Jun 16 2021

#ATA2021: Telehealth Is Key to Equity and Access for Every Patient Population

The COVID-19 pandemic forced the healthcare industry to pivot toward telehealth quickly, but some patients were at risk of being left behind. Providers share how their organizations bridged the digital divide.

Telehealth has always been a useful tool for bringing care to populations without traditional access. While the COVID-19 pandemic accelerated telehealth adoption out of necessity, it also highlighted the healthcare disparities for those without transportation, mobility, stable housing, broadband access or digital literacy.

Healthcare professionals shared their organizations’ experiences in bringing care to every population — including the homeless, patients with limited English proficiency and older adults — during several panel sessions at the American Telemedicine Association’s 2021 virtual conference.

Telehealth Brings Healthcare to the Homeless

Getting healthcare to the homeless can be a challenge because homeless people may lack of privacy in shelters, have transportation issues or have nowhere to store belongings when they come in for an appointment. Several healthcare organizations have used telehealth to address these concerns.

In an ATA2021 session titled “Massive Compassion and Simple Technology: Bringing Telehealth to the Homeless During the COVID-19 Pandemic,” panelists discussed different ways in which their organizations are bringing healthcare to the homeless.

Bre Loughlin, CEO of Nurse Disrupted in Wisconsin, started her company during the pandemic to conduct COVID-19 screenings for homeless people. Using mobile care station kits, Nurse Disrupted brings telehealth to the shelter. Loughlin said compassion training for staff, including the technical services team, was a major part of the program’s success.

“We needed to create an environment where people would engage with us for screening,” she said. “In a survey we conducted, 96 percent of people said they had better access to healthcare, and 92 percent said they had better access to COVID-19 education. It’s not just about the technology but also the human-computer interaction and making sure communication was appropriate with the patient population.”

Bre Loughlin
Healthcare for the homeless helps resolve homelessness. We want to be clear that resources help reduce homelessness, and healthcare is at the core of why some are seeking shelter.”

Bre Loughlin CEO, Nurse Disrupted

Everyone at the shelter is given the same initial screening questions before those in need of services are brought to the care station. Loughlin said this method gives the patient confidence that the information they provide and the appointment are private.

“We want to show the world that this works. Healthcare for the homeless helps resolve homelessness. We want to be clear that resources help reduce homelessness, and healthcare is at the core of why some are seeking shelter,” she said.

Loughlin’s company is looking to expand to low-resource areas and places in need of specialty providers.

Boston Health Care for the Homeless Program (BHCHP) partnered with the Massachusetts General Hospital Center for Telehealth to expand primary care to those outside downtown Boston using a web-based portal. Dr. Jennifer Tan, a dermatologist with both organizations, said the dermatology clinic closed during the pandemic, leading BHCHP to convert clinic space into protected spaces where patients could have virtual visits with providers using iPad devices.

“Coordinated virtual visits translated to better care,” said Tan. “It’s provides a way for specialists in medicine to help their primary care colleagues on the front lines of homeless medicine. It also has a cost-saving effect.”

MORE FROM ATA2021: How remote patient monitoring can provide insightful patient care.

In Colorado, Care on Location CEO Jonathon Savage and his team bring telehealth to homeless people on the streets using mobile backpacks. Savage explained that homeless people often had difficulty getting to scheduled appointments. His company partnered with Colorado Coalition for the Homeless, which already had an outreach team, to bring care to the homeless population. The backpacks have extendable legs so the telemedicine case can stand up on slopes or other terrain.

“The nurses became telehealth facilitators,” said Savage. “The backpack is essentially a pop-up clinic.”

Nurses can take vital signs and enter information into the electronic health record onsite. The kit also includes a mobile camera for patients who can’t stand.

“Patients get the full spectrum of an exam without leaving their belongings or location,” said Savage.

He pointed out that healthcare is difficult to navigate even for professionals in the healthcare space.

“Telehealth is a way to decrease confusion and increase access,” he said.

Combining Translation and Telehealth Helps LEP Patients

Income, digital skills, access to broadband and limited English proficiency (LEP) all have an impact on whether a person has access to telehealth, said Jamey Edwards, CEO of Cloudbreak Health, during a panel discussion titled “Reducing Telehealth Disparities When Language Barriers Exist.” He pointed out that LEP patients have a lower rate of telehealth visits.

Melina Kolbeck, director of language access services at Children's Health of Dallas, said her organization had to find a way to provide a safe environment for children and their parents during the beginning of the pandemic. The hospital closed many of its clinics to minimize exposure and reduced the number of interpreters onsite.

Kolbeck’s team turned to telehealth to ensure that LEP patients and their parents received the same level of communication and compassion that they experienced prior to the pandemic.

