Heather M. Hylton, MS, PA-C MS, PA-C
While strides have been made in the overall expansion of (and reimbursement coverage for) telehealth services during the COVID-19 pandemic, there continue to be areas of opportunity to remove barriers that limit access to telehealth services. For some patients who are in resource-stretched or rural settings, their primary option for access to healthcare may be telehealth. As we begin to move beyond COVID-19 and conceptualize the next iteration of healthcare delivery, it is essential to continue focused efforts around dissolving barriers that limit access to telehealth services.
A helpful table of factors influencing the implementation and uptake of telemedicine has been delineated by Lopez et al. A few key barriers are described below:
Technology Tool Access: While some households maintain multiple devices like desktop and laptop computers, tablets, and smartphones, not all have the means to acquire basic devices or keep them in good working order. In addition, as some devices age, operating system updates required to successfully run evolving telehealth technologies may exceed what an older device is capable of running.
Digital Divide: Broadly speaking, the digital divide is the chasm between those who have internet access and those who do not. There are a number of factors that influence an individual's internet access, including affordability and network stability. One of the Federal Communication Commission's (FCC) strategic goals is to close the digital divide through facilitation of efforts to implement affordable broadband access across the United States. In addition, the FCC is involved with a number of healthcare-focused initiatives to improve access to telehealth services.
The FCC has also created an interactive platform called Mapping Broadband Health in America. The various overlays and measures give the user information on specific health-related disparities within the context of broadband availability in a state or county.
Design Thinking: Simply stated, the technology a patient is required to use to access telehealth services should be designed with the patient's preferences, needs, and challenges driving the creative process. Tools that are less intuitive or more cumbersome to use may have less appeal. This is particularly relevant for those less experienced in using digital technology.
While a silver lining of the pandemic has been the scaling of telehealth to meet patients where they are, many access barriers remain. As part of the access equation, patients need to be able to acquire appropriate devices and be able to run them at a reasonable price point. Continued public and private efforts to bridge the digital divide will be imperative to ensuring equitable access to telehealth services. The applications patients need to use to engage in telehealth should be focused on the user experience; ease of use could ultimately influence a patient's choice to integrate telehealth into their personal or family's healthcare.
In principle, scaling telehealth should enhance access to high-quality healthcare; however, continued efforts are needed to remove the barriers that limit this access and consequently further exacerbate healthcare disparities within underserved populations.