Telehealth promises easier access to care, but for whom? Those with iPhones can benefit from health applications and those with internet capability can find a highly rated specialist in a snap, but what about those without smart phones and without a strong WiFi signal? Telehealth is playing an increasingly prominent role in health care. As we rely on it more and more to expand services and access to care, we have a responsibility to consider what effect it might have on underserved populations and to use the growth of IT in medicine to lessen the disparities in healthcare, rather than widening the gap. Telehealth can refer to many different areas of health IT, and every form has implications for health disparities. Online platforms like MyChart give patients access to their health records and allow them to request an appointment or fill a prescription over a secure website rather than via email or over the phone. They are very convenient for those with a personal computer and access to the internet. However, people who don’t might become frustrated when their only way to make an appointment is to weed through a menu of items over the phone before finally getting connected to a live person. By relying on telehealth, we’ve made things easier for those with means while stealing resources from older communication avenues, like administrative assistants, and in the process creating a deeper digital divide.
Despite the huge growth in smartphone usage and free WiFi networks, there is still evidence that underserved populations, whether due to geography or economic disadvantage, are less likely to have access to the internet and computer technologies due to economic status, geography, literacy level, local infrastructure or cultural differences.
Furthermore, the health needs of underserved communities may be different than those targeted by most health and wellness technologies. The incidence of chronic disease is much higher, but so is teenage pregnancy, HIV and STDs. Telehealth needs to be carefully implemented to meet the challenges presented by the complexity of these patients’ needs. It cannot be viewed as a one-size-fits-all solution on it’s own.
For example, it might make sense that with each secure email containing lab results for a patient’s HbA1c for their diabetes there was a reminder to get an STD screening. However, when the office only has one phone number for that patient and they don’t pick up the phone, it is hard to have this extra level of outreach. Finding a system that integrates different areas of health – such as primary care, sexual health, mental health – is a challenge but one that a solution could have a marked benefit to underserved populations.
Despite the complications, there is still an opportunity to make telehealth work better and more efficiently for underserved populations. A 2011 report by the UnitedHealth Center for Health Reform and Modernization found that telehealth can lessen health disparities if while using telehealth to provide primary care to rural areas, there is also an effort to raise patient comfort levels with technology and allow patients in rural areas to choose how they access information and care. Some healthcare providers working with underserved communities have already made an effort to make health IT work for their populations such as the mobile van in Albuquerque that enables rural patients to see medical specialists from the University of New Mexico via teleconferencing.
Physicians have several opportunities to use health technology more equitably. They could send new patients a quick survey to assess their access to and comfort level with technology before bombarding them with online resources. As medical students we learn to steer clear of making assumptions, and as physicians we should not assume that all of our patients have smartphones and access to the internet. Physicians working with underserved populations are responsible for making sure that the patients are getting equal care both inside and outside the exam room. There is an opportunity to ensure telehealth equality, but physicians must first be aware of the level of technological literacy and access that their patients have before being able to come up with creative solutions.
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About The Author
Kristen Kelly is a medical student at Sidney Kimmel Medical College Class of 2018.