The healthcare industry has undergone a massive transformation over the past few decades, driven largely by technological advancements. From electronic health records (EHRs) to telemedicine, technology has revolutionized the way healthcare is delivered and managed. However, as healthcare becomes increasingly digitized, concerns about equitable access to these technologies have emerged, leading to the concept of “tequity”—the intersection of technology and equity in healthcare. This concept is particularly crucial in the context of case management, where the effective use of technology can significantly influence patient outcomes. This article delves into the concept of tequity in healthcare, exploring its implications for case management and offering strategies to ensure that technology-driven healthcare remains accessible and equitable for all patients.
Tequity, a portmanteau of “technology” and “equity,” refers to the fair and equitable distribution and use of healthcare technology across diverse populations. It emphasizes the importance of ensuring that all patients, regardless of socioeconomic status, race, geographic location or other social determinants of health, have access to the benefits of healthcare technology. Tequity is not just about providing access to technology but also about ensuring that the technology is used effectively and appropriately to meet the needs of diverse patient populations.
In the healthcare context, tequity involves addressing the digital divide, which refers to the gap between those who have access to modern information and communication technologies and those who do not. The digital divide can lead to disparities in healthcare access and outcomes, particularly for vulnerable populations such as the elderly, low-income individuals and rural communities. By focusing on tequity, healthcare organizations can work toward bridging this divide and ensuring that all patients benefit from technological advancements.
CHALLENGES AND BARRIERS TO TEQUITY IN HEALTHCARE
While the concept of tequity is gaining recognition, there are several challenges and barriers that must be addressed to achieve it in healthcare.
- Digital Divide: The digital divide remains one of the most significant barriers to tequity in healthcare. According to a report by the Pew Research Center (2021), 15% of adults in the United States do not use the Internet, with higher rates of non-use among older adults, rural residents and those with lower incomes. This lack of access to the internet and digital devices can prevent patients from accessing telehealth services, patient portals and other digital health tools, leading to disparities in healthcare access and outcomes.
- Digital Literacy: Even when patients have access to digital health tools, they may lack the skills to use them effectively. Digital literacy, which includes the ability to navigate and use digital technologies, is a critical component of tequity. A study by Jacobs et al. (2020) found that low digital literacy is associated with poorer health outcomes, as patients may struggle to use telehealth platforms, EHRs and other digital health resources. Addressing digital literacy is essential to promoting tequity in healthcare.
- Health Literacy: Health literacy, or the ability to understand and use health information, is another important factor in tequity. Patients with low health literacy may struggle to engage with digital health tools, particularly if these tools are not designed with their needs in mind. For example, a study by Shahid et al. (2022) found that low health literacy is associated with poorer health outcomes, as patients may have difficulty understanding health information and making informed decisions about their care.
- Systemic Inequities: Systemic inequities, such as disparities in healthcare access and quality, also pose challenges to tequity. These inequities can be exacerbated by the increasing reliance on digital health tools, as vulnerable populations may be less likely to have access to these tools or to benefit from their use. For example, a study by Nouri et al. (2020) found that racial and ethnic minorities are less likely to use patient portals, highlighting the need to address systemic inequities in digital health.
THE ROLE OF CASE MANAGEMENT IN PROMOTING TEQUITY
Case management plays a critical role in promoting tequity in healthcare. Case managers are responsible for coordinating care for patients, ensuring that they receive the appropriate services and resources to meet their healthcare needs. As technology becomes increasingly integrated into healthcare delivery, case managers must also consider the role of technology in patient care and work to ensure that it is used equitably.
The Case Management Society of America’s (CMSA) Standards of Practice for Case Management emphasize the importance of technology in case management, particularly in ensuring that patients receive timely, efficient and coordinated care. According to these standards, case managers are responsible for leveraging health information technology (HIT) to enhance communication, collaboration and care coordination across the healthcare continuum. This includes assessing that all patients have equitable access to HIT, that they or their caregivers have the ability to use the recommended technology and that technology is used in a way that promotes health equity and improves patient outcomes (CMSA, 2022).
CONCLUSION
Tequity is a critical concept in the modern healthcare landscape, where technology plays an increasingly central role in care delivery and management. For case managers, promoting tequity involves not only ensuring that patients have access to healthcare technology but also addressing the barriers that may prevent them from using it effectively. By assessing patients’ technological needs, advocating for equitable access, providing education and support and addressing cultural and systemic barriers, case managers can help bridge the digital divide and ensure that all patients benefit from the advancements in healthcare technology. As the healthcare industry continues to evolve, the principles of tequity will be essential in ensuring that technology serves as a tool for health equity, rather than a source of further disparity.
