Community Stories

For some rural Pennsylvanians, getting health care can mean driving miles to see a doctor. For others, the obstacle begins long before they ever reach the road.

It can be a website they do not know how to navigate, a patient portal they have never used, a phone they do not have, an internet connection that is too slow or unreliable for a video appointment, or simply the uncertainty of what to click, what information is safe to enter, and whether the technology will work when they need it.

For the medical students working with Penn State’s LION Mobile and Lion Care Tyrone, these barriers have become an increasingly visible part of serving rural communities. The lesson they have learned is straightforward but easy to overlook: putting health information and services online does not automatically make them more accessible.

LION Mobile is a systems-agnostic, transdisciplinary platform for rural vitality and a Penn State College of Medicine asset focused on health prevention, community education, student service, learning, and scholarship. Rather than functioning as a traditional “clinic on wheels,” LION Mobile brings screening, prevention, outreach, health education, and community service directly into rural communities.

That same philosophy shapes Lion Care Tyrone, a student-run free clinic that provides primary care, referrals, and care coordination for people who may otherwise have difficulty accessing health services. But increasingly, meeting people where they are also means recognizing whether they can actually participate in a health care system that has moved much of its everyday work online.

A doctor may be miles away. The portal may be even farther.

Mackensie Koch, a Penn State medical student who has worked with rural patients through Lion Care Tyrone and LION Mobile, has seen the digital divide appear in surprisingly basic ways.

At the Tyrone clinic, she regularly helps patients access Medicaid applications. Some use the clinic’s computers. Others have a phone and can be walked through the process on their own device. For patients who have never navigated these systems, even reaching the correct website can be unfamiliar territory. Then come the questions: What do you click? What information are you supposed to provide? Is the website legitimate? Why does it need a Social Security number or other personal information?

Koch said some patients are particularly uncomfortable entering personal information online, even when they are using government or secure websites. The result is a barrier that has little to do with whether someone qualifies for assistance. The resource may exist. The application may be available. The patient may desperately need the service. But without the ability and confidence to navigate the technology, the resource can remain effectively out of reach.

That distinction matters because technology is no longer simply an optional way of accessing health care. It is becoming part of the infrastructure through which people manage it. Patients are expected to use online portals to communicate with providers, review test results, manage appointments, and receive information. They may be directed online to apply for insurance or benefits. They may be encouraged to use telehealth when an in-person appointment is difficult.

For someone who has grown up using smartphones and laptops, these steps can feel routine. For someone who has never had a computer, does not own a smartphone, or has spent most of their life getting health information face-to-face, they can feel like another language.

Koch has seen how quickly that confusion can have consequences. While working at a pharmacy, she heard about a woman in her 80s who had recently gotten a phone and tried to log into her patient portal. Instead, the woman accidentally canceled all of her doctor’s appointments and removed herself as a patient from every practice she had been using.

Her coworker, Koch recalled, could hardly understand how it had happened. “How did you go in and remove yourself as a patient for every single doctor you ever had?”

The story stayed with Koch because it illustrated a problem she sees more broadly: people may genuinely be trying to adapt to a health care system that is increasingly asking them to use technology, while simultaneously being given very little room to learn how.

“There’s a lot of fumbling in the dark,” Koch said.

She sees that in her own family, too. Her grandfather regularly receives paper notices from doctors’ offices and insurance companies telling him to enroll in MyChart or use other digital health tools. He brings the notices to his family and asks what they mean. Even Koch, who is comfortable with technology, finds patient portals confusing at times.

“I think MyChart’s kind of confusing,” she said. “As somebody who knows a phone and I have some semblance of an idea of how to navigate it, and it’s still like, ‘Oh my God, wait, how do I get to my appointments?’”

The challenge becomes even more pronounced for older adults who may have never used a smartphone for anything beyond making a call. Koch estimated that in her hometown, only about 20% of people over 70 had cell phones when she worked at a pharmacy. Many relied on home phones instead. For those who did have cell phones, she said, the device was often understood primarily as a telephone; texting, apps, and patient portals were foreign concepts.

