In this section, we will cover:
How individuals could get started and become engaged in digital health
How individuals could participate in the enrollment process
What GDHP members are doing to increase individual enrollment and adoption of digital health tools
How Can Individuals Get Started?
An initial step individuals take in digital health is enrolling in digital health programs. After this is done, individuals may look at their records and become more engaged with their health care.
To incentivize individuals to enroll in digital health, you can let individuals know the benefits of enrollment.You can provide individuals a warm welcome and online tutorial to show them how much they can do when they are enrolled. These visuals may help individuals become comfortable and see personal value in digital health tools and may give them reasons to return regularly to manage their health even when they do not see a healthcare provider for a while.
Brazil | From Around the Globe
Educate Citizens and Attract them to Digital Health
In its National Digital Health Strategy (ESD), the Brazil Ministry of Health is developing “mechanisms that attract citizens and their families, as well as user communities, to participate in Digital Health actions, to bring the focus and user needs to the ESD and to facilitate the development of Digital Health services and usage models that are widely used.” To do this, they have initiatives such as an instructional video channel, webinars, free distance education courses, and advertising campaigns. (55) Brazil launched the Unified Health System (SUS) Digital Program. Its mission is to promote digital transformation, universal and equitable access to SUS health actions and services, and integrality and resolvability of healthcare through access to digital health and innovative goods and services for public health. The Program’s three components are:
1. Telehealth, technological solutions, digital health services and innovation within the SUS;
2. Interoperability, analysis, dissemination of data and health information; and
3. Digital health culture, training, continuing education, research, development and innovation in digital health.
How Do Individuals Participate in the Enrollment Process?
GDHP members note there are some ways individuals can enroll in digital health programs:
- Some automatically enroll most or all their populations. They may allow individuals to opt out (e.g., when they choose not to participate).
- Other GDHP members offer voluntary enrollment where individuals opt in to enroll. Some GDHP members encourage voluntary enrollment through advertising and education.
- Hong Kong, China aims to make it as easy as possible to enroll voluntarily in its free national EHR system.
Hong Kong, China | From Around the Globe
Free Electronic Health Record for All
The Hong Kong, China government provides the Electronic Health Record Sharing System (eHealth), an electronic platform that aims to build free and lifelong electronic health records for all members of the public. They provide online or in-person voluntary registration (enrollment). Online, a person can scan a QR code (see below) “to complete identity verification and eHealth registration instantly.” Once registered, they can view parts of their health records (such as medications, allergies, vaccine records), manage authorizations, and perform other functions through the eHealth app. (56)
How are GDHP Members Increasing Enrollment?
Special efforts may be needed to enroll underserved populations who are less likely to receive communication and may have difficulty enrolling. The following examples offer practical ideas that may be helpful to your country. The first two start with the foundation of basic digital skills which may be established before digital health skills are relevant.
Portugal | From Around the Globe
National Programs for Inclusion and Training
Portugal has a digital inclusion program for one million info-excluded adults. The program includes basic training on email, online searching, consultation, use of digital public services, and access to social networks. The National Digital Skills Initiative e.2030 program features the Digital Guarantee, which aims to ensure that all unemployed people have access to an offer, namely professional training, in the digital area appropriate to their skill level.
Ireland’s programs are designed to increase the availability of technology (including broadband), social inclusion, and digital inclusion.
Ireland | From Around the Globe
Leave No One Behind Technologically or Socially
Ireland has a digital inclusion roadmap called Digital for Good, which is a coherent and integrated government approach to deliver the United Nations principle of “Leave No One Behind.” (57)
Regarding connectivity, the National Broadband Plan (NBP) is the government’s flagship initiative to deliver high-speed broadband services to all premises across Ireland. It will ensure that no premises in Ireland are left behind and that every person and business…will have access to high quality, high-speed broadband services. It is the largest infrastructural project in rural Ireland since rural electrification and will cover the 23% of the population that currently lacks broadband. (58)
“The Social Inclusion and Community Activation Programme 2018–2023 provides funding to tackle poverty and social exclusion through local engagement and partnerships between disadvantaged individuals, community organisations and public sector agencies. Digital literacy was identified as a significant theme for support to address social exclusion and promote social inclusion.” (59)
Once individuals have digital literacy, they can benefit by enrolling in digital health. Enrollment can occur at national levels (such as a national portal) or at a state, province, or regional level. Sometimes, local institutions invite individuals in a manner similar to the United States of America example below.
Enrollment is a first step. However, the goal is not to enroll individuals. The goal is to have engaged individuals who benefit by using digital health throughout their lives. Some countries report on the percentage of citizens who are enrolled to access their health records (such as 86% reported in Poland), but few GDHP members report on the adoption rate (the percentage of ongoing active users). Adoption rate is a key consideration of digital health as indicated in the next example which speaks of working through local facilities to increase enrollment and adoption.
United States of America | From Around the Globe
Increase Enrollment and Adoption by Including Portals in Care Plans
The following excerpt from the ASTP/ONC Patient Engagement Playbook highlights the necessity of increased enrollment and adoption: “Inova Health partnered with ASTP/ONC [and others] to identify a solution to encourage patients to enroll in the health system’s EHR patient portal… Inova Health revised the after-visit summary to make the benefits of EHRs salient, highlight clear action steps, and encourage immediate action. Analysis suggests that the revised instructions led to a 10% increase in the probability of online patient portal activation.”
“You can also increase the number of patients who enroll and use the portal by integrating portal use into patients’ care plans. For example, encourage patients to use the portal to make follow-up appointments, stay on top of recommended screenings, or request refills” (60)
Individual Enrollment Recap
Individual enrollment actions include:
- Give individuals a warm welcome when they enroll to encourage them to visit again;
- Communicate the value of digital health to individuals, their families, and their caregivers;
- Aim for high adoption so individuals become active, not inactive, users after enrollment;
- Make special efforts for underserved populations by providing basic digital skills and infrastructure (such as broadband) as part of enrolling them in digital health; and
- Invite individuals to enroll through local institutions in addition to national, regional, state, or province programs.