REFERENCES
Acury, T. A., Sandberg, J. C., Melius, K. P., Quandt, S. A., Leng, X., Latulipe, C. & Bertoni, A. G. (2020). Older adult internet use and eHealth literacy. Journal of Applied Gerontology, 39(2), 141-150.
Case Management Society of America (CMSA). (2022). CMSA Standards of Practice for Case Management. Brentwood, TN: CMSA.
Cheng, C., Beauchamp, A., Elsworth, G. R., & Osborne, R. H. (2020). Applying the electronic health literacy lens: a systematic review of electronic health interventions targeted at socially disadvantaged groups. Journal of medical Internet research, 22(8), e18476.
Hong, Y. R., Lawrence, J., Williams, D., & Mainous, A. G. (2021). Population-level interest and telehealth capacity of US hospitals in response to COVID-19: Cross-sectional analysis of Google search and national hospital survey data. JMIR Public Health and Surveillance, 7(4), e32974.
Jacobs, W., Amuta, A. O., & Jeon, K. C. (2020). Health information seeking in the digital age: An analysis of health literacy, self-efficacy, and gender among adult internet users in the United States. Computers in Human Behavior, 109, 106333.
Jongen, C., McCalman, J., Bainbridge, R., & Tsey, K. (2018). The implementation and evaluation of health promotion services and programs to improve cultural competence: A systematic scoping review. Frontiers in Public Health, 6, 18.
Lee, J., Lee, E. H., & Chae, D. (2021). eHealth literacy instruments: systematic review of measurement properties. Journal of medical Internet research, 23(11), e30644.
Mackert, M., Champlin, S., Pasch, K. E., & Weiss, B. D. (2016). Health literacy and health information technology adoption: The potential for a new digital divide. Journal of Medical Internet Research, 18(10), e264.
National Alliance for Caregiving. (2020). Caregiving in the U.S. 2020. https://www.caregiving.org/caregiving-in-the-us-2020/.
National Digital Inclusion Alliance. (2021). Advocacy and policy. https://www.digitalinclusion.org/advocacy-policy/.
Nouri, S. S., Adler-Milstein, J., Thao, C., Acharya, P., & Sarkar, U. (2020). Patient portal use across diverse patient populations: Associations with patient characteristics and access to care. Journal of the American Medical Informatics Association, 27(9), 1415-1423.
Pew Research Center. (2021). Internet/Broadband fact sheet. https://www.pewresearch.org/internet/fact-sheet/internet-broadband/.
Shahid, R., Shoker, M., Chu, L. M., Frehlick, R., Ward, H., & Pahwa, P. (2022). Impact of low health literacy on patients’ health outcomes: a multicenter cohort study. BMC health services research, 22(1), 1148.
Wodchis, W. P., Dixon, S., Anderson, G. M., & Kurdyak, P. (2015). Integrating care for older people with complex needs: Key insights and lessons from a seven-country cross-case analysis. International Journal of Integrated Care, 15, e021.
, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM, is the associate chief clinical operations officer, care continuum for University of Illinois Health System and the current immediate past president of the Case Management Society of America National Board of Directors and president-elect of CMSA Chicago. She has held positions in acute care as director of case management at several acute care facilities and managed care entities in Illinois, overseeing utilization review, case management and social services for over 14 years; piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication and population health management. Her current passion is in the area of improving health literacy. She is the recipient of the CMSA Foundation Practice Improvement Award (2020) and ANA Illinois Practice Improvement Award (2020) for her work in this area. Dr. Morley also received the AAMCN Managed Care Nurse Leader of the Year in 2010 and the CMSA Fellow of Case Management designation in 2022. Her first book, A Practical Guide to Acute Care Case Management, published by Blue Bayou Press, was released in February, 2022. Her second book, Practical Guide to Hospital Readmission Reduction, published by Blue Bayou Press was released in February 2024. Her third book, Practical Guide to Acute Care Case Management Leadership, is in the works, targeting publication in 2025. Dr. Morley celebrates 25 years of nursing experience and 20 years in case management in 2024. Her clinical specialties include med/surg, oncology and pediatric nursing. She received her ADN at South Suburban College in South Holland, Illinois; BSN at Jacksonville University in Jacksonville, Florida, MSN from Norwich University in Northfield, Vermont, and her DNP at Chamberlain College of Nursing.
ZERBOR/SHUTTERSTOCK.COM
