Remote Health Monitoring: Health Equity Equalizer or False Prophet?

By Meika Neblett, Interim VP and Chief Medical Officer, WellStar Cobb Medical Center

The expansion of digital health has spurred optimism about its potential to improve access, provide continuous care beyond hospital walls, detect early signs of deterioration, and close care gaps for those marginalized by the healthcare system. As we experienced during the pandemic, telehealth, patient portals, remote patient monitoring (RPM), and AI-driven alerts may help democratize healthcare for underserved communities.

So, is remote monitoring the great equalizer?

Maybe, but not without improving digital literacy and expanding broadband access, digital transformation does not inherently produce equity. Instead, it may magnify the structural inequities within traditional healthcare systems.

If we consider digital access a core dimension of healthcare, then equity must be treated as an operational requirement rather than an aspirational outcome.

Telemedicine Utilization and Persistent Inequities

Health inequity is prevalent in many communities, including but not limited to rural communities with limited transportation and local health care; older adults who struggle with technology (like my mother); working parents who can’t take time off for appointments; and those with disabilities and transportation limitations.

How do we get digital health to these communities who would benefit most? Telehealth utilization and preference are determined by structural facilitators and barriers, such as connectivity, device availability, trust, language access, and digital literacy, all of which are unevenly distributed across populations.

Relationship Building Through Frequent Touchpoints

Black Americans have adopted novel medical technologies at lower rates than their White counterparts, due in large part to inaccessibility and well-founded suspicion towards medical innovation. Historic mistrust and communication gaps have highlighted concerns about testimonial injustice and medical gaslighting. The institutionalized mistrust of the medical profession in the Black and brown communities further drives the reluctance and skepticism to utilize remote monitoring and telemedicine. Trust in telemedicine must be developed and bolstered simultaneously to ensure significant adoption and retention.

Careful consideration of the fact that telemedicine may diminish the doctor–patient connection, promote mistrust, and further reduce discordance. To ensure digital interactions are culturally sensitive and authentic, it starts with building strong patient–clinician relationship during in-person health care visits. Thus, it is imperative that we train learners to establish connections via digital platforms to bridge the gap in the digital communication space.

Digital Inclusion as a Social Determinant

Digital inclusion is defined as reliable internet access, affordable data plans, appropriate devices, and digital skills. When we look at digital access like a social determinant of health (SDOH), we see that, just like food deserts, digital deserts are most prevalent in rural and poverty-concentrated areas. Digital access and literacy should be added to every EMR when assessing other SDOH, such as access to food, housing, electricity, and personal safety.

Limited digital literacy is another constraint of patients’ preference for digital/remote access. The inability to navigate portals, complete telehealth visits, or participate in chronic disease management (CDM) programs will not support downstream clinical interventions to achieve equitable outcomes.

Technology Not Validated for All Communities

The focus of AI technology should be to mitigate bias; to ensure that sensors, algorithms, and devices perform consistently across different skin tones, body types, ages, levels of literacy, and/or accessibility differences. Unintentionally biased technology may lead to flawed data that would feed clinical decisions and continue to promote inequitable outcomes. Marginalized communities are consulted late, or not at all, in the process of development or critical design decisions. We need to build services and support that wrap around the technology, like community health workers, interpreters, care navigators, and social workers. Patients need people, not just devices.

Digital Health Equity and ROI

Quantifying the ROI for remote health monitoring can be challenging. There are measurable benefits in cost avoidance, staff efficiency, billable visits, and optimized IT resources. As well as downstream benefits with improved patient outcomes, enhanced patient experience, and higher staff satisfaction. The ROI in the equity lens stems from expanded access to patients in “care deserts”, more activated and empowered patients, which lead to better health outcomes, reduced ED visits, and reduced readmissions. Intangible benefits like reduced friction in workflows or improved staff morale are harder to quantify financially but are still crucial.

Conclusion: Digital Health’s Promise Requires Intentional Equity Design

Telehealth, remote monitoring, patient portal use, and digital design are not innately equitable. Achieving digital health equity requires addressing upstream digital determinants, engaging community health worker, intentionally embedding equity considerations into digital design and implementation, investing in digital inclusion infrastructure, and systematically measuring differential impacts across populations. If we consider digital access a core dimension of healthcare access, then equity must be treated as an operational requirement rather than an aspirational outcome.