Hawaiʻi Resources

There are several special populations in the State of Hawai‘i that have access to care issues. High-risk pregnant women are examples of patients who need to travel from the neighboring islands to Honolulu to receive necessary health care. There is only one Level 3 Mother-Baby hospital in the State of Hawai‘i that is open to all pregnant patients regardless of health plan, ability to pay, and gestational age. The other hospitals on the neighbor islands do not have Neonatal Intensive Care Units (NICUs) to provide care for any premature babies delivered prior to 36 weeks’ gestational age. High-risk pregnant women must therefore travel often to Oʻahu to receive perinatal care services. In addition, the providers on the neighbor islands also struggle to access essential fetal imaging and prenatal diagnostic testing for their patients. Annually 5,000 pregnant women fly from our neighbor islands to Oʻahu for prenatal ultrasound screening for abnormalities that could potentially result in morbidity and mortality. Of which, 100 women are emergency flight transported to O‘ahu (average cost of $10,000- $15,000 per transport). This is a high-risk group that could greatly benefit from telehealth networks and technology that would remove the need to travel and other barriers in receiving the care they need for healthy pregnancies.

Native Hawaiians and Pacific Islanders are one of our special populations that are also the fastest growing populations in the US. In Hawai‘i, they makeup 10.1% of the total population. They disproportionately experience greater health disparities that lead to worse health outcomes. In 2015, Native Hawaiians and other Pacific Islanders significantly lead other race/ethnicities in mortality rates across many indicators. They had the highest mortality rates for all-cause, asthma, breast cancer, cirrhosis, colon cancer, lung cancer, oropharyngeal cancer, prostate cancer, drownings, fall-related injury, and across all age groups. In addition, no other ethnic group has been impacted by COVID-19 more than Pacific Islanders. They account for a plurality of COVID-19 cases (30%) in Hawai‘i despite making up only 4% of the population. Native Hawaiians are third with 17% of COVID-19 cases.

Further, Hawai‘i’s disability community is at a distinct health care access and technological disadvantage. Approximately 62% of adults with a disability own a desktop or laptop computer, compared with 81% of those without a disability. The affordability of devices and connectivity and lack of access to training is only compounded by the need for assistive and adaptive technology. Hawai‘i’s disability community has traditionally been underserved in the area of technical assistance for digital literacy and telehealth. This is a priority special needs community of focus for PBTRC.  

Much of the Hawai‘is population enjoys digital literacy and often takes for granted everyday occurrences like video calling. Access to broadband is increasingly seen as essential and addressing digital inequity is the next step to ensuring all of Hawaii’s underserved disability population is receiving the same access that others consider commonplace.

Broadband infrastructure, broadband access, and digital literacy has been around for a long time. But now, low-income populations who already face barriers with access to care are even more disadvantaged because of the inability to connect to telehealth services. Whether it be the lack of adequate speed, inadequate devices, or lack of knowledge on how to use devices and applications, these unmet health needs must be addressed in conjunction with telehealth.

PBTRC works in collaboration with partners to understand the current needs and technical assistance demands from the community. We will work with various communities to plan for increased “access” to broadband and telehealth access points. PBTRC also recognizes the need for “digital literacy” or “know-how” to use technology effectively for telehealth for patients and families. Telehealth services in Hawai‘i have moved significantly to patients in their homes using their own devices. Based on provider surveys from Hawai‘i Medicaid Managed Care Organizations and the Hawai‘i Primary Care Association that serves our Federally Qualified Health Centers (FQHCs), “digital equity and access” and “digital literacy” are top challenges for health care providers serving our most rural and vulnerable communities.