The rise in telehealth use during the COVID-19 pandemic has showcased two contrasting narratives about access to virtual care.
“COVID accelerated our commitment,” said Alexis McGill Johnson, CEO of the Planned Parenthood Federation of America, during a panel at the American Telemedicine Association’s annual conference and expo this week.
“It was a disruptor, but an accelerator,” she added.
According to McGill Johnson, PPFA found that patients could rely on telehealth during the pandemic to preserve care continuity.
Those seeking gender-affirming treatment, for example, could stay in touch with their provider, even if they relocated during the COVID-19 pandemic. PPFA also offers a chatbot to try and engage users who have commonly asked questions.
“The Internet is full of a lot of misinformation around sexual and reproductive health,” said McGill Johnson. “Being able to connect with someone quickly and help connect the dots – that is an important piece of work.
“We’ve been an innovator in reaching people where they are,” she added. “And we think that our digital health offerings are unique.”
Meanwhile, at University of Utah Health, Dr. Maia Hightower said the team uses a combination of MyChart and Zoom for patient care.
“We intentionally chose Zoom, because the schools were using Zoom as well,” she explained.
The logic was that a patient may be able to use their child or grandchild’s device and Zoom account if they didn’t have access to their own.
In addition to devices and broadband inequity, Hightower said another challenge was with digital literacy, which does not function on a binary. Technological familiarity, like medical care itself, is often highly individualized.
In turn, said Hightower, “We made it very personal through a help desk designed to help patients one-on-one to connect to our platform.”
Both Hightower and McGill Johnson flagged the potential for bias to permeate telehealth, both on an interpersonal and systemic level.
“Being in a pandemic, we’re still in the middle of a reckoning around race and equity,” McGill Johnson said. And existing bias can get “magnified during a quicker visit.”
Meanwhile, on the IT side, Hightower noted (as others have) that inequity can be hardwired into the framework of some technologies.
“If a platform is only available in two languages, then how many are being excluded?” she pointed out.
Silas Buchanan, principal at the Institute for eHealth Equity, also stressed the importance of meeting patients where they are, and with connecting to trusted community partners.
For example, an institute with access to data about the uptake rates of the COVID-19 vaccine should share that information with faith-based organizations that are often deeply involved with individuals’ lives.
“I’m hopeful we can shorten the distance between those ideators and innovators and underserved communities,” he said.
In the future, McGill Johnson says she’s excited about pushing forward with patient-centric innovation.
“All healthcare is local,” she said. “I think that’s really important. Thinking about how we continue to preserve that at a moment where lawmakers are trying to determine … how to resource telehealth and infrastructure – I think that’s really exciting.”
Hightower says she sees telehealth as an opportunity of sorts to try and reshape a medical system that has too often been historically associated with racism and distrust.
“I am so excited about the digital feature,” she said, “as long as we design it [with intent] to be equitable.”