Healthcare goes digital: When doctors go behind the app wall, who gets left behind?

As healthcare becomes more digital, the question arises: is technology making healthcare more accessible or creating new barriers? The smartphone is increasingly becoming the gateway to medical care, but for many, particularly older people, rural communities, low-income families, and those with limited digital literacy, this shift presents new difficulties.

Patients may struggle with internet connectivity, app navigation, password management, document uploading, and understanding online information. In many households, a single smartphone is shared among several family members, and caregivers often act as intermediaries between patients and digital health services.

The digital divide deeply impacts access to care. A DIG-EQUITY study in The Times of India examined the experiences of people with diabetes, caregivers, healthcare providers, policymakers, and community organizations in urban and rural Tamil Nadu. Younger patients were generally more comfortable with smartphones, health apps, and teleconsultations, while many older people needed family members to assist them with appointments, consultations, and accessing medical reports.

Physical limitations, such as impaired vision or hearing, could also hinder digital platform navigation.

Even among younger people, digital access does not guarantee a preference for online care. Some individuals with type 1 diabetes still prefer in-person consultations due to the necessity of physical examinations.

The digital divide is also closely tied to geographical location and financial status. Urban patients typically have better internet connections, smartphones, and access to digital services compared to their rural counterparts. A study published in Nature identified network coverage limitations, inadequate IT infrastructure, high device and system costs, technical expertise gaps, language barriers, and user difficulties as major challenges in India's digital health transformation.

These barriers have practical consequences. Some patients rely on family members' smartphones for teleconsultations, while the cost of smart devices can limit access to mobile health applications. The shift to digital healthcare at the hospital level can create additional queues, as patients must generate tokens through apps before reaching the hospital, further delaying immediate care for those with urgent needs.

For those without smartphones or reliable internet access, the new process can begin hours before their appointment, with patients sometimes waiting overnight in their homes due to connectivity issues or inability to generate digital tokens. Those with smartphones might apply for tokens earlier in the day but still face waiting periods at reception before seeing a doctor.

Dr. Manisha Arora, Director of Internal Medicine at CK Birla Hospital in Delhi, emphasizes that ABHA (Ayushman Bharat Digital Mission) should serve as a facilitator rather than a gatekeeper to treatment.