Telehealth services are uniquely suited to rural and underserved communities. The universal benefits of improving access to care by eliminating travel time, limiting time off work, connecting with specialists and addressing a shortage of health care workers can transform health care delivery in a community. While various barriers exist that can prevent communities from accessing telehealth services – including identifying and scheduling interpreters when there are language barriers – the technology barrier is a critical one as it blocks telehealth options for patient care altogether.
By addressing technology-related barriers, you can begin to break through. The first step is to stay consistent with the family-centered care approach by partnering with families/caregivers and working together towards solutions.
Here are practical ideas to help pediatricians, pediatric medical subspecialists, pediatric surgical specialists and non-physician clinicians who serve in rural and underserved communities overcome four common technology-related telehealth barriers.
- Access to devices such as computers and smartphones
- Availability of broadband internet and data networks serving wide geographical areas
- Reliability of Wi-Fi in households and clinics
- Understanding how to use technology such as web cameras, apps and email
Barrier: Access to Technology
Some families/caregivers may not have computers, laptops, tablets or smartphones. While telehealth may seem impossible in these cases, there are creative ways to get the technology to the people or vice versa.
It’s important to start from the family/caregiver perspective. To determine the needs of your patient community, consider giving a questionnaire to assess:
- What devices people own
- Whether those devices are connected to the internet or data
- If those devices have video or audio-only functions
- If the patient has earbuds or headphones for privacy
- How comfortable your patients are using their devices
- Whether your patients trust a virtual app that connects them with you
The data from the questionnaire can inform you of your patient community’s hardware needs and any educational needs they may have (covered below in Understanding technology).
Some schools issue portable laptops to students to use at home. Ask the family/caregiver if it’s possible to use this device for a telehealth visit. Provide instruction on how you will send a link to connect with your office for the visit.
Families/caregivers who come into the office for an in-person visit can bring their smartphone or laptop. Staff can assist in setting up your telehealth app on the device and providing a quick tutorial on how to access a follow-up visit by telehealth.
Put together a “to-go kit” with a smartphone or tablet, headphones, and written instructions on how to set up the device and connect for the visit. Assign “runner” duty to an office staff member or community partner (community health workers, peer navigators, etc.) to deliver the kit to the patient’s home at the time of the visit and return afterwards to pick it up.
Are there places in the community with access to computers in public places, such as a library? Do these places afford some degree of privacy? You might be able to set up a computer kiosk in a location that provides food assistance where families could connect for a visit.
Barrier: Broadband/Data Availability
Think of broadband service as the cables and fiber optics that bring the internet to a community. Broadband must have enough capacity and strength to serve the needs of all services that rely on internet transmission. Wireless device connection to broadband networks, Wi-Fi, is only as good as the broadband network. For smartphones, data availability is the back up for internet connection when Wi-Fi isn’t available. Data availability is represented by the “bars” on mobile devices.
The first step in working around weak or absent broadband is asking families/caregivers what devices they use and whether they can get a connection. Here are some ways around these disparities:
Parking lot practice
Some families/caregivers are still more comfortable in their vehicle and prefer not to enter the clinic. Set up the telehealth appointment to take place in the parking lot where they can access your Wi-Fi network. Many local recreation centers and schools have expanded their internet strength accessible from their parking lots to accommodate families during the pandemic. Contact those in your area to see if they could be available to serve as a Wi-Fi access point for a telehealth visit from the vehicle.
Use an existing relationship with a small business – such as a grocery store, restaurant, coffee shop or fast-food location – to partner with customers/patients. Ask if they would consider setting aside a private, quiet space where you could set up a laptop or mobile device station. Patients could use the station, which would be connected to the store’s Wi-Fi, for telehealth visits. This partnership can also help the business as it drives customers to their establishment.
Barrier: Wi-Fi Reliability
Sometimes Wi-Fi is available but may lack strength for clear video without the transmission breaking up during the telehealth visit. There are ways to maximize existing Wi-Fi service in homes and clinics.
Advise families/caregivers to stop activities in the home like streaming movies, video gaming and internet browsing during the telehealth visit. This makes more bandwidth available in the home’s Wi-Fi service.
Advise families/caregivers to check with their internet service provider to see if they offer a free upgrade for customers with children in school. They can also check with their mobile phone provider to see if they could upgrade to an unlimited data plan at little or no cost.
Wi-Fi hotspot devices
These are portable Wi-Fi delivery devices that plug in to smartphones or laptops. Some states are currently funding lending programs through public and college libraries for patrons and organizations to use. These hotspots don’t require the borrower to purchase an internet subscription or cellular service, but they must be used in range of a cellular tower.
Inquire with state websites and with your local library. You may be able to check out multiple mobile hotspots and make them available to your patients for telehealth visits. Consider these for families without access to the internet and also for families who do not have enough data on their phones for a telehealth visit.
Barrier: Understanding Technology
Maybe you’ve determined, through your community questionnaire, that families/caregivers have devices connected to the internet, but don’t know how to use them. They may not have an email address where you could send a telehealth appointment link. This is where education and support from your office could help bridge that gap.
Classes and demos
Host small group classes that cover the basics of setting up a telehealth appointment. Use HealthyChildren.org resources like “Telehealth 101: Getting Plugged in to Your Child’s Health,” that build trust in the telehealth concept and give step-by-step instruction on how to get ready for a visit. Demonstrate where to go online to sign up for free email and bookmark the login page on their device.
Even if you provided clear verbal instructions on how to use devices and how to connect to a telehealth visit, provide clear, written instructions in simple steps. Lean into assistance from support staff or community partners who can provide technical support to families/caregivers and patients. Have in-person check-in staff serve in the same role for telehealth visits. They can start the visit and go over any issues before you join the video or mobile call.
Additionally, this telehealth checklist and curriculum, developed by Family Voices, provides tools which can help you better prepare for telehealth visits.
Telehealth provides a way to meet the increasing health needs of patients and families/caregivers. It increases access to care while keeping patients in their medical home. Once you learn family/caregiver perspectives and assess their willingness to try telehealth, you can minimize the barriers to telehealth together.
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