Are we leaving underserved communities and their health and digital equity behind again as we transition to a Web3 and Metaverse platform?

Web3 and the metaverse are emerging technologies that can potentially transform and disrupt the way healthcare is delivered to underserved communities. This transformation and disruption could have significant impact on the patient experience, health equity, and digital equity because of the barriers in accessing healthcare services. Although the metaverse and Web3 could enhance care delivery by leveraging cross-border virtual services, the barriers to social determinants of health (SDoH) still exist and may even be exacerbated. To close the digital gaps and address the SDoH barriers in a Web3 and metaverse world, we must take a multifaceted approach. As clinicians and providers of care and services, we play an important role in promoting digital health equity.

Web3 & the Metaverse

Web3 and the metaverse are emerging technologies that have the potential to dramatically alter the way healthcare services are digitally delivered. Web 1.0 (read-only function) was first implemented in 1989 and started our digital journey by allowing us to connect online; this was the internet or the World Wide Web. Web 1.0 was considered a “web of documents”.¹ Web 2.0 (read-write functions) launched around 2004 and allowed us to connect online as a community, i.e., social media. Web 2.0 was considered a “web of people”.² Web3 (read-write-own functions) was coined around 2014 based on the core framework of a decentralized digital world using blockchain technology which allows us to connect in a community-owned ecosystem. Web3 is considered a “web of data”.³

The metaverse is the platform for Web3 connection and will change the way patients and clinicians interact, communicate, create, and exchange valued healthcare services. The metaverse will provide a way for patients and clinicians to have an immersive experience. A Web3-Metaverse platform potentially can improve interoperability⁴ because the digital assets (such as the patient’s medical record) will be transferrable between metaverse platforms. In our current Web 2.0 environment, a patient never owns their medical record; the provider, medical institution, or vendor that generated the record does. In Web3, the patient will own their medical record (digital asset).⁵ Ownership of the patients’ medical records will be confirmed by using medical non-fungible tokens (NFTs)⁶ which are blockchain-based tokens and considered irrevocable digital certificates of ownership and authenticity. Yes, the metaverse is the next version of the internet and a great disruptive innovation that will decentralize patient data plus give them an immersive and interactive experience by taking advantage of virtual reality (VR), augmented reality (AR), and artificial Intelligence (AI) technologies. A report from Market Research Future (Healthcare in the Metaverse) predicted that by 2030, the healthcare metaverse will be valued at approximately $5.37 billion at a compounded annual growth rate (CGAR) of 48.3%.⁷

Barriers to Adoption and How Those Barriers Will Impact Underserved Patients in a Web3 and Metaverse Era

Healthcare is slow to change and adopt new technology^.8 There will be many barriers to adopting the metaverse⁹ especially with respect to underserved patients and their caregivers. Barriers can fall into five categories: patient barriers, digital infrastructure barriers, intervention design barriers, provider barriers, and health system barriers.¹⁰

The main causes of resistance to adoption of the metaverse platform will fall in the patient barrier category because of the lack of perceived benefit of using the metaverse and poor digital literacy. If patients and caregivers do not see the benefit in using the metaverse ecosystem or if entering data into the system is inconvenient, they will not use it. Poor digital literacy about the metaverse will be more impactful in low-income communities. Middle-income communities will also be impacted if there are constraints on being able to expand the technology to improve patient engagement, provide system accessibility, ensure system affordability, ensure improvement of quality care, and ensure improvement of provider productivity. Additionally, other barriers will include situations when engaging with the metaverse creates more work for the patient, where there is a lack of privacy and trust, where there are technical challenges, and limited access to computers and other supporting equipment such as VR goggles. In middle-income and low-income communities, technology fears, cognitive and physical disabilities, poor metaverse literacy, and lack of cultural relevance will prove challenging for seamless adoption.¹¹

Clinician’s Role to Promote Health Equity in a Web3 and Metaverse Era

During the COVID-19 pandemic, we saw the need for digital healthcare delivery. We also saw and experienced increased inequalities in access to healthcare services because of the digital gaps in underserved communities. We also saw the negative impact on SDoH,¹² because of the digital divide.¹³


Figure 1 outlines a digital health equity framework which can be used for Web3-Metaverse platform adoption efforts so that clinicians can help reduce the digital gap and promote health equity for their patients across four Levels of Influence (Individual, Interpersonal, Community, and Societal). To start, clinicians can act as a metaverse facilitator and focus their efforts on the Digital Environment Domain of Influence (highlighted) and on the Individual Level of Influence to help their patients adopt Web3 services by raising awareness of metaverse services. Staff will also need education in metaverse services so that they can better support patients.¹⁴

Conclusion

The advancement to a Web3 and metaverse healthcare delivery services platform will impact patients and will encounter barriers to adoption. Communities that are underserved and are currently experiencing a digital gap and negative SDoH outcomes will be further impacted, and the digital divide will grow wider if not addressed now. Clinicians play a critical role in preparing their patients to effectively function in this new digital world. We recognize that clinicians will also face challenges in adopting the metaverse, especially since as an industry we are slow to adopt new technology. However, focused efforts and funding must be applied to underserved communities to further reduce the digital gap, ensuring that they are not left behind the advances of the nation or further impacted by negative health outcomes.

