Access to digital health technologies: personalized framework and global perspectives

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Abstract
The emergence and rapid adoption of digital health technologies (DHT) present unprecedented opportunities to democratize and reduce disparities in health care by monitoring health and disease at the point of care in all patients. However, limited access to DHT is becoming a major obstacle to realizing these goals. Access to DHT is influenced not only by well-recognized social determinants of health, but also by digital determinants of health, such as digital literacy and the need for broad access to digital infrastructure, as well as commercial and economic factors. Addressing these challenges and designing unbiased systems of care are essential to enable broad access to DHT and to benefit diverse and under-represented communities. Doing so will fill gaps in the clinical evidence base and avoid perpetuating historical biases. In this Review, we propose a personalized framework to improve access to DHT, addressing determinants of access at the individual, interpersonal, community, society, government and industry levels. We frame these issues globally, highlighting how the challenges to DHT access and potential solutions might differ between continents while also emphasizing common themes. We provide perspectives from partners across the spectrum of health care, including clinicians, clinical trialists, and experts from digital health and industry.

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