Her own grandparents illustrate the problem. Her grandmother is the only one of her grandparents who has a cell phone, meaning her grandfather uses her phone when he needs to participate in telehealth.

That kind of arrangement can make technology technically available without making it genuinely accessible.

The five-minute application that can change a patient’s health

Sometimes, the consequences of that gap are immediate.

At Lion Care Tyrone, Koch helps patients pull up Medicaid applications, navigate the forms, and complete the process. In some cases, the actual application takes only five or 10 minutes once someone sits down with them and walks through it.

Patients are sometimes surprised by how simple it turns out to be.

“After we’re done, they say, ‘Oh, I didn’t know it would be that easy,’” Koch recalled.

That reaction captures the strange nature of a digital barrier: something that takes a trained person five minutes can remain an obstacle for someone else for months or years. A patient may not live near a county assistance office. They may not have a computer or smartphone. They may not know where to begin online or may be uncomfortable entering personal information into a website.

The consequences can extend far beyond the application itself. Koch described patients arriving at the clinic with some of the longest lists of health concerns she has seen because they have not had an equitable way to address them or could not afford care. Someone might have chronic diarrhea, persistent stomach pain, or another ongoing health problem but no way to pay for an outpatient visit.

Helping that person complete a Medicaid application can change what happens next. Once they have coverage, they may be able to see a primary care provider, visit a gastroenterologist or another specialist, receive lab work, and finally begin addressing a problem that has gone untreated.

The technology itself is not the intervention. What matters is what becomes possible once the technology barrier is removed: a website becomes health insurance; health insurance becomes a doctor’s appointment; a doctor’s appointment can become testing, treatment, or a referral.

A task that looks like a small digital skill can therefore become part of a much larger health outcome.

A phone can mean more than a phone

Samyukta Karthik, a third-year Penn State medical student in the Rural Health Flex Track, sees that same connection in her work with LION Mobile and Lion Care Tyrone.

Patients arrive with dramatically different levels of technological experience. Some know how to use their phones but do not know how to navigate a patient portal. Others are not sure how to access a website to apply for Medicare or Medicaid. Some do not know where they could go to use a computer or even where a nearby library might be. The questions range from relatively advanced to what Karthik described as “bare bones.”

That variation is important because digital equity is not simply a question of whether someone has an internet connection. It is also whether they have a device that works for what they need to do, whether they know how to use it, whether they trust the system they are being asked to use, and whether someone can help when they get stuck.

In her clinical experiences, Karthik has seen an especially stark example in a patient who was living out of a car. Reliable internet access was essentially not an option. At times, the clinic’s only way of communicating with the patient was through a family member’s account, including messaging through someone else’s Facebook account.

The patient was also dealing with more immediate challenges: unstable access to food and no reliable place to store medications, including insulin that requires temperature control.

At first, the patient was hesitant about signing up for a free phone service. There was distrust around providing personal information and signing up for something unfamiliar. But Karthik said the conversation changed when the technology was connected to the patient’s actual needs rather than presented as something they simply should have.

Access to a phone and connectivity ultimately helped the patient obtain insurance and apply for a job. It also changed the relationship between the patient and the health care team. With a reliable way to communicate, the clinic could check in about blood pressure, glucose readings, and symptoms between visits. The patient no longer had to depend as heavily on family members to communicate with the clinic or manage their care.

Over time, Karthik said, the patient began to see the technology less as something being imposed on them and more as a tool that gave them greater autonomy.

That distinction is at the heart of digital equity. Connectivity is not valuable simply because it connects someone to the internet. It is valuable because of what that connection allows a person to do: communicate with a health care provider, apply for insurance, apply for a job, manage medications, or simply contact a clinic without asking someone else for help.

The clinic is one spoke in a much larger wheel

For Karthik, those individual connections also reveal something larger about how rural health care works.

Lion Care Tyrone and LION Mobile are not destinations where patients can receive every service they will ever need. They are part of a broader network. A patient might come to a clinic for primary care and then need a specialist, lab work, insurance coverage, a prescription, or follow-up with another provider.

Karthik described these programs as “spokes on a wheel”—one connection point leading a patient toward another part of the system.

