The COVID-19 pandemic has markedly increased telehealth offerings and utilization, and many of these virtual care improvements may be here for the long-term. With all significant advancements and changes in practice, there is risk for exacerbating or even creating disparities in access for certain patient populations, which must be proactively addressed.
However, it is also important to remember that many diverse and underserved communities have significant barriers to in-person care and thus may stand to benefit even more from thoughtfully implemented telehealth services. Equitable access to care is best achieved when the medical home team partners directly with patients, families and communities to inquire about telehealth needs and challenges to inform any decision making. With that being said, there are populations that may benefit from a more detailed assessment and tailored approach.
The following tip sheet provides tips and strategies to facilitate equitable access to telehealth for families/caregivers and patients:
Tips for clinicians working with families/caregivers and patients who have limited access to technology:
- Take Advantage of Community Resources. Ask local schools, libraries, government offices, food banks, shelters, hospitals and non-profit organizations if they have internet-connected computers and private spaces for which families/caregivers can sign up to use for telehealth visits. Alternatively, these sites may be able to offer access to their public Wi-Fi and a private corner for telehealth patients with smartphones but limited internet access or cellular data plans.
- Explore Available Wi-Fi Options. Collaborate with chambers of commerce to see if local businesses may be willing to share a Wi-Fi signal in parking lots or other private areas for telehealth visits.
- Provide Video Conferencing Space. For subspecialty telehealth with a distant referral center, primary care practices may be able to offer a conference room or available exam room computer that patients and families/caregivers can use for their subspecialty visits. Many payers allow such practices to charge an originating site fee for providing such space for patients. Practices could offer the space at the beginning or end of the day to enable access with less impact to their usual practice.
- Become Mobile Device Friendly. Mobile devices are much more common than computers – many families/caregivers now have smartphones. Consider using a telehealth platform that is easy to use on mobile devices.
Tips for clinicians working with families/caregivers who may have low digital and/or health system literacy:
- Encourage Assistance. Many families have a go-to “techie” in their family or community network. For privacy reasons, patients may not want this person to participate in telehealth visits. However, the majority of tech issues occur when video visits are started and ended – ask if there is someone nearby who can help during the visit connection and hang-up steps, then leave the room for the rest of the visit.
- Generate Tips for Troubleshooting. Train all front-desk and clinical staff on basic tech troubleshooting processes to reduce the need for families/caregivers to contact an unfamiliar help desk or tech support staff member. Provide simple 1-2 page tip sheets for staff addressing the most common troubleshooting needs.
- Support the Sign Up Process. Sign up families/caregivers on patient portals and show them how to use telehealth systems during an in-person visit, or have front desk staff do this before or after an in-person visit. The hardest part is getting started!
- Communicate Telehealth Advantages. When trusted providers directly recommend telehealth to families/caregivers, these families are more likely to engage and find ways to overcome tech hesitation. It is also helpful for providers to mention the benefits of telehealth (no travel time, no wait time in the clinic, comfort of their own home). Generic messaging or tech guidance that is only accessible by visiting a practice website might not be enough for families with low digital literacy.
Alternate telehealth modalities when video isn’t an option (phone, patient portal messaging, etc.):
- Determine Technology Barriers. Foster an encouraging and supportive environment for families/caregivers to be honest and open about their technology limitations. Consider inserting screening questions about access to technology into your electronic health record or in-person intake forms in the office.
- Provide Alternatives to Virtual Visits. Even families/caregivers with access to computers or smartphones may not have an internet or data plan sufficient to allow affordable access to all telehealth services. Telehealth services such as live video visits, in particular, may expend a significant portion of a patient’s data plan or exceed their available bandwidth, particularly in households with multiple family members who may be working or attending school remotely. Consideration should be given to providing alternative means of virtual connection such as audio-only phone calls, HIPAA-compliant text messaging, or patient web portals.
- Offer Information on Accessible Data Plans. The Federal Communications Commission (FCC) Lifeline program can provide subsidized cellular data access for low income families/caregivers. Some of these data plans are insufficient for long video visits, but they provide enough data to access patient portals for messaging and other forms of asynchronous telehealth.
- Provide Tutorials. Encourage families/caregivers to take part in tutorials to be more comfortable on how to use patient portal messaging options or other modes of non-video or audio-based communication with providers. Consider making a brief video with instructions on how to access your telehealth platform, patient portal and text out a direct link to the video along with the appointment reminder.
Tips for families/caregivers who may require language accommodations:
- Determine If Accommodations Are Needed. Ask families/caregivers if they need any type of language accommodation, including American Sign Language, to facilitate a successful telehealth visit, in advance of that visit.
- Ensure Interpreter Can Connect. Explore how to connect interpreter services available for in-person care to telehealth appointments. Not all telehealth platforms allow for multi-party calls, so interpreters may need to be physically present with the provider or may need to simultaneously connect to the encounter using a phone line.
- Plan Ahead. Arranging interpreters can take time. Ask staff to look at future telehealth appointments to determine if an interpreter will be needed and make plans before the day of the visit.
- Incorporate Into the Workflow. For health system-affiliated practices, work with administrators to create efficient, standardized system-level workflows to incorporate interpreter services into telehealth appointments.
- HealthyChildren article: Telehealth 101: Getting Plugged in to Your Children's Health
- AAP.org article: Minimizing Telehealth Technology Barriers in Rural and Underserved Communities
- HealthyChildren article: Ask the Pediatrician: Can telehealth "video visits" be a good options for my child?
- Family Voices Telehealth Curriculum: Nuts and Bolts of Telemedicine: Essentials for a Family-Centered Experience
- Family Voices: Preparing for a Successful Telehealth Visit Worksheet
- Family Voices: Telehealth Checklist
- PediaLink Course: Providing Telehealth and Distant Care Services in Pediatrics
This resource is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $6,000,000 with no percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the US Government.
American Academy of Pediatrics