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Making telemedicine more inclusive

As a primary care physician at an academic community health care system in Massachusetts, I received a rapid introduction to telehealth this year. Within days after Massachusetts declared a state of emergency in response to the spread of COVID-19, almost all of our patient visits became telemedicine visits. Our staff reached out to patients to inform them of different ways they could get in touch with their doctor. Many would be able to gain access to health care through a health app connected to their healthcare web portal, or through a phone call or video call. The enormous potential of telehealth was apparent to me within weeks. Yet I also came to understand the need to overcome certain barriers to widespread telehealth access and provide additional support, as some of my stories below illustrate.

Chronic conditions and COVID-19: How did telemedicine help?

Healthcare providers like myself had to quickly adapt our clinical practice to use technology optimally. We found that a combination of phone calls and video calls allows us to continue to monitor people with chronic diseases, such as diabetes, high blood pressure, and heart and lung problems. Video proved particularly helpful in assessing who needed to be seen quickly for a health issue, while avoiding unnecessary exposure to COVID-19 in emergency rooms when possible.

Our organization developed an intensive community management strategy for COVID-19. For example, we were able to educate patients and their families on ways to avoid getting COVID-19, or spreading it. Additionally, we used telehealth to lessen the strain on emergency and hospital systems, conserve personal protective equipment (PPE), and reduce health care costs. By using phone and video triage, clinicians could identify people who were so ill they needed to be seen in clinics or at the hospital. Throughout recent months, telehealth platforms have helped our primary care providers and specialists communicate across various clinics, through virtual huddles and meetings.

Telemedicine can marginalize non-English speakers

Translation resources are key to inclusion for some patients, including a woman I’ll call Maria, who had recently moved from Brazil to just outside Boston with her husband, Jose, and two children.

Muito obrigado!” she exclaimed several months into our telehealth visits. “I feel like a new woman now. My husband and I wish to express our gratitude to you.” The couple contacted our health care services due to a bad skin itch and a rash all over the body. Being non-English speakers, they were struggling to find a health care provider who could help. Fortunately, the combined assistance of our staff and our health interpreter services helped the couple gain access to the patient portal and video technology. Through teledermatology consults we were able to cure them of bacterial, fungal, and parasitic skin infections over a period of two months. Having the translation resources to overcome the language barrier was critical for the success of telemedicine in this case.

Internet and smartphones may be a barrier

In this age of ubiquitous smartphones and high-speed Internet,

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Written by Shobha

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