JMIR Publications

ABSTRACT

Internet-augmented medicine has a strong role to play in ensuring that all populations benefit equally from discoveries in the medical sciences. Yet, data from the Centers for Disease Control and Prevention collected from 1999 to 2014 suggested that during the first phase of Internet diffusion, progress against mortality has stalled and in some cases receded in rural areas that are traditionally underserved by medical and broadband resources. This problem, of failing to extend the benefits of extant medical knowledge equitably to all populations regardless of geography, can be framed as the “last mile problem in healthcare.” In theory, the Internet should help solve the last mile problem by helping to move the best knowledge in the world can reach everyone in the world at low cost and no delay. In practice, the antiquated supply chains of industrial age medicine have been slow to yield to the accelerative forces of evolving Internet capacity. This failure is exacerbated by an expanding digital divide preventing residents of isolated, geographically distant communities from taking full advantage of the digital health revolution. The result, according to the FCC’s Connect2Health Task Force, is the unanticipated emergence of “double burden counties:” counties for which mortality burden is high while broadband access is low. The good news is that a convergence of trends in Internet-enabled healthcare are putting medicine within striking distance of solving the last mile problem both in the U.S. and globally. Specific trends to monitor over the next 25 years include: (a) using community-driven approaches to bridge the digital divide, (b) addressing structural disconnects in care through 4-P medicine, (c) meeting patients at “point-of-need,” (d) ensuring that no one is left behind through population management, and (e) self-correcting cybernetically through the learning healthcare system.