It was only a small hole in the pavement in front of my building last fall. But the seasonal snow, ice and salt, a dramatic increase in traffic and the neglect of a cash-strapped local bureaucracy has produced a honking big pothole that slows a lot of people down.
We face a similar figurative pothole as vital health-related activities such as appointment scheduling, interaction with providers and comparative cost and quality information migrate to the Web. This change threatens to leave behind older people who are more likely to have health conditions for which informed decision making and frequent communication with providers are critically important because they even those who are Web-savvy are more likely to experience changes in vision, hearing, cognitive abilities and fine motor skills that inhibit their ability to successfully navigate and use online services.
Much research has described those age-related limitations and many authoritative bodies have translated that research into practical recommendations about the online functionality and content organization that works best for older people. A quick look at some popular online patient portals (one from a university hospital) and decision tools for prescription drugs and health care providers even those designed for older people shows that Web designers and app developers have yet to comply. Colors, contrast, fonts, language use and organization are generally inconsistent with these recommendations. No doubt this is because the creative young techies behind such online tools and apps find it difficult to imagine the needs of an audience that differ so from their own.
This small pothole stands to grow:
- The number of older people is increasing as baby boomers age. Unfortunately, there is no reason to believe that the rate of change in this group's cognition, vision, hearing and fine motor skills all of which are necessary to use and benefit from online health services will slow.
- While the trend in Web use and proficiency among older people is rising as baby boomers come of age, unfortunately, it is unlikely that that their health literacy and numeracy both critical for increased participation in health care are simultaneously improving.
- Smartphones are quickly becoming the dominant means of Web access for many people, including many who previously had none. Unfortunately, those tiny bright screens may not be up to the task of accommodating the normal sensory and motor changes of aging, leaving older people with the alternative of cumbersome and expensive laptops and desktop computers.
- Government incentives through the Affordable Care Act and American Recovery and Reinvestment Act are accelerating the implementation of electronic health records (EHRs) with patient portals through which essential access to scheduling, health records and secure contact with providers will take place.' Publicly and privately produced decision support tools that make it possible to choose among Medicare Part D plans, hospitals, health plans and providers are currently available mostly online. Unfortunately, cost considerations will undoubtedly weaken the telephone customer service, provider presence and technical assistance that make it possible for many older people to use these services.
What about fixing the pothole?
I think we can agree that actively engaging in our health care is no longer just a nice thing we might do if we have a little extra time and good online access. It is now necessary to participate knowledgeably if we are going to benefit fully from the health services available to us. This imperative will only become stronger with the implementation of new technologies intended to reduce the cost of health care by placing increased responsibility on individuals to perform administrative and health-related tasks exclusively online.
Those who are unable to participate in their care because of issues related to access, design, functionality and content of online resources will suffer. Of course it is not only aging boomers who stand to lose here: Chances are that many people who are already ill or frail or who lack functional health literacy will fall behind regardless of age. But the potential size of the baby boomers' particular pothole poses such a threat to progress toward efficient, effective health care that it may spark some much-needed poking from the government and greater responsiveness from the private sector to the needs of an aging population.
Pre-emptive filling of the pothole will require both, and if we are lucky, the pressure to make online health information and services accessible, understandable, inexpensive, and useful for older people will improve the ride for all of us.