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This piece was written using a policy perspective draft from 2023 (unpublished) co-authored by Sabrina Ford, PhD, Bree Holtz, PhD (me), Katie Mitchell, PhD, and Kelly Hirko, PhD.
The COVID-19 pandemic brought an unprecedented reliance on technology to sustain healthcare and social connections. Telemedicine platforms replaced clinic visits, and web-based scheduling became the default for vaccine appointments. While these innovations helped many, they also amplified inequities for those already marginalized—particularly older adults in rural communities.
We often think of technology as neutral, a solution that universally improves lives. But in reality, technology reflects the systems, biases, and gaps of the societies that create it. When designed without inclusivity in mind, health technologies can exacerbate the very disparities they aim to solve.
Pandemic Lessons: Technology's Ethical Blind Spots
The rollout of COVID-19 vaccines in the U.S. relied heavily on online scheduling systems. This presented an insurmountable barrier for millions of older adults in rural areas. Limited access to high-speed internet, low digital literacy, and the absence of tech-savvy family members due to social distancing meant many were left behind. Vaccine access became a public health challenge and an ethical failure of innovation.
Telemedicine, too, became a lifeline for many during the pandemic. Yet for rural older adults, the lack of reliable broadband or digital devices meant they were less likely to benefit from these services. Even when internet access was available, telehealth platforms often assumed a level of technological proficiency that many older adults didn’t have. The very tools designed to bridge gaps in care ended up widening them.
These examples reveal a critical truth: Technology isn’t neutral. It reflects the choices we make during its design and deployment. When we ignore the needs of vulnerable populations, we fail in innovation and our ethical obligations.
The Ethical Need for Inclusive Design
Innovation in healthcare technology must begin with inclusivity. This isn’t just about moral responsibility; it’s about creating solutions that work for everyone, regardless of geography, age, or digital literacy.
Inclusive design means meeting people where they are by creating low-tech telehealth options, such as phone-based consultations or simplified user interfaces, to accommodate the needs of rural older adults. It also requires actively co-creating solutions by engaging underserved communities in the design process, ensuring that technologies address real-world barriers and align with the lived experiences of those who will use them. Furthermore, addressing the digital divide is critical; broadband access must be treated as a public utility and recognized as a fundamental social determinant of health to ensure equitable access to digital health tools.
Failing to prioritize inclusivity in healthcare technology isn’t just an ethical oversight; it has tangible consequences. Rural older adults already face higher rates of chronic conditions and lower access to healthcare services. Technology that excludes them only deepens these disparities.
Moreover, as digital health tools become the norm, the gap between those with access and those without will only grow. This isn’t just a rural issue. It’s a national crisis that demands urgent action.
Future Considerations
As we continue to reflect on the lessons of COVID-19, it’s clear that the path forward requires inclusion, equity-driven decisions, thoughtful implementation, and reflection. To do so, policymakers must prioritize broadband expansion in rural areas, developers must integrate inclusivity into design processes, and we must proactively support patients with limited digital literacy.
Broadband internet access is no longer a luxury—it is a critical determinant of health. Rural communities, where approximately one-third of residents lack reliable broadband access, face significant barriers to telehealth and other digital health tools. Policymakers must prioritize funding and infrastructure projects to close this digital divide, treating broadband as a public utility akin to water and electricity. Initiatives should draw on lessons from previous broadband implementation programs to ensure equitable access, with special attention to underserved rural older adults disproportionately impacted by technological inequities.
Developers of healthcare technologies must adopt inclusive design principles by involving diverse populations in the creation process. This includes co-designing tools with rural older adults and other underserved groups to ensure that the resulting solutions address real-world challenges, such as limited digital literacy. For example, telehealth platforms can include simplified interfaces, user-friendly instructions, and low-bandwidth options that meet users where they are, both geographically and technologically. Such approaches ensure that innovation does not unintentionally exacerbate disparities but provides meaningful solutions for our most vulnerable populations.
While healthcare systems are vital in connecting patients to technological solutions, a multi-stakeholder approach is essential to support individuals with limited digital skills. Community organizations, public health agencies, and tech companies should collaborate to provide resources like digital literacy training and in-person or phone-based assistance for using telehealth platforms. For example, proactive outreach through health system electronic medical records can identify and support older rural adults in accessing digital healthcare services. Such efforts must also consider the availability of non-digital options for those who are unable or unwilling to use technology.
Technology is only as equitable as the people who create and deploy it. By centering inclusivity in health innovation, we can build a future where everyone—not just the digitally privileged—can thrive.
References:
CDC (2024) COVID-19: older adults
Whitten P, Holtz B, Laplante C, et al (2010) An independent investigation into the deployment of the federal communications commissions’ rural health care pilot program. Telemed J E Health 16:1005–1011. https://doi.org/10.1089/tmj.2010.0100
Whitten P, Holtz B, Krupinski E, Alverson D (2010) Challenges of the rural healthcare pilot program broadband initiative. Telemed J E Health 16:370–372. https://doi.org/10.1089/tmj.2009.0134
Telemedicine in the News
The Telehealth Modernization Act of 2024 set to expire.
From Judy Stone at Forbes: The Telehealth Modernization Act of 2024, which extends pandemic-era telehealth access, hangs in the balance. If Congress doesn’t act before December 31, millions could lose access to remote healthcare services, especially vulnerable populations like rural, elderly, and disabled patients. This bill ensures Medicare beneficiaries can receive telehealth care from home, expanding services to match the post-pandemic demand. While telehealth offers life-changing convenience and better compliance, debates over costs and funding have slowed progress.
Read the full story here.