Discussing digital exclusion in healthcare

Discussions about digital inclusion, or exclusion, are often missing from healthcare.
 
It’s a multifaceted issue, bigger than that of affordability and material or geographical access to technology.
 
It also involves digital literacy and confidence to engage with technology. It encompasses cultural appropriateness, trust in technology, and disability accessibility, such as using closed captioning on website videos for hearing impaired people.
 
Unlike the prophecies of our early tech overlords, the explosion of the internet and more recently AI hasn’t transformed our world into a place where all have equitable access to information. In some ways, it has entrenched the gap between the digital haves and digital have-nots even further.
 
In Australia, we measure digital inclusion across different populations and locations using the Australian Digital Inclusion Index. Recent results suggest that access to technology and the ability to use it are generally on the increase, though affordability continues to present a major barrier.
 
At the national level, 20.6% of Australians are ‘digitally excluded’, and 9.2% are considered ‘highly excluded’.
 
Digital exclusion disproportionally affects Aboriginal and Torres Strait Islander people, culturally and linguistically diverse communities, people experiencing socioeconomic disadvantage and/or unemployment, people with a disability, people with a cognitive impairment or dementia, older Australians, and people living in rural and remote communities.
 
The ‘digital divide’ is experienced by our patients in a multitude of ways.
 
It can prevent people from making an appointment, receiving and managing eScripts, using telehealth, accessing their My Health Record, or using apps that could help them to monitor and take charge of their health.
 
But there are also other less obvious consequences.
 
While digital mental health options can bring the cost of vital treatment down, these options aren’t going to be suitable for those who can’t afford a smartphone, home computer or reliable internet.
 
And distrust of AI can prevent Aboriginal and Torres Strait Islander people not only from using these technologies, but also taking up leadership roles in AI development and governance around data sovereignty.
 
Approaches for addressing digital exclusion and the digital divide must consider the needs of affected individuals, and obviously there’s a need for national policy initiatives to tackle this issue.
 
One thing we can do as GPs is check in with our patients about whether they can access health information via a phone or computer, including whether they have adequate internet access. Part of that conversation will be asking whether they feel confident in using their device as well.
 
It’s important that we keep offering non-digital alternatives too, ensuring patients can call to book, fill in paper forms, and request a telephone call for telehealth appointments.
 
Education is also part of the picture.
 
GPs and general practice staff can encourage and empower patients to access My Health Record and eScripts. Educating our staff, or a key staff member, to be digital support champions within the practice can help other staff and patients.
 
We can also include simple, step-by-step instructions for using key tools as a resource in the waiting room, including how to book online appointments, how to receive and manage eScripts, and how to access My Health Record.
 
The push to modernise the delivery of healthcare can mean that some people are left behind. We need to be vigilant about how the digital divide can cement existing inequities in the healthcare system and entrench harms experienced by marginalised groups.
 
Let’s make sure that efficiency doesn’t come at the cost of care.
 
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