Mass General Brigham Understands That Digital Equity Supports Health Equity
Monday, January 27, 2025
Digital Beat
Mass General Brigham Understands That Digital Equity Supports Health Equity
Following up on the release of The Human Infrastructure of Broadband: Looking Back, Looking Around, and Looking Ahead, we are providing examples of core, complementary, and coalition models for digital equity work. This series of organizational profiles delves deeply into how these programs work, the problems they are best suited to solve, the populations they are best suited to reach, and the support they need to succeed. Learn more about the Human Infrastructure of Broadband Project.
“I helped a 78-year-old patient who came from New York. He did a bunch of tests on Mass General Hospital’s main campus and was urged [by staff] to see all of his lab results but couldn’t enroll by himself, even tried a couple of times. So the front desk brought him to me. I helped him register and set up a passcode for him to log in easier every time, thanks to his cooperation and patience for giving me all the info I needed. After he logged into the patient gateway, he was so excited that he showed me his lab results and immediately sent a message to one of his doctors ... And he could not wait for one result to come up, and his doctor told him this test had to wait one week to get it. It was a pleasant experience, and he even got his cell phone charged at my little desk beside the patient gateway enrollment!”
—Mass General Digital Access Coordinator
Mass General Brigham (MGB) is a large hospital system in the greater Boston area. MGB employs more than 1,200 clinicians, who serve more than 1.25 million patients. During the COVID-19 pandemic, MGB identified disparities in patients’ access to video visits and its patient gateway. These disparities had likely always been present across the patient population, but the global health crisis drew attention to them. MGB leaders looked at who did and did not use its online patient gateway. Unsurprisingly, those who were not using the patient gateway were largely members of racial and ethnic minority groups, particularly those whose primary language was not English. In response, MGB began initiatives aimed at increasing health equity and digital access. A pilot grant was launched in 2021 to begin a digital navigator program, initially targeted at enrolling people with diabetes in the patient gateway.
The three-to-four-month pilot program became what is now called the Digital Access Coordinator Program, funded through MGB’s United Against Racism initiative, which began in 2022. Although navigation programs within health care systems are not uncommon, MGB’s is uniquely situated. As one of several initiatives in MGB’s United Against Racism work, the Digital Access Coordinator Program is tasked with actively working to dismantle racial disparities in health care.
Digital access coordinators (DACs) speak the top non-English languages spoken by MGB patients: Spanish, Portuguese, Haitian-Creole, Russian, Cantonese and Mandarin Chinese, and Arabic. DACs assist patients with enrollment in and navigation of MGB’s patient gateway and the use of other digital tools. The Digital Access Coordinator Program also lends iPads to established patients at an MGB practice who live in zip codes in the Boston area with the highest levels of health care disparities. DACs evaluate whether a patient would be a good candidate for MGB’s tablet loaner program, and will often refer them to that program to confirm their eligibility. Patients who don’t otherwise have access to a device with a working camera and/or internet access at home must also have a specific clinical need, such as diabetes, hypertension, behavioral health, or remote patient monitoring. The loaner tablets include cellular internet access and are managed by MGB’s Information Services division. Tablets are configured and enabled solely for tasks related to health care.
The Digital Access Coordinator Program has been successful for both patients and clinicians. Clinic staff report that being able to offload the task of introducing patients to the system’s digital tools is helpful and lets them focus on direct care. A dedicated DAC helping to navigate those tools can more effectively help patients onboard and use them. Between May 2021 and November 2022, the DAC Program contacted more than 16,000 patients and enrolled over 60 percent of them in the patient gateway. There has been strong interest in expanding the program to place DACs at additional locations, according to Senior Program Manager Jess Szulak. “We are looking to expand and evolve our program,” Szulak says. “There are some other hospital locations that have been very interested. They’ve seen articles about our program and are asking if we have any plans to expand because they’d be interested in having a resource on-site.”
