This is part one in a series of posts on digital health equity and innovation. A version of this content recently appeared as a guest post: “Melting the Iron Triangle: Prioritizing Health Equity in Dynamic, Innovative Healthcare Landscapes” and podcast episode on KevinMD.com.
As a Master of Healthcare Administration (MHA) student completing my administrative residency in the health technology industry, I chose to dedicate my capstone project to a topic positioned at the intersection of what I had learned in graduate school and what I had learned during my residency. While administrative residencies are typically in a hospital or consulting setting, I matched with Elation Health, a primary-care focused electronic health record company as the organization’s first administrative resident. During my residency, I gained an even greater comprehensive understanding of the complexities in the U.S. healthcare system, while taking advantage of the flexibility and independence afforded to me to pursue my passions and ideas as an early careerist. As it turns out, health technology is the perfect realm for leveraging administrative healthcare knowledge in the pursuit of healthcare innovations.
Having completed my graduate degree in a fully remote setting during the course of the pandemic, I recognize how privileged I am to have the tools and resources needed to not only achieve academic success digitally, but to also maintain my physical and mental health digitally via telehealth. Studying the recent, multifaceted advancements to health technology, as well as health disparities that existed long before COVID-19, I quickly became interested in examining the relationship between health innovation and health equity.
The Theory of the Iron Triangle
Pandemics have long served as a catalyst for robust, rapid changes to the status quo of healthcare. Though the devastation and pain caused by the COVID-19 pandemic persists, it is through public health crises that the most impactful advancements are made to the healthcare system as a whole. America’s healthcare landscape, though systematically flawed, continues to represent a hub of medical and technological innovation, rapidly adapting to meet evolving demands. As healthcare leaders continue to meet the challenges of the rapidly evolving healthcare environment, a major obstacle remains: the iron triangle.
The theory of the iron triangle, first introduced in Medicine’s Dilemmas: Infinite Needs Versus Finite Resources by William Kissick in 1994, asserts that the elements of cost, quality, and access in healthcare cannot be simultaneously improved without worsening at least one of the other elements. In this new era of digital health technologies, the iron triangle is more relevant than ever, with advancements widely embraced during the pandemic – such as telehealth – filling the immediate need for access to health. But are the populations at greatest risk in terms of access, quality, and cost of healthcare the ones truly benefiting from these innovations?
As it turns out, despite digital health technologies showing promise for the future of healthcare, vulnerable populations are often left with an even larger health disparity gap. Because of this unintended consequence of health innovation, disparities resulting from the digital divide combine with existing, multi-factor inequities in healthcare.
The Biggest Revolution in Patient Experience
While the technological boom in the healthcare field is not a circumstance of the pandemic, the accelerated roll-out and adoption of digital features certainly are. And rapid innovation in the healthcare technology field is not a bad thing in itself. Healthcare technology discoveries improve healthcare access, quality of life, patient safety, and even save lives – for example remote patient monitoring devices and robotic surgery. Although digital health innovations have made a significant impact on patient engagement through empowering individuals’ autonomy over their own health, these modern health tools could yield a much greater impact if they were not primarily utilized by populations already advantaged in terms of cost, access, and quality of care.
In contradiction to the iron triangle, some argue that “digital communications and telepresence facilitate keeping patients away from the physical facility – ideally, at home – thereby increasing access and reducing costs, and appears to be doing so without a decrease in quality.” However, the developments in digital healthcare themselves haven’t resulted in a profound impact on vulnerable populations and health equity. Without predetermined strategies for leveraging digital health innovations through a health equity lens, cost, access, and quality may not improve for those who need it the most.
Check back in for the next part of this series to learn about digital health equity, the digital determinants of health (DDOH), and how minor changes to patient-facing tools can optimize innovation for all.