Seattle Children’s Hospital’s data team used proxy metrics to narrow down which patients might be affected by digital inequities. They pulled data points from CDC census data on social vulnerabilities, such as lack of internet access and prevalence of multi-family households. These data points were layered alongside no-show rates and a map of patients’ locations. The resulting heat map gave the Seattle Children’s team a better idea of regions where patients weren’t accessing care because they lacked the necessary digital means. (See figure 1 on page 10.)

The different social vulnerabilities can be toggled on and off to get a better understanding of why those patients might benefit from support. For example, areas on the map with high no-show rates and a lack of internet connectivity might benefit from the placement of community kiosks instead of loaner devices.

The heat map has already been useful in addressing digital inequities. Directors use the map for other areas of strategic growth such as kiosk placement, broadband connectivity offerings, telehealth expansion opportunities, and additional services for vulnerable populations.

The community resource team at Seattle Children’s plays a crucial role in building relationships with patients, ultimately earning their trust. Patients, especially those who haven’t had a lot of interaction with the health system, often feel uncomfortable asking for help. That makes it difficult for health systems to identify effective methods of support when patients can’t, or won’t, describe the kinds of support they need.

Seattle Children’s community resource team (which existed before Covid-19) includes members who speak most languages used in the area, and all members are trained in cultural humility. (See Our Take on cultural humility.)

Partnering with social workers, the community resource team serves as the intake for patients and families who live in areas identified on the heat maps. The team works with patients to better understand their individual needs and educates patients about potential solutions to determine which would work best. These interactions help the community resource team point patients toward loaner devices or community kiosks. The team also encourages adoption of the virtual care technology through education and digital literacy training.

Seattle Children’s loaner device program and community kiosks, which were funded through grant money, provide options to patients with different needs. For example, loaner programs work well in rural areas where travel is a hurdle to accessing health care. Community kiosks work well in areas with high populations of people who lack access to Wi-Fi.

Loaner program
The loaner program provides patients with tablets and options for internet connectivity so they can access the patient portal and conduct virtual visits. The team at Seattle Children’s Hospital retain oversight on the devices by restricting new app downloads and limiting the available apps to Zoom, MyChart, their own Seattle Children’s app, and an internet browser. The devices are shipped to the patients for free or can be picked up at a clinic, depending on the patient’s preferences.

Community kiosks
Kiosks have been placed throughout communities in public places such as homeless shelters, libraries, and schools. Social distancing requirements during Covid-19 interrupted the placement of community kiosks, but the team at Seattle Children’s is exploring future opportunities.

To participate in the kiosk program, every resource location had to sign a memorandum of understanding (MOU) and agreed to wipe the device after every use to ensure privacy.

Seattle Children’s Hospital knows that successfully reducing digital inequities depends on long-term adoption of the technology. Here are some tactics that Seattle Children’s uses to ensure a user-friendly experience:

Keep devices consistent between inpatient, outpatient, loaner programs, and kiosks
Seattle Children’s Hospital uses the same tablets across all health care settings to make it easier for patients to become comfortable using the technology.

Accommodate patients with inclusive user experience (UX) design
The team employed a UX designer to create educational materials and design the technology to support all patients, including non-English-speaking patients and patients who are deaf or hard of hearing. Some of the features included:

• Instructions translated into multiple languages and tailored to specific reading levels
• Sign language, closed captioning, and other accessibility features
• Option for patients who are deaf or hard of hearing to connect with provider who is also deaf or hard of hearing

Allow patients to use devices for non-health care activities
In addition to accessing health care, patients can use the devices for things like schoolwork, family Zoom calls, and browsing the internet. Letting patients use the devices other activities helps increase digital literacy, which is critical for education and employment opportunities.