That means the goal cannot be to make a free clinic or a student-run program the only place a patient knows how to turn. Patients need multiple reliable points of connection so they can continue receiving care throughout the year.

Technology increasingly sits inside those connections. A patient may need a phone to hear from a clinic, internet access to complete an insurance application, a patient portal to communicate with a physician, or a reliable connection to participate in a telehealth appointment. If one of those pieces is missing, the connection can break.

Karthik believes the same principle applies to the people providing support. Medical students and free clinics can help build connections, but they should not have to be the only ones doing it.

She pointed to the potential for someone within a community itself to become a trusted digital resource—someone in Tyrone, for example, whom residents could turn to when they have questions about setting up a portal, navigating a health care website, or using a device.

That kind of local support could also strengthen something beyond digital access: social connection. A person would not simply have somewhere to go when their internet or device failed; they would have a familiar person in their community who could help them navigate a complicated system.

Telehealth is a bridge—but it cannot stand on its own

Telehealth is often presented as one of the clearest solutions to rural health care access. When a specialist is dozens of miles away, a video appointment can eliminate the need for a long drive. When transportation is difficult or a patient cannot easily take time away from work, connecting remotely can make an appointment possible.

The students interviewed for this story do not dispute that. The problem is what happens between saying that telehealth is available and actually being able to use it.

Madalyn Fernbach, another Penn State medical student working with LION Mobile, sees telehealth as an important bridge for people who cannot easily make it to a provider. The clinics may encourage patients to consider a virtual appointment when a doctor’s office is closed, far away, or otherwise difficult to reach.

“Telehealth is extremely valuable,” Fernbach said, particularly for people who cannot make it in person.

But she also emphasized why in-person care remains important. People often prefer face-to-face appointments because of the relationship they can build with a provider. Fernbach said she personally enjoys those encounters more than telehealth because of the opportunity to establish rapport and connection.

That preference can be especially important for older rural residents. Fernbach said it can be unfair to expect someone from a different generation to suddenly become comfortable with video calls, Wi-Fi, and unfamiliar digital systems. Older adults may already have fewer nearby providers, making them particularly vulnerable if they are also uncomfortable using the digital systems intended to bridge that geographic gap.

Koch has experienced that challenge in her own family.

Her grandparents live in a rural community that she describes as a “one red light” town. Her grandmother has arthritis, which makes it difficult to hold a phone securely. During telehealth appointments, she has accidentally hit the red button and disconnected from the doctor while adjusting her grip.

The problem was not simply that she did not understand telehealth. She physically struggled to operate the device.

That experience illustrates why digital equity cannot be reduced to digital literacy. A person can understand what they are supposed to do and still encounter a physical, cognitive, or accessibility barrier that prevents them from doing it.

Karthik sees another layer to the problem. Patients frequently ask whether they can complete appointments through telehealth because they cannot travel. But discussions about expanding telehealth often focus on whether insurance will cover the visit rather than on the practical steps required to make the appointment possible.

“We don’t really get into the nitty-gritties of what that technology access is,” Karthik said.

For a sustainable telehealth system, she said, the pieces have to work together: infrastructure, follow-up through health systems, training on the physician side, health literacy coaching for patients, and technology that is actually accessible to the person using it.

“There’s so many different bits of that that I think sometimes get lost or drowned out under the broader label of improving telehealth access,” she said.

In other words, telehealth can be a bridge, but the bridge still needs roads on both sides.

Rural access is not just an older adult issue

The interviews also challenge the idea that digital exclusion is solely an issue affecting today’s oldest adults.

Koch grew up in Tremont, Pennsylvania, a very small community in a valley between two mountains. Her high school had a computer lab rather than individual computers for students, and much of her schoolwork was handwritten. When she arrived at college and encountered a world in which assignments were submitted online and students were expected to have personal laptops, the transition was jarring.

She knew how to use technology. What she had not had was the same access to technology as many of her peers.

Her experience points to another dimension of the digital divide: access shapes familiarity. A young person can be perfectly capable of learning technology and still enter college, the workforce, or a health care system at a disadvantage because they have had fewer opportunities to use it.

