The release of final rules from the Office of the National Coordinator for Health Information Technology's (ONC) Cures Act in March 2020 places a new focus on patients' access to their health data. 1 The ONC rules make "health data more computable and [give] patients more control of their medical record." 1 Hopefully, patients will be able to interact more easily with their data through patient portals and mobile health apps, and "shop for care by comparing costs, understanding possible treatments, and expected health outcomes." 1 The new rules intend to increase the pace of innovation and investment in patient-facing tools. Building on more than 300 000 health apps and $7.4 billion in digital health investments in 2019 alone, this policy environment may significantly transform the ways patients access care. 2 In light of the current coronavirus disease 2019 (COVID-19) pandemic, and the success in Taiwan and Singapore in using health information to identify, trace, track, and quarantine individuals, a more user-friendly system has become even more important. 3,4 However, improvements in patient self-management, care coordination, quality, and cost-effectiveness may be stymied by persisting digital divides. Given the recognition of the higher morbidity and mortality for underserved patients with COVID-19, including African Americans, understanding and eliminating these digital divides are critical. 5 Thus, the benefits of these innovations will require active efforts to ensure the needs of diverse groups are included in design and implementation strategies.Two patient-facing tools, patient portals and mobile health apps, represent patients' primary digital touch points with the health care system, and the importance of these tools is expanded with the new rules. These modalities also serve as means to access telehealth services, collect data, and address population health, patient-reported outcomes, and social determinants of health. Patient portals are one of the earliest investments in telehealth technology, yet uptake has lagged among underserved populations, including patients of racial/ethnic minority groups, limited English proficiency, low socioeconomic status, older age, and low literacy. 6 For example, Anthony et al 6 found that patients on Medicaid or with less than a high school diploma were about twice as likely to be nonportal users. This is not only relevant for clinical care, but also for research as portals become trial recruitment tools.Similarly, mobile apps have not been designed for underserved populations. 7 The ONC rules should prompt renewed efforts aimed at digital health equity. This will require guiding the commercial and regulatory landscape that currently influences the design and implementation of these technologies. In this Viewpoint, we highlight inequities in these digital health tools and opportunities to apply an equity framework in the era of expanded patient access to data.

Protein dephosphorylation by the serine/threonine protein phosphatase 2A (PP2A) modulates a broad array of cellular functions. PP2A normally acts as a heterotrimeric holoenzyme complex comprising a catalytic subunit bound by regulatory A and B subunits. Characterization of the regulatory A subunit isoforms (ROOTS CURL IN NAPHTHYLPHTHALAMIC ACID1 [RCN1], PP2AA2, and PP2AA3) of Arabidopsis thaliana PP2A has shown that RCN1 plays a primary role in controlling root and hypocotyl PP2A activity in seedlings. Here we show that hypocotyl and root growth exhibit different requirements for RCN1-mediated regulation of PP2A activity. Roots of rcn1 mutant seedlings exhibit characteristic abnormalities in cell division patterns at the root apical meristem, as well as reduced growth under ionic, osmotic, and oxidative stress conditions. We constructed chimeric A subunit genes and found that restoration of normal root tip development in rcn1 plants requires both regulatory and coding sequences of RCN1, whereas the hypocotyl elongation defect of rcn1 plants can be complemented by either RCN1 or PP2AA3 transgenes. Furthermore, the RCN1 and PP2AA3 proteins exhibit ubiquitous subcellular localization patterns in seedlings and both associate with membrane compartments. Together, these results show that RCN1-containing PP2A has unique functions that cannot be attributed to isoform-specific expression and localization patterns. Postembryonic RCN1 function is required to maintain normal auxin distribution and stem cell function at the root apex. Our data show that RCN1-regulated phosphatase activity plays a unique role in regulating postembryonic root development and stress response.

