Tackling the Digital Divide to Improve Telehealth

Telehealth, while available for more than a decade, zoomed to the forefront in 2020. The pandemic and shelter-in-place orders created a perfect storm for widespread use of virtual visits and other modes of telehealth.

However, some patients have a misperception that telehealth is only for the tech savvy, or only valuable in very limited situations, or something that will go away once the pandemic subsides.

“The rapid uptick in use of telehealth has been amazing and wonderful because it has so many benefits,” says Cleveland Clinic neurologist Marisa McGinley, DO. “Telehealth is here to stay, so we really need to understand what barriers still exist and make sure we’re not leaving any patient groups or communities behind.”

That was the driving force behind a recent telehealth conference — held virtually, of course — led by Dr. McGinley and hosted by the Clinical and Translational Science Collaborative of Cleveland. Structured as an “unmeeting,” with minimal structured presentations and more group collaboration, the conference attracted clinicians, researchers, governmental agencies, industry partners and patients across the U.S.

“There’s been good research showing gaps — certain populations [such as low-income, Black and Hispanic populations] not using telehealth to the same degree as others,” says Dr. McGinley, whose own research focuses on telehealth for patients with multiple sclerosis. “As we move forward, we don’t want those gaps to widen.”

Breaking down the issues

The multidisciplinary gathering heard brief presentations by industry insiders and then scattered into breakout sessions to discuss issues in more detail. Sessions addressed:

• Telehealth barriers for aging, urban and minority populations. Potential root causes include lack of trust in the healthcare system and technology limitations. Potential solutions may involve enlisting family or healthcare advocates to build trust, and providing more technology support.
• Understanding patient experience and priorities. “We have partnered with patients to understand what they desire in the virtual environment,” says conference presenter Julie Rish, PhD, Associate Chief Experience Officer at Cleveland Clinic. Dr. Rish emphasized the importance of listening to patients and incorporating their views in telehealth strategy. “Patients have various preferences about how they want to use technology in healthcare. I am most fascinated by their thoughts on the value of telemedicine. We need to address their doubts that telemedicine is safe and trustworthy and often can provide the same quality of care as an in-person visit.”
• Payer and policy considerations. Along with showing the value of telehealth services, there is a need to re-evaluate coverage and jurisdiction. Challenges include current protocols in medical licensing and defining jurisdiction by patient location.
• Incorporating digital technologies. Although the in-person element is missing from virtual visits, telehealth can augment in-person care by providing more precise, quantitative assessments with new tools like Cleveland Clinic’s Digital Neurological Vital Signs app. The smartphone app collects data on gait, coordination, cognition and other factors that providers assess during a neurological exam, explains conference presenter Jay Alberts, PhD, Vice Chair of Innovation in Cleveland Clinic’s Neurological Institute. “Instead of subjectively assessing a patient’s condition, we can be objective,” he says. “And real-time data like this may help engage patients between visits, providing actionable information — like encouraging them to increase their step count from 3,000 today to 5,000 tomorrow.”
• Underserved populations. Healthcare models need to adapt to address disparities in both rural and urban populations, and language and age factors. Data is needed not just on accessibility to telehealth but on its clinical outcomes for underserved populations.
• Virtual approaches to routine care and chronic conditions. “To date, we’ve done a lot of comparing in-person care with telemedicine, but that’s not the right focus anymore,” says Dr. McGinley. “The question should not be about which is better but about the right dosing of telemedicine and how it should be incorporated. How do we make it additive — not replacing in-person care, but transforming it?”

Just the beginning

As telemedicine becomes a mainstay of healthcare, the medical community will continue to find ways to make it sustainable and accessible for all patient populations.

“Our work at the conference sparked new collaborations among participants, inspiring some to embark on new research or pursue grant funding for new projects,” says Dr. McGinley. “There’s a lot that we can do to begin improving telehealth. But, to make sweeping change, there ultimately needs to be a national initiative that transcends academic, government and industry silos.”