Most DACs do their work at a primary care clinic, embedded within the care team, at locations that have been identified to have low rates of patient gateway enrollment. Clinical team members refer patients directly to DACs to receive assistance. DACs introduce patients to the patient gateway and teach them how to use it to access their health records and test results, make appointments, and message their doctors. Referrals can be immediate and in person, or a note may be added to the patient’s electronic health record, and the DAC will follow up by phone. No appointment is needed to meet with DACs, who are regularly available in the waiting areas of their assigned clinics. Patients are encouraged to walk up to ask for help. Embedded DACs also have remote work days when they do telephone outreach and support. The embedded service model in which a DAC works full-time at one location and clinicians make a warm handoff referral has been the most successful for MGB. The program also employs some hybrid DACs who perform a mix of remote work and staff pilot clinics a couple of days a week. The pilot clinics are those where the program has expanded beyond the primary care setting and main hospital campus. Telephone outreach is a key responsibility for hybrid DACs.
When working remotely, DACs help patients schedule telehealth appointments and understand what to expect during the appointment. The approach DACs take is not to get as many patients signed up as possible, but to help people who are ready and to encourage but not push people who may be hesitant. And that can take some time. DAC Ariel Gonzalez shares a story of a patient with whom he spoke monthly for almost a year until they were finally ready to sign up and use the patient gateway. When not assisting patients directly, DACs generate reports from the electronic health record system to identify patients for cold-call outreach or follow-up on clinician referrals.
There are many reasons that MGB patients can benefit from meeting with a DAC. Some may be ready to sign up and use the patient gateway; others may be hesitant about technology and accessing sensitive health information online. Some patients are wary of accessing sensitive information like health records online, or they fear identity theft or other risks. In these situations, DACs are trained to meet patients where they are, to provide information and educate but not push or pressure them into joining and using the patient gateway. Gonzalez shares that many of the people he assists are new Americans and may not have a smartphone or a computer and internet access at home. Even those who do have a device may not be familiar with the device’s capabilities. Electronic health record systems and patient gateways are also less common in countries where many MGB patients are from originally.
In addition to hiring more full-time staff, the program has started to expand to community health settings, in which interested DACs visit communities through Brigham’s Community Care Van initiative. The Community Care Van initiative sends clinicians in mobile health vans to provide care directly in communities around specific clinics and hospitals. Embedded DACs must coordinate with their clinics around this outreach to balance the workload at their regular locations, but DACs like Ariel Gonzalez find that doing visits with the community vans is a good way to connect with patients quickly.
“You can connect with patients ... on an easier scale than trying to connect with them on a phone call or trying to schedule appointments with patients, which can be tricky, admittedly depending on how busy the clinic is. And also it helps those clinicians just realize that you have this other way that you can reach out to your patients,” says Gonzalez.
MGB’s Digital Access Coordinator Program is funded as part of the institution’s broader United Against Racism initiative. According to Senior Program Manager Jess Szulak, the nearly $1 billion United Against Racism initiative demonstrates the institution’s commitment to removing systemic disparities in health care, which includes the targeted work of the DACs. “This is part of Mass General Brigham’s mission,” says Szulak. “I don’t think our program will ever go away. I think they see the benefit and importance of having our team on-site to help the patients.” Being directly tied to Mass General Brigham’s mission and funded by a core institutional initiative is key to its long-term sustainability—the Digital Access Coordinator Program is intended to be permanent.
What We Can Learn
An Institutional Commitment to Digital Equity is Critical
The Digital Access Coordinator Program grew out of MGB’s response to digital inequities exposed during the COVID-19 pandemic. MGB connected those disparities to broader inequities experienced by historically marginalized groups in the United States. The institution’s commitment to reducing these inequities in health care through its United Against Racism initiative sustains the work of the DAC program at MGB. As a large health system connected to a research institution in a major metro area, MGB has more resources than smaller health systems, and its staff may also have more latitude to explore ways to improve care. Still, the DAC model stands as an example to other health systems interested in similar patient support. Regardless of a health care organization’s size or location, digital disparities in health care will be present.