The infrastructure in Koch’s hometown created another barrier. She described having only one internet provider available, with poor service that made activities such as online college courses difficult. When her mother tried to take college courses online, pages struggled to load. The family eventually purchased an additional device to amplify the connection.

Her grandparents’ home had a similar problem. Even having Wi-Fi did not necessarily mean having a connection that worked well enough for everyday online activity.

That experience is important because “has internet” is not a complete measure of digital access. A connection must also be reliable, affordable, and sufficient for what a person needs to do.

The same is true for LION Mobile.

Karthik said the mobile program strategically tries to locate some events near churches or other existing institutions that may have stronger connectivity. But the program also travels to farms and other remote locations where that option is not always available. In those places, weak connectivity can affect the program’s own TVs, iPads, phones, and other digital tools.

Fernbach has seen similar challenges. Some communities have weak cell service or unreliable Wi-Fi, which can make it harder for the program to use tablets for research projects or other digital tools.

The problem is not necessarily that communities are completely disconnected. Fernbach described it more as an additional hurdle: the connection may be slower, less reliable, or simply more difficult to establish.

That distinction matters. Digital exclusion is not always a complete absence of technology. Sometimes it is the accumulation of small barriers that make using technology harder than it should be.

Trust matters as much as technology

There is another barrier that cannot be solved simply by laying more fiber or distributing more devices: trust.

Karthik said rural communities are not monolithic. People have different backgrounds, experiences, and relationships with technology. Some are excited about new tools. Others are hesitant. Some prefer a traditional doctor’s visit because they value the relationship and familiarity of face-to-face care.

That preference should not automatically be interpreted as resistance to progress. For many people, especially those who have experienced health care through a long-standing relationship with a local physician, trust is part of the care itself.

Karthik also emphasized that rural patients are often highly knowledgeable and capable. The problem is not necessarily a lack of intelligence or willingness to learn. Sometimes, she said, health care systems simply fail to communicate in a way that makes sense in people’s lives.

The same principle applies to digital equity.

Telling someone that an online portal is convenient does not necessarily make it useful to them. Showing them how the portal can help them communicate with their doctor may. Explaining that a phone can help them manage their blood sugar, apply for a job, obtain insurance, or communicate with a clinic may accomplish more than telling them that everyone needs a smartphone.

Karthik saw that transformation in the patient who was initially hesitant about getting a phone. Once the patient understood what the technology could do for them, resistance gave way to greater confidence and independence.

The program has tried to build that same philosophy into its everyday work. Patients may leave with QR codes, handouts, magnets, or stickers that provide step-by-step instructions for navigating insurance and other services. Some materials include contact information for IT desks because patients may use different health care systems, and the students themselves do not always know how every system works.

The tools are intentionally practical. They recognize that the goal is not to make every patient an expert in technology. It is to make the next step easier.

Sometimes the missing infrastructure is a person

For Koch, one of the most promising solutions is therefore not necessarily another app or another website.

It is a trusted person.

She imagined rural senior centers, community health centers, churches, or other gathering places becoming places where residents could get help navigating digital health tools. A staff member or community leader could be trained to help people access patient portals, prepare for telehealth appointments, or understand how to use a device.

The goal would not be to turn every senior center into a technology classroom. It would be to make sure that someone is there when a person gets stuck.

Karthik sees the same possibility within the health care system itself. Medical students can learn enough about digital navigation to help patients, but they eventually leave the student clinic. A more sustainable model would build digital navigation into the broader community health care team, with people who are available year-round rather than only when a student program happens to be operating.

That could mean a digital leader within a rural community, a community health worker, or another trusted local person who knows where residents can go for help.

The idea fits naturally with Karthik’s “spokes on a wheel” metaphor. A student clinic can be one spoke. A community health worker can be another. A primary care provider, library, church, social service agency, or health system can form others. The strength comes from giving people multiple places to turn rather than expecting a single program to hold the entire system together.

Bringing technology—and care—to the community

There is an irony at the center of LION Mobile’s work.

Technology can help bring health care closer to people, but sometimes the most effective way to close the gap is still to physically show up.

