Cutting-edge technologies often serve as the drivers of innovation, and within healthcare can inspire pioneers to devise new means of spotting illnesses or streamlining patient care. But it’s vital for digital health entrepreneurs and innovation-minded providers to look beyond the patients who would hardly blink an eye at yearly device upgrades or $1,000+ smartphones, and remember that there are huge demographics for whom anything beyond a flip phone and basic cell service is unattainable.

“There’s differences both in the depth of technology and the level of connectivity that the users have, and a lot of it is fueled by differences in socioeconomic status and, to a certain extent, where you are geographically in the country,” Anish Sebastian, cofounder and CEO of Babyscripts, maker of a virtual obstetrics care platform, told MobiHealthNews. “What we’ve learned though is that while that exists, that doesn’t necessarily translate to ‘digital health isn’t a valuable tool or value offering.’ So what we got into was ‘hey, what can mobile and digital tools do to help in these kinds of scenarios?’”

Babyscripts, a virtual obstetrics care platform, has been partnered with Penn Medicine’s Heart Safe Motherhood program to deliver text message-based postpartum monitoring to young mothers. By contributing to this program and reviewing its own user base over the past couple of years, Sebastian said that his company has frequently observed major disparities in patients’ technology use and access.

“Just the other day I saw someone who was on Android Jellybean or KitKat or something like that, one of the older ones that you don’t see too often but still exist. You have this kind of huge variation as you start to look at a much broader population, so I think the approach there is what is the lowest common denominator,” he said. “Make sure your technology and the platform also has a waterfall-like approach to looking at text-based messaging is important.”

Providers and digital health startups can’t always assume that their patients’ personal devices have access to a range of features, he said. This means that SMS and text messaging-based communications are more likely to reach their targets than, say, multimedia educational videos. Similarly, having an optional browser-based web component allows patients the flexibility to set up accounts or access information either on a desktop computer or on mobile web browsers supported by most phones. Most importantly, he said, it’s inclusive of the patients who can’t download or run apps on their non-premium devices.

“They might have a feature phone that doesn’t have the features we’re looking for, they might not have [network data] to download our app, and things like that,” Sebastian explained. “Maybe they don’t have even enough storage on their phone to download your application, yet they’ll still have some kind of browser. So, the ability to set up and access information through a web browser is important — and that could be either on a smartphone or a desktop.”

While 4G and especially 5G are often out of reach for these demographics, Sebastian noted 3G networks are much more prevalent and accessible. In many cases, he said that organizations may find it worth the upfront cost to supply their patients with low-cost tools that can help them access the networks and, subsequently, stay in contact with care services.

“What we’ve done for example is we ship something called a Mommy Kit out to moms that are out there. What we’ve done is shipped a scale with a sim card in there — that takes away the need for this heavy patient-focused connectivity. Literally all they need is 3G service and we’re good to go.

“Now, there’s a cost threshold or benefit analysis you have to do, right? We incur more costs by providing that connectivity out of the box, but of course if the patient needs it and the use case is there and the ROI is there from the health standpoint, you’re able to do that. In a high acuity setting, you might want to pull those levers of connectivity out of the box as opposed to relying on the patient to bring their own connectivity.”

Of course, there are still plenty of simple, tried-and-true methods of contacting patients that are just as valuable now as they ever were.

“This sort of goes without saying, but the ability to just get on phone calls, right? Whether it’s through a POTS (plain old telephone service) system or it’s through voice over IP, just connecting to people through a phone is important,” he said. “We call patients all the time. We see what’s going on, whether they have any issues, deliver information through that. We rely on the phone system as the other mechanism by which we connect to users when everything else fails.”

Sebastian said that simple phone calls can facilitate what he sees as one of the most important components of treating underserved patients: the need to develop strong relationships between individuals and the various resources available within their communities. In this sense, he said that digital health companies will see the most success if they can align their solutions with the local services that can provide lifelong support.

“We’ve found that when digital health is aided with a care navigator, with an actual person on the other end, it has a 10-times if not more impact,” he said. “A lot of what social determinants is about is making meaningful connections, not just with your care team but also the larger community of care. We actually brought on a social worker to our team full time just to help with this. If it was simply a bot or some other digital tool, it wouldn’t have been nearly as effective as if it was aided with someone else on the other end. That’s like an amplification argument — I as a social worker may be able to handle a census of 30 or 40, with digital tooling I can make a much bigger impact.”

For Sebastian, the effectiveness of these kinds of approaches serve as a reminder that digital health is hardly a silver bullet, especially when it comes to social determinants of health. Rather, it’s about building tools that can work around patients’ lives to deliver as much value as possible.

“Someone that’s living in New York City that’s upper-middle class and can get the latest-greatest, are they getting the most out of it? Yes, because you can integrate into Alexa or Siri and all this stuff, you’re getting the biggest squeeze out of it,” he said. “But that doesn’t mean that someone with a feature phone from five years ago can’t get value via mobile or digital health.”