Szulak explains, “I think there’s always going to be a need wherever you go, whether it’s a language barrier, digital skills, training barrier ... A lot of the patients that we do help, they just didn’t even know this [program] existed. No matter where you go, I think you’re always going to run into some of the similar barriers or challenges to folks having access or using digital tools.”
Digital Navigation Services Are Best Integrated and Embedded in Clinical Care Settings
Though MGB has tried several models of providing digital navigation services through its DACs—embedded in a clinical team, a hybrid model of some on-site and mostly remote, or even stationed at an information desk—by far the most successful model has been DACs integrated and embedded in a single clinic or care location. Dr. Jorge Rodriguez speaks to the advantages of the model: “I think it’s just the nature of having [DACs] be part of the workflow and getting the clinic to get to know them and view them as a resource. And I think also patients seeing them in the context of their clinical or their health care team ... makes a difference.”
Adaptability is Key to Bringing the DAC Model to Different Health Care Settings
MGB’s ability to fund the DAC Program is certainly tied to its size and its association with a research university. And though there is a need for similar programs in other settings, such as in rural or smaller health systems, funding a program internally in those settings might be more challenging. Reflecting on the unique situation of MGB, Dr. Rodriguez says, “The funding piece, I think, definitely plays a big role ... Sometimes when I talk to other organizations, they ask, ‘Where’s this funding coming from? Who’s paying for this?’ And they say, ‘I don’t know if we have the funds to have that many full-time employees dedicated to this.’” But while large institutions like MGB tend to be able to operate programs like this independently, smaller health systems could approach similar initiatives through partnerships with external community organizations or nonprofits providing the digital navigation service.
Looking Ahead
What’s next for the Digital Access Coordinator Program at MGB? The program is well funded and supported by the institution, so staff are focused on refining their model of service, expanding to new locations, and identifying metrics that will help to demonstrate deeper patient engagement and the impact on clinical care. While enrollments in the patient gateway have been a primary metric of engagement, staff want to understand how and whether the program is improving patient outcomes. There’s also an interest in addressing other digital literacy needs that patients may have, such as identifying misinformation and disinformation, especially with the recent explosion of artificial intelligence use online. Dr. Rodriguez frames the future of the program using a common health care model: “In health care, we often use the Donabedian model. It describes health care quality in the three domains: structure, process, and outcomes. The structure [refers to] what resources you have available—how many DACs you have, and the health care infrastructure. Then processes [checking in with DACs regularly on process and progress, asking questions such as]: ‘How are you?’ and ‘Are you enrolling people in the [patient gateway]?’ We’re ... at that process point. And we’re trying to really get to the outcomes point, which might be the impact on clinical care. So I think the program is going to get there. And I really want [digital] navigation in general to kind of push in that direction.”
The Mass General Brigham Digital Access Coordinator Program has a structure in place. Staff regularly evaluate their processes and make adaptations as needed. The outcomes of the work are not yet fully demonstrated, but program leaders have planned for and expect the outcomes of this important work to be fully demonstrated as the program matures.
Written by: Chris Ritzo
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- Free Geek, Devices, and Digital Equity
- Mass General Brigham Understands that Digital Equity Supports Health Equity
- Northwest Center Engages Community, Advances Digital Skills
- The Cuyahoga Metropolitan Housing Authority Leans Into Collaboration
- North Carolina Community College System Brings the Classroom to the Learners
- Digital Connect Makes Digital Navigation Approachable
- Black Churches 4 Digital Equity: Community Anchors and Committed Advocates
- Seattle's Equity-Based Approach
- The Kūpuna Collective: A Public Health Coalition Advancing Digital Equity
- What We Know About the Human Infrastructure of Broadband
- The Human Infrastructure of Broadband: Looking Back, Looking Around, and Looking Ahead
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