LION Mobile does exactly that. The program travels to rural communities for screening, prevention, health education, outreach, and community service, meeting communities where they are and developing partnerships around local needs.

One example is HHD 497, a transdisciplinary course sponsored by Dr. Dennis Shea, Associate Dean at Penn State’s College of Health and Human Development. Over the 13-week course, students visit Bennett’s Valley Senior Center for four full Friday afternoons, developing relationships with residents, listening to local needs, and serving the community through a focused partnership based on those needs.

The course demonstrates how education can be used to advance a service mission. Rather than separating student learning from community service, the program brings the two together: students learn in the community while using what they learn to respond to community-identified needs.

For Fernbach, the mobile program itself is one of the most impressive forms of innovation she has encountered through the program. She sees it less as a piece of technology in the traditional sense and more as a vehicle for restoring access to health care in places where physical health care infrastructure has disappeared or become harder to reach.

“When I think of technology, I’m less thinking of the things we’re talking about before, like Wi-Fi and whatever else,” Fernbach said. Instead, she thinks about “the physical areas of health care” that have been taken away and the ability to use a vehicle to bring some of that care back into communities.

That physical infrastructure does not make digital infrastructure less important. In fact, the two increasingly depend on one another. The mobile program uses technology for screening, education, research, and other services, and weak connectivity can make those tools more difficult to use.

Karthik has seen the same thing during outreach to farms and other remote locations. The program may have iPads, TVs, phones, and other equipment, but those tools are only as useful as the connection available in the place where the program parks.

The digital divide, in other words, does not affect only the person sitting across from a provider. It can also affect the ability of a community-based health program to deliver its services in the first place.

Building a digital health system people can actually use

For Pennsylvania leaders, the message from these medical students is not that technology should be abandoned.

It is the opposite.

Technology can be extraordinarily useful. It can save a patient a trip to a county assistance office. It can connect someone with insurance. It can make it possible to monitor a patient’s health between appointments. It can help someone apply for work. It can connect a rural resident with a provider who might otherwise be too far away.

But technology works best when it is treated as part of a larger system of support.

Fernbach identified reliable Wi-Fi, funding for devices such as tablets and laptops, and education as important pieces of that system. That education cannot stop at teaching someone how to operate a device. People also need to know how to use technology safely, particularly as more health and financial information moves online.

Patients need to recognize scams, protect personal information, and distinguish legitimate communications from fraudulent ones. A person who has been told to use technology for health care also needs to know what information is safe to enter and when a request for personal information should raise questions.

Koch offered a similarly practical vision for Pennsylvania: train people who already interact with community members—county assistance workers, community organizations, churches, and other trusted local contacts—to provide basic digital navigation.

Instead of expecting family members, neighbors, or volunteers to shoulder the entire responsibility of teaching one another, digital support could become part of the infrastructure of existing community services.

Karthik’s experience suggests why that investment matters. The goal is not simply to get someone online. It is to help them reach the point where being online gives them more control over their own lives.

For one rural patient, that meant moving from communicating through a family member to having their own phone. It meant getting insurance and applying for a job. It meant being able to communicate with health care providers and participate more independently in their own care.

For another patient, it might mean opening a Medicaid application without having to travel miles to a county office. For an older adult, it might mean having someone trusted nearby who can help them connect to a doctor. For a rural community, it might mean having the broadband infrastructure necessary for telehealth to work reliably.

The technology will continue to change. Patient portals will evolve. Telehealth will become more common. New devices and digital tools will enter health care.

But the fundamental question will remain the same: Can the person who needs the service actually use it?

The answer depends on much more than whether a website exists. It depends on whether the internet reaches their home, whether they can afford the connection, whether they have a device, whether the device is accessible to them, whether they know how to use it, whether they trust the system, whether they can recognize a scam, and whether there is a person they can turn to when something goes wrong.

The students working in rural Pennsylvania are seeing what happens when those pieces come together—and what happens when they do not.

Their experiences suggest that digital equity is not separate from health equity. It is increasingly one of the ways health equity is delivered.

And in communities where a doctor’s office may already be many miles away, making sure people can actually use the digital pathways to health care may be just as important as building the pathways themselves.