Using Digital Health to Improve Health and Reduce Disparities with Dr. Megan Ranney

MCPHS Center for Campus Life invited Megan Ranney, MD, MPH, FACEP, an emergency physician and academic dean at Brown University, to speak about using digital health to improve health and reduce disparities.

The talk was part of the spring Cardinal Conversations, a speaker series dedicated to bridging students across healthcare disciplines to discuss global topics and their relation to the healthcare field. The previous speaker was Nii Addy, PhD, a neuroscientist and professor at Yale University School of Medicine, who spoke about the importance of mental health and wellness in 2022.

Dr. Ranney is a practicing emergency physician, researcher, and national advocate for innovative approaches to public health. She holds the Warren Alpert Endowed Professor of Emergency Medicine at Alpert Medical School of Brown University, is Founding Director of the Brown-Lifespan Center for Digital Health, and is Academic Dean at the School of Public Health at Brown University. Her funded research focuses on developing, testing, and disseminating digital health interventions to prevent violence, mental illness, and related epidemics.

Emergency Medicine and Mental Health

In the fast-paced world of emergency medicine, Dr. Ranney takes care of acute time-sensitive conditions where she has minutes to intervene. She also takes care of the underlying issues and roots of these conditions such as social, physical, or emotional violence which takes months, years, or a lifetime to develop.

“Whether it's someone who's an insulin-dependent diabetic and isn't taking their insulin because they're anxious or depressed or whether it's someone who has chronic stomach pain or headaches because they're actually a victim of partner violence,” she says, “those underlying disorders are part of my care and they're, of course, part of the care of everyone across our health care system.”

She explains that the emergency department serves as the front door to the health care system and the problems that she sees are magnified for her colleagues and friends who work in primary care offices and community health centers.

“These problems are going to come through your doors as well,” she says.

Digital Health

As a result of the ubiquitous use of technology, Dr. Ranney explained digital health is a great tool for healthcare professionals to better reach their patients. While she was working in Kenya in the early 2000s, Dr. Ranney saw the use of daily text messaging to help patients maintain adherence to antiretrovirals, the treatment for HIV. She also cited the use of text messaging to help patients find appointment times.

“Many of you have probably experienced telehealth over the last two years. The idea that you're having a visit with your doctor with your physical therapist, with your therapist remotely rather than in person, this is a critically important part of digital health,” she says. “But telehealth is only the beginning of digital health. This “telehealth” is basically taking what we do face-to-face, and instead putting a video in between. There’s so much more – from text-messaging to social media to wearable monitors. And overall, it works to help reduce disparities.”

She explained that the pandemic saw a dramatic increase in people using telehealth for the first time — 61% of Americans wanted access to electronic health records on apps/portals, 56% of Medicare beneficiaries used telephone-only appointments, and 30 percent saw an increase in vaccination rates if text messages were used.

Dr. Ranney said that telehealth is the tip of the iceberg and there is a full spectrum of digital tools that we can use to change access to healthcare. She explained that in addition to text messaging, and telehealth, there are now newer tools that can also be used to promote health and reduce disparities.

New Tools For Health

She explained that there are new tools to help patients maintain compliance with their pills and other tools that even tell patients when they should use a rescue inhaler based on local pollen counts.

“The vast majority of Americans have access to and are comfortable using some form of technology. So it becomes a way to access all of us. That said, there are disparities in access,” she says, “between those who are living with or without a disability . . . as well as across income divides, according to race and ethnicity, and according to age.”

She particularly spoke about the division created by internet accessibility.

“People who live in rural areas are less likely to have broadband than people who live in urban or suburban areas, and there are certain parts of urban areas that have lower access to broadband than that. It's not just a rural issue; for example, there are pockets like the South Side of Chicago or parts of my own city of Providence that have incredibly poor broadband access,” she says.

Age and Tech-Readiness

In addition to being conscious of access, other considerations include “tech-readiness,” the comfort, ease, and ability to troubleshoot technology.

“Not surprisingly, as folks get older, they report lower tech-readiness. In other words if you give them something complicated they are more likely to say ‘I’m done, I’m not comfortable with this,’” she says. “Interestingly, though, if you look at the same question and correct for the number of forms of technology that people say that they own, these discrepancies disappear. Studies have shown that if you have an older person who has a smartphone and uses social media, they have the same tech-readiness and same willingness to use it as one of our students who has the same tech - a cell phone and uses a bit of social media.”

Dr. Ranney said that tech-readiness is therefore just as much about the technology that we are already using, as it is about actual age.

“It’s not that people that are older can’t use technology, it’s just that they aren’t used to it,” she says.

Calls To Action

When designed well, Dr. Ranney believes that digital health provides immense opportunities to mitigate disparities and reach people across racial, socioeconomic, age, rural/urban divides. She cited the use of MyCOVIDRisk app and #GetUsPPE which were used during the pandemic to connect with the general public.

She believes that work is still needed to increase access such as expanding infrastructure and interoperability for both healthcare workers and patients as well as insurance coverage of services. There is also a need to think about designing programs that are multilingual, comfortable, and safe for the patients to ensure the end users’ needs are kept in mind.