Gaps in Health Literacy and Internet Connectivity For Digital Health

Sherri Douville
4 min readNov 13, 2022

The Highways or Competencies That Aren’t

I’ve been asked constantly, many times why we at Medigram, focus on the clinical environment and our passion around empowering physicians to be more efficient and effective with technology that works when nothing else does on mobile. This post is intended to explain the competency and technical gaps that necessitate separating consumerism from enterprise digital health models.

I’m not afraid of impossible challenges but what I refuse to do is work in something intractable, beyond the scope of my resources. That’s why I do not focus my work on wellness, patient engagement, or consumerism in health. Customer acquisition cost alone is $1000 per consumer!

At Medigram, the Mobile Medicine company; we focus on the clinical environments of hospitals and manufacturing of medical devices.

When one is blind to essential details, it’s like wearing a blindfold

Two overarching reasons:

Why we do not have a wellness/patient engagement professional focus:

Here is a brilliant analysis of the low 12% population health literacy [1] published here in the Lancet that helps explain the rationale for why I do not focus in my work on things that are impacted by or require patient/consumer health literacy or technical literacy for success. That’s because of the powerful, intractable challenges in the way. As a CEO, if I can’t get extraordinary talent and capital to work towards attractive business outcomes in near term terms; I have no business working on the issue(s). I do allocate limited and defined amounts of time as well as political, social, professional forms of capital, and intellectual support to champion and empower people whose public health, health system, and educational roles are conducive to equity goals; though in my view, it has to be done in practical, highly efficient ways that deserve its own post. These problems/opportunities of “consumerism” and “wellness” are of a staggering scope beyond my own power, material, and time resources to make any worthwhile difference in the near term. I think it’s fair to say that this assessment applies to most organizations.

There is a technical parallel explained in the following Electronic Frontier Foundation piece.

Why there is minimal consumerism professional focus in my work from a technical infrastructure perspective:

EFF explains the technical parallel to the kinds of intractable challenges described in the Lancet paper below:

Further, there are other infrastructure gaps in data maturity for mobile compatible, more liquid data elements for when data matters clinically, as well as technology training and support.

Most importantly, the gap between the market for consumer tech and “consumerism of IT” and often SaaS expectations and what the customers in each market will pay for, that is cybersecurity; willingness to resource and fund cybersecurity in consumer and software as a service, SaaS markets diverge too far from regulated medical enterprise requirements to lend itself to rational company alignment/market timing fit, and building.

How Is This All Impacted by Interoperability?

As explained in this blog, interoperability efforts while laudable, are perhaps most often short of providing value in clinical quality in ways that truly help patients, health systems, providers, and appear to lack comprehensive cybersecurity. Tip: the interoperability post is LONG, scroll to the end where it says “conclusion” to get to the bottom line.

While being under constant attack, healthcare systems and their leaders often feel that patients hold them accountable to the quality of digital apps that have access through an API such as FHIR to their medical information. Any industry insider knows and as we explain in our book, Advanced Health Technology to bet that consumer facing apps will have poor cybersecurity hygiene.

That is one reason that organizations such as the CIO leadership group, CHIME and others appear to want to take a more thoughtful, practical, detailed approach to interoperability for consumer-facing health apps as they stated in a recent letter, “Despite our best efforts to educate our members, significant knowledge gaps and confusion still exist within the provider and vendors communities with respect to implementation and enforcement of information blocking regulations.” [2]

To be clear, I am a champion of widespread wellness, education, equity, and cybersecurity. Though my fiduciary duties and interests compel me to fit those activities into limited, highly efficient, strategic mechanisms.

I am happy to discuss these issues with our key stakeholders when consideration for every tiny required technical, process, skill, competency, implementation, training, support, incentives details are well thought out and accounted for including cybersecurity and privacy competencies.

To be clear, given the direction of policymakers [3] and leaders [4] of our field; at least the latter issue, cybersecurity competence divergence will start to become more aligned and addressable; but not in time for entrepreneurs today who have to attract extraordinary talent and capital to compelling businesses in terms of the current, near term, mid term, and somewhat longer term requirement to separate consumerism from enterprise digital health.

By Sherri Douville, CEO at Medigram, the Mobile Medicine company. Recognized in 8 categories of top CEOs by Board Room Media (Across SMS, mHealth, iOS, IT, Database, Big Data, Android, Healthcare). Top ranked medical market executive worldwide and #1 ranked in mobile technology categories (mhealth, iOS, Android), #1–2 (on any given day) for the cybersecurity market in the U.S. on Crunchbase. Best selling editor/author, Mobile Medicine: Overcoming People, Culture, and Governance & Advanced Health Technology: Managing Risk While Tackling Barriers to Rapid Acceleration, Taylor & Francis; Series Editor for Trustworthy Technology & Innovation + Trustworthy Technology & Innovation in Healthcare.

[1] Understanding the Health Literacy of America Results of the National Assessment of Adult Literacy

[2] CHIME Leads Request for HHS to Delay Information Blocking Deadline

[3] Congressional report finds health care sector ‘uniquely vulnerable’ to cyber attacks

[4] CHIME Urges FTC to Stringently Enforce Health Breach Notification Rule