“It was a frustrating time for providers. They were being asked to use a new way to communicate, diagnose and provide for patients’ needs via video, without being hands on,” said Kolbeck. “Telehealth apps and platforms were not prepared for LEP patients. We provided the translation for the platform because they were so busy trying to accommodate every company they were working with at that time. My in-person staff integrated with the platform.”

ATA LEP session

Providing toolkits in non-English languages can create better access to telehealth for LEP patients, said Albert Chan of Sutter Health.

She said poor Wi-Fi and lack of devices on the patient side made the switch to telehealth challenging, but Children’s Health found ways to make it work.

Sutter Health in California sees 3.3 million patients at its 24 hospitals annually. Albert Chan, vice president and chief of digital patient experience at Sutter Health, said 10 percent of the organization’s patients don’t speak English as their primary language. With telehealth visits increasing from 7,410 in 2019 to approximately 1.1 million in 2020, the disparities for LEP patients became more apparent.

Spanish speakers are the largest LEP patient population at Sutter Health, but only 28.3 percent of Spanish-speaking patients were using telehealth, a lower rate than any other language group. Chan said Sutter Health addressed this disparity by uploading toolkits in Spanish on its website so patients could better access the telehealth services. The organization also set up a tech support chat offering Spanish for further accessibility.

Sutter Health had approximately 20,000 interpreter sessions a month, including American Sign Language, using a third-party service.

“It’s about language equivalency, not just proficiency,” said Chan.

Training Is Important to Help Seniors Bridge the Digital Divide

A recent survey by market research firm Parks Associates shows that 60 percent of people age 65 and older consider themselves familiar with telehealth. Jennifer Kent, vice president of research at the firm, gave an overview of the findings during a session titled, “Lessons Learned While Expanding Access and Care to the Aging Population.”

“Over the past year we’ve seen incredible growth in familiarity and use. A third of seniors say they’re extremely familiar with telehealth,” said Kent. “And 42 percent of consumers 65 and older tell us they have used telehealth services in the past 12 months. That’s up from just 6 percent in 2019. What’s even more incredible is that seniors are telling us they’ve had pretty positive experiences.”

Kent also pointed out that tech companies often design products with young, affluent and tech-savvy consumers in mind because they are usually the early adopters. Products typically aren’t designed for seniors, but Kent said that is starting to change. Many products now have user interfaces with voice capabilities or are designed for those with impaired dexterity.

READ MORE: Smart technologies create a more connected environment for older adults.

Older adult veterans at VA Puget Sound Health Care System were willing to try telehealth services during the pandemic, according to Amanda Olney, program coordinator for the TeleRehabilitation Enterprise Wide Initiative. She said providers were the hesitant ones, but their reluctance gave way out of necessity.

“As people were using FaceTime and Zoom to connect to family and communities, they became more familiar with the technology and more willing to try it out,” said Olney.

Luckily, Olney said, the VA already had a service in place before the pandemic to loan out tablets to veterans without devices, which helped her organization pivot quickly. The VA also offered technology training, using telehealth techs to do test calls prior to beginning virtual physical therapy services.

“We have a national help desk to do test calls as many times as necessary,” said Olney. “With physical therapy, the patients have to do multiple visits. The repetition helped.”

David Lindeman, director of health at the Center for Information Technology Research in the Interest of Society (CITRIS) and the Banatao Institute at the University of California, said he’s seen a fantastic increase in acceptance, willingness and understanding of the benefits of telehealth, especially among those who are homebound or have transportation issues.

ATA seniors and tech

The pandemic led to higher telehealth adoption among seniors due to necessity, but David Lindeman with CITRUS said training is key to comfort with the technology.

“On the positive side, we have acceptance but there are still the fundamental issues of getting broadband and technology to older adults in addition to digital literacy,” said Lindeman, who also serves as director of CITRIS’ Center for Technology and Aging. “There are issues around user interfaces and sometimes the inability to use technology.”

CITRIS created a three-point program to bring broadband to older adults in affordable housing, those who are homebound and those in rural communities. The organization has worked with internet service providers to bring affordable broadband to those in need and also created a process to get feedback from seniors about what worked for them during the training process.

“There have been pain points, but the pandemic has brought us opportunities to overcome those,” said Lindeman, who added that it’s important to push the boundaries of telehealth technology. “We can’t assume that what we have now will suffice. There are smart homes and the Internet of Things bringing the technology to the home where older adults live. I think we’re going to see more personalized telehealth. There’s been a transformation in the past year, and it’s a very exciting time in this space.”

Keep this page bookmarked for articles from the event, which runs through June 29. Follow us on Twitter @HealthTechMag as well as the official organization account, @AmericanTelemed, and join the conversation using the hashtags #ATA2021 and #GoTelehealth.

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