COVID-19 transmission and death-rates are higher among low-income and racial minority populations. These same populations may lack the technology needed for the universal transition to telemedicine that has occurred during COVID-19. This creates the possibility of racial disparities. Some underpinnings that promote disparities includes limited health, digital, or even language literacy as well as lack of access to digital health technologies.
Dr. Sarah Nouri and colleagues (2020) identified signals of disparities in an urban Hospital setting and provided 4 tenets to ensure equitable telemedicine use:
Identify potential disparities in access: Take data on who is accessing care and receiving services. The following populations are at risk for limited digital literacy/access: older adults, low socioeconomic status, limited health literacy, limited english proficiency, and racial/ethnic minorities. Ongoing data collection and evaluation will show patient involvement prior to and after telemedicine implementation across the groups at higher risk.
Mitigate digital literacy and resource barriers: Consider having an outreach practice in which patients are provided support in setting up digital health platforms. This may involve having the patient’s family / friends help in navigating health technology, creating and distributing tutorials on how to use digital platforms, helping clients obtain low-cost devices, and helping seniors and low-income adults access low-cost commercial broadband Internet services available to them through the National Digital Inclusion Alliance.
Remove health system-created barriers: This may include not enforcing all patients to enroll in patient-facing portals if they have difficulty doing so, offering interpreter services, and helping patients’ navigate technical and logistical challenges to participate in telemedicine visits.
Advocate changes to support sustained and equitable access: Advocate for policy changes that temporarily provide free broadband Internet access, help at-risk patients obtain digital equipment to engage in telemedicine services, and ensure insurance companies pay similar rates for telemedicine services.