Learn more about Web3 and the Metaverse during Dr. Ann Ingraham’s session at ABQAURP's Annual HCQ&PS Conference on Friday, October 20, 2023. For more information and to register, visit www.abqaurp.org/AnnualConference.

^1,2,3 Choudhury, N. (2014). World Wide Wed and Its Journey from Web 1.0 to Web 4.0. (IJCSIT) International Journal of Computer Science and Information Technologies. Vol. 5 (6), 8096-8100. Retrieved from https://ijcsit.com/docs/Volume%205/vol5issue06/ijcsit20140506265.pdf

⁴ Bhattacharya, P., Saraswat, D., Savaliya, D., Sanghavi, S., Verma, A., Sakariya, V., Tanwar, S., Sharma, R., Raboaca, M., & Manea, D. (2023). Towards Future Internet: The Metaverse Perspective for Diverse Industrial Applications. Mathematics. 11(4):941. Retrieved from https://doi.org/10.3390/math11040941

⁵ Subramanian, H. (2023, Feb 27). A Decentralized Marketplace for Patient-Generated Health Data: Design Science Approach. J Med Internet Res. 25:e42743. doi: 10.2196/42743. PMID: 36848185; PMCID: PMC10012005

⁶ Mesko, B., Dhunnoo, P. (2022, Jan 12). NFT in Healthcare: How Patients Could Monetise Their Health Data. The Medical Futurist. Retrieved from https://medicalfuturist.com/nfts-an-health-data/

⁷Gupta, A. (publisher). (2023, March). Healthcare in Metaverse Market, Market Research Report. Retrieved from https://www.marketresearchfuture.com/reports/healthcare-in-metaverse-market-10900

⁸Abutaleb, R.A., Alqahtany, S. S., Syed, T.A. (2023). Integrity and Privacy-Aware, Patient-Centric Health Record Access Control Framework Using a Blockchain. Applied Sciences. 13(2):1028. Retrieved from https://www.mdpi.com/2076-3417/13/2/1028

⁹Gibbons, M.C. (2011 Jan 1). Use of Health Information Technology among Racial and Ethnic Underserved Communities. Perspectives in Health Information Management. 8(Winter):1f. PMID: 21307989; PMCID: PMC3035830. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035830/

¹⁰Alvarado, M.M., Kum, H-C., Coronado, K.G., Foster, M.J., Ortega, P., & Lawley, A.M. (2017, Feb 13). Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme. Journal of Medical Internet Research. 02;19(2). DOI: 10.2196/jmir.6382. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329647/

¹¹Rodríguez-Rabassa, M., Torres-Marrero, E., López, P., Muniz-Rodriguez, K., Borges-Rodríguez, M., Appleton, A.A., Aviles-Santa, L., & Alvarado-Domenech, L.I. (2023). Stressors and Impact of the COVID-19 Pandemic on Vulnerable Hispanic Caregivers and Children. International Journal of Environmental Research and Public Health. 20(3):1838. Retrieved from https://www.mdpi.com/1660-4601/20/3/1838

¹²Morita, S.X., Hirotaka, K. (2023, Jan 1). Racial Disparity and Trend of Food Scarcity Amid COVID-19 Pandemic in the United States. Cureus. 15(1): e33232. Doi:10.7759/cureus.33232. Retrieved from https://www.cureus.com/articles/107017-racial-disparity-and-trend-of-food-scarcity-amid-covid-19-pandemic-in-the-united-states#!/

¹³Richardson, S., Lawrence, K., Schoenthaler, A.M., & Mann, D. (2022, Aug 18). A framework for digital health equity. npj digital medicine. 5: 119. Retrieved from https://www.nature.com/articles/s41746-022-00663-0

¹⁴Leach, B., Parkinson, S., Gkousis, E., Abel, G., Atherton, H., Campbell, J., Clark, C., Cockcroft, E., Marriott, C., Pitchforth, E., & Sussex, J. (2022, July). Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review. Journal of Medical Internet Research. Vol 24, No 7. Retrieved from https://www.jmir.org/2022/7/e33911