Understanding The Digital Health App Divide

Closing the gap between how a product should work and how it actually works in the wild is one of the most significant — and most overlooked — challenges for health organizations. Bridging this divide is essential to ensuring accessibility, equity, and improved patient safety.

Digital health is designed based on ideals

Traditional testing and test automation relies on ideal conditions: the latest devices running the latest OSes with access to a high-speed internet connection, and users following carefully mapped out paths every time. Internal QA teams validate the functionality of the product in a highly structured environment. While this practice is necessary for validating that the product works as intended, it assumes consistency and stability.

Real life, however, is messy.

Lab environments cannot accurately capture all real-world factors that arise in the wild. Device variability is one of the most common culprits. In a corporate environment, IT departments standardize hardware and push regular software updates. In reality, patients use outdated devices from different vendors. Screen resolutions, operating systems, apps competing for resources and even battery health vary between devices, introducing quirks that affect performance.

Beyond technical factors, real-world validation is sometimes necessary to avoid additional legal and compliance risks. For instance, testing prescription pickup workflows or complex integration with various health insurance, Medicare and Medicaid plans might require engaging real users with authorized data.

And don’t forget the human factor. Patients won’t always follow workflows perfectly. They might skip steps during onboarding. They might be distracted, using the tool while caregiving or in a noisy environment. Accessibility also comes into play; users may rely on assistive technology, such as screen readers or voice navigation, that conventional QA processes might overlook.

Health literacy also varies between users. Some can struggle with medical terminology or following complex instructions. Others might not be native English speakers. You won’t find these points of friction in a lab environment.

When digital tools are tested in a simulated environment rather than the real world, bugs often go unnoticed — until they reach the patient. There’s no guarantee users will file a report if the product doesn’t work as expected; they may simply abandon the tool altogether. When you consider the potential ramifications of digital failure in this industry, you can see that these are potential health risks, not just inconveniences.

What happens when digital health tools get it wrong

Digital health tools come with high stakes. They can affect appointment attendance, medication adherence and patient monitoring. Usability issues can quickly become safety issues.
Inaccessible intake forms can prevent patients from submitting critical health information. Login errors can lead to missed telehealth appointments. Poorly labeled buttons can prevent prescription refills.

Accessibility gaps also have significant compliance implications. Frameworks like the Web Content Accessibility Guidelines (WCAG) provide core principles for organizations to follow to make digital content accessible to all users, including people with disabilities. The Americans with Disabilities Act (ADA) and Section 1557 of the Affordable Care Act (ACA) include nondiscrimination provisions that apply to digital health experiences. Failing to meet these standards puts organizations at risk of legal scrutiny and reputational damage. 

Automated accessibility tools can potentially find up to 40% of accessibility issues, but what about the remaining 60%? That leaves plenty of opportunity for inaccurate captions, missing audio descriptions or inappropriate image alt text that go unnoticed until the product reaches a human.

Close the gap between expectation and reality

Organizations can’t rely on lab or AI testing alone. Through real-world validation, they can achieve greater insights, but it’s not without painpoints. That means recruiting the actual patients a product is designed for, testing on devices they actually own and with the assistive tools they rely on. 

Validation should span multiple device types, operating systems and hardware generations. One survey found that the most commonly owned Apple phone is the iPhone 13 (10%), followed by the iPhone 14 (8%) and iPhone 11 (7%). Another survey found that 55% of cellphone users upgrade their phone every two to three years. Testing across a range of devices helps uncover performance issues that may surface outside of a controlled network.