Background and objectivesMany aspects of CKD management rely heavily on patient self-care, including medication and dietary adherence, self-monitoring of BP, and daily physical activity. Growing evidence suggests that incorporating smartphone-based applications can support self-care in CKD and chronic disease more generally.Design, setting, participants, & measurementsWe identified applications targeting patients with CKD by conducting a search of the US Apple App Store (iOS) and Google Play Store (Android) using the following four phrases: “kidney disease,” “renal,” “dialysis,” and “kidney transplant.” We considered the first 50 applications for each search term on each application store. We adapted a previously described framework for assessment of mobile health applications to account for kidney disease–specific content areas and evaluated applications on their types of patient engagement, quality, usability, and safety. Engagement and quality were assessed by both a patient and a nephrologist, usability was assessed by a patient, and safety was assessed by a nephrologist. Overall, two patients with CKD and three nephrologists performed the evaluations. We examined pairwise correlations between patient, nephrologist, and consumer ratings of application quality.ResultsOur search strategy identified 174 unique applications on Android and 165 unique applications on iOS. After excluding applications that were not related to kidney disease, were not patient facing, or were last updated before 2014, 12 Android-only applications, 11 iOS-only applications, and five dual-platform applications remained. Patient and nephrologist application quality ratings, assessed by the net promoter score, were not correlated (r=0.36; P=0.06). Consumer ratings on the application stores did not correlate with patient ratings of application quality (r=0.34; P=0.18).ConclusionsOnly a small subset of CKD applications was highly rated by both patients and nephrologists. Patients’ impressions of application quality are not directly linked to consumer application ratings or nephrologist impressions.

The collection of patient reported outcomes (PROs) allows us to incorporate the patient’s voice within their care in a quantifiable, validated manner. Large scale collection of PROs is facilitated by the electronic health record (EHR) and its portal, though historically patients have eschewed the portal and completed patient reported outcome measures (PROMS) in clinic via tablet. Furthermore, access to and use of the portal is associated with known racial inequities. Our institution oversees the largest clinical PRO program in the world, and has a long history of racially equitable PRO completion rates via tablet. However, when the COVID-19 pandemic forced us to remove tablets from clinics and rely exclusively on portal use for PRO completion, profound racial disparities resulted immediately. Our experience quantifiably demonstrates the magnitude of inequity that the portal, in its current configuration, generates and serves as a cautionary tale to other health care systems and EHRs.

As smartphone and sensors continue to become more ubiquitous across the world, digital biomarkers have emerged as a scalable and practical tool to explore disease states and advance health. However, as the digital divide of access and ownership begins to fade, a new digital divide is emerging. Who are the types of people who own smartphones or smart watches, who are the types of people who download health apps or partake in digital biomarker studies, and who are the types of people who are actually active with digital biomarker apps and sensors – the people providing the high-quality and longitudinal data that this field is being founded upon? Understanding the people behind digital biomarkers, the very people this emerging field aims to help, may actually be the real challenge as well as opportunity for digital biomarkers.

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Background: For limited English-proficient (LEP) patients, the digital divide has narrowed, creating a new population of Internet users. However, language-appropriate health information is difficult to find. Community health center (CHC) websites are health information resources and their homepages are critical access points for patients. CHCs supported by Health Resources and Services Administration (HRSA) care for many LEP patients. Objective: We sought to determine the number of HRSA-supported CHC websites providing translated homepage content. Research Design: In February 2017, we performed a cross-sectional analysis of the language availability of CHC homepages. Measures: The primary outcome was availability of translated content on CHC homepages. Secondary outcomes were method of translation and associations between homepage translation and CHC demographics, including percent LEP population and socioeconomic and Internet access characteristics. Results: Of the 1400 CHC homepages, 480 (34.3%) provided translated information with half using Google Translate. We found higher odds of having a translated homepage as the LEP population by county increased [odds ratio (OR): 1.26, confidence interval (CI): 1.07–1.49, P=0.005], Internet subscription at the state level increased (OR: 1.19, CI: 1.02–1.38, P=0.026), and if health centers were in metropolitan areas (OR: 1.81, CI: 1.31–2.51, P<0.001). There was also higher likelihood of having a homepage translated to Spanish in counties with higher Spanish LEP populations (OR: 1.39, CI: 1.19–1.63, P<0.001), but this did not extend to non-Spanish languages (OR: 0.85, CI: 0.71–1.04, P=0.131). Conclusions: Despite increased Internet use among LEP patients and linguistic diversity of the CHC populations, there is a lack of language-appropriate content on CHC website homepages.

Publicly reported data can help identify hot spots of discarded needles and examine indicators of spatial association. In Boston, the number of discarded needles being reported is rising, with the highest density of needles found in 2 central neighborhoods with several outlying hot spots. Most needles were found near areas associated with social stress and substance use disorder. Public Health Implications. This analysis represents a novel way of leveraging publicly available information to target community responses to the opioid epidemic. Identifying hot spots of discarded needles may enable public health organizations to target future efforts to encourage safer needle disposal practices and reduce public injection drug use.