THURS-025 - Impact of Age and English Proficiency on Adoption of Ehealth Apps in Vulnerable Hospitalized Patients

Brief Abstract Summary: Our research strives to discover the factors behind the paradox that despite them benefiting the most from accessing their continued care post-discharge using their hospital’s eHealth app, hospitalized inpatients routinely turn it down. Our highly patient conversation centric research assesses the overall receptivity, and the impact of age, and English proficiency on the adoption of the MyMountSinai app among inpatients at the Mt. Sinai Morningside Hospital. A low 21.4% final app download rate was observed. App adoption in this hospitalized population is a multifactorial decision. Yet our data shows that age ≥65 years is a reliable negative determinant of receptivity to eHealth (Pearson’s coefficient -0.406) and contributed to ~17% of this decision (r-squared analysis 0.166). Surprisingly, English proficiency played no part in app-adoption rates. The success of our work is in the hundreds of patient verbatims that shed light on the digitalization barriers that seniors actually face.

Detailed abstract description:

Background: Healthcare access is rapidly digitizing. Smartphone based applications (apps) are likely the future of medicine. Across major hospital systems, today it is possible to download that hospital’s app to one’s phone, make appointments, see laboratory results, and order medication. It is even possible to get “treated” by one’s doctor through these apps’ e-consultation features.
Yet, United States government data (HealthIT.gov) shows that 21% of America never accesses health apps. Even more paradoxical is the observation that hospitalized patients awaiting discharge, who are most likely to benefit from receiving their continued care in the comfort of their homes using their hospitals' eHealth app, frequently turn it down. What could be the reason for people to reject such medical convenience?
Our research assesses the overall receptivity, and the impact of age and English proficiency (as independent variables) on the adoption of the MyMountSinai (MMS) app in a very vulnerable population of hospitalized inpatients at the Mt. Sinai Morningside Hospital in New York City.

Methods: This work studies the factors that influenced the decision-making process of N=100 convalescent inpatients at a New York City hospital as to whether they’d sign up for MMS or not. Given the frailty of our patient population, a very objective and rigid interview-based approach was deemed not to be appropriate. Building a bond was far more important than just asking questions and receiving answers. Through elaborate and often very personal conversations with our subjects, the researchers eventually wove in the topic of the MMS app. While many patients turned down any mention of digital health, patients who wanted to learn about MMS were extensively educated on the benefits of MMS. Thereafter, success is measured by this patient’s willingness to download the app immediately.

Results: A promising initial MMS “education” rate of 56% but a low final app-adoption rate of 21.4% was observed in our cohort of hospitalized patients. Given the acuteness of their medical condition MMS-adoption in this population was a complex multifactorial decision. Yet our data demonstrates that age ≥65 years is a reliable negative determinant of receptivity to eHealth (Pearson’s coefficient -0.406) and contributed to ~17% of this decision (r-squared analysis 0.166). Surprisingly, English proficiency played no part in app-adoption rates (Pearson’s coefficient 0.006; r2 = 1.3 x 10-5). Qualitatively, heart-wrenching patient verbatims collected illustrate the roadblocks to digitization that seniors face daily.

WHAT's IN IT FOR THE ATTENDEE: Our data and patient verbatims demonstrate how overzealous adoption of digital eHealth disservices our seniors, the very population that needs medical care the most. We urge hospitals globally to not do away with the good old “paper and pencil” just yet; every one of us knows someone who still needs it.