demand for adequate high quality eHealth applications. Hospitals with state-of-art health information on their websites would be able to push these organizations in creating a stronger patient-physician relationship. A better-informed patient using these applications will be a healthier citizen.